A nurse is caring for an older adult. Which sensory change will the nurse identify as normal during the assessment?

Choice A reason: Depression is strongly linked to insomnia in older adults, causing difficulty falling asleep due to rumination, low mood, or altered sleep architecture. Assessing for depression is critical, as it may underlie the sleep disturbance, requiring targeted interventions like therapy or antidepressants to improve sleep and mental health.

Choice B reason: Muscle fatigue may cause physical discomfort but is not a primary cause of difficulty falling asleep. It is more likely to affect sleep quality than initiation. Depression is a more common and significant contributor to insomnia in older adults, making this an incorrect choice.

Choice C reason: Hypertension can be associated with sleep apnea but is not directly linked to difficulty falling asleep. It may result from poor sleep but is less likely the cause. Depression is a more prevalent cause of insomnia, making this a less relevant condition to assess.

Choice D reason: Hypothyroidism can cause fatigue and sleepiness, not difficulty falling asleep. It is less commonly associated with insomnia compared to depression, which significantly disrupts sleep onset in older adults. This condition is less relevant to the patient’s presentation, making it incorrect.

Choice A reason: Culture and ethnicity influence pain perception but are not easily modifiable. They shape attitudes toward pain expression, not pain itself. Focusing on these risks overlooking modifiable factors like anxiety, which directly amplify pain. Interventions targeting modifiable psychological factors are more effective in reducing pain intensity and improving patient coping strategies.

Choice B reason: Previous pain experiences and cognitive abilities are relatively fixed, shaping pain perception but not easily altered. Modifiable factors like anxiety have a greater immediate impact on pain. Focusing on these risks delaying interventions like relaxation techniques, which directly reduce pain amplification, improving outcomes in acute or chronic pain management.

Choice C reason: Age and gender are non-modifiable factors influencing pain sensitivity but not amenable to change. Anxiety and fear, which exacerbate pain through stress responses, are modifiable and more relevant for intervention. Prioritizing age or gender misdirects focus, delaying strategies like cognitive therapy that effectively mitigate pain in clinical settings.

Choice D reason: Anxiety and fear are modifiable factors that amplify pain via heightened stress responses, increasing muscle tension and pain perception. Interventions like relaxation, mindfulness, or counseling can reduce these, lowering pain intensity. Focusing on these targets psychological contributors, improving pain management and patient comfort, especially in acute or chronic pain scenarios.