The nurse is obtaining the height and weight of an older adult client. The client asks why the height is 1 inch less than last year. What is the best response by the nurse?
1. "Your bones are weaker and are shrinking."
2. "I am sure you are mistaken and just don't remember from last year."
3. "Your height decreases with age due to musculoskeletal changes."
4. "Stand up straighter this time and we will measure again."
3
Rationale 1: During the older adult years the bones may lose density, but they do not shrink.
Rationale 2: To confront the client and say "I am sure you are mistaken and just don't remember from last year" is an inappropriate response and does not answer the client's question.
Rationale 3: Height of older adults may decrease as a result of thinning of the intervertebral discs. There can also be a flexion of the hips and knees, which affects the ability to stand erect.
Rationale 4: There can also be a flexion of the hips and knees, which affects the ability to stand erect.
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