Just after an appointment with the health care provider, an older adult client asks the nurse,

Question

"Why can't I seem to exercise like I did when I was younger? I just don't have the endurance that I did when I was 45, even though I feel good. The health care provider says I'm in good health and can exercise, but do you think there could be something wrong with me?" Which response by the nurse is the most appropriate?

1. "I think you should discuss this further with the health care provider; maybe you need more tests."
2. "As individuals get older, there are normal changes that occur in the body, specifically the heart and lungs, that may contribute to decreased endurance."
3. "The health care provider cleared you for exercise. I'm sure you are fine."
4. "The body undergoes physiologic changes that can affect your endurance, such as decreased cardiac output and increased residual air volume in the lungs."

Answer 1

Correct Answer: 2

The nurse should explain to the client in simple terms that it is normal in the older years to experience a decrease in endurance due to the physiologic changes that occur with aging. Specifically, the heart becomes stiffer, which affects the pumping action, the valves of the heart become less pliable, leading to decreased filling and emptying, and cardiac output and reserve is decreased. This makes it difficult for the heart to adjust quickly to increased demands. The respiratory system is less efficient. Lungs are stiffer, residual air (space where gas exchange does not occur) is increased, and vital capacity (area where gas exchange does take place) is decreased. The respiratory effort is increased to keep up with oxygen demands. Staying active will help a person build endurance. The nurse should first answer the client's question/concern. It may be appropriate to suggest further discussion with the health care provider if the client isn't satisfied with the nurse's explanation, but suggesting further testing may lead the client to believe the nurse suspects there is something wrong. Telling the client, "The health care provider cleared you for exercise. I'm sure you are fine," does not answer the client's questions or address the concern. Responding to the client with "The body undergoes physiologic changes that can affect your endurance, such as decreased cardiac output and increased residual air volume in the lungs," is a medical explanation that the client may not understand.