GERO (VNSG 1126) CH. 11 "Self-Perception and Self-Concept" NCLEX-STYLE QUESTIONS

In today's society, people usually have more negative experiences than positive ones. True or False?

True

The home health nurse caring for older adult patients knows it is most important to closely screen patients for depression who are taking which medications? (Select all that apply.) A) Digoxin (Lanoxin) B) Lisinopril (Prinvil) C) Amitriptyline (Elavil) D) Atorvastatin (Lipitor) E) Venlafaxine (Effexor) F) Oxycodone (Oxycontin)

A) Digoxin (Lanoxin) B) Lisinopril (Prinvil) D) Atorvastatin (Lipitor) F) Oxycodone (Oxycontin) Antiarrhythmics, antihypertensives, antihyperlipidemics, and analgesics are all associated with an increased incidence of depression. Elavil and Effexor are both antidepressants; therefore, the patient has already been diagnosed with depression and screening is unnecessary. They should be assessed for the success of treatment, however.REF: Page 203

The nurse should assess for changes in behavior that are likely to indicate depression such as: (select all that apply.) A) Increased alcohol consumption B) Changes in daily routines C) Agitation and irritability D) Isolation and withdrawal E) More frequent calls to familiy F) Complains of palpitations, trembling, and dry mouth

A) Increased alcohol consumption B) Changes in daily routines C) Agitation and irritability D) Isolation and withdrawal Careful assessment is necessary to recognize problems with depression before they result in other—even more serious—problems. Some changes that warrant further investigation include increased use of alcohol or mood-altering drugs, changes in daily routines, agitation, irritability, isolation, and withdrawal. REF: Page 203

The nurse working in the long term care facility knows which factors of life in the long term care facility can lower the patients' self-esteem? (Select all that apply.) A) Limited meal and snack choices B) Requiring assistance with toileting C) Variety of activities available daily D) Small living areas with limited storage space E) Companionship with others at the same life stage F) Structured meal, medication, and activity schedule

A) Limited meal and snack choices B) Requiring assistance with toileting D) Small living areas with limited storage space F) Structured meal, medication, and activity schedule Structured meal, medication, and activity schedule Reduction of choices, space, and requiring assistance with toileting are factors of life in the nursing facility that can decrease a patient's self-esteem. A variety of activities to choose from and companionship of people from the same stage in life would increase the patient's self-esteem.REF: Page 201

The nurse should recognize what signs of suicide risk in older adults? (Select all that apply.) A) Loss of a spouse or a closed loved one. B) Obsession with clothes and appearance. C) Frequent complaints of physical ailments. D) Giving away possessions to friends and family. E) Dependence on others to care for them. F) A new interest in firearms.

A) Loss of a spouse or a closed loved one. C) Frequent complaints of physical ailments. D) Giving away possessions to friends and family. F) A new interest in firearms. Loss of a spouse can be a trigger for suicidal thoughts. Other signs can include giving away one's possessions and becoming suddenly interested in guns and firearms. Quite often, a person who has committed suicide recently made a visit to a health care provider with complaints of various physical ailments. An increased interest in one's appearance is not associated with suicide risk. REF: Page 210

The nurse is supervising care of a patient with anxiety by an unlicensed assistive personnel. Which action by the UAP in response to the patient's increased anxiety would prompt the nurse to intervene immediately? A) Offering the patient a cup of coffee B) Assisting the patient to a quiet room C) Speaking softly and reassuringly to the patient D) Placing a hand on the patient's arm while speaking

A) Offering the patient a cup of coffee The UAP would be correct to remove the patient to a quiet room, speak softly and reassuringly to the patient, and use gentle touch to calm the patient. Coffee should be avoided as it is a stimulant and may worsen the patient's anxiety.REF: Page 209

How is positive self-esteem promoted in older adults? (select all that apply.) A) Strong personal value B) Supportive family that takes care of everything for the older adult. C) An external ideal goal drawn from society. D) The ability to find motivation through negative feedback from friends and family. E) Good health and wealth.

A) Strong personal value E) Good health and wealth. People with positive self-esteem have strong personal values and believe that they have the ability to control their lives. They have had positive life experiences and have received positive feedback from others. Good health and wealth have a positive effect on self-esteem. REF: Page 200

The older adult patient presents to the clinic for a routine exam. Which characteristic(s) if exhibited by the patient indicates low self-esteem? (Select all that apply.) A) Unshaven face B) Disheveled clothing C) Frequent eye contact D) Strong and unpleasant body odor E) Head held high with a straight back F) Quick and appropriate response to questions

A) Unshaven face B) Disheveled clothing D) Strong and unpleasant body odor Signs of poor self-esteem include unkempt appearance, body odor, slouching, or slumping, and disinterest in the interview questions. Signs of good self-esteem include frequent eye contact, good posture, and well-groomed appearance.REF: Page 201

Older adults have a higher rate of __________ suicides than do other age groups. A) successful B) unintentional C) accidental D) unsuccessful

A) successful

Which is a verbal cue of an older adult experiencing low self-esteem? A) "I need help now." B) "I can't do anything right anymore." C) "I wish I were young again." D) "I can't do things like I used to."

B) "I can't do anything right anymore." Those who have low self-esteem are likely to display certain characteristic behaviors. These individuals are likely to speak of themselves in negative terms. Statements such as "Don't waste your time on me" or "I can't do anything right" are indicative of low self-esteem. REF: Page 205

The nurse and unlicensed assistive personnel (UAP) are preparing to turn in bed a patient who has recently undergone hip replacement surgery. The nurse notes the patient is suddenly tachypneic and diaphoretic with dilated pupils and tensed extremities. What is the best response on the part of the nurse? A) "I'm so sorry; have we angered you in some way?" B) "You seem upset all of a sudden. Please tell me what is bothering you" C) "I will give you a dose of pain medication before we turn you to help with the pain" D) "Please don't worry; we have a very good system for turning patients with injuries like yours"

B) "You seem upset all of a sudden. Please tell me what is bothering you" The nurse should validate the patient's concerns and request an explanation so interventions can be made appropriately. The patient may be in pain, angry, or afraid. The nurse should not assume it is any one of the three without first requesting more information from the patient. The nurse should not tell the patient to not worry as this does not validate the patient's concerns; it also assumes the patient is exhibiting a fear response, which may not be accurate.REF: Page 208

The nurse has conducted an assessment of a new patient who has come to the medical clinic. The 82-year-old patient has had osteoarthritis for 10 years and diabetes mellitus for 20 years. The patient is alert but becomes easily distracted during the nursing history. The patient recently moved to a new apartment, and the patient's pet beagle died just 2 months ago. Which is this patient most likely experiencing? A) Dementia B) Depression C) Delirium D) Disengagement

B) Depression Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation. The symptoms presented by this patient do not indicate dementia, delirium, or disengagement.

Successful aging has sometimes been described as: A) ageism. B) mind over matter. C) great body image. D) being over the hill.

B) mind over matter.

The nurse in the long term care facility knows which patient is likely to have the highest self-esteem? A) 83-year-old patient with mild dementia and 3 estranged children B) 82-year-old patient with a colostomy whose children and grandchildren visit every Sunday C) 86-year-old patient with urge incontinence and diabetes whose husband and daughters visit daily D) 75-year-old widower with diabetes and hypertension whose out-of-state children call on holidays

C) 86-year-old patient with urge incontinence and diabetes whose husband and daughters visit daily Although the patient suffers from incontinence at times, the patient has a strong support system that visits often. Lack of support system in the form of family and friends is very important to self-esteem. Therefore, the patients with estranged children or children who only call on holidays will likely have significantly lower self-esteem than the patients with families that visit daily and weekly. A colostomy can be more detrimental to a patient's self-esteem than occasional urge incontinence.REF: Page 205

When an older adult suffers a major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis, for what should the nurse be alert? A) Dementia B) Delirium C) Depression D) Stroke

C) Depression The onset of depression could be abrupt or gradual, but the usual cause is a major life-altering event in the life of the person experiencing the depression. Delirium is rapid onset and usually has a physiological cause; dementia's onset is slow; and a stroke presents with neurological changes.

The nurse is planning care for a patient who recently underwent surgery for creation of a colostomy. Which goal is most appropriate for the nursing diagnosis of disturbed body image? A) Patient will identify 3 resources for support in one day B) Patient will discuss fears regarding self-care by discharge C) Patient will look at ostomy during a pouch change in two days D) Patient will independently perform ostomy care and pouch change

C) Patient will look at ostomy during a pouch change in two days The biggest indicator of acceptance of body image is the ability to look at and touch a deformity. Therefore, the most appropriate goal for the disturbed body image nursing diagnosis is that the patient will look at the ostomy during a pouch change in two days. A colostomy is a huge physical change and should be expected to require multiple days for acceptance. Although the ability to independently perform ostomy care and pouch change further indicates acceptance, this goal does not have a time frame for completion and may take days or weeks to occur. Discussing fears regarding self-care by discharge and identifying support resources are important goals for this patient but are not the best barometer for acceptance of body image.REF: Page 204

The nurse knows that which patient is most likely to be depressed? A) The 72-year-old patient with diabetes and hypertension who lives at home alone B) The 84-year-old patient hospitalized for sepsis following an untreated urinary tract infection C) The 73-year-old patient who has had his left hip replaced and is a resident of a long term care facility D) The 76-year-old patient with hemiplegia due to a cerebrovascular accident who requires full-time nursing care at home

C) The 73-year-old patient who has had his left hip replaced and is a resident of a long term care facility Residents in long term care facilities have higher depression rates than older adults who are hospitalized or live at home with or without nursing care.REF: Page 203

The nurse is preparing to assist an older adult patient with his activities of daily living. Which approach is most effective for improving the patient's self-esteem? A) "Good morning. Are we ready to get cleaned up and dressed for breakfast?" B) "Good morning, Mr. Smith. It's time to get cleaned up and ready for breakfast now" C) "Hi, honey. I'm here to get you cleaned up and handsome so you can go to breakfast" D) "Good morning, Mr. Smith. Would you like to get cleaned up and ready for breakfast now?"

D) "Good morning, Mr. Smith. Would you like to get cleaned up and ready for breakfast now?" The nurse should address the patient respectively with his surname and ask him if he is ready to get cleaned up for breakfast. It is inappropriate to refer to the older adult patient as "we" instead of "you" as this is disrespectful. Regardless of the nurse's relationship with the patient, the nurse should not refer to the patient as "honey" instead of his given or surname. Lastly, the nurse should avoid telling the patient it is time to get ready instead of offering him the choice.REF: Page 205

The nurse who works with older adult patients in a long term care facility knows which is the best way to promote good self-esteem in her patients? A) Set up the patient's food tray upon delivery B) Keep a structured schedule for the patient's day C) Quickly and efficiently perform the patient's activities of daily living for the patient D) Allow enough time each day for the patient to perform his or her own activities of daily living

D) Allow enough time each day for the patient to perform his or her own activities of daily living Allowing the patient to perform activities of daily living as independently as possible gives the patient a sense of independence and control, which promotes good self-esteem. Setting up the patient's food tray is helpful, but may not take into account his level of need. A structured schedule is especially good for patients with dementia but is not helpful for self-esteem improvement if it is not the schedule the patient wants.REF: Page 201

Which is true of suicide risk in the older adult? A) It is lower and less violent compared to other age groups. B) It is highest in white women over 80 years old with a chronic illness. C) It is increasing, because only 42% of seniors seek treatment for depression. D) It is often triggered by pain, a recent loss, or a stressful event.

D) It is often triggered by pain, a recent loss, or a stressful event. Triggers for suicide can include severe emotional or physical pain or a recent loss or stressful event (such as the diagnosis of a terminal disease). Such triggers are present in a large percentage of those who attempt suicide. REF: Page 203

When assessing an older adult's risk for self-esteem problems, which nursing diagnosis is NOT appropriate? (Select all that apply.) A) Anxiety B) Fear C) Hopelessness D) Reminiscence E) Powerlessness

D) Reminiscence Anxiety, Fear, Hopelessness, and Powerlessness are all appropriate nursing diagnoses for a patient with decreased self-esteem. Reminiscence is not a nursing diagnosis. REF: Page 201

One of the most common fears of older adults is death. True or False?

False