1. A student nurse visiting a senior center says, “It’s depressing to see these old people. They are weak and frail. I doubt any of them can engage in a discussion.” The student is expressing a. reality. b. ageism. c. empathy. d. vulnerability.
ANS: B
Ageism is a bias against older people because of their age. None of the other options applies to the ideas expressed by the student.
- A nurse plans an educational program for staff of a home health agency specializing in care of the elderly. Which topic is the highest priority to include?
a.
Pain assessment techniques for older adults
b.
Psychosocial stimulation for those who live alone
c.
Preparation of psychiatric advance directives in the elderly
d.
Ways to manage disinhibition in elderly persons with dementia
ANS: A
The topic of greatest immediacy is the assessment of pain in older adults. Unmanaged pain can precipitate other problems, such as substance abuse and depression. Elderly patients are less likely to be accurately diagnosed and adequately treated for pain. The distracters are unrelated or of lesser importance.
- Select the best comment for a nurse to begin an interview with an elderly patient.
a.
“I am a nurse. Are you familiar with what nurses do?”
b.
“Hello. I am going to ask you some questions to get to know you better.”
c.
“You look comfortable and ready to participate in an admission interview. Shall we get started?”
d.
“Hello. My name is _______ and I am a nurse. How you would like to be addressed by staff?”
ANS: D
The correct opening identifies the nurse’s role and politely seeks direction for addressing the patient in a way that will make him or her comfortable. This is particularly important when a considerable age difference exists between the nurse and the patient. The nurse should address patients by name and not assume patients want to be called by a first name. The nurse should always introduce self.
4. Which information is most important to obtain during assessment of an older adult diagnosed with health problems? a. Functional ability and emotional status b. Chronological age and sexual function c. Economic status and sources of income d. Developmental history, interests, and activities
ANS: A
Information related to functional ability and emotional status provides an overview of a patient’s problems and abilities. It guides selection of interventions and services to meet identified needs. The distracters reflect information of relevance, but are not of highest priority.
- A 75-year-old patient comes to the clinic reporting frequent headaches. As the nurse begins the interaction, which action is most important?
a.
Complete a neurological assessment.
b.
Determine whether the patient can hear as the nurse speaks.
c.
Suggest that the patient lie down in a darkened room for a few minutes.
d.
Administer medication to relieve the patient’s pain before continuing the assessment.
ANS: B
Before proceeding with any further assessment, the nurse should assess the patient’s ability to hear questions. Impaired hearing could lead to inaccurate answers.
- Which statement about aging provides the best rationale for focused assessment of elderly patients?
a.
The elderly are usually socially isolated and lonely.
b.
Vision, hearing, touch, taste, and smell decline with age.
c.
The majority of elderly patients have some form of early dementia.
d.
As people age, thinking becomes more rigid and learning is impaired.
ANS: B
Only the key is a true statement. It cues the nurse to assess sensory function in the elderly patient. Correcting vision and hearing are critical to providing safe care. The distracters are myths about aging.
- A nurse assesses an elderly patient. The nurse should complete the Geriatric Depression Scale if the patient answers which question affirmatively.
a.
“Would you say your mood is often sad?”
b.
“Are you having any trouble with your memory?”
c.
“Have you noticed an increase in your alcohol use?”
d.
“Do you often experience moderate to severe pain?”
ANS: A
Feeling low may be a symptom of depression. Low moods occurring with regularity should signal the need for further assessment for other symptoms of depression. The other options do not focus on mood.
8. A health care provider writes these new prescriptions for a resident in a skilled nursing facility: 2 g sodium diet, restraint as needed, limit fluids to 1800 mL daily, continue antihypertensive medication, milk of magnesia 30 mL PO once if no bowel movement for 3 days. The nurse should a. question the fluid restriction. b. question the order for restraint. c. transcribe the prescriptions as written. d. assess the resident’s bowel elimination.
ANS: B
Restraints may be imposed only on a written order of the health care provider that specifies the duration during which the restraints can be used. The Joint Commission guidelines and Omnibus Budget Reconciliation Act regulations also mandate a number of other conditions that must be considered and documented before restraints are used. The other prescriptions are appropriate.
- An elderly patient must be physically restrained. Who is responsible for the patient’s safety?
a.
The nurse assigned to care for the patient
b.
Unlicensed assistive personnel who apply the restraint
c.
Family member who agrees to application of the restraint
d.
Health care provider who prescribed application of restraint
ANS: A
Although restraint is prescribed by a health care provider, the restraint is a measure carried out by nursing staff. The nurse caring for the patient is responsible for safe application of restraining devices and for providing safe care while the patient is restrained. Nurses may delegate the application of restraining devices and the care of the patient in restraint, but the nurse remains responsible for outcomes. Even when family agree to restraint, nurses are responsible for providing safe outcomes.
- A new nurse asks, “My elderly patient’s CT scan of the head shows many Lewy bodies are present. What should I do about assessing for pain?” Select the best response from the nurse manager.
a.
“Ask the patient’s family if they think the patient is experiencing pain.”
b.
“Use a visual analog scale to help the patient determine the presence and severity of pain.”
c.
“There are special scales for assessing patients with dementia. Let’s review how to use them.”
d.
“The perception of pain is diminished by this type of dementia. Focus your assessment on the patient’s mental status.”
ANS: C
Lewy bodies associated with dementia [Faculty note: Lewy bodies are defined and addressed in Chapter 23]. There are special scales to assess the presence and severity of pain in patients with dementia. The Pain Assessment in Advanced Dementia Scale evaluates breathing, negative vocalizations, body language, and consolability. A patient with dementia would be unable to use a visual analog scale. The family may be able to help the nurse gain perspective about the pain, but this strategy alone is inadequate. The other distracters are myths.
- An advance directive gives legally binding direction for health care interventions when a patient
a.
has a new diagnosis of cancer.
b.
is diagnosed with Parkinson’s disease.
c.
is unable to make decisions for self because of illness.
d.
diagnosed with amyotrophic lateral sclerosis is unable to speak.
ANS: C
Advance directives are invoked when patients are unable to make their own health care decisions. The correct response is the most global answer. A diagnosis of cancer or Parkinson’s disease does not mean the patient is unable to make a decision. For a patient with amyotrophic lateral sclerosis, there are other ways to communicate beyond speaking.
- A patient asks, “What advantage does a durable power of attorney for health care have over a living will?” The nurse should reply, “A durable power of attorney for health care
a.
gives your agent authority to make decisions during any illness if you are incapacitated.”
b.
can be given only to a relative, usually the next of kin, who has your best interests at heart.”
c.
can be used only if you have a terminal illness and become incapacitated.”
d.
cannot be implemented until 30 days after the documents are signed.”
ANS: A
A durable power of attorney for health care is an instrument that appoints a person other than a health care provider to act as an individual’s agent in the event that he or she is unable to make medical decisions. No waiting period is required for it to become effective, and the individual does not have to be terminally ill or incompetent for the person appointed to act on the individual’s behalf.
13. A physically frail elderly patient with mild cognitive impairments needs services of a facility that can provide supervision and safety as well as recreation and social interaction. The family cares for this patient during the evening and night. Which type of facility should the nurse suggest to meet this patient’s needs? a. Adult day care program b. Skilled nursing facility c. Partial hospitalization d. Group home
ANS: A
A day care program provides recreation and social interaction as well as supervision in a safe environment. Nursing, medical, and rehabilitative care are usually not provided. Skilled nursing facilities go beyond meeting recreational and social needs by providing medical interventions and nursing and rehabilitation services on a 24-hour basis. Partial hospitalization provides acute psychiatric hospital programs. A group home is inappropriate and would not meet the patient’s needs.
14. A 79-year-old white male tells a nurse, “I have felt very sad lately. I do not have much to live for. My family and friends are all dead, and my own health is failing.” The nurse should analyze this comment as a. normal pessimism of the elderly. b. evidence of risks for suicide. c. a call for sympathy. d. normal grieving.
ANS: B
The patient describes loss of significant others, economic security, and health. He describes mood alteration and voices the thought that he has little to live for. Combined with his age, sex, and single status, each is a risk factor for suicide. Elderly white males have the highest risk for completed suicide.
- In a sad voice, an elderly patient tells the nurse of the recent deaths of a spouse and close friend. The patient has no other family and only a few acquaintances in the community. The nurse’s priority is to determine whether which nursing diagnosis applies to this patient?
a.
Risk for suicide related to recent deaths of significant others
b.
Anxiety related to sudden and abrupt lifestyle changes
c.
Social isolation related to loss of existing family
d.
Spiritual distress related to anger with God
ANS: A
The patient appears to be experiencing normal grief related to the loss of her family, but because of age and social isolation, the risk for suicide should be determined and has high priority. No defining characteristics exist for the diagnoses of anxiety or spiritual distress. The patient’s social isolation is important, but the risk for suicide has higher priority.
- When making a distinction as to whether an elderly patient has confusion related to delirium or another problem, what information would be of particular value?
a.
Evidence of spasticity or flaccidity
b.
The patient’s level of motor activity
c.
Medications the patient has recently taken
d.
Level of preoccupation with somatic symptoms
ANS: C
Delirium in the elderly produces symptoms of confusion. Medication interactions or adverse reactions are often a cause. The distracters do not give information important for delirium.
- An 85-year-old has difficulty walking after a knee replacement. The patient tells the nurse, “It’s awful to be old. Every day is a struggle. No one cares about old people.” Select the nurse’s best response.
a.
“Everyone here cares about old people. That’s why we work here.”
b.
“It sounds like you’re having a difficult time. Tell me about it.”
c.
“Let’s not focus on the negative. Tell me something good.”
d.
“You are still able to get around, and your mind is alert.”
ANS: B
The nurse uses empathetic understanding to permit the patient to express frustration and clarify her “struggle” for the nurse. The distracters block communication.
18. A 76-year-old is indifferent and responds to others only when they initiate an interaction. What form of group therapy would be most useful to promote resocialization? a. Orientation b. Activity group c. Psychotherapy d. Reminiscence
ANS: D
Reminiscence therapy in a group setting can help to resocialize regressed and apathetic patients. The nurse can encourage discussion about past pleasant events or memories: first car, favorite memory from school, favorite band or song, seasonal activities growing up, etc. Assisting to evoke pleasant feelings or memories is an effective method to improve mood particularly in those with memory impairment. Group psychotherapy would not be effective for this patient. An activity group does not address the patient’s problem. Orientation groups can exacerbate a patient’s distress.
- A nurse assesses four patients between the ages of 70 and 80. Which patient has the highest risk for alcohol abuse? The patient who
a.
consumes 1 glass of wine nightly with dinner.
b.
began drinking alcohol daily after retirement and says, “A few drinks keep my mind off my arthritis.”
c.
drank socially throughout adult life and continues this pattern, saying “I’ve earned the right to do as I please.”
d.
abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends Alcoholics Anonymous (AA).
ANS: B
Alcohol abuse and dependence can develop at any age, and the geriatric population is particularly at risk. Losses, such as retirement, widowhood, and loneliness, are often related. The distracters describe patients with a lower risk for alcohol abuse.
- A nurse wants to assess for suicidal ideation in an elderly patient. Select the best question to begin this assessment.
a.
“Are there any things going on in your life that would cause you to consider suicide?”
b.
“What are your beliefs about a person’s right to take his or her own life?”
c.
“Do you think you are vulnerable to developing a depressed mood?”
d.
“If you felt suicidal, would you tell someone about your feelings?”
ANS: B
This question is clear, direct, and respectful. It will produce information relative to the acceptability of suicide as an option to the patient. If the patient deems suicide unacceptable, no further assessment is necessary. If the patient deems suicide as acceptable, the nurse can continue to assess intent, plan, means to carry out the plan, lethality of the chosen method, and so forth. The other options are less direct, may produce responses that may be unclear, or are appropriate for later in this discussion.
- A community health nurse visits an elderly person whose spouse died 6 months ago. Two vodka bottles are in the trash. When the nurse asks about alcohol use, this person says, “I get lonely and drink a little to help me forget.” Select the nurse’s most therapeutic intervention.
a.
Assess whether this patient is drinking and driving.
b.
Advise the person not to drink alone because the risks for injury increase.
c.
Teach the person about risks for alcoholism and suggest other coping strategies.
d.
Arrange for the person to attend an AA meeting for older adults.
ANS: D
This person needs help with alcohol abuse as well as social involvement. An AA meeting for older adults will provide an opportunity for peer bonding as well as strategies for coping with stress without abusing alcohol. The distracters will not be therapeutic in this instance.
22. Discharge planning begins for an elderly patient hospitalized for 2 weeks diagnosed with major depressive disorder. The patient needs ongoing assessment and socialization opportunities as well as education about medication and relapse prevention. The patient lives with a daughter, who works during the week. Select the best referral for this patient. a. Behavioral health home care b. A skilled nursing facility c. Partial hospitalization d. A halfway house
ANS: C
Partial hospitalization will provide services the patient needs as well as give supervision and meals to the patient while the daughter is at work. Home care would not provide socialization. The patient does not need the intensity of a skilled nursing facility. A halfway house provides 24-hour care and usually expects involvement in off-campus programs.
23. A patient living in community housing for the elderly says, “I don’t go to the senior citizen’s club. They play cards and talk about the past because that’s all they can do.” The nurse analyzes these remarks to represent a. failure to achieve developmental tasks. b. thinking associated with ageism. c. hypercritical behavior. d. paranoid thinking.
ANS: B
Ageism is negative stereotyping and devaluation of people based on their age. Older adults might be as guilty of ageism as younger individuals. The other options are not substantiated by the information given in the scenario.
24. A nurse plans a staff education program for employees of a senior living community. Which topic has priority? a. Late-onset schizophrenia b. Depression and suicide c. Dementia d. Delirium
ANS: B
Older Americans frequently experience undiagnosed depression and are disproportionately more likely to commit suicide. Educating staff about signs and symptoms of high-risk patients and early intervention strategies will decrease morbidity and mortality. The other conditions have a lower prevalence.
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Chapter 115
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Chapter 217
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Chapter 327
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Chapter 428
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Chapter 522
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Chapter 626
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Chapter 728
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Chapter 822
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Chapter 930
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Chapter 101
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Chapter 110
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Ch. 12-V30
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Ch. 1328
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Ch.20-12-T17
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Ch.20-23-T28
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EXAM 263
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Chapter 19- Sleep Wake Disorders25
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Chapter 25- V28
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Ch. 27-V28
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Chapter 2823
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Chapter 29 v24
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Chapter 32- V29
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Chapter 17- T26
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Chapter 24- T30
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Chapter 25- T30
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Chapter 26-T30
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Chapter 28-T17
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Chapter 29-T15
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Chapter 35-T16
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Chapter 1535
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Chapter 2234
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Chapter 2332
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Chapter 3134
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Chapter 1128
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Chapter 2121
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chapter 1829
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source 130
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Source 218
