Practice Questions Chapter 10

An older patient who just celebrated an 85th birthday comes into the emergency department with a fractured arm and bruises over the chest and back. The nurse suspects the patient is a victim of physical abuse. Which individuals will the nurse specifically assess the patient as being the abuser? Select all that apply. 1. Spouse 2. Nephew 3. Granddaughter 4. Next door neighbor 5. Adult daughter caregiver

1,2,3,5 Spouses account for 11.3% of abuse cases. Family members account for 21.5% of abuse cases. Family members account for 21.5% of abuse cases. The typical abuser is an adult child, accounting for 32.6% of abuse cases.

Primary prevention of elder mistreatment is a healthcare goal. The nurse recognizes that one of the risk factors often present in elder mistreatment situations is: 1. Male gender. 2. History of domestic violence. 3. Caregiver independence. 4. Elder abandonment.

2. History of domestic violence. Rationale: A characteristic of elder mistreatment includes a history of domestic violence. Females are more likely than males to become victims of elder mistreatment. Home care is not a risk factor for mistreatment. Caregiver independence is not related to mistreatment of the elderly. Elders who have minimal family support may feel abandoned.

The nurse is caring for a patient who has been the victim of elder abuse by her son. According to the situational violence theory of elder mistreatment, which situation would have occurred? 1. The son is unemployed. 2. The care of the patient has overwhelmed the son. 3. The patient sent the son to live at boarding school. 4. The son witnessed several young boys being beat up in the neighborhood.

2. The care of the patient has overwhelmed the son. The situational violence theory suggests that elder mistreatment is thought to be a result of the caregiver becoming overwhelmed by the care the patient requires.

Which patients seen by a nurse working in the emergency department identify a situation that suggests a case of elder mistreatment? 1. An 86-year-old patient who has three dime-size burned areas on the upper inner thigh 2. A 77-year-old patient who fell at home after tripping over the dog and broke an arm about 30 minutes earlier 3. A 73-year-old patient with a history of gastric ulcers who is found to be anemic after vomiting blood 3 hours earlier 4. An 85-year-old patient who has several small areas of bruising on the back of the hands and is taking medication for platelets and coagulation

1. An 86-year-old patient who has three dime-size burned areas on the upper inner thigh The patient who has skin burns suggestive of cigarette burns in an area normally covered by clothing is suggestive of abuse.

The adult daughter of an older patient is researching viable skilled facilities to have the patient admitted for long-term care needs. This research has not revealed much information about institutional abuse. Why is this information not readily available to the daughter? Select all that apply. 1. Residents may fear retribution. 2. Managers fear adverse publicity. 3. Staff members fear losing their jobs. 4. Family members fear having to find a new agency for the patient. 5. Billing department members fear not getting paid for services provided to patients.

1,2,3,4 A federal report revealed large delays in the reporting of incidents of elder mistreatment in nursing homes. One reason for this delay is that residents may fear retribution if they report the abuse. A federal report revealed large delays in the reporting of incidents of elder mistreatment in nursing homes. One reason for this delay is that the managers of the facilities may fear adverse publicity about the abuse. A federal report revealed large delays in the reporting of incidents of elder mistreatment in nursing homes. One reason for this delay is that staff members may fear losing their jobs if they report abuse of residents. A federal report revealed large delays in the reporting of incidents of elder mistreatment in nursing homes. One reason for this delay is that families may fear having to find a new agency for the patient.

In which situations is institutional mistreatment of older patients most likely to occur? Select all that apply. 1. Staff burnout 2. Staffing shortage 3. Patient aggressiveness 4. Inadequate staff training 5. Family members frequently visit

1,2,3,4 Staff burnout may be a precipitating factor in the mistreatment of nursing home residents. Staffing shortages may be a precipitating factor in the mistreatment of nursing home residents. Patient aggressiveness was found to be a predictor of physical and psychological abuse by staff members. Inadequate staff training may be a precipitating factor in the mistreatment of nursing home residents. Frequent family visits are not identified as being a precipitating factor in the mistreatment of nursing home residents.

An older patient has been brought into the emergency department with injuries caused by suspected physical abuse. Which tools could the nurse use to assess this patients injuries? Select all that apply. 1. Indicators of abuse screen 2. AMA assessment protocol 3. Adult protective services report 4. Brief abuse screen for the elderly 5. Hwalek-Sengstock elder abuse screening test

1,2,4,5 The indicators of abuse screen is a 29-item set of indicators for use by social service agency practitioners to identify elder mistreatment. The AMA assessment protocol is a checklist used if abuse is suspected. Adult protective services do not use a specific format. Intake forms are used to document calls of suspected elder mistreatment from public hotlines and state agencies. The brief abuse screen for the elderly asks five standard questions that focus on abuse. The Hwalek-Sengstock elder abuse screening test is one 15-item assessment screen for detecting suspected elder abuse and neglect.

The daughter of an older patient who is a resident of a nursing home suspects the patient is a victim of abuse. What should the nurse suggest that the daughter do about this situation? Select all that apply. 1. Visit the facility at varied times. 2. Do nothing until evidence is obtained. 3. Realize that the patient can be confused. 4. Participate in the residents council. 5. Actively participate in care plan meetings.

1,4,5 For the older adult living in long-term care facilities, the California Advocates for Nursing Home Reform recommend that family should visit the facility at varied times. The nurse should not recommend that the daughter do nothing about the situation until evidence is obtained. The older patient could be drastically harmed. There is no evidence that the older patient is confused. The nurse should not make this recommendation to the daughter. For the older adult living in long-term care facilities, the California Advocates for Nursing Home Reform recommend that the family participate in the residents council. For the older adult living in long-term care facilities, the California Advocates for Nursing Home Reform recommend that the family actively participate in care plan meetings for the older patient.

Mistreatment that occurs in long-term-care facilities and that is directed toward the elderly is often due to: Select all that apply. 1. Inadequate education of staff concerning the needs of the elderly resident. 2. Low wages of the nursing assistants. 3. Staff's lack of interest in the elderly as individuals. 4. Heavy workloads of the facility staff.

1. Inadequate education of staff concerning the needs of the elderly resident. 4. Heavy workloads of the facility staff. Individuals who have few skills and inadequate education in the complex care needs of the elderly, along with accompanying low wages and heavy workloads, may mistreat the elderly out of simple frustration. Interest level in the needs of the elderly client has not been implicated.

The nurse suspects that a home health aide who comes into the home every day to provide basic hygiene care is abusing an elderly client. What is the best way to initially gather more information about the situation to confirm suspicions of abuse? 1. Interview the client in private. 2. Confront the caregiver about suspicions. 3. Contact the home health aide's employer. 4. Request the police perform an investigation.

1. Interview the client in private. Rationale: The best method of getting information is to interview the client in a private setting. Depending on the responses of the client, the nurse can develop a plan about how to proceed. The nurse may then consult the family or involve a social services agency. Notification of the authorities or the home health aide's employer may take place after the initial collection of information.

Categories of elder mistreatment include which of the following? Choose all that apply. 1. Psychological/emotional abuse 2. Substance abuse 3. Abandonment 4. Caregiver strain 5. Under medicating

1. Psychological/emotional abuse 3. Abandonment Rationale: Caregiver strain and substance abuse often are contributing factors in elder abuse cases. However, they are not categories or types of elder abuse. Psychological abuse is a type of harm or risk of serious harm that includes intentional actions such as demeaning or threatening an older person who is dependent on a caregiver for some of their basic needs. Abandonment is defined as desertion or willful forsaking of providing for the safety and basic needs of a dependent, frail elder. Undermedicating an elderly person is a possible sign of neglect.

An older patient lives alone and has not bathed or changed clothing for several days. An investigator for adult protective services visits and determines this patient is experiencing which type of elder mistreatment? 1. Self-neglect 2. Physical abuse 3. Psychological abuse 4. Financial exploitation

1. Self-neglect Self-neglect occurs when mentally competent patients engage in behaviors that threaten their own safety and well-being. Failure to maintain proper hygiene practices falls into this category of elder mistreatment. Physical abuse is the intentional infliction of physical injury or pain. Psychological abuse involves the infliction of anguish or emotional abuse. Financial exploitation is taking advantage of an older person for monetary or personal benefit.

Which laboratory studies would the nurse anticipate the need for in potential cases of elder abuse? Choose all that apply. 1. Total protein and albumin 2. Chemistry studies (including sodium) 3. Thyroid Stimulating Hormones (TSH) and T4 4. Vitamin B12 and folate 5. Liver function tests

1. Total protein and albumin 2. Chemistry studies (including sodium) 3. Thyroid Stimulating Hormones (TSH) and T4 4. Vitamin B12 and folate Rationale: Signs of dehydration and malnutrition, especially in the absence of disorders that would commonly cause these problems, increase the suspicion for elder mistreatment. Thyroid abnormalities are commonly seen with aging, but are not indicative of neglect or abuse.

An emergency room nurse is caring for an older patient brought in by a neighbor. The neighbor states that the patient lives with a son who drinks a lot. What does the nurse assess that suggests elder neglect? Select all that apply. 1. Thick, yellow fingernails 2. Pressure ulcer on the sacrum 3. Dry, cracked lips and tongue 4. Small skin tears to the right elbow 5. Cracked, dry skin on the lower legs bilaterally

2,3 Thick, yellow fingernails could be an expected finding in an older patient and not indicative of neglect. A pressure ulcer on the sacrum is a manifestation of caregiver neglect. Common signs and symptoms of neglect include dehydration, which would be manifested as dry, cracked lips and tongue. Small skin tears to the right elbow do not necessarily indicate caregiver neglect and could have occurred during routine activities in the home. Cracked dry skin on both lower legs does not necessarily indicate caregiver neglect. This could be an expected finding in an older patient.

The home healthcare nurse is preparing an educational program for other healthcare providers regarding elder abuse. What information should the nurse include? Select all that apply. 1. The typical abuser is the spouse. 2. The typical abuser is the adult child. 3. The typical elder who is abused is a woman. 4. The majority of abuse occurs in the home setting. 5. The majority of abuse occurs in the long-term care setting.

2,3,4 Spouses account for only 11.3% of abuse. Adult children account for 32.6% of abuse. The typical older person who is abused is a Caucasian woman. The vast majority of abuse and neglect occurs in the domestic setting. Although institutional abuse can occur, the vast majority of abuse occurs in the home setting.

During a home visit, the nurse is concerned that an older patient is experiencing caregiver neglect. What did the nurse assess in this patient? Select all that apply. 1. Agitation 2. Listlessness 3. Dry, cracked skin 4. Bruises on both arms 5. Skin irritation on both inner thighs

2,3,5 Listlessness is a manifestation of caregiver neglect. Dry, cracked skin could indicate dehydration, which is a manifestation of caregiver neglect. Skin irritation on both inner thighs could indicate urine burns, which is a manifestation of caregiver neglect.

An older patient is accompanied to a physicians office visit with an adult daughter who walks with an assistive device. The older patient is hard of hearing, has osteoarthritis, and has difficulty completing activities of daily living. Which nursing diagnosis would the nurse identify as being the priority at this time? 1. Social isolation 2. Caregiver role strain 3. Ineffective protection 4. Situational low self-esteem

2. Caregiver role strain Caregiver role strain is the priority since the daughter walks with an assistive device and needs to help the older patient who is hard of hearing, has osteoarthritis, and has difficulty completing activities of daily living. The daughter may become stressed with having to help the older patient as well as herself with care needs.

When a nurse determines with a high degree of confidence that an elderly home-bound client has been mistreated, an appropriate intervention would be: 1. Arranging for police surveillance of the home. 2. Consulting with the physician about admission to the hospital for a thorough assessment of the client. 3. Interrogating the primary caregivers. 4. Waiting until a social services agency completes an investigation before developing a plan.

2. Consulting with the physician about admission to the hospital for a thorough assessment of the client. Rationale: It is appropriate to admit a client to the hospital for a thorough assessment in a safe environment and serves as an immediate way to remove the client from the situation. Social services will conduct an investigation, but the nurse has a responsibility to formulate a plan of care for the client. The caregiver may or may not be responsible for the abuse so it would not be appropriate for the nurse to interrogate the caregiver. Police surveillance is not done for suspected mistreatment.

What will the nurse keep in mind when documenting the suspected abuse of an older patient? 1. Photo documentation is not usually included as part of the documentation. 2. Documentation should include objective data of the older patients reaction when the suspected abuser is present. 3. It is important to include the nurses personal opinion of the suspected abuser and the nurses prior experience in similar cases. 4. The details of the documentation should not be reported to the adult protective services; it is important that they come to an independent conclusion about the issue of abuse.

2. Documentation should include objective data of the older patients reaction when the suspected abuser is present. Older adults who appear fearful when in the presence of a suspected abuser will need careful assessment as this may be a warning sign of mistreatment. Physical indicators of elder mistreatment that are clearly described will assist interdisciplinary members with diagnosis as well as with planning goals of patient care.

An older patient is being abused by family members in the home and asks about adult protective services. What should the nurse explain about these services? 1. They punish persons who abuse the elderly. 2. They provide services to protect older people who may be abused or neglected. 3. They provide a way to permanently keep the older patient separated from the abuser. 4. They place older patients who cannot adequately care for themselves in nursing homes.

2. They provide services to protect older people who may be abused or neglected. Adult protective services (APS) programs are social services organized to protect vulnerable older adults who may be abused, neglected, or exploited.

Which of the following is categorized on the Elder Abuse Instrument (EAI) as possible indicators of neglect? Choose all that apply: 1. Bruises at various stages of healing 2. Urine burns 3. Decubiti 4. Fractures 5. Malnutrition

2. Urine burns 3. Decubiti Rationale: Urine burns and decubiti are listed as possible indicators of neglect; bruises at any stage or fractures and malnutrition are listed as possible abuse indicators.

An older patient is accompanied by an adult daughter who is the patients primary caregiver for a routine clinic visit. While in the waiting room, the adult daughter is observed sitting quietly and not talking with the patient. During the examination, what should the nurse assess the adult daughter for? Select all that apply. 1. Employment 2. Physical status 3. Caregiver stress 4. Substance abuse 5. History of psychopathology

3,4,5 Caregivers of older adults should be assessed at each primary care visit for caregiver stress, substance abuse, and a history of psychopathology.

An older patient tearfully tells a nurse that she must buy the neighbors groceries or the neighbor will not drive the patient to the store. The nurse recognizes this situation as being which type of elder mistreatment? 1. Abuse 2. Neglect 3. Exploitation 4. Abandonment

3. Exploitation Elder mistreatment by exploitation involves the abuser taking advantage of the older person for monetary or personal benefit. This is the case in which the older patient is being coerced to buy the neighbors groceries.

The nurse is concerned that specific families in a community are at increased risk for transgenerational violence. Which family situation exemplifies the transgenerational theory of violence? 1. Family with a daughter who abuses alcohol 2. Family with a daughter who has severe arthritis and finds it increasingly difficult to deal with her forgetful, frail mother 3. Family with a son who, as a teenager and young adult, had serious arguments with his parents, who were emotionally abusive to him 4. Family with a daughter who is working two jobs with significant debts and cares for her father, who is becoming more confused and dependent

3. Family with a son who, as a teenager and young adult, had serious arguments with his parents, who were emotionally abusive to him The theory of transgenerational violence involves a continuum of family violence. A child grows up in a home where a contentious family relationship and some form of abuse is the norm. The child who was abused grows up and later becomes aggressive and abusive to the elderly parent.

The home care nurse is preparing to visit an older female patient who lives in her sons home. Prior to the visit, which risk factors for elder abuse will the nurse review? 1. Male gender 2. Hispanic race 3. Impaired cognitive status 4. High socioeconomic status

3. Impaired cognitive status Cognitive impairment is a risk factor for elder abuse.

The nurse is concerned that an older patient is at risk for abuse because the patient lives with an adult son who is an alcoholic. Which theory of elder mistreatment is this nurse basing this concern for the patient? 1. Isolation 2. Situational 3. Psychopathology 4. Transgenerational

3. Psychopathology In the psychopathological theory of elder abuse, caregivers who have preexisting conditions may have impaired capacity to give appropriate care, such as a caregiver with alcohol dependency may not be able to exercise appropriate judgment in caregiving of an older adult, which can ultimately lead to abuse or neglect.

The nurse is caring for an older patient who has been the victim of elder abuse by an adult son. According to the transgenerational violence theory of elder mistreatment, which situation would have occurred with the patient? 1. The son is an alcoholic. 2. The care of the patient has overwhelmed the son. 3. The patient was abusive to the son when he was a child. 4. As a child, the son witnessed the father beating the mother.

3. The patient was abusive to the son when he was a child. The transgenerational violence theory suggests that elder mistreatment is thought to be part of the family violence continuum. It begins with child abuse and ends with elder abuse.

Which of the following statements made to the nurse by an elderly person would be most likely to raise suspicion of potential abuse or neglect? 1. "I'm ready to go when God takes me." 2. "Life just doesn't have the same meaning to me since my wife died." 3. "I don't feel like there's much reason to go on." 4. "It's not the best situation for me, but I don't know what my son and his wife would do if they couldn't live with me."

4. "It's not the best situation for me, but I don't know what my son and his wife would do if they couldn't live with me." Rationale: Statements relating to feelings of loss, grief, or even depression are often made by the elderly, but are not indicators of abuse. A statement expressing dissatisfaction with living conditions involving potential for financial exploitation should be investigated further.

Which older patient is at greatest risk for mistreatment in the home? 1. An active older patient with well-controlled diabetes who lives alone 2. A healthy older patient who is retired from owning a business and lives with an adult son 3. An older patient with a history of coronary bypass surgery, is active, and lives with the spouse 4. An older patient with severe osteoarthritis and macular degeneration who lives with a single daughter who has an adult son with cerebral palsy

4. An older patient with severe osteoarthritis and macular degeneration who lives with a single daughter who has an adult son with cerebral palsy Risk factors for elder mistreatment include being female, over the age of 75, having a dependent functional status, having a poor social network, poverty, minority, cognitive impairment, and having less than an 8th grade education. An older patient with severe osteoarthritis and macular degeneration who lives with a single daughter who has a son with a health problem is at the greatest risk for mistreatment in the home.

The nurse suspects that an older patient has been physically abused. What must be included in the medical workup for this patient? 1. Pelvic examination 2. Toxicological screening 3. Complete blood count and blood chemistries 4. Complete visual examination with clothing removed

4. Complete visual examination with clothing removed If you suspect elder mistreatment or abuse, a complete visual examination of the older person without clothing is necessary. Abusers may strike where clothing hides the resulting bruises. You can protect privacy by assessing the older persons body one area at a time from head to toe.

A visitor to a long-term care institution witnesses an attendant scolding a patient with dementia about being incontinent. What type of abuse is the visitor witnessing? 1. Neglect 2. Exploitation 3. Caregiver burnout 4. Psychological abuse

4. Psychological abuse A caregiver who scolds and ridicules a patient who is unable to care for him- or herself is committing psychological abuse by inflicting anguish and psychological pain.

A nurse who plans to do research on caregiver strain in spouses of homebound elderly with cognitive impairment due to dementia is most likely to choose which theory of elder mistreatment to guide the study? 1. Social isolation theory 2. Exploitation theory 3. Transgenerational violence theory 4. Situational theory

4. Situational theory Rationale: Situational theory examines the burdens of caregiving and the ability of the caregiver to meet the needs and demands of the elderly individual. Mistreatment may result when the situation becomes overwhelming for the caregiver. The other theories do not relate to caregiver strain.

Which of the following situations could be the source of an ethical dilemma for the nurse with respect to elder mistreatment? 1. The elderly person is not competent to make decisions. 2. The elderly person shows only minimal injuries from the abuse. 3. The family sues the nurse for reporting abuse. 4. The elderly person decides to return to the abusive setting.

4. The elderly person decides to return to the abusive setting Rationale: The nurse recognizes an ethical dilemma is posed when a competent adult chooses to return to the setting in which abuse occurred, because there is a high likelihood of abuse being repeated. The elderly person who is not competent will not be allowed to make decisions about the living situation. Injury is not a source of an ethical dilemma, nor is legal action taken against a nurse.

An older patient with a black eye is diagnosed with a broken arm that is reported as being caused by falling on a shovel while clearing snow from a walkway. Why should the nurse suspect physical abuse with this patient? 1. The patient is confused. 2. The patient is 65 years old. 3. The patient is African American. 4. The patients testing results are inconsistent with the history given.

4. The patients testing results are inconsistent with the history given. One sign of elder mistreatment includes diagnostic testing results inconsistent with the history given.

An elderly person reports all of the following experiences to the nurse. Which of the reported experiences is the most likely indicator of exploitation of the elderly person? 1. The client is not allowed to attend highly anticipated family events. 2. The client is being threatened with admission to a nursing home. 3. Family members rarely visit. 4. There is not any money available to purchase personal hygiene products.

4. There is not any money available to purchase personal hygiene products. Rationale: When the elderly are exploited, others take advantage of them, almost always with respect to money matters. The exploiters may or may not be family members. Failure to visit or inability to attend family events is not exploitation. Threats may be attempts at coercion but are not exploitation

The home care nurse asks an older patients caregiver to complete a questionnaire regarding caregiver strain. The caregiver states, You are here to see my mom. Why do you need information about me? Which is the most appropriate response by the nurse? 1. We fill out this paperwork for all caregivers. 2. We need to make sure you dont abuse your mother. 3. Its just something that the insurance companies make us fill out. 4. We need information about how you are dealing with caring for your mother. We dont want you to become overwhelmed.

4. We need information about how you are dealing with caring for your mother. We dont want you to become overwhelmed. It has been documented that fewer older adults report mistreatment by family members, which may be a protective act. Caregivers of older adults should be assessed at each primary care visit for caregiver stress, substance abuse, and a history of psychopathology. The Modified Caregiver Strain Index has been recommended by the Hartford Institute of Geriatric Nursing as the best practice in the nursing care of older adults. This instrument is a valid and reliable screening tool and can identify caregivers in need of support.