Chapter 10- Elder Abuse and Neglect

14. A home health nurse visits a client who has a history of alcoholism and dementia. The client's words are incoherent, and the client's clothes are filthy. The client is unsteady and leaning to the right, and the room in the rooming house is in disarray. The only word that the nurse can clearly identify is "no." Which action by the nurse is most appropriate at this time? A) Ask the neighbors what has been happening. B) Call emergency services for transport to a hospital. C) Leave and return later. D) Search the room for empty bottles.

Ans: B Victims of self-neglect are likely to have the following characteristics: older age; chronic illness; functional limitations; solo living arrangements; social isolation; inadequate economic resources; and dementia, mental illness, substance abuse, or hoarding behaviors. If the elder is incapable of deciding whether to accept or reject emergency services, then these services should be provided.

7. A nurse who provides care in a clinic comes into contact with numerous older adults, many of whom have bruises of various sizes and stages on their body. What pattern of bruising is most suggestive of possible abuse? A) Significant bruising on the shin region of a client's leg B) Bruising on both ears and both sides of the neck C) Bruising on the back of a client's hands D) Bruising on both of a client's elbows

Ans: B Bruising on the neck and ears is not typically accidental. Conversely, bruising on the backs of the hands, elbows, and shins is more common and less likely to raise the suspicion of abuse

1. An 80-year-old is seen in the emergency department for a fall. The client has bruises on the upper arms and appears depressed. The client is accompanied by a grandchild, who is unkempt, glassy-eyed, and whose breath smells of alcohol. Which of the following should be a priority with the nurse? A) Assess whether the older adult is safe in the home environment. B) Determine whether legal interventions are appropriate. C) Assess the client's degree of frailty and chronic health problems. D) Determine the mental capacity of the older adult.

Ans: A The first priority should be to see whether the older adult is safe and then determine his competency. Legal intervention can be pursued after safety and competency are determined. The degree of frailty and chronic health problems is assessed with safety issues and determination of competency.

12. A nurse prepares a presentation regarding elder abuse and neglect. Which of the following types of abuse should the nurse include? (Select all that apply.) A) Alcohol (substance) B) Financial C) Mandatory D) Physical E) Psychological F) Sexual

Ans: B, D, E, F The National Center on Elder Abuse (2013a) recognizes seven major types of abuse: physical, sexual, emotional or psychological, neglect, abandonment, financial or material exploitation, and self-neglect

11. A nurse in a hospital setting assesses an older adult and is unsure if the assessment data warrant notification to the authorities for elder abuse. Which action is most appropriate for the nurse at this time? A) Determine if the person has dementia. B) Discuss findings with the family. C) Follow the hospital protocol for reporting. D) Question the visitors.

Ans: C The nurse is a mandatory reporter for potential elder abuse; the authorities can make the final determination if abuse has occurred or not. Nurses assess all potential contributing conditions but the immediate responsibility is to follow the protocol for reporting. Determining whether the person has dementia is not within the scope of nursing

3. A neighbor notices an 81-year-old getting water from someone's outside faucet. The neighbor notices that this person's ankles are very swollen and there is an open wound on her left leg. The older adult says, "I stopped taking my pills because the water department turned off my water and I can't use the bathroom. My daughter did not pay the water bill, and she never has time to take me to the doctor so my legs can be checked." The neighbor calls adult protective services. Which of the following interventions is the priority when the nurse visits for an evaluation and does not find any immediate danger? A) The competency of the older adult in making decisions needs to be determined. B) The daughter needs to be picked up by the police on a neglect charge. C) The older adult needs to be involuntarily committed to a long-term care facility. D) An involuntary legal intervention needs to be initiated immediately.

Ans: A Because the older adult is not in immediate danger, the first step is to determine her competency and the ability to make decisions for herself

9. A wound care nurse is assessing a 76-year-old client. The client has intimated to the nurse that her son sometimes "flies off the handle and gets rough with me." Which response made by the nurse is the best response? A) "When you say 'gets rough,' what does that look like?" B) "What do you think usually provokes this to happens?" C) "I'm going to have to phone adult protective services right now." D) "Why do you think that there is that response with anger or frustration?"

Ans: A Safety is the first priority in cases of elder abuse and prompt action is often necessary. However, gathering additional information, detail, and context is appropriate when a threat is not immediate. Speculating about a perpetrator's motives is unnecessary and inappropriate.

5. A 30-year-old grandchild lives with and provides care for the 75-year-old grandparent. The grandparent has congestive heart failure, hypothyroidism, and chronic pain from a compression fracture and osteoporosis. The grandchild supervises the older adult's medications. The home health nurse notes that the older adult has extra diuretic pills and that the pain medications for a month have been used and cannot be refilled for 2 more weeks. The older adult tells the nurse: "Those pain pills don't work, my back is always hurting." The nurse notes that the older adult's ankles are very swollen. Which of the following things should the nurse do first? A) Call adult protective services and ask for an immediate evaluation. B) Assess the grandchild's understanding of her grandmother's needs. C) Take the grandmother to the emergency department immediately. D) Tell the older adult that her grandchild is probably taking her pain medications.

Ans: B Physical neglect can arise from the caregiver's lack of knowledge. It is important to assess the caregiver's understanding of the dependent person's needs before drawing other conclusions

8. An 81-year-old has been living for the past 2 years in a long-term care facility. However, financial pressures have required that the resident move in with the oldest child and spouse. Which of the following statements if made by the child's spouse should signal a potential risk for elder abuse? A) "I sure hope that we'll qualify for some home care because this seems pretty overwhelming." B) "This won't be easy for anyone. I think I might even end up having to juggle my work schedule." C) "He's used to being waited on here, but at our place he's going to have to fend for himself." D) "I'm probably going to even have to get some friends or neighbors to help out from time to time."

Ans: C It is normal and reasonable to be somewhat overwhelmed with the prospect of providing care for an older adult. However, a suggestion that the older adult may have to go without care is problematic and a potential precursor to elder abuse (neglect).

10. An older adult who appears to be between 85 and 95 has been brought to the emergency department by emergency medical services after being found wandering in the street. The older adult is filthy, confused, and exhibits numerous bruises to the face and neck as well as signs of malnutrition and dehydration. What problem should the nurses prioritize for assessment and intervention? A) Hygiene B) Malnutrition C) Dehydration D) Potential elder abuse

Ans: C Nursing guidelines emphasize that interventions related to hydration status are higher priority than most other problems, including hygiene, and malnutrition; elder abuse is not an immediate threat when the older adult is in a health care setting

6. A nurse who works with the older population is aware that elder abuse takes many forms. Which of the following examples most clearly constitutes elder abuse? A) A paid caregiver cleans and assists with shopping for an older adult who lives alone. B) An older adult assists with child care in exchange for room and board at her niece's house. C) A daughter manages her mother's finances after the older adult granted her power of attorney. D) A daughter changes her mother's incontinence brief only after the urine has soaked through all her clothing because she wants to save money

Ans: D Allowing an older adult to remain in soiled clothing as a way of preserving financial assets is a form of elder abuse. Power of attorney confers legitimate financial control to an individual and this is not necessarily coercive or abusive. Fair exchanges of services for money or housing do not constitute abusive situations.

2. Which of the following is true about cognitive impairment and abuse of older adults? A) Older adults who live alone are always willing to acknowledge their impairments. B) Cognitively impaired older adults are usually able to meet minimum standards of care. C) When the older adult denies cognitive impairment, the risk for abuse declines. D) Older adults become more vulnerable to abuse because of cognitive impairment.

Ans: D When the older adult denies cognitive impairment, the risk for abuse increases. Older adults who are cognitively impaired are not able to meet minimal standards of care. Older adults who live alone may be afraid to acknowledge their impairments

13. A nurse assesses an 85-year-old client and finds bruises on the arms and shins and a skin tear on the right hand. Which action is the priority for further nursing assessment? A) Consider the family as a reliable source of information. B) Determine if the person is depressed. C) Follow the protocol for reporting elder abuse. D) Review the client's medications and medical diagnoses

Ans: D The nurse has not yet gathered enough data to determine whether elder abuse is a potential factor. The client/family may not know the source of the bruises, and in fact may provide inaccurate information if they contribute to an abusive situation. It is important to consider adverse medication effects and some medical conditions as potential causes of bruising.

4. Which of the following statements is true about the laws of mandatory abuse reporting? A) Government agencies, not individual nurses, are responsible for reporting abuse. B) Mandatory reporting laws require reporters to know whether abuse or neglect has occurred, rather than just suspecting it has occurred. C) The use of an abuse reporting protocol replaces individual responsibility for reporting. D) A registered nurse is mandated to report abuse or neglect if it is suspected.

Ans: D In all states within the United States, individual nurses are responsible for reporting abuse. Mandatory reporters are required to report the suspicion of abuse or neglect. Protocols do not replace individual responsibility. Protocols clarify individual roles and enhance the credibility of the abuse report.