An older adult client has been admitted to a skilled nursing facility. Which of the following can be caused by physical restraints? (Select all that apply.)

Choice A reason: This is incorrect because 120/80 mm Hg is a normal blood pressure, not a high risk factor for diabetes mellitus. High blood pressure, or hypertension, is a common complication of diabetes mellitus, as it can damage the blood vessels and increase the risk of cardiovascular disease. However, having a normal blood pressure does not rule out the possibility of having diabetes mellitus, as other factors, such as blood sugar level, family history, or lifestyle, can also influence the risk.

Choice B reason: This is incorrect because total cholesterol 198 mg/dL is a borderline high cholesterol level, not a high risk factor for diabetes mellitus. High cholesterol, or hyperlipidemia, is a common complication of diabetes mellitus, as it can affect the metabolism of fats and increase the risk of atherosclerosis and cardiovascular disease. However, having a borderline high cholesterol level does not confirm the diagnosis of diabetes mellitus, as other factors, such as blood sugar level, family history, or lifestyle, can also influence the risk.

Choice C reason: This is incorrect because palpable peripheral pulses are a normal finding, not a high risk factor for diabetes mellitus. Peripheral pulses are the pulsations of the arteries that can be felt in the extremities, such as the wrists or ankles. Palpable peripheral pulses indicate that the blood flow to the extremities is adequate and not compromised by diabetes mellitus. However, having palpable peripheral pulses does not rule out the possibility of having diabetes mellitus, as other factors, such as blood sugar level, family history, or lifestyle, can also influence the risk.

Choice D reason: This is correct because 68 years of age is a high risk factor for diabetes mellitus. Age is one of the non-modifiable risk factors for diabetes mellitus, as the risk increases with advancing age. This is because aging can affect the insulin production and sensitivity, as well as the body composition and function. Older adults are more likely to have diabetes mellitus than younger adults, especially if they have other risk factors, such as obesity, family history, or sedentary lifestyle. Therefore, 68 years of age is a high risk factor for diabetes mellitus.

Choice A reason: This is incorrect because over-the-counter NSAIDs are not generally harmless, especially for older adults. NSAIDs can cause gastrointestinal bleeding, renal impairment, hypertension, and increased risk of cardiovascular events. Older adults are more susceptible to these adverse effects due to age-related changes in pharmacokinetics and pharmacodynamics, as well as the presence of comorbidities and polypharmacy. Therefore, NSAIDs should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.

Choice B reason: This is correct because stool softeners and laxatives should be used with opioids. Opioids can cause constipation, which can lead to abdominal pain, nausea, vomiting, fecal impaction, and bowel obstruction. Older adults are more prone to constipation due to decreased intestinal motility, reduced fluid intake, and use of other medications that affect bowel function. Therefore, stool softeners and laxatives should be prescribed along with opioids to prevent and treat constipation in older adults.

Choice C reason: This is incorrect because opioids are not less effective in older clients than in younger clients. Opioids are potent analgesics that can relieve moderate to severe pain in older adults. However, opioids can also cause respiratory depression, sedation, confusion, delirium, falls, and dependence. Older adults are more sensitive to these side effects due to altered pharmacokinetics and pharmacodynamics, as well as the presence of cognitive impairment and frailty. Therefore, opioids should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.

Choice D reason: This is incorrect because the dose limit for acetaminophen is not difficult to reach for older adults. Acetaminophen is a safe and effective analgesic for mild to moderate pain in older adults. However, acetaminophen can cause hepatotoxicity, especially at high doses or in combination with other medications that contain acetaminophen. The recommended maximum daily dose of acetaminophen for older adults is 3 grams, which can be easily reached if the patient is not aware of the amount of acetaminophen they are taking. Therefore, acetaminophen should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.