Ch 18: Mental Health Promotion for Older Adults

b) Glomerular filtration declines Pg. 269 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.

10. A nurse is teaching an older adult about the normal physical changes that occur with aging. The nurse determines that the teaching was successful when the older adult identifies which change as an expected finding? a) Total body water increases b) Glomerular filtration declines c) Muscle mass increases d) Body fat decreases

b) Suicide thoughts Pg. 277 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.

1. A 78-year-old man was admitted for depression. It is imperative that the nurse's assessment must include information regarding... a) Family involvement b) Suicide thoughts c) Cognitive abilities d) Supports in the community

c) Reaction time Pg. 270 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.

11. Many cognitive abilities are preserved or even enhanced during aging. What is impaired with normal aging? a) Attention b) Alertness c) Reaction time d) Consciousness

a) Poor health Pg. 275 Risk factors for suicide in older adults include being white, male, widowed or divorced, retired or unemployed, living alone in an urban area, in poor health (including poor mental health) or lonely, and having a history of poor interpersonal relationships.

12. Risk factors for suicide in older adults include... a) Poor health b) Previously physically active c) Socially active d) Married

c) Focus more on accuracy than speed in responding Pg. The phenomenon "speed accuracy shift" refers to when older adults focus more on accuracy than speed in responding.

13. A nursing student is discussing with an older client changes in how older adults process and respond to questions. During this discussion the student explains "speed-accuracy shift" as older adults doing which of the following? a) Focus on giving only the desired answers b) Focus on only information that is important to them c) Focus more on accuracy than speed in responding d) Focus more on speed than accuracy in responding

a) Allowing the client enough time to answer the question c) Keeping the discussion focused on one topic at a time Pg. 270 When communicating with an older adult, allow the older adult enough time to answer the questions. Older adults may need extra time to process information. In addition, the nurse should minimize distractions such as the television or other noise and avoid sitting in the shadows. The nurse should speak slowly and clearly to the patient, in a loud tone of voice but not shouting and limit the number of topics discussed at one time to prevent information overload.

14. A nurse is developing a plan of care for an older adult with a chronic illness. Which intervention would be most appropriate for the nurse to include when communicating with the older adult? Select all that apply. a) Allowing the client enough time to answer the question b) Sitting away from the client in the shadows to avoid distractions c) Keeping the discussion focused on one topic at a time d) Having the television on in the background when talking with the client e) Speaking loudly to the client, shouting if necessary

b) Older adults need smaller doses of the same medication and become toxic more quickly than do younger adults Pg. 268 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.

15. When using psychotropic medications in older adults, which of the following is true? a) Older adults should rarely be given psychotropic medications unless they are suicidal b) Older adults need smaller doses of the same medication and become toxic more quickly than do younger adults c) Older adults often do not understand why they are receiving psychotropic medications d) Older adults often need more medication because their livers do not metabolize as much of the drug as do those of younger people

b) "I'm still mourning the loss of my spouse who died over two years ago" c) "I'm pretty much a homebody and stick to myself" d) "I've been having some major health problems for the past several years" Pg. 275 Risk factors that have been found to increase an older adult's risk for suicide include poor mental or physical health, depression, social isolation, a history of poor interpersonal relationships, rigid coping style, and alcohol or drug abuse. These factors are demonstrated by the patient's statements about having major health problems, engaging in prolonged mourning about the loss of a spouse, and being a homebody. The patient's statements about being flexible to challenges suggests that the patient is using appropriate coping mechanisms; the patient's statement about wine with dinner suggests occasional alcohol use, not alcohol abuse.

16. A nurse is assessing an older adult client's risk for suicide. Which statement by the client would the nurse interpret as placing the client at increased risk? Select all that apply. a) "I drink a glass of wine or two with dinner once or twice a month" b) "I'm still mourning the loss of my spouse who died over two years ago" c) "I'm pretty much a homebody and stick to myself" d) "I've been having some major health problems for the past several years" e) "I've learned to be flexible about challenges that pop up in my life"

c) Lung disease Pg. 271 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).

17. A nurse is assessing an older adult who says, "My memory is a real problem. There are times my memory just fails me. It's so frustrating." The nurse reviews the client's history related to threats to the client's memory. Which condition would the nurse most likely identify as a possible contributing factor? a) Gastrointestinal disturbances b) Rheumatoid arthritis c) Lung disease d) Diabetes

b) Polypharmacy Pg. 274 Polypharmacy is the use of several medications and often associated with chronic illness and long-term drug therapy.

18. The older adult consumes two to six prescription medications and two to three over-the counter medications each day. This use of numerous medications that sometimes leads to drug abuse and adverse drug reactions is known as which of the following? a) Pharmacokinetics b) Polypharmacy c) Pharmacodynamics d) Pharmacology

b) Face the client e) Repeat and revise questions, as needed Pg. 270 Techniques that are appropriate for the nurse to implement when communicating with an older adult client include facing the client and repeating and revising questions, as needed. Although it is important to speak at an appropriate volume based on the any hearing loss, the nurse should speak slowly, not quickly. Settings with distractions, including a day activity room, should be avoided because distractions negatively affect the communication process. The nurse should avoid the urge to finish the client's sentences by allowing adequate time for the client to complete a thought.

19. Which communication technique is appropriate for the nurse to use when conducting a health history interview with an older adult client? Select all that apply. a) Use the day activity room as the setting b) Face the client c) Speak quickly and loudly d) Finish the client's sentences, as needed e) Repeat and revise questions, as needed

a) The nurse should assess for hearing and visual deficits Pg. 269 Although principles of therapeutic communication are applicable across the lifespan, older adults require some special adaptations because of age-related changes. Physical factors, such as decreased vision or hearing, may interfere with communication. Age-related changes in hearing require nurses to use a lower-pitched voice and eliminate background noise. Speaking in a somewhat louder voice may be necessary if hearing loss is clear. Nurses must not assume, however, that all older people have difficulty hearing and speak to them unnaturally loudly, which can be irritating. They assess for hearing and visual deficits early and then implement various helpful techniques based on findings.

2. In order to engage in therapeutic communication with an older adult, which of the following should the nurse consider? a) The nurse should assess for hearing and visual deficits b) The nurse should use the same communication techniques as with younger individuals c) The nurse may need to repeat instructions due to memory impairment d) The nurse should speak in a loud voice when communicating with older clients

c) Intelligence and personalities are stable across the lifespan in the absence of disease Pg. 271 Intelligence and personality are stable across the life span, in the absence of disease; however, the learning abilities of older people may be more selective, requiring motivation.

20. The nurse is working in a long-term care facility providing care to a group of older adults. When assessing the clients' personalities and intelligence, which information would be most important for the nurse to keep in mind? a) Learning abilities of older people remain relatively static with any change b) Motivation is unrelated to an older adults ability to learn c) Intelligence and personalities are stable across the lifespan in the absence of disease d) Intelligence and personalities are highly variable with frequent changes across the lifespan

b) Health care costs Pg. 273 Although retirement, widowhood, and functional dependency may contribute to the client's financial concerns, health care costs probably are the largest contributor to economic insecurity in older people. The aging of the population has significant implications in terms of health care costs associated with Medicare.

21. A nurse is assessing an older adult client who has come to the clinic for an evaluation. The client has several chronic illnesses and voices concerns about finances. When reviewing the client's history, which component would the nurse identify as the primary contributor to the client's concerns? a) Functional dependency b) Health care costs c) Widowhood d) Retirement

d) Capacity to be resilient Pg. 279 Positive mental aging is more than the absence of mental disorders and impairment but rather is more a reflection of resilience—the capacity to adapt, feel in control, and make decisions about care and life. A key action is to listen to older adults themselves so that they can recognize and tap into the wisdom accumulated over a lifetime to help older adults negotiate the many challenges faced in later life.

22. A nurse is discussing the process of aging with a group of community health nurses. When describing the concept of positive mental aging, which concept would the nurse most likely emphasize as crucial? a) Absence of mental disorders b) Lack of mental impairment c) Ability to listen to others d) Capacity to be resilient

a) Post-retirement activities Pg. 269 Although the needs of older adults are highly individualized, generally, the young-old are challenged to develop new roles after retirement. This group of individuals may need programs and services that help them find meaningful activities. The old-old group tends to need supportive and protective services. Rehabilitation programs are generally appropriate for any age group.

23. A nurse is working as part of a team tasked with developing programs for the older adult population in the community. Adults between the ages of 65 to 74 years of age account for the largest segment of the community's older adult population. Which type of program would be most appropriate for this group? a) Post-retirement activities b) Protective services c) Support services d) Rehabilitation programs

d) Older women Pg. 275 Older women are more likely to live in poverty than older men (11.5% compared to 6.6%). Older people living alone have the highest poverty rates.

30. Which population is more likely to live in poverty? a) Middle-aged men b) Older men c) Children d) Older women

c) Mental processing speed Pg. 270 Mental processing speed and reaction gradually decline in aging. Generally, it takes longer for older people to process information and give a response, which can lead to problems in reaction times (driving) and interactions with others. These changes may influence other cognitive operations such as working memory, speech processing and attention. A person's ability to remember the spoken word, attend to important information, or perform tasks may also be affected.

24. A nurse notes that an older adult client takes a little longer to respond when asked a question. The nurse interprets this as indicating a change in which function? a) Working memory b) Speech processing c) Mental processing speed d) Attention span

a) A female of African descent who is 82 years of age Pg. 275 The client at greatest risk for poverty who would benefit from the inclusion of nutritional interventions in the plan of care is a female of African descent who is 82 years of age. This client has three risk factors for poverty: age, ethnicity, and gender. The White female who is 75 years of age has one risk factor for poverty: gender. The male of Native American/First Nations heritage has one risk factor: his age. The male of Asian descent has one risk factor: ethnicity.

25. Which older adult client is at the greatest risk for poverty and thus would benefit from the nurse including specific nutritional interventions in the plan of care? a) A female of African descent who is 82 years of age b) A male of Asian descent who is 78 years of age c) A white female who is 75 years of age d) A male of Native American/First Nations heritage who is 85 years of age

a) Agitation b) Depression d) Dementia Pg. 277 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). Obsessive-compulsive disorder and trichotillomania (repetitive hair pulling) are not associated with undernutrition.

26. A nurse is providing care to an older adult client who is undernourished. Based on the nurse's understanding about the effects of undernutrition, the nurse would be alert for the development of which mental health problem? Select all that apply. a) Agitation b) Depression c) Trichotillomania d) Dementia e) Obsessive-compulsive disorder

a) Conscientiousness b) Self-control c) Traditionalism Pg. 271 Research has identified some personality traits as being associated with longevity such as conscientiousness, responsibility, self-control and traditionalism. Personality traits, extroversion, openness to experience, agreeableness, and conscientiousness are related to successful aging.

27. A nurse is conducting an in-service presentation for a group of nurses about personality and aging. When discussing longevity related to personality, which trait would the nurse include as playing a role in long life? Select all that apply. a) Conscientiousness b) Self-control c) Traditionalism d) Extroversion e) Agreeableness

c) Attitudes of the staff Pg. 270 Although nursing home residents may remain interested in maintaining sexual relationships, the attitudes of the staff and physicians constitute an additional barrier for this population. The stigma often associated with sexual activity in later life is also perpetuated by young adults' negative attitudes toward late-life sexuality and further contributes to lack of acceptance that sexual feelings and behaviors are normal at all ages. Interest in and enjoyment of sexual activities can continue until one's death despite physical changes that affect sexual functioning. Health, a desire to remain sexually active, access to a partner, and a conducive environment contribute to positive sexual experiences.

28. Which issue would most likely be a barrier to seniors residents of a nursing home who have a desire to maintain sexual relationships? a) Problems associated with sexual performance b) Lack of sexually active older adults c) Attitudes of the staff d) Risk of sexually transmitted diseases

c) Focus more on accuracy than speed in responding Pg. 270 The nurse should explain to the client that older adults focus more on accuracy than speed in responding. Hurrying older adults to answer questions may interfere with their ability to provide the correct answer. Memory impairments, exercising less caution, and taking greater risks are not associated with memory and the older adult.

29. 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) Tend to exercise less caution due to the aging process c) Focus more on accuracy than speed in responding d) Have memory impairments that affect their responses

a) Increased time to achieve an erection c) Decreased urgency for ejaculation d) Longer refractory period Pg. 269-270 Physiological changes in men include a decline in testosterone production, increased time to achieve erection, less firm erections, decreased urgency for ejaculation, decreased sperm production, and a longer refractory period (i.e., the amount of time before the man can achieve another erection).

3. A nurse is preparing a presentation for a local senior center on sexuality, sexual activity, and the older adult. When describing the physical changes that occur in an older adult male, which information would the nurse most likely include? Select all that apply. a) Increased time to achieve an erection b) Increased sperm production c) Decreased urgency for ejaculation d) Longer refractory period e) Increased testosterone production

a) Mental problems d) Fatigue e) Pressure sores Pg. 277 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.

31. Adequate nutrition is an important factor in maintaining mental health. Which are problems that can result from undernutrition? Select all that apply. a) Mental problems b) Increased gastric motility c) Moist skin d) Fatigue e) Pressure sores

d) Older adults experience a more stable life than younger adults Pg. 272 Older adults often comment that time seems to go faster than when they were younger. Experts have yet to agree on an explanation for this experience, but there are several factors that contribute to this change in time perception. The lives of older adults tend to be more stable than their younger counterparts as months, weeks and years unfold with fewer life changes that demarcate periods of time. Life transitions of younger persons are often dramatically different from each other such as children growing up and leaving home, job changes, and relocation. Aging adults have less time in life than younger people. Younger persons often plan for their future; whereas time for older adults is limited. Thus, the present is the older adult's future; whereas a younger person prepares for a different future than their present life.

32. A nurse is assessing an older adult in the clinic. During the assessment, the older adult says, "Time sure does seem to fly much faster now than when I was younger. Any idea why this is so?" Which information would the nurse most likely integrate into the response? a) Older adults are involved in planning for their future b) Older adults experience more life changes as they grow older c) Older adults face similar life transitions as do younger adults d) Older adults experience a more stable life than younger adults

b) A 78-year-old with cognitive impairment Pg. 272 Estimates of the prevalence of functional dependency vary, but in general, studies show that difficulty in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs) increase with advancing age and that cognitive impairment significantly predicts functional decline. Although any of the patients listed could be at risk, the patient who is the oldest and experiencing cognitive impairment would be at greatest risk.

33. A nurse is assessing several older adult patients. When reviewing each patient's medical record, which patient would the nurse most likely identify as being at greatest risk for functional decline? a) A 69-year-old with depression b) A 78-year-old with cognitive impairment c) A 65-year-old with chronic heart failure d) A 70-year-old with chronic lung disease

d) Focusing on accuracy rather than speed of answering Pg. 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.

34. How quickly an older adult responds to questions has been termed speed-accuracy shift, which refers to... a) Identifying their focus on answering without delay b) Focusing on the previous question asked c) Identifying their learning deficits d) Focusing on accuracy rather than speed of answering

d) Older adult's home Pg. 276 Although elder abuse can occur anywhere, clinical and empirical evidence suggests that a shared living arrangement increases the opportunities for contact that can lead to conflict and mistreatment. Abuse of older adults tends to take place where the individuals live: most often in the home where abusers are apt to be adult children, other family members such as grandchildren, or spouses or partners of older adults.

35. A nurse is conducting a program at a community center about elder abuse. When describing where this type of abuse most likely occurs, the nurse would identify which location? a) Residential facility b) Acute care facility c) Community center d) Older adult's home

d) Decision-making support Pg. 278 Supporting a sense of control and decisional capacity is critical to self-care. Instructional aids, large-print labels and calendars are compensatory strategies that encourage adherence to care.

36. A nurse is working with an older adult client to enhance the client's self-care. When developing the plan of care for this client, which aspect would be the priority? a) Calendars b) Large print labels c) Instructional aids d) Decision-making support

b) Retirement c) Changes in residence d) Loss of partner Pg. 278 Major changes in social roles with aging include retirement, loss of partner, and changes in residence. Polypharmacy and infection can occur with aging, but they are not social changes.

37. A nurse who works at a local center for senior citizens is assessing several older adults. Which change would the nurse most likely identify as affecting their social roles ? Select all that apply. a) Infection b) Retirement c) Changes in residence d) Loss of partner e) Polypharmacy

c) Integrity versus despair Pg. 271-272 The eighth stage that is related to late adulthood is integrity versus repair.

38. Nurses working with older adults may use Erikson's eight stages to assess level of development. Which of the following developmental tasks is specific for late adulthood? a) Generativity versus stagnation b) Initiative versus guilt c) Integrity versus despair d) Intimacy versus isolation

b) "I should walk for 1 hour each day" Pg. 273 Keeping active mentally is important by participating in volunteer organizations and activities in the community and being involved actively in church and political groups. Good nutrition and fluids are essential to physical health. Because of various factors related to aging, including decreased absorption of some substances, older people probably should take at least one basic multivitamin and mineral supplement. The nurse may wish to suggest to most clients (unless contraindicated because of other physical factors) that they exercise at least 30 minutes a day, three times a week.

39. The nurse is giving a presentation to the community on healthy aging. At the conclusion, she asks each group member to state one health-promoting action he or she can take. Which of the following responses indicates the need for clarification? a) "I should take a vitamin and mineral supplement" b) "I should walk for 1 hour each day" c) "I should drink plenty of fluids" d) "I should get involved in community life"

b) Social security Pg. 273 Financial concerns certainly impact one's adjustment to retirement. Social security continues to provide the largest single source of income for older adults, but retirement income security now often requires earnings from working in later life. Many no longer have pensions, savings, or investments to sustain them in retirement.

4. A nurse is preparing a presentation for a local community group about retirement and strategies to promote a successful retirement. When describing the major source of income with retirement, which source would the nurse most likely include? a) Investments b) Social security c) Personal savings d) Employee pension plans

a) Poor health c) Inadequate social support e) Lower income Pg. 276 The prevalence of mistreatment of the older adult appears to be related to low income, poor health, and lack of social support. Race and ethnic differences have not been shown to play a role.

40. A nurse is reviewing an older adult's history for possible factors that would increase the client's risk for maltreatment. Which factor would the nurse most likely identify as placing the client at risk? Select all that apply. a) Poor health b) Latino culture c) Inadequate social support d) African-American race e) Lower income

d) Summarize important points periodically Pg. 270 When interacting with an older adult, it is important to summarize important points periodically to improve understanding and comprehension. The nurse should limit the number of topics discussed at one time to prevent information overload. The nurse should also ask one question at a time to minimize confusion and use simple, short sentences.

41. A nurse is working with an older adult client and teaching the client about their condition. When implementing the teaching plan with the client, which strategy would be most appropriate to use? a) Ask questions successively to evaluate understanding b) Cover all the topics in one session c) Use longer, complex sentences to get the point across d) Summarize important points periodically

c) Gerotranscendence Pg. 272 Although Erik Erikson identified "integrity versus despair" as a developmental task specific to late adulthood, recently his wife, Joan Serson, published an extension of his theory that included old age as a ninth stage, gerotranscendence. The ninth stage is not generativity, resilience, or maturational crisis.

42. Recently Joan Serson, Erik Erikson's wife, published an extension of his theory that included old age. This ninth stage is known as which of the following? a) Generativity b) Resilience c) Gerotranscendence d) Maturational crisis

d) Old age is a period of continued growth and development with its own tasks Pg. 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.

43. With regard to developmental stages, which of the following is true about older age? a) Individuals no longer go through formal developmental stages when they are older b) The individual completes personal developmental stages prior to age 65 c) If an individual never completed a specific developmental task, he or she may easily do so once he or she is elderly d) Old age is a period of continued growth and development with its own tasks

b) Blood pressure Pg. 274 Hypertension is a known side effect for the prescribed medication, especially when used for the older adult client; therefore, the priority assessment for this client is blood pressure. Although some clients may experience changes in heart rate, specifically tachycardia, this tends to be dose dependent and is not the priority assessment. This medication does not affect the client's temperature or respirations.

44. The nurse provides care for an older adult client who is prescribed venlafaxine HCl for the treatment of depression. Which priority assessment does the nurse include in the client's plan of care based on this pharmacologic therapy? a) Temperature b) Blood pressure c) Heart rate d) Respiratory rate

a) Anxiety b) Dementia c) Depression Pg. 268 1 in 4 older adults has a significant mental disorder, with depression, anxiety disorders and dementia being among the most common.

45. 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) Anxiety b) Dementia c) Depression d) Bipolar disorder e) Schizophrenia

b) Memory loss Pg. 271 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.

46. Which of the following is not a normal part of aging? a) Dulled sense of smell b) Memory loss c) Muscle mass decrease d) Decreased visual acuity

a) Muscle mass decreases c) Body fat increases e) Total body water decreases Pg. 269 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. In the brain, healthy older adults have a reduction in gray matter, increase in cerebrospinal fluid, increased white matter abnormalities, and lower metabolic rates at rest.

47. A nurse is teaching a group of older adults about physical changes that occur with aging. Which change would the nurse most likely include in the discussion? Select all that apply. a) Muscle mass decreases b) Sex hormones increase c) Body fat increases d) Glomerular filtration increases e) Total body water decreases

b) Older adults Pg. 268 Older adults are at somewhat greater risk than younger age groups for the development or recurrence of mental health problems.

48. A nursing student correctly identifies members of which age group to be at increased risk for the development or recurrence of mental health problems? a) Young adults b) Older adults c) Middle adults d) Adolescents

c) History of alcohol abuse e) Comorbid heart disease and arthritis Pg. 274 Risk factors for mental illness in older adults include poor physical health, alcohol and substance abuse, polypharmacy, bereavement and loss, and lack of social support and suicide. The patient's history of alcohol abuse and comorbid heart disease and arthritis would be risk factors. Polypharmacy involves the use of 5 or more medications; this patient is taking only 2 medications, so this would not be considered polypharmacy. Since the patient's spouse died 8 years ago, this would not necessarily place the patient at risk; more information about the patient's grieving would be needed. Engaging in four social activities per week would keep the patient fairly active and engaged with others, thereby reducing the risk for mental illness.

49. A nurse is providing care to an older adult. On reviewing the client's history and physical examination, which factor would the nurse identify as placing the person at risk for mental illness? Select all that apply. a) Death of spouse 8 years ago b) Regular participation in four social activities per week c) History of alcohol abuse d) Use of two medications e) Comorbid heart disease and arthritis

c) "I just don't seem to feel very well lately" Pg. 277 Depressive symptoms among older adults are more likely to include vague somatic issues, such as not feeling well; cognitive symptoms, such as not being able to focus or being forgetful, hypersomnia (being excessively sleepy), and appetite changes rather than reports of depressed mood. The statement about the abdominal pain is specific and highly descriptive, not a vague somatic report. Not sleeping well at night suggests insomnia, not hypersomnia.

5. An older adult comes to the clinic for an evaluation. The nurse suspects that the client may be experiencing depression. Which statement would the nurse most likely interpret as most commonly associated with depression in this age group? a) "I keep focusing on things I have to do" b) "I don't sleep well at night anymore" c) "I just don't seem to feel very well lately" d) "I have this terrible sharp pain in my abdomen"

d) Create a medication administration record so that the client can check off his medications as he takes them each day Pg. Teaching clients about their medications is a serious responsibility. In addition to a medication list, a medication administration sheet might be helpful. This plan not only serves as a reminder about what the client should take and when, but also its check-off format enables supervision of medication adherence.

50. Which of the following interventions would be most effective in helping an older adult living alone to manage his medication regimen? a) Ask a neighbor or family member to monitor the client's medications b) Ensure that a responsible person prepours the medication for the week into medication containers marked with the name of each day c) Review dosages and times with the client and have him repeat the information d) Create a medication administration record so that the client can check off his medications as he takes them each day

b) 4th Pg. 269 The gradual decline usually begins in the 4th and 5th decades of life, but these changes do no limit activity until the 7th and 8th decades.

51. All five of the senses gradually decline in acuity with age. The gradual decline may begin in which decade of life? a) 3rd b) 4th c) 7th d) 8th

a) Personality Pg. 271 Personality is stable throughout the life span. All five senses gradually decline in acuity with age, usually beginning in the fourth and fifth decade of life, but these changes do not limit activity until the seventh decade. Taste, touch, and smell undergo a uniform dulling. Visual and auditory losses can significantly impact independence and self-mastery.

6. What is stable throughout the life span? a) Personality b) Sense of smell c) Vision d) Reaction time

b) Orientation to the older adult Pg. 273 Residential care in foster care homes, family homes, personal care homes, residential care facilities, or assisted living arrangements provides the older adult with a protected environment. Perhaps the most important feature of assisted living facilities is the orientation toward the elderly resident that empowers the frail older adult by sharing responsibilities for care and activities of daily living. This empowerment orientation enhances their choices and manages risks.

7. A nurse is working with a family to determine the most appropriate living arrangements for an older adult. When describing the different facilities, which feature would the nurse most likely include as most important about assisted-living facilities for older adults? a) Level of staff and caregivers b) Orientation to the older adult c) Type of services offered d) Environment

b) Bridge employment Pg. 272-273 Bridge employment is a term used to denote payment for work for those receiving a pension. Gerotranscendence refers to a theory that provides for ongoing personal growth in dimensions such as spirituality and inner strength with an emphasis on the meaning of life and making positive use of solitude. Resilience is the ability to adapt successfully to stress, trauma, or chronic adversity. Cognitive reserve refers to the resistance to decline in functioning of the brain.

8. While interviewing an older adult client, the client states, "Even though I'm getting a small pension, I'm still working four days a week." The nurse interprets this statement as reflecting which concept? a) Resilience b) Bridge employment c) Cognitive reserve d) Gerotranscendence

d) Denial Pg. 277 The stigma of mental illness continues to interfere with the willingness of older adults to seek treatment. This fear can lead to denial of problems.

9. The stigma of mental illness can lead to the use of which defense mechanism? a) Regression b) Compensation c) Repression d) Denial