Gerontology Tabloski Chapter 7

An older patient is prescribed a monoamine oxidase inhibitor (MAOI) medication. Which meal choice requires the nurse to intervene immediately? 1. Smoked salmon with salad and bleu cheese dressing 2. Grilled chicken salad on whole wheat with fresh fruit 3. Turkey sandwich with American cheese and coleslaw 4. Chicken salad on a croissant, carrot sticks, and fresh apple

Answer: 1 Explanation: 1. Because these drugs inhibit the metabolism of norepinephrine, hypertensive crisis can occur if they are administered with other drugs or food that raise blood pressure such as anticholinergics, stimulants, and foods containing tyramine including smoked meats and fish, red wine, aged cheese, beer, bologna, pepperoni, liver, raisins, and bananas. 2. None of these food items contain tyramine, which should be avoided in the patient receiving a MAOI. 3. None of these food items contain tyramine, which should be avoided in the patient receiving a MAOI. 4. None of these food items contain tyramine, which should be avoided in the patient receiving a MAOI.

During an interview, the nurse notes that an older patient is having mild difficulty with some words and forgets the names of people. The patient is alert, oriented to time, person, and place, and makes appropriate responses. What does the nurse determine this patient's cognitive changes to mean? 1. Normal signs of aging 2. Early symptoms of dementia 3. Indicators of depression in the elderly 4. Memory impairment that may be related to cerebral ischemia

Answer: 1 Explanation: 1. Cognitive changes vary widely in the elderly; however, older people will not suffer significant memory impairment. Many may experience mild problems with word finding and remembering names. The changes observed in this patient are normal signs of aging. 2. A problem with finding words and forgetting names is not a symptom of dementia. 3. A problem with finding words and forgetting names is not a symptom of depression. 4. A problem with finding words and forgetting names is not related to cerebral ischemia.

An older patient admits to feeling worthless and depressed since the death of their spouse. Which health risk is most concerning to the nurse? 1. Suicide 2. Situational depression 3. Dementia 4. Self-harm

Answer: 1 Explanation: 1. Older persons over the age of 65 have the highest suicide rates of all age groups. A major risk factor for suicide is depression. An inappropriate feeling of worthlessness is a symptom of depression. 2. Situational depression is of concern, but it is not the most concerning risk for this patient. 3. The patient is not demonstrating symptoms of dementia. 4. The patient is showing signs of depression, which may lead to the less severe risk of self-harm.

An older patient is concerned about remembering to take prescribed medications. What strategies should the nurse recommend to this patient? Select all that apply. 1. Rely on habit to take the medication. 2. Use an assistive device such as a pillbox. 3. Suggest a family member provide the medication. 4. Discuss moving to an assisted living facility for safety. 5. Discuss reducing the number of medications with the physician.

Answer: 1, 2 Explanation: 1. Reliance on habit helps to reduce the chances of forgetting vital information, such as taking prescribed medications. 2. Using assistive devices such as pillboxes helps to reduce the chances of forgetting vital information, such as taking prescribed medications. 3. Suggesting that a family member provide the medication would be an unnecessary burden to the family. 4. There is no reason for the patient to be transferred to an assisted living facility. 5. Consulting the healthcare provider to alter the drug schedule may be necessary but would be considered after other strategies have been tried.

The nurse educator is preparing an educational program about psychiatric issues in older patients. Which symptoms should be included in instruction? Select all that apply. 1. Flat affect 2. Thoughts of suicide 3. Social withdrawal and isolation 4. Delusions and hallucinations 5. Difficulty in performing ADLs

Answer: 1, 2, 3, 4 Explanation: 1. A psychiatric symptom that should be investigated and not written off as a normal change of aging includes problems with emotional expression such as a flat affect. 2. A psychiatric symptom that should be investigated and not written off as a normal change of aging includes suicide. 3. A psychiatric symptom that should be investigated and not written off as a normal change of aging includes social withdrawal and isolation. 4. A psychiatric symptom that should be investigated and not written off as a normal change of aging includes delusions and hallucinations. 5. Difficulty in performing ADLs does not necessarily indicate a psychiatric issue.

An elderly, Asian patient is admitted for suicide precautions. After performing an assessment, the nurse identifies a history of multiple, unsuccessful suicide attempts in the past three years. Which factor(s) may have contributed to the delay in treatment? Select all that apply. 1. Ageism 2. Poverty 3. Cultural bias 4. Discrimination 5. Birth order

Answer: 1, 2, 3, 4 Explanation: 1. Minority elders are at increased risk for mental health problems because of ageism and a negative stereotype toward older adults. 2. One factor that contributes to poor mental health in minority elders is poverty. 3. Minority elders are at risk for mental health problems because of cultural bias. 4. One factor that contributes to poor mental health in minority elders is discrimination. 5. Although a predictor of personality traits, birth order does not increase the risk for delayed mental health treatment.

What should the nurse instruct an older patient to do to cope with age-associated cognitive changes? Select all that apply. 1. Read daily 2. Write "notes to self" 3. Play computer games 4. Learn memory enhancement techniques 5. Avoid group conversations

Answer: 1, 2, 3, 4 Explanation: 1. One way to cope with age-associated cognitive changes is to read daily in order to keep the mind challenged and mentally active. 2. One way to cope with age-associated cognitive changes is to write "notes to self." 3. One way to cope with age-associated cognitive changes is to play computer games. 4. One way to cope with age-associated cognitive changes is to learn memory enhancement techniques. 5. The patient should be encouraged to socialize to maintain social relationships and support.

The nurse is concerned that an older patient has a problem related to regular alcohol consumption. What did the nurse assess in this patient? Select all that apply. 1. Anxiety 2. Malnutrition 3. Social isolation 4. Bruises from falling 5. Dependence on family members

Answer: 1, 2, 3, 4 Explanation: 1. Problems related to excessive or regular alcohol consumption include anxiety. 2. Problems related to excessive or regular alcohol consumption include malnutrition or failure to prepare and eat an adequate diet. 3. Problems related to excessive or regular alcohol consumption include social isolation because of avoiding people who do not drink or are judgmental. 4. Problems related to excessive or regular alcohol consumption include recurrent bruises from falls. 5. Problems related to excessive or regular alcohol consumption do not include dependence on family members.

The nurse is preparing a presentation on grief. What information should be included regarding factors that can affect duration and the course of grieving? Select all that apply. 1. Centrality of loss 2. Suicide of an adult child 3. Death of a child who lived next door 4. Cultural and ethnic influences 5. Survivor's religious or spiritual belief system

Answer: 1, 2, 3, 5 Explanation: 1. Factors that can affect the duration and course of grieving include the centrality of the loss. 2. Factors that can affect the duration and course of grieving include the relationship of those involved in a suicide. 3. Factors that can affect the duration and course of grieving include the relationship of those involved. 4. Factors that can affect the duration and course of grieving do not include cultural and ethnic influences. 5. Factors that can affect the duration and course of grieving include the survivor's religious or spiritual belief system.

The daughter of an elderly patient expresses concern about a change in the patient's mental health. Which is most likely due to normal cognitive changes? Select all that apply. 1. Decline in the ability to draw 2. Decrease in size of vocabulary 3. Difficulty filtering out irrelevant information 4. Difficulty switching attention from one person to another 5. Increased need to repeat information to the patient

Answer: 1, 3, 4, 5 Explanation: 1. A decline in visuospatial task ability such as drawing declines with aging. 2. Vocabulary improves with age. 3. The ability to filter out irrelevant information declines with age. 4. The ability to switch attention between people declines with age. 5. Information-processing speed declines with age, necessitating the need to repeat information to the patient several times.

The discharge nurse is teaching insulin administration to an older patient. Which teaching strategy would be best? 1. Provide written materials to reinforce the verbal instructions. 2. Encourage repetitive exercises to review new information until it is understood. 3. Allow longer teaching times to compensate for a slower learning pace. 4. Provide instruction to relatives so the patient will not be overwhelmed with new information.

Answer: 2 Explanation: 1. Short-term memory, or primary memory, remains relatively stable when aging. 2. Normal age-related changes include a slowing of information processing, which results in the need for repetition of information. 3. Another age-related change includes the inability to maintain sustained attention. Long teaching sessions would not be appropriate. 4. Assuming the older patient cannot learn new information is a false belief of the aging process.

The nurse is planning care for an older patient diagnosed with major depression who states that voices are telling the patient to kill himself. Which nursing diagnosis would be a priority for this patient? 1. Social isolation 2. Risk for suicide 3. Disturbed sleep pattern 4. Altered sensory perception

Answer: 2 Explanation: 1. Social isolation might be causing the patient to hear voices; however, this would not be the priority diagnosis at this time. 2. The patient is hearing voices that are telling him to kill himself. This patient is at risk for suicide. 3. The patient may or may not have disturbed sleep. This is not the priority diagnosis for the patient at this time. 4. Even though the patient is hearing voices, which would be an alteration in sensory perception, the voices are telling the patient to kill himself. This is not the priority diagnosis for the patient at this time.

The nurse is assessing an older patient exhibiting signs of paranoia. Which is known to increase the risk of developing of this disorder? Select all that apply. 1. Food allergies 2. Hearing loss 3. Dementia 4. Social isolation 5. Cognitive impairment

Answer: 2, 3, 4, 5 Explanation: 1. Food allergies are not known risk factors for paranoia. 2. Hearing loss is a risk factors for the development of paranoia. 3. Risk factors for the development of paranoia include dementia. 4. Social isolation is a risk factor for the development of paranoia. 5. Risk factors for the development of paranoia include cognitive impairment.

An older patient wakes up from sleep, confused, and insists a family member is in the other room. What information within the patient's medical record should the nurse consider as a source of the patient's confusion? 1. The patient is elderly. 2. The patient's spouse recently died. 3. The patient received pain medication. 4. The patient has a history of cardiac disease.

Answer: 3 Explanation: 1. Age does not cause confusion. 2. The loss of a loved one may cause depression but is not identified as a reason for confusion. 3. Certain medications like sleeping pills, tranquilizers, and some pain medications can cause symptoms similar to dementia. 4. Cardiac disease alone is not known to cause confusion.

An elderly patient is admitted for abdominal pain. The nurse assesses withdrawal, somatic complaints, and continued, unrelieved pain. What nursing action is indicated? 1. Request an anti-anxiety medication 2. Contact the family to intervene 3. Assess for signs and symptoms of depression 4. Obtain an order for stronger pain medication

Answer: 3 Explanation: 1. Further assessment is required to determine patient's current needs. 2. The family may be ineffective in meeting the patient's psychological needs. 3. The major signs of depression in the older person include multiple somatic complaints and reports of persistent chronic pain. 4. Obtaining different pain medication would not treat potential psychological problems.

The nurse working in a long-term care facility is coordinating a screening for depression. Which is the primary benefit of this event? 1. Educates family about signs of depression 2. Allows family to lower their expectations of their loved one 3. Identifies symptoms of depression often associated with chronic illness and pain 4. Allows early intervention with antidepressant medication

Answer: 3 Explanation: 1. Screening an older patient for depression allows for earlier identification and treatment. Education to the family would follow. 2. Screening older patients for depression is not done to lower expectations from older patients' family members. This action helps to identify those patients who need intervention to treat depression. 3. Depression is the mental health problem of greatest frequency and magnitude in the older population. The risk of depression in the older person increases with other illnesses and when ability to function becomes limited. Symptoms of depression are often associated with chronic illness and pain. 4. Depression in older adults is often undetected and untreated. Non-pharmacological approaches are the first line of care for depression.

An older patient with cardiac disease has frequent sleep problems and insomnia. How would the nurse describe these manifestations? 1. Abnormal sleep disturbances due to chest pain 2. Predictive signs of respiratory disease 3. Negative symptoms of stress and anxiety 4. Expected manifestations of cardiac disease

Answer: 3 Explanation: 1. Sleep problems due to chest pain are not normal signs for older patients. 2. There is no information to suggest that sleep problems and insomnia are predictive signs of respiratory disease. 3. Symptoms that indicate an older person may be suffering negative effects of stress include sleep problems and insomnia. 4. There is no information to suggest that sleep problems and insomnia are expected manifestations of cardiac disease.

During an assessment, the nurse learns that an older patient feels his heart race during times of stress. How would the nurse best describe this event? 1. "Your body is reacting with a fight-or-flight response which is normal." 2. "Your body is releasing a chemical to make your heart stronger because it is weak." 3. "This is not a normal response, and further testing will be required." 4. "This is an emergency and will require immediate hospitalization."

Answer: 3 Explanation: 1. The fight-or-flight response stimulates epinephrine release and increases pulse, blood pressure, blood glucose, and muscle tension. 2. Epinephrine is released but does not make the heart stronger. 3. This is not a normal response. 4. This is not an emergency that requires immediate hospitalization.

The nurse is planning an educational session on suicide in the older patient population. What information should the nurse include in this presentation? Select all that apply. 1. An older patient does not have the physical strength to commit suicide. 2. A patient should never be questioned about suicide intent. 3. Suicide rates are the highest in people age 65 and older. 4. An older person who contemplates suicide is more likely to complete the act than a younger person. 5. Many older adults who commit suicide had visited their primary care physician within the previous month.

Answer: 3, 4, 5 Explanation: 1. Suicide can occur by methods that do not require physical strength to perform. 2. Suicide intent is part of the nursing assessment for depression. 3. Older persons age 65 and over have the highest suicide rates of all age groups. 4. An older person who contemplates suicide is more likely to complete the act than a younger person because older people often employ lethal methods when attempting suicide, experience greater social isolation, and generally have poorer recuperative capacity, which makes them less likely to recover from a suicide attempt. 5. Approximately 70 percent of older adults who commit suicide had visited their primary care physician within the previous month.

The nurse is assessing an older patient in a long-term care facility. Which observation best indicates the need for depression screening? 1. Slight decline in memory 2. Increase in socialization 3. Increased energy and participation 4. Persistent sadness

Answer: 4 Explanation: 1. A slight decline in memory is not unexpected in an older patient. 2. Increased socialization is not a sign of depression. 3. Increases in energy and participation are not signs of depression. 4. Persistent sadness is a sign of depression.

Which statement made by an older patient best indicates to the nurse that the patient might be contemplating suicide? 1. "I wish I could stop all of this pain." 2. "I'll beat this cancer even if it kills me." 3. "I'll get through this one day at a time." 4. "I'm no use to anyone. I might as well be dead."

Answer: 4 Explanation: 1. Expressing a desire to have pain end does not indicate that an older patient is contemplating suicide. 2. This statement reflects determination and is not expressing suicidal intentions. 3. This statement reflects facing illness and is not expressing suicidal intentions. 4. The statement that reflects uselessness and being dead is one that should be analyzed for suicidal intentions.

The son of an older patient is concerned about the patient's ongoing forgetfulness and asks the nurse to explain what could be wrong with the patient. How should the nurse respond to the son? 1. "Memory difficulties are hard for family members to deal with." 2. "My parents are the same age as yours, and they can't remember anything." 3. "Forgetfulness is common in older adults. It's nothing you need to worry about." 4. "Memory difficulties can be due to underlying issues including anxiety, chronic pain, or depression."

Answer: 4 Explanation: 1. Memory difficulties are difficult for family members to deal with, but this is not the most appropriate statement at this time. The nurse is discounting the son's feelings. 2. The nurse is showing sympathy with the statement about the parents but is not addressing the son's feelings. 3. Forgetfulness is common in older adults, but this statement is not therapeutic. 4. Cognitive changes can be due to anxiety, chronic pain, depression, or Alzheimer's disease.

An older patient's spouse passed away 4 years ago; however, the patient still sets a place at the dinner table for the spouse and has never removed any clothing or other personal items from the home. What does the nurse suspect the patient is experiencing? 1. Normal grief 2. Hopelessness 3. Survivor guilt 4. Pathological grief

Answer: 4 Explanation: 1. Normal grief is that which lasts within a 2-year time frame. 2. Hopelessness is when the patient sees no hope in life. This is not what the patient is experiencing. 3. Survivor guilt is associated with a traumatic event where a person survives when another loved one does not. 4. Grief persisting longer than 2 years is considered pathological in the United States.

While organizing a walking program at an assisted living facility, one resident asks why older people should exercise. Which is the nurse's best response? 1. "You aren't too old to exercise." 2. "Older people often forget to exercise." 3. "Your doctor has ordered it." 4. "Exercise can reduce stress and improve physical health."

Answer: 4 Explanation: 1. The statement "You aren't too old to exercise" does not answer the resident's question. 2. Memory problems are not a normal part of aging. 3. Having a doctor's order does not answer why exercise is beneficial. 4. Exercise can help to break the cycle of long-term negative effects of stress and reduce the harmful effects of elevated cortisol levels caused by stress.

The nurse is admitting an older patient who requires a cane for ambulation, bilateral hearing aids, and monthly vitamin B12 injections. The daughter of the patient tells the nurse that the patient no longer remembers how to use a toothbrush or turn on the television set. Which information requires further assessment? 1. Vitamin deficiency 2. Loss of hearing 3. Assistive device for ambulation 4. Cognitive change

Answer: 4 Explanation: 1. Vitamin deficiency is being currently treated with medication and does not require further, immediate assessment. 2. Hearing loss is compensated with hearing aid devices and does not require further, immediate assessment. 3. Using a cane for ambulation compensates for unstable ambulation and does not require further, immediate assessment. 4. Normal, healthy older persons who forget what an item is used for or how to use it should be referred for further evaluation and treatment.