GERIATRICS CHAPTER 11

An older adult has recently been placed in a long-term care facility. What would the nurse expect to see exhibited in the patient? a. Feeling unloved and unlovable b. Feeling angry with the isolation c. Feeling unworthy for attention d. Feeling determined to be his or her own support

ANS: A Without an emotional support system, the older adult comes to feel unloved and unlovable.

What influences an older adult's self-concept? (Select all that apply.) a. Financial security b. Social life c. Physical health d. Mobility e. Cognitive function

ANS: A, B, C, D Cognitive function is not directly related to a person's self-concept.

What must an older adult develop in order to achieve Erikson's task of integrity versus despair? (Select all that apply.) a. A positive attitude toward aging b. Positive self-esteem c. A manageable degree of illness d. A ready support system e. Control of all life choices

ANS: A, B, C, D It is necessary for the older adult to have some degree of control but not complete control of life choices for the development of integrity rather than despair.

The nurse notices there has been a change in the behavior of an 84-year-old home patient over the past few weeks. What methods can be used to assess the patient's self-perception and self-concept? (Select all that apply.) a. Observing his physical appearance b. Monitoring for changes in his vital signs c. Encouraging him to verbalize his feelings d. Observing for changes in activities e. Participating in group activities

ANS: A, B, C, D Patients' self-perception is not assessed by having them participate in group activities.

What influences the older adult's self-perception? (Select all that apply.) a. Family support b. Ethnic heritage c. Health status d. Financial status e. Sense of independence

ANS: A, C, D, E A patient's sense of independence is the most significant aspect of self-perception.

What forms an individual's self-identity? (Select all that apply.) a. Values b. Ambition c. Interaction with others d. Self-esteem e. Ability to control his or her life

ANS: A, C, D, E Ambition is not a part of self-identity.

What actions by the nurse would help a patient who is experiencing a loss of self-control? (Select all that apply.) a. Allowing the patient to make choices whenever possible b. Assisting the patient to perform all self-care activities c. Respecting the patient's right to refuse treatment d. Explaining all procedures ahead of time e. Adapting the environment to enhance self-care

ANS: A, C, D, E Assisting the patient in all self-care activities is going to increase the perception of powerlessness.

How can an older adult with a failing memory assume control to improve self-image? (Select all that apply.) a. Attitude toward aging b. Financial needs c. Physical appearance d. Time use e. Relationships

ANS: A, C, D, E Persons who take control of the many aspects of their personal lives and well-being will have a good self-image.

The nurse in a long-term care facility notes signs of depression in a resident who is ordinarily positive. What newly prescribed medication could contribute to the depression? a. Erythropoietin b. Corticosteroids c. Calcium replacement d. Broad-spectrum antibiotics

ANS: B Depression can be caused by the initiation of drugs such as corticosteroids, glycosides, hormones, and antihypertensive agents.

An older adult has recently moved to a long-term care facility. The family asks what can be done to ease the transition. What would be the most appropriate suggestion of the nurse? a. Send cards or gifts instead of personal visits. b. Visit and call often to remind the resident that she or he is cared for. c. Limit contact for several weeks to encourage independence. d. Communicate with the long-term facility's staff to inquire about the resident's well-being.

ANS: B Frequent visits and calls by family and friends help maintain self-esteem and self-worth in the newly admitted resident.

What symptom could be an indicator of depression in an 80-year-old man? a. Repetitive routines b. Agitation and irritability c. Constant talking d. Seeking the company of family members

ANS: B Irritability and agitation are signs of depression, as are cessation of routines, mood swings, social withdrawal, and unwillingness to talk.

How does the concept of ageism portray older adults? a. An inactive population of self-indulgent persons b. A group that has opted to isolate themselves c. Physically inept and nonproductive d. An antisocial but active group

ANS: C Ageism defines the older adult as physically inept, nonproductive, and essentially unattractive.

Which older adult would be at the highest risk for suicide? a. One with a lack of activity b. One with an altered nutritional intake c. One who abuses alcohol d. One who has a chronic disease

ANS: C Older adults who abuse alcohol are at a higher risk of suicide.

The long-term care facility nurse is aware that the resident most at risk for suicide related to depression is the a. 70-year-old man with diabetes. b. 75-year-old woman with chronic obstructive pulmonary disease. c. 80-year-old woman with a bipolar disorder. d. 85-year-old man with schizophrenia.

ANS: C Persons with affective disorders are most at risk for suicide related to depression.

What would cause the most damage to the self-concept of an older adult who lives in a long-term care facility? a. Being perceived as a single group rather than an individual b. Having individual needs that are not met c. Losing many personal belongings d. Losing social contact

ANS: C The losses of home, spouse, car, and independence in making choices are devastating blows to someone's self-image, even if he or she has social contacts and individual needs are met.

The 70-year-old woman who had a stroke 3 months ago has a body image disturbance related to her spastic right arm and contracted fingers of the right hand. How can the nurse assist the patient in improving her body image? a. Teach her to write with her left hand. b. Place articles within easy reach of her left hand. c. Help her select colorful scarves or accessories to cover her right arm. d. Show her massage techniques to increase circulation in her right arm.

ANS: C The selection of colorful accessories to cover the arm will help with her damaged body image. Learning to write with the left hand, learning massage techniques, and being able to reach items are good nursing care but do nothing for enhancement of body image.

What causes the greatest damage to self-worth? a. Measuring self against internal ideals b. Measuring self against individual values c. Measuring self against external standards d. Measuring self against expressions of positive feedback

ANS: C The use of external standards rather than internal values is an inadequate platform for self-worth. The use of positive feedback and internal individual values supports a positive perception of self-worth.

What can the long-term care nurse do to best relieve anxiety in a female resident? a. Stimulate her with group activity. b. Sedate her to allow her to sleep. c. Provide her with coffee for relaxation. d. Offer her a diversion of a quiet activity.

ANS: D Involving the anxious resident in a pleasant activity such as music therapy, conversation, or a craft can allay anxiety. Stimulation frequently adds to anxiety, and sedation does not address the need for anxiety-reducing coping skills.

What would be considered the most important indicator of a positive self-image in an older adult living in a long-term care facility? a. Feeding self independently b. Maintaining urinary continence c. Having family visitors every week d. Neat grooming and wearing fresh clothing

ANS: D Neat grooming and care in personal appearance are cardinal indicators of a positive self-image.

What is a common feeling for an older adult who is placed in a long-term care facility? a. Rejection b. Safety c. Making a fresh start d. Immediate assistance at hand

ANS: A Placement equals rejection in the minds of many older adults, even if the placement was unavoidable and necessary.

What would the home health nurse expect the depressed patient to use in excessive amounts as the depression increases? a. Alcohol b. Corticosteroids c. Caffeine drinks d. Comfort foods

ANS: A Tobacco and alcohol are frequently used excessively as depression increases.

What would have the largest impact on maintaining a positive self-perception? a. Ability to control life's choices b. Financial success attained in life c. Family relationships d. Degree of wellness

ANS: A Being in control of life's choices increases and maintains a positive self-perception.

The 75-year-old woman newly admitted to a long-term care facility seems fearful of her surroundings and is frequently tearful, saying, "I don't know what to do!" What action by the nurse would most help decrease her fear? a. Help the resident identify and verbalize her specific fears. b. Assure the resident that she has nothing to be afraid of. c. Keep the light on in the resident's room 24 hours a day. d. Play quiet music on the resident's radio.

ANS: A Identification of specific fears helps crystallize the resident's concern and can help define the remedy.

An older adult in a long-term care facility has been diagnosed with depression. What would indicate a need for further assessment of suicide risk? a. Asking for assistance in writing a will b. Voicing the intention to visit his brother c. Donating excess clothing to charity d. Asking the young widow next door for a dinner date

ANS: A Making or altering a will is an indication of suicidal ideation.

Which patient would have the highest risk of suicide? a. 85-year-old male with a history of an affective disorder b. 50-year-old female with a recent divorce c. 70-year-old female with high blood pressure d. 65-year-old male with chronic asthma

ANS: A Older men and older adults with a history of affective disorder are the highest risk for suicide.

The newly admitted 80-year-old female resident sits in her room and stares at the TV all day. What action by the nurse would best aid the patient in increasing self-esteem? a. Encouraging her to participate in self-care activities b. Suggesting that she change the channel to an intellectually stimulating program c. Giving her privacy until she becomes accustomed to the long-term care facility d. Arranging for a meal tray rather than having her eat in the dining room

ANS: A Participation in self-care activities increases self-esteem and independence and puts the resident in control of her appearance.

The nurse admits a 70-year-old female to the long-term care facility. While assisting with the assessment, the nurse notes that the patient's husband died 2 months ago and that she has pain daily in her deformed hands from rheumatoid arthritis, needs assistance to dress herself, and has become incontinent of urine. What is the most appropriate nursing diagnosis for this patient? a. Risk for disturbed self-perception b. Powerlessness c. Hopelessness d. Impaired social reaction

ANS: A Patients at risk for disturbed self-perception have had conditions that have resulted in changes in their body image, body function, loss, recent relocation, and chronic pain.