Chapter 29: Mental Health Disorders of Older Adults

As part of a follow-up home visit to a client age 80 years who has had surgery, a nurse discusses the client's risk for delirium with his family members. Which of the following would the nurse include as placing the client at increased risk? Select all that apply. - Urinary tract infection - Hypertension - Acute stress - Bone fractures - Dehydration - Electrolyte balance

- Urinary tract infection - Acute stress - Bone fractures - Dehydration

When assessing a client with dementia, a nurse identifies that the client is experiencing hallucinations. Based on the nurse's understanding of this disorder, which type of hallucination would the nurse expect as most common? - Auditory - Visual - Gustatory - Olfacotry

- Visual

After educating a group of nursing students on Alzheimer's disease and appropriate nursing care, the instructor determines that the education was successful when the students identify which of the following as the foundation for providing care to the client and family? - Therapeutic relationship - Medication therapy - Injury prevention - Functional independence

- Therapeutic relationship

A nurse is caring for a client diagnosed with delirium who has been brought for treatment by his son. While taking the client's history, which question would be most appropriate for the nurse to ask the client's son? - "Has your father taken any medications recently." - "Are you aware of your father falling or injuring his head in any way." - "Has your father had a recent stroke?" - "Has your father experienced any major losses recently?"

- "Has your father taken any medications recently?"

A nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate? - "Basically, this diagnosis is based on the client's inability to walk normally - "Your report of gradually developing confusion over time was the basis for the diagnosis." - "His diagnosis is primarily based on the rapid onset of his change in consciousness." - "The client's exposure to an infectious agent led us to determine the diagnosis."

- "His diagnosis is primarily based on the rapid onset of his change on consciousness."

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? - "How often do you bathe or shower?" - "How many times do you change clothes during the day?" - "How often do you cook meals for yourself?" - "How often do you go to the store to buy groceries?"

- "How often do you go to the store to buy groceries?"

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? - "I am the kind of the universe." - "Creatures are living in my closet." - "The government has people following me." - "My roommate keeps stealing my clothes."

- "My roommate keeps stealing my clothes."

A nursing instructor is preparing a presentation on the etiology of Alzheimer's disease (AD). When discussing the role of neurotransmitters in the course of the disease, which of the following would the instructor most likely emphasize? - Serotonin - Acetylcholine - Dopamine - Norepinephrine

- Acetylcholine

A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for which of the following? - Aphasia - Apraxia - Agnosia - Executive function

- Agnosia

A client is admitted to the hospital with dementia related to Parkinson's disease. The client is being treated for a fractured tibia from a recent fall. The nurse should assess the client's history for use of which type of medication? - Anticholinergics - Dopamine agonists - Anxiolytics - Benzodiazepines

- Anticholinergics

Assessment of an older adult client 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? - Assess for development of orthostatic hypotension - Instruct the client to stop taking the psychiatric medications - Interview the client' family about the client's coping skills and current stress level - Suggest the client periodically use an alcohol-based mouthwash several times a day

- Assess for development of orthostatic hypotension

A nurse makes a home visit to a family caring for a client with Alzheimer's disease. The client's wife tells the nurse that she hasn't been out of the house for more than 2 weeks because her sister has been unable to help care for the client. Which nursing diagnosis would the nurse identify as the priority? - Ineffective Family Coping related to care of a client with Alzheimer's disease - Risk for Activity Intolerance related to Alzheimer's disease - Caregiver Role Strain related to social isolation - Powerlessness related to seclusion and long-term care of client

- Caregiver Role Strain related to social isolation

A son brings his mother to the clinic for an evaluation. The son's mother has moderate Alzheimer's disease without delirium. The nurse assesses the client for which of the following as the priority? - Hearing deficits - Mania - Strange verbalizations - Catastrophic reactions

- Catastrophic reactions

A nurse is caring for a client age 78 years who is taking an anticholinergic medication and complains of dry mouth. Which of the following would be most appropriate for the nurse to suggest? Select all that apply. - Chew hard candies - Rinse the mouth with a glycerol mouthwash - Use more seasoning on food - Drink decaffeinated beverages often

- Chew hard candies - Rinse the mouth with a glycerol mouthwash

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? - Suicide is less of a risk in this population compared with the middle-aged adults - Married African American men are at greater risk for suicide in this group - Depression is greatest risk factor for suicide in this population group - White women account for the highest number of suicide deaths in this age groups

- Depression is greatest risk factor for suicide in this population group

A nurse is providing care to a client with Alzheimer's disease who is exhibiting suspiciousness and delusional thinking. Which of the following would be most important for the nurse to do with this client? - Tell the client that he is experiencing delusions - Confront the client about his distorted thinking - Correct the client's interpretation of the situation - Determine the trigger for the distorted thinking

- Determine the trigger for the distorted thinking

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 more accurate picture of the social support resources available - Evaluation of the family's ability to effectively care for the older client - Determination of the extent of the client's memory impairment - A much-needed period of respite and support for the family members

- Evaluation of the family's ability to effectively care for the older client

A group of nursing students is reviewing information about delirium and dementia. The students demonstrate a need for additional review when they identify which of the following as a characteristic of dementia? - Fluctuation changes within a 24-hour period - Possible hallucinations - Normal psychomotor activity - Globally impaired cognition

- Fluctuation changes within a 24-hour period

A client with Alzheimer's disease is admitted to an acute care facility for treatment of infection. Assessment reveals that the client is anxious. When developing the client's plan of care, which of the following would be least appropriate for a nurse to include? - Frequently provide reality orientation - Simplify the client's routines - Limit the number of choices to be made - Establish predicable routines

- Frequently provide reality orientation

A daughter brings her mother, who has Alzheimer's disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, the nurse would be alert for the possibility of which side effect? - Gastrointestinal distress - Mild headache - Muscle tics - Blurred vision

- Gastrointestinal distress

A nurse is talking with the husband of a female client diagnosed with Alzheimer's disease. During the conversation, the husband tells the nurse that "she often begins to scream and curse for no apparent reason." The nurse interprets this as which of the following? - Hypersexuality - Disinhibition - Hypervocalization - Apathy

- Hypervocalization

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? - Orientation to time - Inability to recognize familiar objects - Diminished executive functioning - Restricted judgement

- Inability to recognize familiar objects

While reviewing the medical record of a client with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type? - Atypical antipsychotic - Cholinesterase inhibitor - NMDA receptor antagonist - Benzodiazepine

- NMDA receptor antagonist

A client is brought to the emergency department by his wife. The wife states that over the past few hours, the client has become disoriented and confused. "He didn't know where he was and did't seem to recognize me or be able to carry on a coherent conversation." The nurse suspects delirium. When reviewing the client's medication history with the wife, which of the following medications would alert the nurse to a potential cause? Select all that apply. - Propranolol - Acetaminophen -Diphenhydramine - Verapamil - Quinidine

- Propranolol - Diphenhydramine - Quinidine

While a nurse is caring for a hospitalized client in the advanced stages of Alzheimer's disease, the client begins to have a catastrophic reaction to feeding himself. Which of the following should the nurse do first? - Remain calm and reassuring - Restrain the client temporarily - Draw the curtains to darken the room - Offer to feed the client

- Remain calm and reassuring