Today’s NCLEX-RN® question of the day focuses on which assessment findings are expected to be found in older patients and which are not.
An older adult client is admitted to the nursing unit for a cough and increasing fatigue. Which assessment finding should the nurse recognize as an expected age-related change?
A. Hyperactive cough reflex
B. Decreased anterior-posterior (AP) chest diameter
C. High-pitched wheezing sounds on expiration
D. Decreased ciliary action
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The correct answer to today’s NCLEX-RN® Question is…
D. Decreased ciliary action
Rationale: Normal age-related respiratory changes include decreased ciliary action and mucociliary clearance, which both increase the client’s risk of aspiration and respiratory infections.
Main takeaway
Normal age-related changes in the respiratory system include decreased ciliary action and mucociliary clearance, decreased cough and laryngeal reflexes, and increased A-P diameter. These changes impair respiratory efficiency, thus increasing the risk of aspiration and respiratory infections.
Incorrect answer explanations
A. Hyperactive cough reflex
Rationale: As clients age, the cough and laryngeal reflexes tend to decline rather than become hyperactive.
B. Decreased anterior-posterior (AP) chest diameter
Rationale: As clients age, the AP chest diameter tends to increase rather than decrease.
C. High-pitched wheezing sounds on expiration
Rationale: Expiratory high-pitched wheezing is not an expected age-related change. Instead, it is associated with narrowed airways.
References
Meiner, S. E., & Yeager, J. J. (2019). Gerontologic Nursing. St. Louis, MO: Elsevier.
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