Nursing Entrance Exam: English
Read the following selection from Chapter 11, Care of the Older Person, found in of Mosby’s Textbook
for Nursing Assistants. Prepare for a short quiz by marking the text as you read and re-read the selection.
Follow these steps:
1. Number the paragraphs before reading
2. On the first read-through:
a. Circle key terms and essential words
b. Highlight or box unfamiliar words
3. On the second read-through:
a. Underline key points
b. Underline relevant information
c. Take notes as you read
Go to the website provided by your counselor and follow the directions to begin the online quiz. Return
this packet to your counselor once you’ve finished. You may turn this page over to begin.
1
Mosby’s Textbook For Nursing Assistants
CHAPTER 11 Care of the Older Person
The Integumentary System
The skin loses its elasticity, strength, and
fatty tissue layer. The skin thins and sags.
Wrinkles appear. Secretions from oil and sweat
glands decrease. Dry skin and itching occur. The
skin is fragile and easily injured. The skin's
blood vessels are fragile, increasing the risk for:
• Skin breakdown
• Skin tears (Chapter 33)
• Pressure ulcers (Chapter 34)
• Bruising
• Delayed healing
Brown spots appear on sun-exposed areas.
They are called "age spots" or "liver spots."
They are common on the wrists and hands.
Loss of the skin's fatty tissue layer affects
body temperature. The person is more sensitive
to cold. Protect the person from drafts and cold.
Sweaters, lap blankets, and extra blankets are
helpful. So are higher thermostat settings.
Dry skin causes itching. It is easily
damaged. A shower or bath twice a week is
enough for hygiene. Partial baths are taken at
other times. Mild soaps or soap substitutes are
used to clean the underarms, genitals, and under
the breasts. Often soap is not used on the arms,
legs, chest, and abdomen. Lotions and creams
prevent drying and itching. Deodorants may not
be needed because sweat gland secretion is
decreased. See Chapter 20 for hygiene.
Nails become thick and tough. Feet usually
have poor circulation. A nick or cut can lead to a
serious infection. See Chapter 21 for nail and
foot care.
The skin has fewer nerve endings. This
affects sensing heat, cold, pressure, and pain.
Burns are great risks. Fragile skin, poor
circulation, and decreased sensing of heat and
cold increase risk of burns. Older persons often
complain of cold feet. Socks provide warmth.
Do not use hot water bottles and heating pads
because of the risk for burns.
White or gray hair is common. Hair loss
occurs in men. Hair thins on men and women.
Thinning occurs on the head, in the pubic area,
and under the arms. Women and men may
choose to wear wigs. Some color hair to cover
graying. Facial hair (lip and chin) may occur in
women.
Hair is drier from decreases in scalp oils.
Brushing promotes circulation and oil
production. Shampoo frequency depends on
personal choice. Usually it decreases with age. It
is done as needed for hygiene and comfort.
Skin disorders increase with age. They
rarely cause death if treated early. The risk of
skin cancers increases with age. Prolonged sun
exposure is a cause.
Skin changes can be seen. Gray hair, hair
loss, brown spots, wrinkles, and sagging skin are
some examples. These changes can affect selfesteem and body image.
The Musculo-Skeletel System
Muscle cells decrease in number. Muscles
atrophy (shrink). They decrease in strength.
Bones lose minerals, especially calcium.
Bones lose strength. They become brittle and
break easily. Sometimes just turning in bed can
cause fractures (broken bones).
Vertebrae shorten. Joints become stiff and
painful. Hip and knee joints flex (bend) slightly.
These changes cause gradual loss of height and
strength. Mobility also decreases. Older persons
need to stay active. Activity, exercise, and diet
help prevent bone loss and loss (of muscle
strength. Walking is good exercise. Exercise
groups and range-of-motion exercises are
helpful (Chapter 27). A diet high in protein,
calcium, and vitamins is needed.
Bones can break easily. Protect the person
from injury and falls (Chapters 12 and 13). Turn
and move the person gently and carefully
(Chapter 17). Some persons need help and
support getting out of bed. Some need help
walking.
The Nervous System
Nerve cells are lost. Nerve conduction and
reflexes slow. Responses are slower. For
example, an older person slips. The message
telling the brain of the slip travels slowly. The
message from the brain to prevent the fall also
travels slowly. The person falls.
Blood flow to the brain is reduced.
Dizziness may occur. It increases the risk for
falls. Practice measures to prevent falls (Chapter
13). Remind the person to get up slowly from
2
Mosby’s Textbook For Nursing Assistants
CHAPTER 11 Care of the Older Person
bed or chair. This helps prevent dizziness
(Chapter 27).
Changes occur in brain cells. This affects
personality and mental function. So does
reduced blood flow to the brain. Memory is
shorter. Forgetfulness increases. Responses
slow. Confusion, dizziness, and fatigue may
occur. Older persons often remember events
from long ago better than recent ones. Many
older people are mentally active and involved in
current events. They show fewer personality and
mental changes. (See Chapter 46 for confusion
and dementia.)
Sleep patterns change. Falling asleep is
harder for older persons. Sleep periods are
shorter. They wake often at night and have less
deep sleep. Less sleep is needed. Loss of energy
and decreased blood flow may cause fatigue.
They may rest or nap during the day. They may
go to bed early and get up early.
The Senses. Aging affects touch, smell, taste,
sight, and hearing.
Touch. Touch and sensitivity to pain and
pressure are reduced. So is sensing heat and
cold. These changes increase the risk for injury.
The person may not notice painful injuries or
diseases. Or the person feels minor pain. You
need to:
 Protect older persons from injury
(Chapters 12 and 13).
 Follow safety measures for heat and
cold (Chapter 35).
 Check for signs of skin breakdown
(Chapters 20, 33, and 34).
 Give good skin care (Chapter 20).
 Prevent skin tears (Chapter 33) and
pressure ulcers (Chapter 34)
Taste and smell. Taste and smell dull. Appetite
decreases. Taste buds decrease in number. The
tongue senses sweet, salty, bitter, and sour
tastes. Sweet and salty tastes are lost first. Older
people often complain that food has no taste or
tastes bitter. They like more salt and sugar on
food.
The eye. Eyelids thin and wrinkle. Tear
secretion is less. Dust and pollutants can irritate
the eyes.
The pupil becomes smaller and responds
less to light. Vision is poor at night or in dark
rooms. The eye takes longer to adjust to lighting
changes, causing vision problems when:
 Going from a dark to a bright room
 Going from a bright to a dark room
Clear vision is reduced. Eyeglasses are often
needed. The lens of the eye yellows, making
greens and blues harder to see.
Older persons become more farsighted. This
is called presbyopia. (Presby relates to aging.
Opia means eye.) The lens becomes more rigid
with age. It is harder for the eye to shift from far
to near vision and from near to far vision. These
changes increase the risk of falls and accidents.
The risk is greater on stairs and where lighting is
poor. Eyeglasses are worn as needed. Keep
rooms well-lit. Nightlights help at night.
The ear. Changes occur in the acoustic nerve.
Eardrums atrophy. High-pitched sounds are hard
to hear. Severe hearing loss occurs if these
changes progress. A hearing aid may be needed.
It must be clean and correctly placed in the ear.
Wax secretion decreases. Wax becomes
harder and thicker. It is easily impacted (wedged
in the car). This can cause hearing loss. A doctor
or nurse removes the wax.
The Circulatory System
The heart muscle weakens. It pumps blood
with less force. Problems may not occur at rest.
Activity, exercise, excitement, and illness
increase the body's need for oxygen and
nutrients. A damaged or weak heart cannot meet
these needs.
Arteries narrow and are less elastic. Less
blood flows through them. Poor circulation
occurs in many body parts. A weak heart works
harder to pump blood through narrowed vessels.
Exercise helps maintain health and wellbeing. Many older persons exercise daily. They
walk, jog, golf, and bicycle. They also hike, ski,
play tennis, swim, and play other sports. Older
persons need to be as active as possible.
Sometimes circulation changes are severe.
Rest is needed during the day. Over-exertion is
avoided. The person should not walk far, climb
3
Mosby’s Textbook For Nursing Assistants
CHAPTER 11 Care of the Older Person
many stairs, or carry heavy things. Personal care
items, TV, phone and other needed items are
kept nearby. Some exercise helps circulation. It
also prevents blood clots in leg veins. Some
persons need to stay in bed. They need range-ofmotion exercises (Chapter 27). Doctors may
order certain exercises and activity limits.
The Respiratory System
Respiratory muscles weaken. Lung tissue
becomes less elastic. Often lung changes are not
noted at rest. Difficult, labored, or painful
breathing (dypsnea) may occur with activity.
(Dys means difficult. Pnea means breathing.)
The person may lack strength to cough and clear
the airway of secretions. Respiratory infections
and diseases may develop. These can threaten
life.
Normal breathing is promoted. Avoid heavy
bed linens over the chest. They prevent normal
chest expansion. Turning, re-positioning, and
deep breathing are important. They help prevent
respiratory
complications
from
bedrest.
Breathing usually is easier in semi-Fowler's
position (Chapter 18). The person should he as
active as possible.
The Digestive System
Saliva glands produce less saliva. This can
cause difficulty in swallowing (dysphagia). (Dys
means difficult. Phagia means swallowing.) Dry
foods may be hard to swallow. Taste and smell
dull. This decreases appetite.
Secretion of digestive juices decreases. This
makes fried and fatty foods hard to digest. This
may cause indigestion.
Loss of teeth and ill-fitting dentures cause
chewing problems. This causes digestion
problems. Hard-to-chew foods are avoided.
Ground or chopped meat is easier to chew and
swallow.
Dry, fried, and fatty foods are avoided. This
helps swallowing and digestion problems. Oral
hygiene and denture care improve taste. Some
people do not have teeth or dentures. Their food
is pureed or ground.
Peristalsis decreases. The stomach and colon
empty slower. Flatulence and constipation can
occur (Chapter 23). High-fiber foods help
prevent constipation. However, they are hard to
chew and can irritate the intestines. They include
apricots, celery, and fruits and vegetables with
skin and seeds. Persons with chewing problems
or constipation often need foods that provide
soft bulk. They include whole-grain cereals and
cooked fruits and vegetables.
Fewer calories are needed. Energy and
activity levels decline. More fluids are needed
for chewing, swallowing, digestion, and kidney
function. Foods are needed to prevent
constipation and bone changes. High-protein
foods are needed for tissue growth and repair.
However, some older persons lack protein in
their diets. High-protein foods (meat and fish)
are costly.
The Urinary System
Kidney function decreases. The kidneys
shrink. Blood flow to the kidneys is reduced.
Waste removal is less efficient.
The ureters, bladder, and urethra lose tone
and elasticity. Bladder muscles weaken, Bladder
size decreases, storing less urine. Urinary
frequency or urgency may occur. Many older
persons have to urinate (void) during the night.
Urinary incontinence (the loss of bladder
control) may occur (Chapter 22).
In men, the prostate gland enlarges. This
puts pressure on the urethra. Difficulty voiding
or frequent urination occurs.
Urinary tract infections are risks. Adequate
fluids are needed. The person needs water,
juices, milk, and gelatin. Provide fluids
according to the care plan. Remind the person to
drink. Offer fluids often to those who need help.
Most fluids should be taken before 1700 (5:00
PM). This reduces the need to void during the
night.
Persons with incontinence may need bladder
training programs. Sometimes catheters are
needed (Chapter 22).
4