1.The nurse is caring for an older adult who reports severe chronic pain. To best assess age-related physiologic changes that could influence plans for initiating an appropriate drug regimen, the nurse prepares the client for which laboratory evaluation?
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An older adult client is being assessed for possible alcohol abuse. To best assess the client's risk potential, the nurse asks:
"How many alcoholic drinks do you consume each week?"
An older adult client is currently undergoing detoxification for alcohol at a rehabilitation center. When assessing the client using the Clinical Institute Withdrawal Assessment tool the nurse determines the client's current score to be 23. The nurse:
arranges for the client to be transferred to an acute care hospital.
A 68-year-old man with a history of alcohol abuse is admitted to the acute care facility for reports of abdominal pain. Based on your understanding of alcohol withdrawal, the nurse knows that if client is currently abusing alcohol, he will most likely:
develop withdrawal symptoms 48 to 72 hours after her last intake of alcohol.
Since diagnosing substance abuse in the older adult client can be difficult because symptoms can be subtle and atypical, the nurse is particular interested in determining the cause of a client's:
extensive history of falls.
...A 67-year-old woman presents at the emergency department with symptoms that suggest possible abuse of a narcotic analgesic. To best assure the client's safe care, the nurse asks:
..."What prescribed drugs are you currently taking?"
Your 78-year-old client reports that she has frequent constipation as a result of medications she is prescribed and asks the nurse for advice about using a daily over-the-counter laxative. The most appropriate response to her question is that it would be best for her to:
consult her health practitioner before using nonprescription drugs.
...When initially planning care for the older adult client who is prescribed clonidine patches as part of a smoking cessation program, the nurse:
...asks the client if he is currently taking any antihypertensive medications.
...The nurse explains to ancillary staff that caffeine abuse is difficult to diagnose in the older adult client because caffeine intoxication symptoms:
...can be confused with normal effects of aging.
11. The nurse prepares to administer PRN diazepam (Valium) to an older client for signs that she is developing impending alcohol withdrawal delirium. These signs include:
...pulse, 118 beats/min; and BP 160/90.
.When planning an educational program on cancer for a group of older adults, the nurse includes information regarding racial and ethnic patterns of cancer in the United States that includes:
the incidence of cancer is highest among African Americans.
An older adult client asks the nurse why so many of her friends are developing cancers. The nurse responds best when answering:
"As we age our cells are less able to regulate replication appropriately."
An older adult client expresses concern about developing cancer in the future and asks the nurse advice about cancer prevention. The nurse shares that:
"While there are some behaviors that can help minimize your risk, the possibility of developing cancer is usually determined by age 65."
An older adult client has rheumatoid arthritis, which limits her manual dexterity and ability to perform breast self-examinations. In order to best address the client's need for breast health promotion, the nurse teaches the client to:
use the palm of her hand to perform monthly breast examinations.
Which statement, if made by an older Caucasian adult man, indicates the need for further teaching about prostate cancer and its prevention?
"Digital rectal examinations aren't very effective in diagnosing prostate cancer."
When obtaining a health history, the nurse recognizes that an older adult client has a risk factor for colorectal cancer when he reports:
a history of inflammatory bowel disease.
While awaiting the results of testing to determine a diagnosis of cancer, an older adult client asks a nurse to explain what happens when cancer metastasizes. The nurse responds:
"Cancer cells move from one location to another unconnected location."
The family of an older adult diagnosed with cancer asks the nurse to explain how gene therapy might benefit their father. The nurse responds:
Gene therapy involves the injection of a virus that makes the cancer cells incapable of reproducing.
The nurse observes a suspicious mole on the back of an older adult who is undergoing palliative radiotherapy for brain metastasis. The nurse suspects that the mole:
will not be screened.
10. The family of an older adult client with breast cancer is reluctant to agree to the suggested treatment plan because they "have heard such horrible things about radiation therapy." The nurse responds:
..."Radiation therapy no longer causes such terrible side effects."
11. After a course of chemotherapy for cancer of the throat, an older adult client is admitted to the hospital with persistent nausea and vomiting. The nurse should initially assess the client for:
...dehydration and infection.
12. The daughter of an older adult woman who had a colostomy as a result of colon cancer tells the nurse, "Mom seems to be so withdrawn; she has stopped going out with her friends and I'm really concerned." The most relevant nursing diagnosis for the client's reaction is:
...Social isolation.
13. An older adult client diagnosed with colon cancer is being evaluated for surgical removal of the tumor. The nurse explains that the primary consideration is the:
...client's presurgical health status.
14. An older adult client is undergoing palliative surgery for colon cancer metastasis. The nurse explains to the family that this intervention is intended to:
...relieve the pain associated with spread of the tumor.
The nurse documents that a newly widowed older adult client is likely experiencing physical grief responses when she:
has difficulty getting up from the chair.
The nurse is confident that an older adult is successfully completing the tasks associated with mourning his wife's death when he
takes a female acquaintance to the movies.
While the family of a newly widowed older adult client lives several hours away, they are interested in providing their mother with appropriate support. The nurse suggests it would be most helpful if they would:
telephone her daily and arrange for a neighbor to help with the shopping.
A 68-year-old client who has recently lost his wife of 50 years shares with the nurse that he'll, "never get over missing her." The nurse is most therapeutic when responding:
"You'll never get over your loss but you can learn to live with it."
The nurse documents that a client is likely experiencing exaggerated grief when she:
re-reads her late husband's diaries nightly since his death 2 years ago.
The nurse is caring for an older adult who recently lost an adult child as a result of automobile accident. They shared a home and enjoyed a healthy parent-child relationship. The nurse is confident that the client has progressed appropriately through the mourning process when she:
plans a summer vacation with friends from work.
The nurse evaluates how an older adult client will react to the death of a spouse based on how he:
:reacted when his beloved dog was sent to live with his son.
A novice hospice nurse shows the best understanding of the nursing role related to an older adult client's mourning over the loss of her son when stating:
"I see mourning as a very individualized process."
An older adult man has been the primary caregiver for his chronically ill wife for the last 10 years. When his wife dies, the nurse prepares the family for the likely possibility that their father will express:
personal relief that she has died.
A hospice nurse shows the best understanding of the personal commitment to the dying client by:
...being available emotionally and physically throughout the entire dying proce
The nurse shows an understanding of the primary factor that facilitates the adjustment to the loss of a spouse when asking:
..."Are you planning to continue to run your flower shop?"
The nurse determines that the daughter of a widowed older adult client has a poor understanding of the grieving process when she reports that:
..."It's been 16 months since dad died but mom still hasn't moved on with her life."
.When administering medications to older adults, the nurse shows an understanding of the effect of aging on drug distribution by monitoring the client's:
plasma albumin levels
An older adult client has been ordered to receive the drug warfarin (Coumadin). The nurse's primary intervention involves monitoring the client for drug toxicity by daily review of his:
prothrombin time.
A 72-year-old client with a history of diabetes and hypothyroidism is being admitted to an assisted living facility. During the admission assessment the client reports difficulty falling asleep. The nurse shows an understanding of sleep dysfunction and the older client when asking:
"Are you taking medication for your thyroid problem?
A 65-year-old client is receiving propranolol (Inderal) for hypertension. Which outcome is the best indicator of goal success when considering the drug's potential effect on the client's quality of life?
The client experiences no injuries as a result of dizziness.
The nurse responsible for administering medications to the residence of a long-term care facility shows an understanding of the risk of injury this population experiences when:
implementing the 5 Rights of medication administration routinely.
An older adult diabetic client is mildly hypertensive. The nurse prepares to educate the client regarding angiotensin II-blocking agents since these drugs are especially useful in older adults because they:
protect the kidney's function.
The nurse shows an understanding of medication-related risk factors common to older adults when asking:
"Do you regularly take any dietary supplements?"
An older adult client is having difficulty remembering when to take several of her prescribed medications. To improve the client's compliance with her medication, regimen the nurse:
teaches the client to administer daily pills with a pill dispenser.
When preparing information concerning cardiovascular risk factors for a group of older adults, the nurse stresses that cigarette smokers are four times more likely to die of sudden cardiac death than nonsmokers because smoking:
increases platelet aggregation.
When assessing an older, female African American adult, the nurse notes that she has been a type 2 insulin-dependent diabetic 10 years. The nurse notes that the client's greatest risk for developing secondary hypertension is her:
vascular system status.
When administering Lopressor to an older adult client with hypertension, the nurse is careful to have the client's care plan include:
frequent assessment for dizziness and/or syncope.
The nurse educates the obese older adult client that the single most important outcome that will affect cardiac health is:
a 10% reduction in weight
In order to evaluate an older client for possible renal failure as a result of chronic untreated hypertension, nurse prepares to:
collect a urine sample.
The nurse recognizes that the symptoms that have priority for care are:
: acute confusion observed in a 78-year-old female
It is suspected that an older adult client is experiencing severe hypertension. The nurse documents symptoms that support this diagnosis when the client reports:
difficulty reading the newspaper's print.
A novice nurse requires additional education on the assessment findings reflective of arterial vascular deficiency when suggesting the condition's symptoms include:
2+ edema in calf and foot of left leg.
The nurse shows an understanding of how anemia symptoms present in the older population when:
assessing the client for pale oral mucous membranes.
. When evaluating the effectiveness of discharge teaching for an older adult client who had a pacemaker implanted, the nurse determines the client has an appropriate understanding of the device when stating:
"I'll take my pulse each morning before my first cup of coffee."
A 76-year-old client has been recently diagnosed with cardiac valvular disease. The nurse assesses the client and recognizes that the medical diagnosis is supported by:
he client's report that, "walking around the block makes me short of breath."
The nurse best maximizes an older adult's potential to avoid developing a postsurgical respiratory infection by:
evaluating the client's ability to effectively cough and deep breathe.
An older adult's pulmonary function studies indicate that his vital capacity is reduced and his residual volume is increased. The nurse recognizes that these test results are observed in the client's:
swallow breathing.
The nurse is concerned about an older adult client developing toxic levels of the prescribed theophylline when it is determined that the client has a(n):
one-pack a day smoking habit.
The nurse is aware the typical occurrence of comorbidities in the older adult. Motivated by this knowledge the nurse assesses a client with diagnosed respiratory dysfunction for possible:
poor wound healing of the legs and feet.
Because the older adult is not as likely to exhibit the typical signs of ineffective gas exchange, the nurse is particularly suspicious of:
irritability in a usually pleasant client.
The nurse preparing information for the caregivers of a 79-year-old with chronic respiratory issues will make the greatest impact on their ability to provide quality care while maintaining their own emotional well being by including:
an explanation on how to preserve the client's sense of autonomy.
An older client admitted to the hospital with symptoms strongly suggestive of tuberculosis has a negative Mantoux test. The nurse correctly anticipates that:
the skin test will be repeated to achieve a booster effect.
An older adult client who has tuberculosis is being treated with the drugs isoniazid 300 mg daily, rifampin 600 mg daily, and pyrazinamide 1500 mg daily. The nurse stresses the importance that the client:
avoid alcohol while on the drug therapy.
An 80-year-old client is concerned about contracting pneumonia. The nurse educates her that the key to prevention is:
being vaccinated against the disease every 5 years.
Because the diagnosis of asthma can be difficult in that it mimics other conditions, the nurse gives priority to assessing an older client who presents with symptoms of acute respiratory distress for:
substernal chest pain.
The nurse caring for an older adult prescribed corticosteroids for asthma educates the client that the medication is safe and well tolerated when:
used exactly as prescribed.
The nurse caring for an older adult with type 2 diabetes mellitus places importance on assessing the client for:
skin temperature and hair growth pattern on the legs.
The nurse recognizes that an older adult on both antihypertensive and antidepressant drug therapies has a specific need for:
an effective history focusing on sexual function
Aware that older adult clients often present with nonclassic symptoms of type 2 diabetes mellitus, the nurse is particularly suspicious of a client reporting:
recent problems reading and an infected sore on his toe that won't heal.
During the daily assessment of an older adult client 2 days after abdominal surgery, the nurse observes signs that the client may have an underactive thyroid. The data supporting this suspicion includes:
muscle cramps, fatigue, and cold intolerance.
The nurse is preparing to provide an older newly diagnosed diabetic client with information regarding type 2 diabetes. The nurse initially:
asks the client whether they would prefer to watch a video or read a pamphlet.
The nurse shows an understanding of the effective assessment of an older adult diabetic client's cardiac status when documenting:
BP 126/78 recumbent and 122/78 sitting
The nurse teaching a 79-year-old with type 2 diabetes about the importance of regular exercise suggests that the client:
walk on the treadmill each morning for 30 minutes.
A 66-year-old is being evaluated for an underactive thyroid gland. The diagnosis of hypothyroidism is supported when the nursing assessment notes:
client report that "I always wear a sweater."
A 73-year-old is being admitted to an assisted living facility. During the admission assessment and history, the nurse suspects the client may be experiencing primary osteoporosis when noting:
the client is ½ inch shorter than he was at his last physical.
An 80-year-old client has nausea and vomiting related to a gastrointestinal disorder. The nursing intervention most likely to help the client is to:
offer sips of soda every 15 minutes until more is tolerated.
.When preparing to discharge an older client who has begun to experience dysphagia, the nurse suggests that the problem can minimize by:
eating small meals every 2 to 3 hours rather than three large meals daily.
An older client is being taught about oral gingivitis. The nurse has included instruction about maintaining an oral hygiene program, signs and symptoms of oral infection, and the importance of maintaining regular professional dental care. What important teaching has been missed
the importance of adequate nutrition for maintaining oral health.
Which statement, if made by the older adult with recently diagnosed gastritis, indicates the need for further teaching about the condition or its treatment?
"Smoking has little effect on my stomach problem."
You have been assigned to teach a 75-year-old client about her newly diagnosed diverticulitis. When planning for the teaching session, you want to make certain that you explain that:
increasing dietary fiber and keeping well hydrated is effective in reducing the symptoms associated with diverticulosis.
The nurse caring for an older adult diagnosed with hyperplastic polyps instructs him that:
the presence of blood in the stool requires a repeat sigmoidoscopy examination.
An older adult reports chronic constipation. When asked why this problem has gotten worse with age, the nurse responds:
"It's possible that you have lost the ability to feel when you need to move your bowels."
An elderly client reports episodes of fecal incontinence. The nurse provides appropriate emotional support when assuring the client that:
the problem generally responds well to bowel control programs.
The daughter of a dependent older client reports to the nurse that her mother requires regular soapsuds enemas to manage her chronic constipation. The nurse responds that:
an alternative management technique should be discussed.
A 68-year-old client is reporting symptoms that suggest a peptic ulcer. The nurse shows an understanding of the risk factors for this condition when asking whether:
there is a family history of peptic ulcers.
To best identify a risk for injury resulting in hospitalization of an older adult client who has experienced evidence of musculoskeletal aging, the nurse assesses for:
history of falls.
When caring for the older adult client who underwent knee replacement surgery 8 days ago, the nurse assesses for symptoms of the complication that the client is at greatest risk for when:
monitoring the pedal pulse on the affected leg.
An effective nursing activity to reduce the risk of hip dislocation after hip replacement surgery in the older adult client is for the nurse to:
apply an abduction splint while the client is in bed
An older adult client has experienced a left knee replacement asks the nurse, "When will I be back to normal?" The nurse responds that:
"Bending your left knee to a 90-degree angle will likely feel normal to you."
The nurse caring for an older client diagnosed with spl stenosis encourages the client to notify his physician if he experiences:
a burning sensation in either one or both legs.
The nurse is assisting a 65-year-old female client with planning an exercise program to prevent osteoporosis. The nurse shows an understanding of appropriate exercise when stating:
"Do you have a friend who would walk with you for 30 to 60 minutes?"
An older adult client has been casted for fractured left wrist. The nurse shows an understanding of the client's risk for the development of compartment syndrome when:
assessing capillary refill in the nail beds of the fingers of the left hand.
An older adult client has been admitted to the hospital with suspected Paget's disease. What clinical manifestation will the nurse want to monitor for in an attempt to differentiate Paget's disease from other types of musculoskeletal diseases?
Ataxia and/or mild hearing loss
An older confused client is recovering from a stage IV sacral pressure ulcer. The nurse shows an understanding of this client's risk for developing osteomyelitis by:
adhering to sterile technique when changing the wound's dressing.
An older adult is diagnosed with rheumatoid arthritis. When discussing exercise with the client, the nurse makes the greatest positive impact on the client's quality of life when stating:
"Let's discuss ways for you to exercise your joints."
The nurse caring for an older adult client prescribed allopurinol (Zyloprim) minimizes the client's risk for developing a serious outcome of this therapy by:
offering him fresh, cold water frequently during the day.
When caring for older adults, the nurse expects to encounter the normal urinary age-related outcome of:
nocturia.
An 87-year-old client who does not have a history of urinary incontinence has suddenly become incontinent. In dealing with this problem, the nurse's first action should be to:
review his medication record for medications that may be causing urinary incontinence.
An older adult client reports "losing urine" when she bends over or gets out of a chair. In light of her symptoms, the nurse edits the client's care plan to include Altered urinary function, __________ incontinence.
stress
When assessing the client for urinary incontinence, which client symptom best supports the nursing diagnosis of overflow incontinence?
"I have small accidents ever since I developed a cystocele."
An older cognitively impaired adult client is being prepared for discharge to be cared for by her daughter. The nurse knows that the continued success of the client's bladder training for urinary incontinence primarily rests upon the:
daughter's ability to support the training.
An older adult client is hospitalized for surgery to treat injuries he received in an automobile accident. The nurse recognizes symptoms suggestive of an upper urinary tract infection when the client:
is not able to state where he is or what day it is.
An older adult woman has a resistant strain of pneumonia. To best minimize her risk of developing acute renal failure, the nurse:
offers the client a drink at least every 2 hours while she is awake.
An older client is admitted with possible chronic renal failure (CRF). The nurse notifies the attending physician with the results showing the client's:
decreased creatinine clearance level.
The nurse is completing an admission assessment on an older client who has been diagnosed with benign prostate hyperplasia. The nurse's priority questioning focuses on:
typical urinary voiding patterns.
An older adult who is experiencing age-related postural hypotension shares with the nurse that he fears "something is really wrong" because he is the only one in his social group experiencing the problems. The nurse responds:
"While your dizziness appears to be age-related, the compensating mechanisms of your friends may be the reason they don't have the problem."
The nurse educates the older client on the possible risks for injury related to the common age-related changes to the senses by stressing the importance of:
installing auditory smoke alarms.
The nurse is conducting an admission assessment on a mildly confused older client. The nurse best assures an accurate history by first:
directing the questions to both client and family.
A nurse caring for an older client diagnosed with acute depression shows an understanding of the client's risk for developing delirium when:
physically being present to help the client with eating meals.
When assessing an older client displaying symptoms reflective of delirium, the nurse focuses the assessment on:
physiological dysfunction resulting from the symptoms.
An 80-year-old client exhibiting signs of dementia representative of Alzheimer's disease (AD). The nurse supports that possibility when determining that the client:
has a history of viral encephalitis.
When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to:
show him a picture of a toothbrush when it time for oral hygiene.
A 73-year-old client diagnosed with vascular dementia is admitted for exacerbation of asthma. The nursing history determines that has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior. The nurse's initial responds is to:
notify the admitting physician immediately.
Which of the following statements, when made by family members caring for an older client with dementia, indicates peaceful acceptance of the situation?
"The hospice nurses are so helpful when I needed time for myself."
The son of a 78-year-old suspected of experiencing Alzheimer's disease (AD) asks the nurse if there is a diagnostic test that can confirm the diagnosis. The nurse responds that:
postmortem autopsy is the only definitive diagnostic tool.
An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques. The nurse shows an understanding of dementia when sharing with staff that:
"We will implement new interventions that address the disease's progression."
The nurse explains that the plan of care for an older adult client with seborrheic dermatitis of the scalp should include:
applying selenium shampoo to scalp.
An older adult client reports simple xerosis with mild pruritus. The nurse educates her on the importance of:
Applying an lanolin rich cream and avoiding scratching the areas.
The nurse plans to assess for candidiasis as a priority intervention for a:
58-year-old with a casted left foot.
An 87-year-old client developed herpes zoster after surgical repair of a hip fracture. The priority nursing diagnosis is:
Risk for infection related to impaired skin integrity
The presence of which skin assessment finding, if noted on an older adult client, should cause the nurse to suspect a premalignancy?
An oozing, rough, reddish macule on the ear
An older adult client has been taught measures to prevent the development of skin cancer. Which statement, if made by the client, indicates that he needs more teaching?
"I will certainly miss my vegetable and flower gardening."
When assessing the older adult client's skin for indications of melanoma, the nurse should inspect for a(n):
irregularly shaped multicolored mole.
An older adult client newly diagnosed with peripheral vascular disease is being educated on the possibility of developing a foot ulcer. The nurse describes the possible lesion as being:
shiny, dry, with cyanotic skin.
An older adult client has an open, draining wound on the medial aspect of his right leg. The skin surrounding the wound is reddish-brown with surrounding erythema and edema. Based on this information, the nurse edits the client's care plan to include Impaired skin integrity:
related to altered venous circulation.
When assessing for squamous cell cancer, a home health nurse is particularly concerned about a suspicious lesion on the:
Lower lip of a 70-year-old African-American male
The nurse of a bedridden 74-year-old woman is evaluating whether the family members understand how to position the client correctly. The nurse is confident the family is capable of effective positioning when it is observed that the client's:
position is changed at least every 2 hours.
An older adult client reports burning and itching eyes. On assessment, the nurse notes swelling of the eyelid margins bilaterally. What additional data are necessary to confirm the nurse's suspicion of blepharitis?
The eyelids are reddened from seborrhea.
The morning of his scheduled cataract extraction and intraocular lens placement of the right eye, an older adult client expresses concern that he will not remember his instructions for home care. Which statement is the best response to the client's concern?
"We will provide you with written instructions."
Your 88-year-old client is hospitalized for a retinal detachment. He is on bed rest, and both eyes are covered with patches. Which nursing diagnosis takes priority at this time?
High risk for injury related to altered sensory perception
A 66-year-old client has been diagnosed with type 2 insulin-dependent diabetes mellitus. When discussing vision related complications the nurse recognizes that the client has an understanding of symptom management when she states that she lost most of her vision as a result of diabetic retinopathy. Which behavior indicates that she may be having difficulty adapting to her diminished vision?
"I schedule my yearly eye examination for the week of my birthday"
A 77-year-old client who is quiet and withdrawn may have a hearing deficit related to impacted cerumen. During the nursing assessment the nurse confirms supporting evidence of the condition when noting:
client statement of having a feeling of fullness in his ears.
An older adult client reports "ringing" in her ears. What additional data should the nurse gather to help determine the cause of the client's problem?
Use of prescription medications
An older client with presbycusis has been advised to purchase a hearing aid and asks about its function and use. Which information is most accurate to give the client about the function of hearing aids?
Hearing aids amplify sound but do not improve the ability to hear.
A 96-year-old client reports symptoms xerostomia. The nurse attempts to minimize the effects of the condition by:
providing appropriate fluids with the client's meals.
. The preferred way for the nurse to communicate with a 72-year-old hearing-impaired client is to:
speak clearly and directly, facing the person.
To educate clients on health promotion measures to minimize the effect of normal age-related changes in immunity, the geriatric nurse:
stresses the importance of maintaining intact skin and mucous membranes.
An older adult client who is generally in good health starts experiencing numerous colds and now pneumonia. What factor from her nursing history most likely has placed her at increased risk for the development of these infections?
A beloved pet died 6 months ago.
A 65-year-old man has smoked tobacco most of his adult life. When planning health promotion education for him, the nurse includes information that such smoking:
is a risk factor for community-acquired pneumonia.
An older adult client is experiencing problems with chewing while recovering from extensive oral surgery. The nurse best affects this client's risk for infection by:
asking which flavors of protein supplement drink he would prefer.
The nurse caring for a cognitively impaired older adult admitted to an acute care facility best minimizes this particular client's risk for developing a nosocomial infection by:
Poor nutrition can contribute to a client's risks for the development of a nosocomial infection particularly among the older immunocompromised population.
The nurse caring for an older adult client currently receiving traditional drug therapy for methicillin-resistant Staphylococcus aureus (MRSA) recognizes that the client is at risk for developing:
vancomycin-resistant Enterococcus (VRE) infection.
The nurse preparing an educational facts sheet on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome AIDS for older adults includes reference to which of the following?
Delayed recognition of HIV contributes to its poor prognosis.There is a short interval from HIV infection to AIDS in older adults.
The geriatric nurse caring for the older female immunosuppressed client is particularly concerned when the client reports which of the following? Select all that apply.
Flulike muscle aching Burning upon urination Constipation