Chapter 29 & 30 Test (Mental Health Disorders & Delirium and Dementia)

An 81-year-old client with a history of depression has been admitted to the hospital for the treatment of diverticulitis. Which intervention would the nurse most likely implement to foster the client's mental health? A. Organize a life review to remind the client of the positives that exist in the client's life B. Selecting a roommate for the client who is actively social and demonstrates an optimistic outlook in life C. Encouraging the client to actively engage in decision-making about routine and care D. Performing as many of the client's ADLs as possible to minimize the perceived burden of responsibility

C. Encouraging the client to actively engage in decision-making about routine and care

A nurse is providing care to an older adult client with dementia. Which intervention would the nurse identify as the priority? A. Promoting plenty of activity B. Providing physical care C. Ensuring client safety D. Respecting the individual

C. Ensuring client safety

A recreational therapist has proposed an organized program to the nurse manager of a long-term care facility that the therapist claims can significant improve the self-concept of residents. Which component of the therapist's program is most likely to achieve the stated goal? A. Bringing in a staff member's dog to regularly interact with the residents B. Organizing a series of health promotion classes for residents that will be conducted by staff nurses C. Holding reminiscence sessions where residents are encouraged to write autobiographical life reviews D. Beginning a chair aerobic class to increase physical activity by frail residents

C. Holding reminiscence sessions where residents are encouraged to write autobiographical life reviews

An 80-year-old who is receiving treatment for chronic obstructive pulmonary disease in the medical unit of a hospital has been displaying frequent signs of anxiety since admission. Which action would the nurse implement as the priority? A. Working with the occupational therapist to provide the client with meaningful activity B. Explaining to the client that his discharge will occur soon now that the prognosis has improved C. Implementing a predictable routine along with explanations prior to nursing interventions D. Ensuring that the client has an appropriate benzodiazepine prescribed

C. Implementing a predictable routine along with explanations prior to nursing interventions

An older adult comes to the clinic for a follow-up visit. The client is being treated for anxiety. Which information would the nurse need to integrate into the care of this client? A. Older adults should be encouraged to have daily coffee chats with their peers B. Older adults should avoid thinking about or discussing the source of their anxiety C. Interventions to address anxiety should be specific to the underlying cause D. Medication is the most appropriate treatment for anxiety in older adults

C. Interventions to address anxiety should be specific to the underlying cause

A gerontological nurse if orienting a group of newly hired nurses at a long-term care facility. The nurse is describing the older adults population and their mental health. The nurse determines that additional discussion is needed when the group identifies which aspect as a strength of older adults. A. Most older persons do not have concerns about what they are going to be when they "grow up" because they have already grown up B. Older adults have had more experiences with coping, problem solving, and managing crises because they have lived longer C. Most older adults are still in the process of attempting to learn who they really are D. Older adults typically have faced and overcome numerous stresses over their years

C. Most older adults are still in the process of attempting to learn who they really are

A nurse is conducting an in-service program about mental health in older adults for the staff of a long-term care facility. Which information would be most appropriate for the nurse to include? A. Older adults are less likely to cope by using alcohol inappropriately B. Due to their life experiences, older adults have a lower incidence of depression C. Older adults are more likely than younger adults to choose suicide D. Older adults have a lower overall incidence of mental illness than younger adults.

C. Older adults are more likely than younger adults to choose suicide

An older adult client exhibits a pattern of behaviors that include insomnia, chain smoking, increased blood pressure, an frequency of voiding when anxious. Which action would the nurse most likely implement? A. Have barriers installed to prevent wandering B. Encourage the client to enroll in stimulating classes C. Prepare the client for all expected activities D. Encourage the client to have a glass of wine with dinner

C. Prepare the client for all expected activities

A nurse is assessing an older adult's mental health. During the assessment, which factor would the nurse need to keep in mind about the development of mental illness in this group despite the advantages of experiences? A. Mental illness is to be expected in older adults as they commonly become demented B. Although more people survive to old age, they rarely bring problems that they have throughout their lifetime C. The many losses and challenges of late life may exceed the physical, emotional, and social resources of some persons D. Mental health is generally increasing as a person grows older

C. The many losses and challenges of late life may exceed the physical, emotional, and social resources of some persons

The husband of a 74-year-old female client is distraught at her recent diagnosis of Alzheimer's disease. To identify a cure, the husband is conducting extensive online research as well as speaking with each member of the care team about possible treatments. When talking with the husband, which response would be most appropriate? A. "Drugs that affect the neurotransmitters in the brain are now available that can cure many early cases of Alzheimer's." B. "There is presently no cure for Alzheimer's disease but highly promising treatments are coming soon" C. "Eliminating any exposure to aluminum or mercury has been shown to have a positive impact on people in the early stages of Alzheimer's." D. "There isn't currently a cure available for Alzheimer's but some drugs have been shown to slow the progression of the disease."

D. "There isn't currently a cure available for Alzheimer's but some drugs have been shown to slow the progression of the disease."

A nurse is reviewing the medical records of several clients in the long-term care facility. Which client would the nurse identify as most likely exhibiting signs and symptoms of depression? A. A 76-year-old client who is newly admitted and whose neighbors have stated that the client has become progressively more forgetful in the last several weeks. B. A 73-year-old client who has been seen y the primary care provider for complaints of palpitations, labored breathing, and feelings of doom. C. An 82-year-old who is frequently tearful since learning the death of the spouse 4 days prior D. A 79-year-old client who has withdrawn from participation in regular bridge games and no longer returns calls to friends

D. A 79-year-old client who has withdrawn from participation in regular bridge games and no longer returns calls to friends

A nurse is providing care to an older adult client who is suspected of having alcohol abuse. Which information would be most important for the nurse to integrate into the client's plan of care? A. The incidence of alcohol and illegal drug abuse in older adults is rapidly declining. B. Older adults who abuse alcohol have consistently used it very heavy throughout their lives C. Determining if an older adult suffers form alcohol abuse is relatively easy to assess D. Alcohol abuse can seriously threaten the physical, emotional, and social health of older persons

D. Alcohol abuse can seriously threaten the physical, emotional, and social health of older persons

The environment of a client with dementia includes photographs of the client's family, soft music, and low lighting. The client wears personal items received as gifts. Unused electrical outlets are covered. Once a day, the client exercises with a group. Which item would the nurse identify as missing from this picture? A. Nutritional supplements B. A commode chair C. A Walker D. An ID bracelet

D. An ID bracelet

As per her routing, the daughter of an 82-year-old client recovering from a prostate resection has come to the hospital in the morning to be at the bedside. The daughter has approached her father's nurse and stated that the is uncharacteristically difficult to rouse this morning, with his only verbal response being occasional nonsensical muttering. Which activity would be most appropriate? A. Diagnostic imaging to determine the location of any organic brain changes B. Screening for risk factors that would suggest Alzheimer's disease C. Assessment of the client's mood and current stressors D. Assessment to determine the cause of the client's delirium

D. Assessment to determine the cause of the client's delirium

The nurse is making a home visit to a 77-yea-old client diagnosed with Alzheimer's disease 3 months ago. The spouse is the sole care provider, a responsibility that has become increasingly more difficult. When working with the spouse, which action would be most appropriate for the home care nurse to implement? A. Encouraging the spouse to independently develop techniques for basic care that the spouse feels work best B. Organizing outside help to eliminate the amount of direct care that the spouse provides C. Emphasizing to the spouse the importance of remaining optimistic and enthusiastic when interacting with the client D. Encouraging the spouse to avoid feeling guilty for the times when the spouse needs respite

D. Encouraging the spouse to avoid feeling guilty for the times when the spouse needs respite

An older adult resident becomes violent and physically abusive. Which action would be most appropriate? A. Schedule time for supervised walking. B. Recognize that the client is physically weak and unlikely to cause harm C. Desensitize the client by putting the client in triggering situations D. Get immediate help to protect self and others

D. Get immediate help to protect self and others

A nurse is providing care for a client who is in the late stages of vascular dementia. The nurse is in the habit of reorienting the client to person, place, and time. Which statement best explains the nurse's action? A. Reality orientation should be avoided because it only reminds clients of their cognitive losses B. Reality orientation is ineffective because of the client's deficits associated with the diagnosis of dementia C. Reality orientation is unwarranted because it does not slow the progression of cognitive losses D. Reality orientation can be useful, beneficial intervention when used appropriately

D. Reality orientation can be useful, beneficial intervention when used appropriately

A gerontological nurse is conducting a program for a group of older adults at a senior center about dementia. One of the group members asks, "I know about Alzheimer's disease, but there are other common causes of dementia in older adults?" Which information would the nurse most likely include as a common cause? Select all that apply A. Small infarcts of the brain blood vessels B. Traumatic injury C. Parkinson's disease D. Normal age-related change E. Creutzfeldt-Jakob disease

A, B

An older client is brought to the emergency by local law enforcement. The client was found in an alley next to a bar passed out. The nurse is conducting an interview with the client. Which statement would the nurse identify as indicative of alcohol abuse? Select all that apply A. "They told me my blood alcohol level was 168mg/100mL" B. "I've had some tremor when I stop drinking" C. "Sometimes, I drink a bottle of whiskey or more each day" D. "I've never had any episodes of blacking out" E. "All the health care providers tell me to stop drinking but I'm fine"

A, B, C, E

The nursing staff at a long-term care facility are providing care for a resident who requires total assistance secondary to Alzheimer's disease. Which intervention would the nursing staff implement to foster the resident's dignity, personal worth, and individuality? Select all that apply A. Attempting to engage the resident in conversation despite evidence of cognitive losses B. Ensuring that any nursing interventions for the resident are performed in privacy as much as possible C. Giving the resident choices and options even though the client has difficulty making decisions D. Minimizing stressors by performing as many of the resident's activities of daily living (ADLs) as possible E. Using the resident's name during interactions despite the fact the client is disoriented to person

A, B, C, E

A nursing assistance at a long-term care facility reports to the nurse that an older adult client has been found night-wandering several times over the past week. Which intervention would the nurse most likely include in the client's plan of care? Select all that apply A. Ensure that the client is engaged in daytime activities, particularly late day exercise B. Encourage the client to sleep in the daytime C. Assist the client to the bathroom before bedtime D. Keep the client's overhead light on at all times E. Lock the door so that the client person cannot leave the room

A, C

A nurse is reviewing the medical records of several older adult clients. Each of the clients experienced delirium. Which factor would the nurse most likely identify as precipitating the client's delirium? Select all that apply. A. Urinary Tract Infection B. Neurofibrillary tangles C. A new medication causing confusion D. Dehydration from gastroenteritis E. Low zinc levels

A, C, D

A nurse is facilitating a group consisting of family members of recently diagnosed older adults with Alzheimer's disease. One of the family members asks the nurse, "What causes this disease?" When describing the causes associated with Alzheimer's disease, which information would the nurse most likely include? A. "Alzheimer's appears to result from a combination of genetic and environmental factors and no one theory can explain it." B. "Science has recently discovered the direct link between diet and the development of Alzheimer's disease." C. "There are several factors that cause Alzheimer's disease, and modification or removal of many of these can cause a significant improvement in you loved one's condition." D. "Unfortunately, we still do now really know anything about what exactly causes Alzheimer's."

A. "Alzheimer's appears to result from a combination of genetic and environmental factors and no one theory can explain it."

A nurse is working in a long-term care facility asks the gerontological nurse, "What can I do to help best assist an older resident with mental health issues?" Which response by the gerontological nurse would be most appropriate? A. "Strengthen the client's capacity to manage the condition by promoting the client's health." B. "Eliminate the limitations imposed by the condition by doing everything possible for the individual." C. "Challenge the client by immersing the client in new and unfamiliar situations to stimulate mental functioning." D. "Ensure the client does not spend time alone and away from others in the facility."

A. "Strengthen the client's capacity to manage the condition by promoting the client's health."

A nurse is making a home visit to an older adult client diagnosed with Alzheimer's disease. During the visit, the client's spouse asks, "What would be most helpful in slowing the symptoms?" Which response by the nurse would be most appropriate? A. "There are medications that can slow down the progression by affecting an enzyme that acts on acetylcholine." B. "It's been shown that being exposed to zinc is a cause, so to keep things from getting worse, avoid exposure to zinc" C. "There's been some improvement in the condition when the person avoids exposure to aluminum." D. "You might want to ask the health care provider to prescribe antibiotics prophylactically to keep things under control."

A. "There are medications that can slow down the progression by affecting an enzyme that acts on acetylcholine."

A nurse is working in a long-term care facility recognizes the challenge of fostering and maintaining the mental health of residents. When admitting a new resident to the facility, which statement would be most appropriate for the nurse to make? A. "Try to stay involved in activities that you find satisfying and interesting." B. "To maintain health and balance, it's best to avoid spending too much time alone." C. "It helps to make the most of the time that you spend with your family and peers." D. "Don't hesitate to ask about antidepressants"

A. "Try to stay involved in activities that you find satisfying and interesting."

A gerontological nurse is conducting a program for a group of senior adults and their families about dementia. One of the family members asks, "One time my dad had delirium. Are delirium and dementia the same thing?" Which statement would be the most appropriate? A. A person who has dementia can suffer from delirium B. Dementia occurs in all older adults C. Delirium causes a progressive, irreversible decline in cognition D. Delirium and delirium are the same condition

A. A person who has dementia can suffer from delirium

An older adult is admitted to the hospital for surgery. A day later, the client seems confused and disoriented, imagining there is a trapdoor in the ceiling above the bed. The client's wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that until now he has seemed "sharp as a tack." Which action would be the priority? A. Checking the client's chart for medications that can cause delirium B. Telling the wife there is nothing to worry about C. Having the client evaluated for Alzheimer's disease D. Controlling the environmental temperatures and noises

A. Checking the client's chart for medications that can cause delirium

A nurse if providing care to several adults on the medical unit. When reviewing the medical records of each of the clients, the nurse notes potential risk factors for developing Alzheimer's disease in the future. Which factor would the nurse most likely identify? A. Family history of Down Syndrome B. Polypharmacy C. A diagnosis of autism D. Poorly controlled type 1 diabetes

A. Family history of Down Syndrome

The nursing staff on a subacute, medical unit of a hospital have noted that an 80-year-old client with a diagnosis of Alzheimer's disease tends to become agitated in the evening and early in the night. Which intervention would be most appropriate to implement to address the client's behavior? A. Schedule physical therapy in the afternoon hours to help the client expend energy B. Minimize the amount of touch used in nursing care to avoid stimulating the client C. Ensure the client's room is kept as dark as possible during the times in question D. Limit the client's fluid intake after 17:00 to prevent nocturia

A. Schedule physical therapy in the afternoon hours to help the client expend energy

A nurse is assessing an older adult client brought to the emergency department by a sibling. The nurse suspects alcohol abuse based on which assessment findings? Select all that apply A. Calmness when around others B. Episodes of blackouts C. Frequent injuries or falls due to clumsiness D. Use of alcohol to calm nerves E. Keeping to oneself

B, C, D, E

A nurse is reviewing the medical record of several older adult clients. Which factor would the nurse most likely identify as challenging the older adults' emotional homeostasis? Select all that apply A. Independence from others B. Altered function or body image C. Sensory deficits D. Increased vulnerability to crime and abuse E. Greater awareness of own morality

B, C, D, E

A daughter complains that her mother, who has Alzheimer's disease, thinks and acts so slowly that everything must be done for her. Which suggestion would be most appropriate for the nurse to provide initially to the daughter that might be helpful for both the client and herself? A. "Hire a caregiver to handle to take care of your mother." B. "Encourage your mother's self-care, but do it under supervision." C. "Continue doing things for your mother to save time." D. "Allow your mother to do her own care, an let her do it independently."

B. "Encourage your mother's self-care, but do it under supervision."

An older adult client has been receiving numerous treatments for severe depression but the client's depression has been nonresponsive to treatment. Which therapy would the nurse anticipate being used next for this client? A. Acupuncture B. Electroconvulsive therapy C. Light Therapy D. St. John's Wort

B. Electroconvulsive therapy

A nurse is providing care to an older adult client with dementia. When reviewing the client's history, which condition would the nurse suspect as the most likely cause? A. Hypertension B. Genetic predisposition C. Creutzfeldt-Jakob disease D. Hyperlipidemia

B. Genetic predisposition

An older adult has experienced a progressive loss of mobility over the last several years because of multiple sclerosis. Combined with a narrowing social circle, the client has characterized life as "not worth living" and expressed to her nurse a desire to "end it all." Which response by the nurse would be most appropriate? A. Assure the client that such challenges are not uncommon at this age B. Implement measures to ensure the client's safety C. Inform the client's family about the statements D. Add "risk for depression" to the client's nursing care plan

B. Implement measures to ensure the client's safety

An older adult client is called "Gloomy Gus" by his family, as the client always sees the dark side of things. The client has threatened several times to kill himself but has not followed through on the threats. Lately, the client seems preoccupied and has accidentally taken an overdose of a medication. The client has just threatened suicide again. Which action by the nurse would be most appropriate? A. Ignore the client's "crying wolf again B. Make sure the client gets immediate attention by a psychiatrist C. Remind the client of his many blessings D. Encourage the client to see the primary care provider

B. Make sure the client gets immediate attention by a psychiatrist

A 70-year-old resident of a long-term care facility is in the advanced stages of Alzheimer's disease. Consequently, the resident frequently wanders throughout an, on more than one occasion, outside the facility. Due to cognitive deficits, the client is not responsive to teaching and redirection. Which action by the staff would be most appropriate response to the resident's behavior? A. Begin placing the resident in a wheelchair with a tray when he shows signs of restlessness B. Provide a controlled and safe place within which the resident can wander freely around C. Work with the resident's family to establish a supervision schedule for the resident D. Administer the minimum effective dose of a sedative when resident is most restless

B. Provide a controlled and safe place within which the resident can wander freely around

A nurse is preparing to administer an antidepressant medication to an older adult client with depression. Which information would the nurse need to keep in mind? A. Medications typically used provide limited improvement B. Side effects that can occur in older adults are likely to be significant C. The highest dosage of medications is used initially in treatment D. Medications are the preferred method of treatment

B. Side effects that can occur in older adults are likely to be significant

An older adult client on an acute medical unit of a hospital receiving treatment for a chronic pressure ulcer on his coccyx that has necessitated a temporary colostomy. The accompanying disturbance in his body images and activities of daily living has caused the client to become depressed. During a visit by the client's daughter and son-in-law, the nurse brings the client his scheduled medications, to which the client states, "why not being them all at once so I can end this mess." The daughter dismisses her father's client's statement as simply an expression of a pessimistic demeanor. Which information would the nurse most likely incorporate in the response that the nurse will choose? A. Suicidal ideation in older adults is often a consequence of polypharmacy B. The client's statements require appropriate follow-up and should be taken seriously C. Older adults do sometimes commit suicide, but the problem is more common in younger adults D. Older people attempt suicide frequently but they are rarely successful

B. The client's statements require appropriate follow-up and should be taken seriously

A 78-year-old client has been diagnosed by his geriatrician as being in the third stage of Alzheimer's disease. Which findings would support this assessment? A. The client no longer remembers the wife's name and requires assistance with most of his activities of daily living. B. The client's wife and children have recently noticed a change in memory and judgment with the client getting easily flustered in social situations C. The client is commonly oriented to person but becomes easily disoriented to time and place D. The client displays an uncharacteristically flat affect and denies that any cognitive deficits

B. The client's wife and children have recently noticed a change in memory and judgment with the client getting easily flustered in social situations

The prognosis for an older adult woman in the final stages of Alzheimer's disease is about a year or less. The client has developed breast cancer and the surgeon wants to discuss the possibility of operating. The client cannot grasp the situation, however, and is becoming agitated about it. The client's children think surgery would be painful and not worth the potential benefit. Which suggestion would be most appropriate for the nurse to make? A. The client should soley make the decision B. The need for surgery is of secondary importance C. Surgery is definitely indicated D. The insurer should be involved in the decision

B. The need for surgery is of secondary importance

A 71-year-old client who is obese and has poorly controlled hypertension is brought to the clinic by the spouse. The client states that while being a smoker since his teens, many peers have done likewise and still enjoy good health. Over the last 2 to 3 days, the client's spouse has noted that the client has become uncharacteristically forgetful and suspicious. The client was found wandering outside the house last night. The nurse interprets these findings as indicative of which condition? A. Alzheimer's Disease B. Vascular dementia C. Creutzfeldt-Jakob disease D. Wernicke encephalopathy

B. Vascular dementia

A daughter brings her older adult parent to the community health center for an evaluation. Which assessment findings would lead the nurse to suspect that the client is experiencing depression? Select all that apply. A. Feelings of independence B. Difficulty determining current reality from the past C. Inattention to hygiene D. Changes in sleep patterns E. Complaints of anorexia

C, D, E

A 79-year-old female client, admitted for hip replacement surgery, said that she had insomnia the night before. The client received a dose of a prescribed benzodiazepine. Shortly thereafter, the client began displaying signs of delirium that have persisted until the morning change of shift. Which instruction would the night nurse give to the nurse coming on shift? A. "Make sure you let the family that there are effective drug treatments that will resolve her delirium." B. "Work with the discharge-planning nurse to help the family reassess her living arrangement after discharge." C. "Try to keep her level of stimulation as low as you can when you are working with her." D. "Make sure you get a sedative order from her primary care provider

C. "Try to keep her level of stimulation as low as you can when you are working with her."

A nurse is assessing an older client for depression using the Geriatric Depression Scale-Short Form. Which score would the nurse interpret as indicative of depression? A. 3 B. 24 C. 12 D. 12

C. 12

A nurse is assessing several older adult clients. The nurse determines that which client is experiencing a health problem characterized as delirium rather than dementia? A. An older adult male who has developed an unsteady and awkward gait coupled with uncoordinated motor skills in recent months. B. An older adult female who was diagnosed with a brain tumor and who has experienced consequent changed in behavior and cognition C. An older adult male whose wife has brought him to the emergency department because of forgetfulness and confusion exhibited over the last 48 hours D. An older female adult whose children state that her personality has changed markedly and who has difficulty finding words lately

C. An older adult male whose wife has brought him to the emergency department because of forgetfulness and confusion exhibited over the last 48 hours

To the embarrassment of his family, an 81-year-old male client on on the subacute unit of a hospital has made repeated, sexually inappropriate statements to female staff members. The client's family is adamant that such behavior is uncharacteristic. Which action would the nurse implement first? A. Emphasize to the client that such behavior is not permissible B. Explore pharmacologic treatment options with the client's health care provider C. Attempt to identify the underlying cause of the client's behavior D. Liaise with the nurse manager to ensure the client receives care from male staff

C. Attempt to identify the underlying cause of the client's behavior

The spouse of an older adult client notices that the client is posting reminder notes throughout the the house and making many lists. The spouse thinks that these behaviors might be early signs of Alzheimer's disease. What should be he do? A. Ask his wife's health care provider to order blood work B. Provide his wife with zinc and antioxidant supplements C. Be alert for signs of depression D. Ignore the signs he has notices

C. Be alert for signs of depression

An autopsy is performed to determine the cause of death in an older adult who may have been poisoned. Brain tissue shows neuritic plaques and neurofibrillary tangles in the cortex, but no other abnormalities. What would the future have help for him if he had lived? A. Neuronal atrophy in the frontal lobes B. Dementia associated with smoking and hypertension C. Degeneration of neurons and synapses in the neocortex and hippocampus D. Lewy body dementia

C. Degeneration of neurons and synapses in the neocortex and hippocampus