PrepU Ch. 37 Adult Clients
A nurse identifies an unintentional weight loss of 5 kg during a physical assessment of an older adult. Identifying a mental health problem would be indicated or suggested if client response is ... a) Client's reduced pleasure in eating as difficulty to smell food. b) Afraid to eat as the food is poisoned c) Difficulty swallowing d) A decreased appetite
Afraid to eat as the food is poisoned Explanation: The nurse should note any unintentional weight loss of more than 4.5 kg. The nurse must consider such nutrition changes in light of mental health problems.
A preventative intervention for development of risk factors for suicide is associated with developing ... a) Increased availability of assisted-living communities b) Community-based projects c) Proximity of clinics in the community d) Local hospital supportive agencies
Community-based projects Explanation: Community-based projects have been effective in significantly reducing suicide rates in older adults.
Cognitive changes in the older adult are related to the diagnosis of ... a) Panic disorders b) Delirium c) Anxiety disorders d) Depression
Delirium Explanation: Cognitive changes in older adults are associated with delirium.
Depressive symptomatology among older adults would tend not to include which of the following? a) Depressed mood b) Cognitive symptoms c) Hypersomnia d) Appetite changes
Depressed mood Explanation: Depressive symptomatology among older adults is more likely to include vague somatic complaints, cognitive symptoms, hypersomnia, and appetite changes rather than complaints of depressed mood.
Memory loss is not a normal part of aging, but memory may be less efficient. Memory problems later in life are believed to result from which of the following? a) Lack of relevance b) Sensory problems c) Inattention d) Encoding problems
Encoding problems Explanation: Memory problems in later life are believed to result from encoding or retrieval problems. Other factors associated with memory changes include lack of perceived relevance, sensory problems, not paying attention, and a lack of using repetition to strengthen memory.
How quickly an older adult responds to questions has been termed speed-accuracy shift, which refers to ... a) Focusing on accuracy rather than speed of answering b) Identifying their learning deficits c) Identifying their focus on answering without delay d) Focusing on the previous question asked
Focusing on accuracy rather than speed of answering Explanation: Hurrying older adults to answer questions may interfere with their ability to provide the correct answer. This has been labeled the speed-accuracy shift, by which the older adult focuses more on accuracy than on speed in responding.
Many cognitive abilities are preserved or even enhanced during aging. Which of the following is impaired with normal aging? a) Attention b) Reaction time c) Alertness d) Consciousness
Reaction time Explanation: Mental processing speed and reaction time do gradually decrease from mid to late adulthood and may affect how quickly the older adult responds to questions. This phenomenon has been labeled the speed-accuracy shift, by which the older adult focuses more on accuracy than speed in responding. Normal aging does not impair consciousness, alertness, or attention.
Which of the following are components of the geropsychiatric nursing assessment of psychological domain? a) Risk assessment b) Pain c) Present health status d) Pharmacologic information
Risk assessment Explanation: Assessment of the psychological domain includes the client's responses to mental health problems, mental status examination, behavioral changes, stress and coping patterns, and risk assessment. Present health status, pain, and pharmacologic information are assessment data from the biologic domain.
A nurse assessing an older adult for suicide should assess for high risk factors such as ... a) Frequent visits to primary care clinics b) Family supports c) Frequent church attendance d) Unusual stress
Unusual stress Explanation: In assessing an older client, the nurse should consider unusual stress as indication of high risk for committing suicide.
Significant biologic changes occur in later adulthood. The physiological changes refer to ... a) The brain ventricles are narrower b) Increase in peripheral and central neurons c) Renal clearance increases by as much as 35% d) Blood flow in the liver decreases
Blood flow in the liver decreases Explanation: Reduced blood flow decreases the liver's opportunity to metabolize medications.
Which of the following is the greatest risk factor for suicide in older adults? a) Bereavement b) Depression c) Dementia d) Delirium
Depression Explanation: Depression is the greatest risk factor for suicide. Individuals who are suicidal often believe that they are a burden to their family, who would be better off without them. Neither delirium nor dementia is the greatest risk factor for suicide in older adults. Bereavement is an important and well-established risk factor for depression.
A nurse is providing an in-service educational program for beginning nurses regarding mental health assessment needs of older adults. One of the topics addressed is the importance of interviewing family members in addition to the older adult client. The nurse tells the audience that family members are sometimes able to give a more accurate history than the client himself if the client has memory impairment. The nurse also emphasizes that interviewing family members provides which of the following? a) Evaluation of the family's ability to effectively care for the older client b) A much-needed period of respite and support for the family members c) A more accurate picture of the social support resources available d) Determination of the extent of the client's memory impairment
Evaluation of the family's ability to effectively care for the older client Explanation: By interviewing family members, the nurse expands the scope of the client assessment. Moreover, the nurse has an opportunity to evaluate the caregivers themselves to determine whether they can adequately care for the client and how they are coping with the situation.
Depression in older adults is overlooked by primary care providers as a result of the older adult's ... a) Mostly living in extended supportive families b) Less likely to report feeling sad or worthless c) Frequent emergency department visits d) Minimal contact with primary care providers
Less likely to report feeling sad or worthless Explanation: Older clients are less likely to report feeling sad or worthless than are younger clients.
When using the biopsychosocial geropsychiatric nursing assessment, the nurse uses the mental status examination as part of her evaluation of a 65-year-old client diagnosed with bipolar disorder. The examination is part of which of the following domains? a) Social b) Functional c) Biologic d) Psychological
Psychological Explanation: Assessment of the psychological domain includes the client's responses to mental health problems, mental status examination, behavioral changes, stress and coping patterns, and risk assessment. The mental status examination is not part of the social or biologic domain. There is not a domain per se called functional.
Which of the following is accurate with regard to suicide in older adults? a) Rates increase with age b) Rates decrease with age c) Rates are higher among married men ages 42 to 77 years d) Rates are higher among older white women
Rates increase with age Explanation: Suicide rates increase with age; the rate among older white men is six times that of the general population, according to the American Association of Suicidology. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk for committing suicide.
Which of the following are changes that occur within the brain in healthy older adults? a) Higher metabolic rate at rest b) Decreased cerebrospinal fluid c) Decreased white matter abnormalities d) Reduced gray matter volume
Reduced gray matter volume Explanation: In the brain, healthy older adults have reduced gray matter volume, increased cerebrospinal fluid, increased white matter abnormalities, and lower metabolic rates at rest.
A group of nursing students is reviewing the physical changes that occur in older adults. The students demonstrate understanding of the information when they identify which of the following as contributing to the client's risk for drug toxicity? a) Reduced liver function b) Reduced brain gray matter volume c) Lower metabolic rate at rest d) Decreased body water
Reduced liver function Explanation: Liver function may be reduced because of decreased blood flow and enzyme activity, resulting in increased blood and tissue concentrations of medications. Changes in brain gray matter volume, lower metabolic rate, and decreased body water would not contribute to potential drug toxicity in older adults.
A nursing student is reading an article about protective factors for older adults with mental illness. The article mentions the individual's ability to adapt successfully to stress, trauma, or chronic adversity. The student identifies this as which of the following? a) Empty nest b) Gerotransendence c) Functional status d) Resilience
Resilience Explanation: Resilience is an individual's ability to adapt successfully to stress, trauma, or chronic adversity. Functional status is the extent to which a person can independently carry out personal care, home management, and social functions in everyday life, in a way that has meaning and purpose. Gerotranscendence is the ninth stage of development that provides for continued growth in dimensions such as spirituality and inner strength. An empty nest is a home without children or caregiving responsibilities (common in middle-age adults).
Which of the following are components of the geropsychiatric nursing assessment of psychological domain? a) Present health status b) Pharmacologic information c) Risk assessment d) Pain
Risk assessment Explanation: Assessment of the psychological domain includes the client's responses to mental health problems, mental status examination, behavioral changes, stress and coping patterns, and risk assessment. Present health status, pain, and pharmacologic information are assessment data from the biologic domain.
Which of the following is a risk factor for suicide in later life? a) Female gender b) Anxiety disorder c) African-American race d) State of bereavement
State of bereavement Explanation: Risk factors for suicide in this age group include white race, male gender, history of depression, and recent state of bereavement.
The nurse is caring for a 75-year-old client who lost her husband two weeks ago. She is continually crying and has had a loss of appetite since the death. The nurse should explain to the client and her family that a) if these symptoms persist beyond 1 month, the client is developing depression. b) bereavement is typically not a risk factor for depression. c) depression and suicide are not major mental health risks for the elderly. d) bereaved spouses develop depression during the first year if symptoms continue longer than two months
bereaved spouses develop depression during the first year if symptoms continue longer than two months Explanation: The nurse should instruct the client and her family that depression or adjustment disorder diagnosis is made if these symptoms persist beyond 2 months.
While assessing an older adult, the nurse observes that the client is slow in providing answers to the nurse's questions. The client apologizes for being slow to respond. The nurse should explain to the client that older adults often ... a) focus more on accuracy than speed in responding. b) tend to exercise less caution due to the aging process. c) have memory impairments that affect their responses. d) are more often risk-takers than younger adults are.
focus more on accuracy than speed in responding. Explanation: The nurse should explain to the client that older adults focus more on accuracy than speed in responding.
Adequate nutrition is an important factor in maintaining mental health. Which of the following are problems that can result from undernutrition? Select all that apply. a) Pressure sores b) Increased gastric motility c) Mental problems d) Moist skin
• Pressure sores • Mental problems • Fatigue Explanation: Undernutrition can lead to anemia, inadequate wound healing, increased incidence of pressure sores, impaired elimination, impaired immunological functions, weakness, fatigue, and mental problems (including depression, dementia, and agitation). Decreased gastric motility and dry skin would occur in undernutrition.
In an outpatient setting, the nurse is caring for an 83-year-old client who has been diagnosed with depression. The client tells the nurse that she has had trouble swallowing her food lately. The nurse should document the client's complaint of ... a) dysphoria b) alopecia c) dysphagia d) dyspepsia
dysphagia Explanation: Difficulty swallowing is termed dysphagia. This can lead to dehydration, pneumonia, or asphyxiation.
Epidemiological studies have shown that the incidence of older adults in nursing homes who have symptoms of mental illness is approximately a) 5%. b) 90%. c) 50%. d) 10%.
50%. Explanation: Epidemiological studies since the 1950s have estimated that approximately 25% of older adults in the community and more than 50% of those in nursing homes have symptoms of mental illness.
Epidemiological studies have shown that the incidence of older adults in nursing homes who have symptoms of mental illness is approximately a) 50%. b) 90%. c) 10%. d) 5%.
50%. Explanation: Epidemiological studies since the 1950s have estimated that approximately 25% of older adults in the community and more than 50% of those in nursing homes have symptoms of mental illness.
Late-onset depression typically occurs after which age? a) 50 b) 60 c) 70 d) 40
60 Explanation: The term late-onset depression refers to the development after 60 years of age of depression or depressive symptoms that impair functioning. In late-onset depression, the risk for recurrence is relatively high.
How quickly an older adult responds to questions has been termed speed-accuracy shift, which refers to ... a) Identifying their learning deficits b) Focusing on accuracy rather than speed of answering c) Identifying their focus on answering without delay d) Focusing on the previous question asked
Focusing on accuracy rather than speed of answering Explanation: Hurrying older adults to answer questions may interfere with their ability to provide the correct answer. This has been labeled the speed-accuracy shift, by which the older adult focuses more on accuracy than on speed in responding.
All five of the senses gradually decline in acuity with age. The gradual decline may begin in which of the following decades of life? a) Third b) Seventh c) Fourth d) Eighth
Fourth Explanation: The gradual decline usually begins in the fourth and fifth decades of life, but these changes do no limit activity until the seventh and eighth decades.
Many physical changes occur in older adults. Which of the following is accurate with regards to these changes? a) Glomerular filtration declines b) Muscle mass increases c) Body fat decreases d) Total body water increases
Glomerular filtration declines Explanation: Typically, body fat increases, total body water decreases, and muscle mass decreases. In the renal system, there is a predictable decline in glomerular filtration and tubular secretion.
The nurse is preparing to assess a client age 78 years who has been diagnosed with major depression. Which of the following would the nurse expect to assess as a normal finding? a) Dulled taste sensation b) Enhanced visual acuity c) Decrease in body fat d) Increased muscle mass
Dulled taste sensation Explanation: With aging, the senses of taste, touch, and smell undergo a uniform dulling, body fat increases, muscle mass decreases, and visual acuity decreases.
When conducting an admission assessment on an older adult experiencing symptomology of an anxiety disorder, the psychiatric nurse is particularly interested in the client's response to which of the following? a) His or her family leaving them in an unfamiliar environment b) "Have you ever experienced such a level of anxiety before in your life?" c) Being asked to answer personal questions d) "Do you have an idea why you are so anxious?"
"Have you ever experienced such a level of anxiety before in your life?" Explanation: Most older adults with an anxiety disorder had one when they were younger. Thus, asking whether the client has ever before experienced high anxiety in the past is the most appropriate question.
A protective factor in older adults' mental health against suicide and despair in later life is ... a) Having a sense of meaning or purpose b) Having a substantial income c) Having a number of children d) Having family responsibilities
Having a sense of meaning or purpose Explanation: To have a sense of meaning and purpose is a critical factor in older adults' mental health and is one of the factors that serves as a protection against suicide and despair in later life
A protective factor in older adults' mental health against suicide and despair in later life is ... a) Having a number of children b) Having a substantial income c) Having family responsibilities d) Having a sense of meaning or purpose
Having a sense of meaning or purpose Explanation: To have a sense of meaning and purpose is a critical factor in older adults' mental health and is one of the factors that serves as a protection against suicide and despair in later life.
A group of nursing students is reviewing information about age-related changes occurring in cognition and intellectual performance. The students demonstrate understanding of the concepts when they identify which of the following as a cognitive change for a patient diagnosed with delirium? a) Inability to recognize familiar objects b) Orientation to time c) Diminished executive functioning d) Restricted judgment
Inability to recognize familiar objects Explanation: Impaired consciousness is the key diagnostic criterion for delirium. The patient becomes less aware of his or her environment and loses the ability to focus, sustain, and shift attention. Cognitive changes include problems with memory, orientation, and language. The patient may not know where he or she is, may not recognize familiar objects, or may be unable to carry on a conversation
When comparing dementia and dementia syndrome, the nurse understands that dementia is characterized by which of the following? a) Mood fluctuations b) Focus on disabilities c) Short duration of symptoms d) Rapid onset
Mood fluctuations Explanation: Dementia has an insidious onset, symptoms of long duration, and mood and behaviors fluctuations. The client conceals his or her disabilities.
With regard to developmental stages, which of the following is true about older age? a) Old age is a period of continued growth and development with its own tasks. b) If an individual never completed a specific developmental task, he or she may easily do so once he or she is elderly. c) Individuals no longer go through formal developmental stages when they are older. d) The individual completes personal developmental stages prior to age 65.
Old age is a period of continued growth and development with its own tasks. Explanation: Old age is a period of continued development. Tasks include conserving strength and resources as necessary and adapting to changes and losses that accompany normal aging.
A group of nursing students is reviewing information about the course of aging in future older adults, and qualities that contribute to successful aging. The students demonstrate understanding of this information when they identify which of the following as least important? a) Physical health b) Engagement in life c) Capacity to adapt to change d) Stability with reliable social support
Physical health Explanation: Research shows that four qualities contribute to successful aging: the capacity to adapt to change; engagement and involvement in life; the importance of stability and security with reliable social support; and least importantly, physical health.
Individuals transitioning from young old to old undergo a gradual biopsychosocial, as well as spiritual, process. Looking at this as a positive perspective refers to ... a) Providing time for personal growth and development b) Reminiscing about the good times c) Identifying the psychopathology of their mental illness d) Strengthening their religious beliefs and cultural factors
Providing time for personal growth and development Explanation: From a positive perspective, the later years provide time for personal growth and development, providing an opportunity to do all the things that were impossible when work and family responsibilities took precedence
A nursing student is reading an article about protective factors for older adults with mental illness. The article mentions the individual's ability to adapt successfully to stress, trauma, or chronic adversity. The student identifies this as which of the following? a) Resilience b) Gerotransendence c) Empty nest d) Functional status
Resilience Explanation: Resilience is an individual's ability to adapt successfully to stress, trauma, or chronic adversity. Functional status is the extent to which a person can independently carry out personal care, home management, and social functions in everyday life, in a way that has meaning and purpose. Gerotranscendence is the ninth stage of development that provides for continued growth in dimensions such as spirituality and inner strength. An empty nest is a home without children or caregiving responsibilities (common in middle-age adults).
A male client discloses that he lost his wife of 51 years last year to cancer and that the recent fire in his house was just too much for him to handle. Pending further assessment, the most appropriate nursing diagnosis at this time is what? a) Agitation related to change of environment b) Dysfunctional grieving related to death of wife c) Emotional lability due to dementia d) Situational crisis related to fire
Situational crisis related to fire Explanation: The recent fire is an immediate stressor that has placed the client into crisis. Although the loss of his wife is an important factor in his adjustment, and he is undoubtedly still grieving over that loss, the more immediate diagnosis would center on the situational crisis related to the recent fire. There are no data to support that the client is emotionally labile.
A nurse is assessing a client age 78 years who lives alone in his own home. To assess the client's instrumental activities of daily living, which question would be most appropriate to ask? a) "How many times do you change clothes during the day?" b) "How often do you cook meals for yourself?" c) "How often do you bathe or shower?" d) "How often do you go to the store to buy groceries?"
"How often do you go to the store to buy groceries?" Explanation: Instrumental activities of daily living are part of the functional status assessment of older adults. These activities include shopping, talking on the telephone, and driving or using other transportation. Bathing, showering, dressing, and cooking are examples of activities of daily living.
When completing a biopsychosocial assessment on a geriatric client, the nurse must consider which component of the psychological domain? a) Support systems b) Behavioral changes c) Physical functions d) Family assessment
Behavioral changes Explanation: Components of the psychological domain include behavioral changes, mental status examination, and risk assessment. Physical function is noted in the physical domain. Support systems and family assessment are part of the social domain.
Which of the following are changes that affect mental status in older adults? Select all that apply. a) Hypoxia b) Electrolyte changes c) Fluid overload d) Hyperthyroidism e) Hypothyroidism
• Hypothyroidism • Electrolyte changes • Hypoxia Explanation: Changes that affect mental status in older adults include hypothyroidism, dehydration, electrolyte changes, hypoxia, infection and sepsis, and acid-base imbalance.
The nurse is assessing a client who has a history of heavy drinking and who lost his wife to cancer during the previous year. He reports that he isn't getting as much sleep as he used to when he was younger. Which question would be most appropriate to ask the client to determine if the change in his sleep pattern is related to normal aging or depression? a) "How much did you sleep when you were younger?" b) "What used to help you go to sleep?" c) "Is it hard for you to fall asleep or remain asleep during the night?" d) "Why do you think you continue to ingest so much alcohol?"
"Is it hard for you to fall asleep or remain asleep during the night?" Explanation: Older adult clients often sleep less than they did when they were younger. However, insomnia, the inability to fall or remain asleep throughout the night, may be indicative of depression. Asking the client why he continues to drink alcohol is inappropriate and provides no information about the client's sleep patterns. Asking the client what used to help him go to sleep would be appropriate later to determine the best methods for promoting enhanced sleep.
Educating new nurses regarding ageism would be considered successful if a new RN graduate is heard to say: a) "Elderly persons are so wise and expert about everything life has to offer." b) "Elderly people should be treated with kindness because they do not have many years left." c) "Since the elderly have so many losses and changes, it is normal to expect them to have a major depressive episode at some point during their elderly years." d) "It is critical to treat each elderly person as an individual and to be sure to understand their own life story and events that are affecting them during their older years."
"It is critical to treat each elderly person as an individual and to be sure to understand their own life story and events that are affecting them during their older years." Explanation: Reflecting positively on past life events fosters the attainment of ego integrity, the final developmental stage according to Erikson.
A husband and wife are concerned that the husband's father may be developing depression. In questioning the couple, which of the following statements would support their concern? a) "Dad has been crying off and on now for over two weeks since Mom died. He's also still having trouble sleeping." b) "It's been over two months now since Mom died, and Dad keeps crying; he can't eat or sleep." c) "Dad is agitated and anxious; he's been that way for a month now since Mom died." d) "Mom's funeral was last week, and Dad hasn't been able to eat or sleep since then."
"It's been over two months now since Mom died, and Dad keeps crying; he can't eat or sleep." Explanation: Bereavement, a natural response to the death of a loved one, includes crying and sorrow, anxiety and agitation, insomnia, and loss of appetite. These symptoms, although overlapping with those of major depression, do not constitute a mental disorder. Only when these symptoms persist for two months or longer can a diagnosis of either adjustment disorder or major depressive disorder be made.
A nurse is reviewing the medical records of several older adult clients. The nurse determines that which individual would have the least chance of developing mental health problems with aging? a) A woman who is single, has a college degree, watches what she eats, but really does not exercise b) A man who is married, has a high school education, eats mostly fast food, and walks a mile each day c) A woman who is married with graduate education, eats nutritionally balanced meals, and exercises for 20 minutes each day d) A man who is single, has an eighth grade education, and walks to the mailbox and back every day
A woman who is married with graduate education, eats nutritionally balanced meals, and exercises for 20 minutes each day Explanation: Mental health protective factors include marriage, education and income level, resilience and positive outlook, healthy lifestyle, nutrition, and exercise. Thus, the woman who is married, has a graduate education, eats nutritionally balanced meals, and engages in exercise has four protective factors. Each of the other individuals has only one or two of the protective factors.
Assessment of an older adult diagnosed with dementia with Lewy bodies reveals that the client is receiving psychiatric medications. The client states, "I get dizzy periodically and have trouble walking." Which of the following should the nurse do first? a) Interview the client's family about the client's coping skills and current stress level. b) Suggest the client periodically use an alcohol-based mouthwash several times a day. c) Assess for development of orthostatic hypotension. d) Instruct the client to stop taking the psychiatric medications.
Assess for development of orthostatic hypotension. Explanation: Many psychiatric medications affect blood pressure. Generally, these medications may cause orthostatic hypotension, which can lead to dizziness, an unsteady gait, and falls. A baseline blood pressure is needed to effectively monitor medication side effects. Telling the client to stop taking the medications is inappropriate. Asking family members about the client's coping skills and stress level would provide no information about the client's complaints. Using a non-alcohol-based mouthwash would be appropriate for combating dry mouth.
A nurse assessing a client's social support should ask the following ... a) What is the proximity of the closest government office? b) How many times a week do you go grocery shopping? c) Where do your children live? d) Do you have any one special person you could call if you needed help?
Do you have any one special person you could call if you needed help? Explanation: The nurse can use the following questions to focus on social support: Do you have any one special person you could call if you needed help?
Xerostomia is common among older adults. This condition impairs which area of activities of daily living (ADLs)? a) Eating b) Sleeping c) Bathing d) Walking
Eating Explanation: Xerostomia, or dry mouth, may impair eating. Dry mouth is also a common side effect of anticholinergic medications. Frequent rinsing with a non-alcohol-based mouthwash helps correct the dry condition. Xerostomia does not affect walking, bathing, or sleeping.
A group of nursing students is reviewing risk and protective factors associated with mental disorders in the older adult population. The students demonstrate understanding of the information when they identify which of the following as a protective factor? a) Chronic illness b) Poverty c) Loss d) Education
Education Explanation: Education would be considered a protective factor. Education and income provide older adults with cognitive, economic, and coping reserves that support function and well-being, and are related to physical activity, as well as physical and cognitive function/disability. Poverty, loss, and chronic illness are considered risk factors.
Which of the following older adult cohorts has been defined as the chronological ages of 95 years and older? a) Elite old b) Old old c) Middle old d) Young old
Elite old Explanation: National Institute on Aging has defined chronological categories of the young old (65 to 74 years), the middle old (75 to 84 years), the old old (85 to 94 years), and the elite old (95 years or older).
During support sessions for an older adult following the death of a loved one, the nurse should focus on ... a) Transportation management b) Assisted living and nursing home options c) Medication management d) Financial and employment planning
Financial and employment planning Explanation: Regardless of gender differences, survivors are at higher risk for depression and face financial issues after the death of a loved one.
A decline in memory may be frustrating for the older individual; threats to memory include ... a) Diabetes b) Gastrointestinal disturbances c) Rheumatoid arthritis d) Heart and lung disease
Heart and lung disease Explanation: Threats to memory include medications, depression (impairs concentration and attention), poor nutrition, infection, heart and lung disease (lack of oxygen), thyroid problems (can cause symptoms of depression or confusion that mimic memory loss), alcohol use, and sensory loss (interferes with perception).
A group of nursing students is reviewing information about age-related changes occurring in cognition and intellectual performance. The students demonstrate understanding of the concepts when they identify which of the following as a cognitive change for a patient diagnosed with delirium? a) Diminished executive functioning b) Restricted judgment c) Orientation to time d) Inability to recognize familiar objects
Inability to recognize familiar objects Explanation: Impaired consciousness is the key diagnostic criterion for delirium. The patient becomes less aware of his or her environment and loses the ability to focus, sustain, and shift attention. Cognitive changes include problems with memory, orientation, and language. The patient may not know where he or she is, may not recognize familiar objects, or may be unable to carry on a conversation.
Nurses need to be vigilant in their assessment skills and provide early intervention to older adults as the trend is a) Increased number of adults moving into senior residences b) Decreased number of beds available in nursing homes c) Increased nursing home admissions d) Increased number of adults remaining in their homes as long as possible
Increased number of adults remaining in their homes as long as possible Explanation: Most older adults prefer to age in surroundings that are familiar to them until their health prohibits them from doing so. Implications for health promotion are such that nurses need to be vigilant in their assessment skills, providing ongoing support and facilitating early intervention when needed.
A lack of social support and substance use are linked to the high rates of suicide in older adults. Which age population for men has the highest rate of suicide? a) Males between 25 and 35 years of age b) Males 75 years of age and older c) Males between 55 and 65 years of age d) Males between 45 and 50 years of age
Males 75 years of age and older Explanation: Suicide rates for men are highest for those 75 years of age and older. The rate of suicide attempts to complete suicides among adults ages 65 years and older is four to one.
Which of the following is not a normal part of aging? a) Dulled sense of smell b) Muscle mass decrease c) Decreased visual acuity d) Memory loss
Memory loss Explanation: Memory loss is not a normal part of aging, but memory may be less efficient. Older people may well dismiss information that is not important to them. Decreased muscle mass, decreased visual acuity, and dulled sense of smell occur with aging.
Which of the following is a component in the geropsychiatric nursing assessment of the biologic domain? a) Mental status examination b) Behavioral changes c) Coping patterns d) Present health status
Present health status Explanation: Assessment of the biologic domain involves collecting data about past and present health status, physical examination findings, physical functions, pain, and pharmacologic information. Assessment of the psychological domain includes the client's responses to mental health problems, mental status examination, behavioral changes, stress and coping patterns, and risk assessment.
A 78-year-old man was admitted for depression. It is imperative that the nurse's assessment must include information regarding ... a) Suicide thoughts b) Family involvement c) Supports in the community d) Cognitive abilities
Suicide thoughts Explanation: Older persons who suffer from depression have worse outcomes after medical events such as hip fractures, heart attacks, or cancer, and individuals who are age 75 and older have the highest suicide rate of any age group.
In the elderly population, psychoactive agents should be prescribed at significantly lower dosages than in younger populations. Which of the following best describes the rationale for this? a) Lower dosages should be prescribed because the elderly clients are less able to afford appropriate amounts of these expensive drugs. b) Because in the case of confusion, it is best to decrease the likelihood of overdose by prescribing lowered dosages to elderly clients. c) The elderly clients are less able to understand what daily amounts of drugs they need. d) The physiology of elderly persons renders them less able to metabolize and eliminate psychoactive drugs through the liver and kidney, so they need fewer drugs.
The physiology of elderly persons renders them less able to metabolize and eliminate psychoactive drugs through the liver and kidney, so they need fewer drugs. Explanation: As the body ages, the ability of the liver and kidney to metabolize chemicals decreases. Therefore, it is important to give lower dosages as the individual ages in order to prevent toxicity.
A nurse is caring for a client age 76 years with a hearing deficit caused by presbycusis. Which of the following would be most appropriate for the nurse to do when communicating with the client? a) Address the client's family members. b) Ask if the client can use sign language. c) Use a higher volume of speech. d) Use lower-pitched tones.
Use lower-pitched tones. Explanation: Higher-pitched tones are lost when a person has presbycusis, so lower pitched tones are more easily detected. Using a higher volume (i.e., shouting) is not necessary. Using sign language would be appropriate if the client had deafness. The family members are involved only if the client agrees to their participation.
A client complains that despite good medical care, his wife frequently talks about a variety of physical complaints and bodily sensations, including insomnia, anorexia, and pain. The nurse's best response to his concerns is what? a) "It's part of the anxiety from her illness. It's best to just ignore her complaints." b) "These are common complaints as we age; conveying concern and support would be helpful." c) "From what I understand, your wife has always been a chronic complainer. Is that true?" d) "These are symptoms of cancer and should be investigated immediately."
"These are common complaints as we age; conveying concern and support would be helpful." Explanation: Hypochondriasis or preoccupation with one's physical and emotional health resulting in bodily or somatic complaints is common in the elderly client. The aging person is rechanneling stress and anxiety into bodily concerns as he or she assumes the "sick" role. Support, concern, and interest conveyed to the client serve as secondary gains, reinforcing a sense of control. The caregiver should assess all complaints thoroughly, in a matter-of-fact manner, and avoid stereotyping the person as a "chronic complainer."
After checking a client's blood pressure, he asks the nurse what changes he should expect in himself as he grows older. Which response by the nurse would be most appropriate? a) "Your personality will stay the same, but your intelligence level will lessen somewhat." b) "You don't have anything to worry about; you will basically stay the same." c) "Usually, you can anticipate that you will begin to react to things more slowly." d) "You will become increasingly childlike, and your personality will change."
"Usually, you can anticipate that you will begin to react to things more slowly." Explanation: Changes do occur with aging. Intelligence and personality are stable throughout the life span; however, reaction time slows with age.
Late-onset depression typically occurs after which age? a) 70 b) 60 c) 50 d) 40
60 Explanation: The term late-onset depression refers to the development after 60 years of age of depression or depressive symptoms that impair functioning. In late-onset depression, the risk for recurrence is relatively high.
The nurse assesses a 74-year-old woman with complaints of not feeling rested in the morning when she awakens; further assessment is required to assess her ... a) History of seizures b) Dietary intake in the evenings c) Use of alcohol d) Spiritual beliefs
Use of alcohol Explanation: Sleep problems are also often linked to the use of alcohol. If an older individual reports sleep problems, the nurse should ask about his or her use of alcohol.
The nurse is providing care for an older adult client who has recently been diagnosed with dementia of Alzheimer's type (DAT). Which of the following nursing diagnoses should the nurse prioritize when planning the care of this client? a) Risk for Relocation Stress b) Ineffective Health Maintenance c) Acute Confusion d) Risk for Loneliness
Acute Confusion Explanation: Confusion is the hallmark of dementia and is the diagnosis that relates most closely to the client's immediate safety. Each of the other diagnoses is plausible, but each is likely secondary to the central problem of confusion.
The nurse recognizes the high incidence and prevalence of polypharmacy among older adults. Which of the following measures should the nurse take to prevent and resolve polypharmacy among these clients? a) Instructing older adults to ensure that at least 2 hours elapse between taking each of their medications b) Informing clients that they should temporarily withhold their medications if they experience side effects c) Teaching older adults to ensure that they have all of their prescriptions filled at only one pharmacy d) Encouraging clients' physicians and pharmacists to carefully review clients' medication administration records to identify potential interactions
Encouraging clients' physicians and pharmacists to carefully review clients' medication administration records to identify potential interactions Explanation: (med reconciliation) Close monitoring of a client's medication regimen can help identify and/or prevent polypharmacy in many older adults. It would be inappropriate for a nurse to independently assign a particular schedule of administration, or to tell clients to hold their medications if they experience side effects. It is prudent for clients to use one, rather than several, pharmacy, but this practice is not the essence of polypharmacy.
An older adult is assessed for unexplained behavior and personality changes. The assessment should include ... a) History of abuse b) Family supports c) Experience of chronic pain d) Experience in the past with losses
Experience of chronic pain Explanation: The experience of chronic pain often contributes to unexplained behavior and personality changes.
Many physical changes occur in older adults. Which of the following is accurate with regards to these changes? a) Total body water increases b) Body fat decreases c) Muscle mass increases d) Glomerular filtration declines
Glomerular filtration declines Explanation: Typically, body fat increases, total body water decreases, and muscle mass decreases. In the renal system, there is a predictable decline in glomerular filtration and tubular secretion.
A nurse is assessing an older adult client. Which of the following would the nurse interpret as most indicative of mental health and wellness? a) Keeping social contacts to a minimum b) Experiencing bereavement c) Relying solely on family for assistance d) Interacting with others in the environment
Interacting with others in the environment Explanation: Remaining active throughout one's life is one of the best predictors of mental health and wellness in an older client. People obtain their sense of self-worth through their interactions with others in their environment. A sense of "who one is" is closely tied to the roles that a person plays in life. When older adults relinquish such roles because of physical disabilities, become isolated from friends and family, or begin to sense that they are a burden to those around them rather than contributing members of society, a sense of hopelessness and helplessness often follows. Social support is a reciprocal concept, meaning that simply receiving assistance increases the person's sense of being a burden.
A nursing instructor is preparing for a class discussion on polypharmacy and older adults. Which of the following would the instructor expect to include? a) Older adults often experience a greater risk for adverse reactions. b) Age-related pharmacokinetic changes enhance the drug's therapeutic effectiveness. c) The risk for drug abuse, although present, is fairly rare in this population. d) Medications are usually prescribed in higher doses initially, and then gradually reduced.
Older adults often experience a greater risk for adverse reactions. Explanation: The aging process affects pharmacokinetics and the strength and number of protein-binding sites. These changes place older adults at increased risk for adverse drug reactions. Medication misuse can easily occur and, in some combinations, lead to drug abuse. Most age-dependent pharmacokinetic changes lead to potential accumulation of the drug. Therefore, medication dosage should start low and go slow. Therapeutic effectiveness may or may not be affected.
Which of the following is a component in the geropsychiatric nursing assessment of the biologic domain? a) Present health status b) Coping patterns c) Behavioral changes d) Mental status examination
Present health status Explanation: Assessment of the biologic domain involves collecting data about past and present health status, physical examination findings, physical functions, pain, and pharmacologic information. Assessment of the psychological domain includes the client's responses to mental health problems, mental status examination, behavioral changes, stress and coping patterns, and risk assessment.
While assessing an older adult client for mental health issues, the nurse pays special attention to the client's sensory function based on the understanding of which of the following? a) Most older adults follow a specific pattern of decline in functioning, leading to gradual onset of problems. b) Diminished sensory function can lead to changes in other body systems that may affect the individual's reaction to prescribed medications. c) Changes in the senses can result in changes in cognitive abilities, which mimic the manifestations of mental disorders. d) Sensory decline may affect the individual's ability to process information, possible influencing the findings of the mental status examination.
Sensory decline may affect the individual's ability to process information, possible influencing the findings of the mental status examination. Explanation: Sensory decline is important to consider when assessing psychiatrically ill older adults because diminished senses may affect information processing, potentially affecting interpretation of standard mental status examinations. Sensory function decline does not follow a standard pattern and does not lead to changes in other body systems, nor changes in cognitive abilities. Many cognitive abilities are preserved or even enhanced during aging.
Madge Jones is an 88-year-old African American woman in a nursing home. She is alert and is frequently seen talking and laughing with other clients. Over a period of a few days, the nurse notices that she has become quiet, is disoriented, and is running a low-grade fever. Which of the following might the nurse suspect first? a) She may be experiencing delirium. b) She may have a urinary tract infection. c) She may be becoming demented. d) She may be depressed.
She may have a urinary tract infection. Explanation: Physical illness may appear with psychiatric symptoms, and psychiatric illness may first present with somatic symptoms such as fatigue, sleep disturbance, and weight loss. With the acute onset of her psychiatric symptoms and the presence of low-grade fever, physical infection may be the more likely cause of her mental changes.
Which of the following is a risk factor for suicide in later life? a) African-American race b) Female gender c) Anxiety disorder d) State of bereavement
State of bereavement Explanation: Risk factors for suicide in this age group include white race, male gender, history of depression, and recent state of bereavement.
Which of the following is the priority for the older adult experiencing a mental health problem? a) Ability to complete ADLs b) Appropriate shelter c) Suicide assessment d) Social support
Suicide assessment Explanation: Suicide assessment is the priority for the older adult experiencing mental health problems. It is important to carefully assess recent behavior changes and loss of support. Social support, appropriate shelter, and ability to complete ADLs are important, but would not take priority over safety.
A common problem seen in older adults living in nursing homes is dysphagia. Dysphagia can lead to which of the following complications? Select all that apply. a) Asphyxiation b) Stroke c) Malnutrition d) Pulmonary emboli e) Pneumonia
• Asphyxiation • Malnutrition • Pneumonia Explanation: Dysphagia can lead to dehydration, malnutrition, pneumonia, or asphyxiation. Pulmonary emboli and stroke are not associated with dysphagia.
The nurse is caring for a client diagnosed with dementia. The nurse should monitor the client for symptoms of ... a) delusions b) hopelessness c) bulimia d) anxiety
anxiety Explanation: In dementia, anxiety is very common. The RAID scale has been developed to assess anxiety in clients with dementia.
While assessing an older adult, the nurse observes that the client is slow in providing answers to the nurse's questions. The client apologizes for being slow to respond. The nurse should explain to the client that older adults often ... a) are more often risk-takers than younger adults are. b) have memory impairments that affect their responses. c) tend to exercise less caution due to the aging process. d) focus more on accuracy than speed in responding.
focus more on accuracy than speed in responding. Explanation: The nurse should explain to the client that older adults focus more on accuracy than speed in responding.
Age 65 has arbitrarily become designated as the point at which Americans are considered "old." This may be due to the fact that a) most people have to stop working at this age because they can no longer do their jobs. b) this is the age when Social Security and Medicare benefits become available. c) most people feel older and begin to use the terminology of "old person" at age 65. d) this is the age at which the body experiences physiological changes sufficient to affect functioning.
this is the age when Social Security and Medicare benefits become available. Explanation: Older adults are defined as those older than 65 years. This age has become the arbitrary point at which a person is considered old because it is the age when full Social Security and Medicare benefits become available, leading many to retire from the workforce.
A nurse is assessing an older adult client. Which of the following would the nurse interpret as most indicative of mental health and wellness? a) Keeping social contacts to a minimum b) Relying solely on family for assistance c) Experiencing bereavement d) Interacting with others in the environment
Interacting with others in the environment Explanation: Remaining active throughout one's life is one of the best predictors of mental health and wellness in an older client. People obtain their sense of self-worth through their interactions with others in their environment. A sense of "who one is" is closely tied to the roles that a person plays in life. When older adults relinquish such roles because of physical disabilities, become isolated from friends and family, or begin to sense that they are a burden to those around them rather than contributing members of society, a sense of hopelessness and helplessness often follows. Social support is a reciprocal concept, meaning that simply receiving assistance increases the person's sense of being a burden.
The nurse is planning a presentation to a group of older adults on the topic of suicide in the elderly. Which of the following should be included in the nurse's education plan? a) Depression has been implicated in 50% of all geriatric suicides. b) Females are more likely to attempt suicide than males. c) Suicides in the elderly are often committed by overdosing on medications. d) Widowed white males living alone are more likely to commit suicide.
Widowed white males living alone are more likely to commit suicide. Explanation: Widowed white males living alone are more likely to commit suicide.
One way in which the expression of depressive symptoms in older adults may differ from the presentation in young adults is ... a) older adults may somatize, or discuss their depressive symptoms in terms of physical symptoms or aches/pains. b) older adults remain close to their families and thus become depressed over daily family issues, whereas younger adults often leave their families of origin. c) older adults tend to hold all their feelings in, whereas younger adults do not. d) older adults may appear less suicidal than a younger adult who is depressed.
older adults may somatize, or discuss their depressive symptoms in terms of physical symptoms or aches/pains. Explanation: Depression involves serious and persistent symptoms such as decreased sleep and appetite, loss of interest in activities previously enjoyed, weight loss, depressed mood, physical complaints, anxiety, and inability to concentrate resulting in memory loss. In older adults, physical and mental conditions are intertwined closely, and depression may be expressed through physical concerns.
Normal aging does not impair which of the following? Select all that apply. a) Attention b) Mental processing time c) Reaction time d) Alertness e) Consciousness
• Alertness • Attention • Consciousness Explanation: Many cognitive abilities are preserved or even enhanced during aging. Normal aging does not impair consciousness, alertness, or attention. Mental processing speed and reaction time do gradually decrease from mid to late adulthood and may affect how quickly the older adult responds to questions.
A nurse is developing a plan for establishing appropriate supportive community care services for older adults to promote independence. Which services would the nurse be most likely to include? Select all that apply. a) Transportation b) Homemakers c) Child care d) Housing e) Legal
• Transportation • Homemakers • Legal • Housing Explanation: Examples of supportive services that foster independent community living include information and referral services; transportation and nutrition services; legal and protective services; comprehensive senior centers; homemaker and handyman services; matching of older adults with younger individuals to share housing; and use of the supports available through churches, community groups, mental health agencies and other community agencies (e.g., area agencies on aging). Child care services would be more appropriate for young adults.
The nurse is planning a presentation to a group of older adults on the topic of suicide in the population. One of the group participants asks who has the highest risk of suicide. Which response by the nurse would be most appropriate? a) "Men over the age of 75 years who are divorced or widowed." b) "Older adults who are experiencing a deep and profound depression." c) "Older adult women who are divorced or widowed." d) "Older adults who have multiple prescriptions from a variety of different pharmacies."
"Men over the age of 75 years who are divorced or widowed." Explanation: Suicide rate for men are highest for those 75 years of age and older. The rate of suicide attempts to completed suicides among adults ages 65 years and older is 4 to 1. Rates are the highest for divorced and widowed white men.
Maggie Smith is an 80-year-old white woman who says to her African American nurse, "Honey, I'd rather not have you bathe me. I want a white girl." The most therapeutic nursing intervention for the nurse would be: a) "Maggie, it's too bad that you don't want me to bathe you. We have no one else here who can do it." b) "Mrs. Smith, I wonder why you're saying that. Is there something about me that you don't like?" c) "Oh, Maggie, stop with your complaining. I'm doing your bath, and that's that." d) "Mrs. Smith, I understand your feelings, but that is not possible. Tell me what your concern is with me giving you your bath."
"Mrs. Smith, I understand your feelings, but that is not possible. Tell me what your concern is with me giving you your bath." Explanation: The nurse responds with respect for the patient's values, then follows up with encouraging expression of the patient's conflict using facilitative statements.
While caring for a client age 88 years suspected of having dementia, the nurse assesses the client for a common delusional thought. Which of the following would the nurse interpret as a common delusion? a) "Creatures are living in my closet." b) "My roommate keeps stealing my clothes." c) "I am the king of the universe." d) "The government has people following me."
"My roommate keeps stealing my clothes." Explanation: Common delusional or suspicious thoughts for clients with dementia include "People are stealing my things," "This is not my house," and "My relative is an imposter."
A client complains that despite good medical care, his wife frequently talks about a variety of physical complaints and bodily sensations, including insomnia, anorexia, and pain. The nurse's best response to his concerns is what? a) "These are common complaints as we age; conveying concern and support would be helpful." b) "It's part of the anxiety from her illness. It's best to just ignore her complaints." c) "These are symptoms of cancer and should be investigated immediately." d) "From what I understand, your wife has always been a chronic complainer. Is that true?"
"These are common complaints as we age; conveying concern and support would be helpful." Explanation: Hypochondriasis or preoccupation with one's physical and emotional health resulting in bodily or somatic complaints is common in the elderly client. The aging person is rechanneling stress and anxiety into bodily concerns as he or she assumes the "sick" role. Support, concern, and interest conveyed to the client serve as secondary gains, reinforcing a sense of control. The caregiver should assess all complaints thoroughly, in a matter-of-fact manner, and avoid stereotyping the person as a "chronic complainer."
Significant biologic changes occur in later adulthood. The physiological changes refer to ... a) Renal clearance increases by as much as 35% b) The brain ventricles are narrower c) Increase in peripheral and central neurons d) Blood flow in the liver decreases
Blood flow in the liver decreases Explanation: Reduced blood flow decreases the liver's opportunity to metabolize medications.
A nurse is preparing to conduct an assessment of a woman age 79 years who has come to the clinic for evaluation. When performing this assessment, which of the following would be most appropriate for the nurse to do? Select all that apply. a) Dim any lights that appear too bright. b) Speak slowly in a shouting tone. c) Focus on one topic at a time. d) Use short, simple sentences. e) Face the client from the side.
• Dim any lights that appear too bright. • Use short, simple sentences. • Focus on one topic at a time. Explanation: When conducting an assessment, the nurse should reduce glare from room lighting by dimming lights that are too bright. The nurse should face the person directly when speaking to him or her, using short simple sentences; focusing on one topic at a time; and speaking slowly, clearly, and loudly (but not shouting).
Clients taking some antipsychotic medications can have the side effect of orthostatic hypotension. Which of the following can occur from this side effect? Select all that apply. a) Flushing b) Unsteady gait c) Falls d) Dizziness e) Headache
• Dizziness • Unsteady gait • Falls Explanation: The nurse should take routine vital signs during the assessment. He or she should note any abnormalities in blood pressure because many psychiatric medications affect blood pressure. Generally, these medications may cause orthostatic hypotension, which can lead to dizziness, unsteady gait, and falls. A baseline blood pressure is needed for future monitoring of orthostatic hypotension. Headache and flushing tend to occur with hypertension, not hypotension.
The nurse recognizes the high incidence and prevalence of polypharmacy among older adults. Which of the following measures should the nurse take to prevent and resolve polypharmacy among these clients? a) Instructing older adults to ensure that at least 2 hours elapse between taking each of their medications b) Informing clients that they should temporarily withhold their medications if they experience side effects c) Teaching older adults to ensure that they have all of their prescriptions filled at only one pharmacy d) Encouraging clients' physicians and pharmacists to carefully review clients' medication administration records to identify potential interactions
Encouraging clients' physicians and pharmacists to carefully review clients' medication administration records to identify potential interactions Explanation: Close monitoring of a client's medication regimen can help identify and/or prevent polypharmacy in many older adults. It would be inappropriate for a nurse to independently assign a particular schedule of administration, or to tell clients to hold their medications if they experience side effects. It is prudent for clients to use one, rather than several, pharmacy, but this practice is not the essence of polypharmacy.
The nurse is working with a client whose mobility is impaired secondary to a fall that resulted in a broken hip. In addition, the client, who has diabetes, is developing problems with vision and hearing. The client seems increasingly withdrawn and depressed. The nurse determines that the client is at risk for spiritual distress. Which intervention would be most appropriate? a) Encourage the client to talk about significant childhood religious experiences. b) Read to the client Bible passages that seem particularly relevant to his or her case. c) Offer to take the client to a revival that the nurse's church is holding in the community. d) Explore what the mobility, sight, and hearing changes mean to the client.
Explore what the mobility, sight, and hearing changes mean to the client. Explanation: The nurse can support a client's spiritual growth by exploring the meanings that a particular life change has for the older adult. In late life, existential issues such as experiencing loss, redefining meanings in existence, and living in the present become the standard, replacing the performance and future orientation that characterize earlier adulthood. Spirituality does not necessarily imply religion. Talking about significant childhood religious experiences and reading Bible passages reflect a greater emphasis on religion than spirituality. Offering to take the client to the nurse's church meets the nurse's needs, not the client's needs.
The nurse is working with a client whose mobility is impaired secondary to a fall that resulted in a broken hip. In addition, the client, who has diabetes, is developing problems with vision and hearing. The client seems increasingly withdrawn and depressed. The nurse determines that the client is at risk for spiritual distress. Which intervention would be most appropriate? a) Offer to take the client to a revival that the nurse's church is holding in the community. b) Encourage the client to talk about significant childhood religious experiences. c) Read to the client Bible passages that seem particularly relevant to his or her case. d) Explore what the mobility, sight, and hearing changes mean to the client.
Explore what the mobility, sight, and hearing changes mean to the client. Explanation: The nurse can support a client's spiritual growth by exploring the meanings that a particular life change has for the older adult. In late life, existential issues such as experiencing loss, redefining meanings in existence, and living in the present become the standard, replacing the performance and future orientation that characterize earlier adulthood. Spirituality does not necessarily imply religion. Talking about significant childhood religious experiences and reading Bible passages reflect a greater emphasis on religion than spirituality. Offering to take the client to the nurse's church meets the nurse's needs, not the client's needs.
Which of the following are considered indications of high risk for committing suicide in the older adult? Select all that apply. a) Married b) Firearms in the home c) Social Isolation d) Burden to family e) Active lifestyle
• Firearms in the home • Social Isolation • Burden to family Explanation: Characteristics that indicate for an older adult a high risk of committing suicide include depression, firearms in the home, attempted suicide in the past, a burden to the family, and social isolation. An active lifestyle and being married are not indicators of high risk of committing suicide.
During an assessment of an older adult, a nurse must identify chronic health problems in order to ... a) Use information for cognitive testing b) Identify which could affect mental health problems c) Provide treatment for physical problems not addressed otherwise d) Link direct result of physical problems to mental health problems
Identify which could affect mental health problems Explanation: The nurse must identify chronic health problems that could affect mental health care.
During an assessment of an older adult, a nurse must identify chronic health problems in order to ... a) Identify which could affect mental health problems b) Use information for cognitive testing c) Provide treatment for physical problems not addressed otherwise d) Link direct result of physical problems to mental health problems
Identify which could affect mental health problems Explanation: The nurse must identify chronic health problems that could affect mental health care.
An intervention that the nurse will use for an older adult that may help with the client's loneliness is ... a) Identifying the nearest senior center b) Identifying the nearest nursing home c) Planning a vacation for them to visit friends d) Arranging family visits
Identifying the nearest senior center Explanation: Community resources are essential to an older adult's ability to maintain mental health and wellness, as well as to his or her ability to remain at home throughout the later years. Senior centers are federally or state funded community resources that provide a wide array of services to the older population.
When using psychotropic medications in older adults, which of the following is true? a) Older adults often do not understand why they are receiving psychotropic medications. b) Older adults need smaller doses of the same medication and become toxic more quickly than do younger adults. c) Older adults often need more medication because their livers do not metabolize as much of the drug as do those of younger people. d) Older adults should rarely be given psychotropic medications unless they are suicidal.
Older adults need smaller doses of the same medication and become toxic more quickly than do younger adults. Explanation: Medications can reach toxic levels in the body due to the physical changes of aging. Decreased acid secretion and peristalsis in the gastrointestinal tract may impair absorption. Decreased lean body mass and increased fat affects distribution. Decreased hepatic function can affect metabolism. Decreased blood flow though the renal system decreases excretion.
When using psychotropic medications in older adults, which of the following is true? a) Older adults often do not understand why they are receiving psychotropic medications. b) Older adults often need more medication because their livers do not metabolize as much of the drug as do those of younger people. c) Older adults need smaller doses of the same medication and become toxic more quickly than do younger adults. d) Older adults should rarely be given psychotropic medications unless they are suicidal.
Older adults need smaller doses of the same medication and become toxic more quickly than do younger adults. Explanation: Medications can reach toxic levels in the body due to the physical changes of aging. Decreased acid secretion and peristalsis in the gastrointestinal tract may impair absorption. Decreased lean body mass and increased fat affects distribution. Decreased hepatic function can affect metabolism. Decreased blood flow though the renal system decreases excretion.
Because retirement and widowhood are common events in late life and usually involve a decline in financial resources, older adults are at high risk for poverty. Which of the following is an accurate statement regarding the older population and poverty? a) Older women are more likely to live in poverty than older men. b) Older white Americans live below the poverty line more than older people of color. c) Older men are more likely to live in poverty than older women. d) Older married people have the highest poverty rates.
Older women are more likely to live in poverty than older men. Explanation: Older women are more likely to live in poverty than older men. Older people living alone have the highest poverty rates. Older people of color live below the poverty line more than white Americans, as do older adults living in rural areas compared with their urban counterparts.
The nurse is working as part of a team to help reduce the stigma attached to mental health treatment for the older adult population. Which of the following would be most appropriate to do to achieve this outcome? a) Institute a wide range of social support services. b) Provide education about mental health and mental disorders. c) Initiate screening programs for symptoms. d) Ensure older adults receive integrated community care.
Provide education about mental health and mental disorders. Explanation: Nurses can help reduce the stigma through educational interventions and facilitation of access to services. Initiating screening programs would help to allow for early recognition of symptoms, promoting prompt treatment. Ensuring integrated community care would help avoid premature institutionalization. Instituting a wide range of social support services would aid in transitioning older adults experiencing losses.
Individuals transitioning from young old to old undergo a gradual biopsychosocial, as well as spiritual, process. Looking at this as a positive perspective refers to ... a) Identifying the psychopathology of their mental illness b) Reminiscing about the good times c) Providing time for personal growth and development d) Strengthening their religious beliefs and cultural factors
Providing time for personal growth and development Explanation: From a positive perspective, the later years provide time for personal growth and development, providing an opportunity to do all the things that were impossible when work and family responsibilities took precedence.
The nurse is planning a presentation to a group of older adults on the topic of suicide in the elderly. Which of the following should be included in the nurse's education plan? a) Widowed white males living alone are more likely to commit suicide. b) Females are more likely to attempt suicide than males. c) Depression has been implicated in 50% of all geriatric suicides. d) Suicides in the elderly are often committed by overdosing on medications.
Widowed white males living alone are more likely to commit suicide. Explanation: Widowed white males living alone are more likely to commit suicide.
The nurse working in a psychiatric facility for the older adult identifies which of the following to be among the most common mental disorders in the older adult? Select all that apply. a) Schizophrenia b) Dementia c) Depression d) Anxiety e) Bipolar disorder
• Dementia • Depression • Anxiety Explanation: One in four older adults has a significant mental disorder, with depression, anxiety disorders and dementia being among the most common.
A nurse is preparing a presentation for a group of colleagues about suicide and the older adult population. Which of the following would the nurse include in this presentation? a) Depression is the greatest risk factor for suicide in this population group. b) Suicide is less of a risk in this population compared with middle-aged adults. c) Married African American men are at the greatest risk for suicide in this group. d) White women account for the highest number of suicide deaths in this age group.
• Depression is the greatest risk factor for suicide in this population group. Explanation: Depression is the greatest risk factor for suicide. Individuals who are suicidal often believe that they are a burden to their family, which would be better off without them. In addition, suicide assessment is a priority for older adults experiencing mental health problems. It is important to carefully assess recent behavior changes and loss of support. Suicide is a major mental health risk for older adults. Suicide rates increase with age; the rate among older white men is six times higher than that of the general population. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk of committing suicide. White men account for more than 80% of suicide deaths in this older age group. Older white men are at the highest risk for suicide, with a rate of approximately 31.1 suicides per 100,000 persons each year.
The nurse is caring for an older adult client and is reviewing the client's medications. Which of the following findings indicates polypharmacy? Select all that apply. a) Change in medication b) Drugs used to treat adverse drug reactions c) Interacting medications d) Use of duplicate medications e) Use of herbal remedies
• Interacting medications • Use of duplicate medications • Drugs used to treat adverse drug reactions • Use of herbal remedies Explanation: Polypharmacy, the use of duplicate medications, interacting medications, or drugs used to treat adverse drug reactions, is common in older adults. The nurse must ask the client and family to list all medications, including over the counter medications, vitamins, and herbal supplements, as well as the times that the client takes each drug. A change in medication, while important to assess, is not considered polypharmacy.
Adequate nutrition is an important factor in maintaining mental health. Which of the following are problems that can result from undernutrition? Select all that apply. a) Mental problems b) Fatigue c) Increased gastric motility d) Pressure sores e) Moist skin
• Mental problems • Fatigue • Pressure sores Explanation: Undernutrition can lead to anemia, inadequate wound healing, increased incidence of pressure sores, impaired elimination, impaired immunological functions, weakness, fatigue, and mental problems (including depression, dementia, and agitation). Decreased gastric motility and dry skin would occur in undernutrition.
Adequate nutrition is an important factor in maintaining mental health. Which of the following are problems that can result from undernutrition? Select all that apply. a) Increased gastric motility b) Mental problems c) Pressure sores d) Moist skin e) Fatigue
• Pressure sores • Fatigue • Mental problems Explanation: Undernutrition can lead to anemia, inadequate wound healing, increased incidence of pressure sores, impaired elimination, impaired immunological functions, weakness, fatigue, and mental problems (including depression, dementia, and agitation). Decreased gastric motility and dry skin would occur in undernutrition.
