TEST BANK CHAPTER 28 OLDER ADULTS VARCAROLIS ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NUR, Exams of Advanced Education

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TEST BANK CHAPTER 28 OLDER ADULTS

VARCAROLIS ESSENTIALS OF PSYCHIATRIC

MENTAL HEALTH NURSING A

COMMUNICATION APPROACH TO EVIDENCE-

BASED CARE

A student nurse visiting a senior center tells the instructor, "It's so depressing to see all these old people. They are so weak and frail. They are probably all confused." The student is expressing what attitude? a. Reality b. Ageism c. Empathy d. Distrust b. Ageism Ageism is defined as a bias against older people because of their age. None of the other options can be identified from the ideas expressed by the student. A community mental health nurse plans an educational program for staff members at a home health agency that specializes in the care of older adults. What topic is of high priority? a. Identifying depression in older adults b. Providing cost-effective foot care for older adults c. Identifying nutritional deficiencies in older adults d. Psychosocial stimulation for those who live alone a. Identifying depression in older adults Which is the best statement for a nurse to use when beginning an interview with an older adult patient? a. "Hello, [call patient by first name]. I am going to ask you some questions to get to know you better." b. "Hello. My name is [nurse's name]. I am a nurse. Please tell me how you would like to be addressed by the staff." c. "I am going to ask you some questions about yourself. I would like to call you by your first name if you don't mind." d. "You look as though you are comfortable and ready to participate in an admission interview. Shall we get started?" b. "Hello. My name is [nurse's name]. I am a nurse. Please tell me how you would like to be addressed by the staff." A 75-year-old patient comes to the clinic reporting frequent headaches. After an introduction at the beginning of the interview, what should the nurse address? a. Initiate a neurological assessment.

b. Assess if the patient can hear the spoken word clearly. c. Suggest that the patient lie down in a darkened room to rest. d. Administer medication to relieve the patient's pain prior to the assessment. b. Assess if the patient can hear the spoken word clearly. Before proceeding, the nurse should assess the patient's ability to hear questions. Hearing ability often declines with age. Impaired hearing could lead to inaccurate answers. The nurse should not administer medication (an intervention) until after the assessment is complete. Which statement about aging provides the best rationale for focused assessment of older adult patients? a. Older adults are often socially isolated and lonely. b. As people age, they become more rigid in their thinking. c. The majority of older adults sleep more than 12 hours per day. d. The senses of vision, hearing, touch, taste, and smell decline with age. d. The senses of vision, hearing, touch, taste, and smell decline with age. A nurse asks the following questions while assessing an older adult. The nurse will add the Geriatric Depression Scale as part of the assessment if the patient answers "yes" to which question? a. "Would you say your mood is often sad?" b. "Are you having any trouble with your memory?" c. "Have you noticed an increase in your alcohol use?" d. "Do you often experience moderate-to-severe pain?" a. "Would you say your mood is often sad?" A 78-year-old nursing home resident diagnosed with hypertension and cardiac disease is usually alert and oriented. This morning, however, the resident says, "My family visited during the night. They stood by the bed and talked to me." In reality, the patient's family lives 200 miles away. The nurse should first suspect what as the trigger for the resident's experience? a. A side effects associated with medications. b. Early Alzheimer's disease associated with advanced age. c. A transient ischemic attack and developed sensory perceptual alterations. d. Previously unidentified alcohol abuse and is beginning alcohol withdrawal delirium a. A side effects associated with medications. A health care provider writes these new prescriptions for a resident in a skilled care facility: "2 g sodium diet; restraint as needed; limit fluids to 2000 mL daily; 1 dose milk of magnesia 30 mL orally if no bowel movement occurs for 3 days." Which prescription should the nurse question? a. Restraint b. Fluid restriction c. Milk of magnesia d. Sodium restriction

a. Restraint Restraints may be applied only on the written order of the health care provider that specifies the duration during which the restraints can be used. The Joint Commission guidelines and Omnibus Budget Reconciliation Act regulations also mandate a number of other conditions that must be considered and documented before restraints are used. The other orders may be appropriate for implementation. If an older adult patient must be physically restrained, who is responsible for the patient's safety? a. Nurse assigned to care for the patient. b. Nursing assistant who applies the restraint. c. Health care provider who ordered the application of the restraint. d. Family member who agrees to the application of the restraint. a. Nurse assigned to care for the patient. An older adult patient brings a bag of medication to the clinic. The nurse finds one bottle labeled "Ativan" and one labeled "lorazepam," and both are labeled "Take two times daily." Bottles of hydrochlorothiazide, Inderal, and rofecoxib, each labeled "Take one daily," are also included. Which conclusion is accurate? a. Rofecoxib should not be taken with Ativan. b. The patient's blood pressure is likely to be very high. c. This patient should not self-administer any medication. d. Lorazepam and Ativan are the same drug; consequently, the dose is excessive d. Lorazepam and Ativan are the same drug; consequently, the dose is excessive Lorazepam and Ativan are generic and trade names for the same drug, creating an accidental overdose situation. The patient needs medication education and help with proper, consistent labeling of bottles. No evidence suggests that the patient is unable to self-administer medication. The distractors are not factual statements. An advance directive gives valid direction to health care providers when a patient is demonstrating what characteristic? a. Aggression b. Dehydration c. Ineffective verbally communicate d. Unable to make health care decisions d. Unable to make health care decisions Advance directives are invoked when patients are unable to make their own decisions. Aggression, dehydration, or an inability to speak does not mean the patient is unable to make a decision.

A patient asks the nurse, "I already have a living will. Why should I have a durable power of attorney for health care also?" The nurse should provide what as the truth related to a durable power of attorney for health care? a. It gives your agent the authority to make decisions about your care if you are unable to during any illness. b. It can be given only to a relative, usually the next of kin, who has your best interests at heart. c. It authorizes your physician to make decisions about your care that are in your best d. It can be used only if you have a terminal illness and become incapacitated. a. It gives your agent the authority to make decisions about your care if you are unable to during any illness. Recognizing the risk for acquired immunodeficiency syndrome (AIDS) among older adults, nurses should provide health teaching focused on what? a. Discouraging sexual expression b. Using birth control measures c. Avoiding blood transfusions d. Encouraging condom use d. Encouraging condom use A 79-year-old white man tells a visiting nurse, "I've been feeling sad lately. My family and friends are all dead. My money is running out, and my health is failing." How should the nurse analyze this comment? a. Normal negativity of older adults b. Evidence of suicide risk c. A cry for sympathy d. Normal grieving b. Evidence of suicide risk The patient describes the loss of significant others, economic insecurity, and declining health. He describes mood alteration and expresses the thought that he has little to live for. Combined with his age, sex, and single status, each is a risk factor for suicide. Older adult white men have the highest risk for completed suicide. A patient tells the nurse of the recent deaths of a spouse of 50 years as well as an adult child in an automobile accident. The patient has no other family and only a few friends in the community. What is the priority nursing diagnosis? a. Spiritual distress, related to being angry with God for taking the family b. Risk for suicide, related to recent deaths of significant others c. Anxiety, related to sudden and abrupt lifestyle changes d. Social isolation, related to loss of existing family b. Risk for suicide, related to recent deaths of significant others

When making a distinction as to whether a patient is experiencing confusion related to depression or dementia, what information would be most important for the nurse to consider? a. The patient with dementia is persistently angry and hostile. b. Early morning agitation and hyperactivity occur in dementia. c. Confusion seems to worsen at night when dementia is present. d. A patient who is depressed is preoccupied with somatic symptoms. c. Confusion seems to worsen at night when dementia is present. Both dementia and depression in older adults may produce symptoms of confusion. Noting whether the confusion seems to increase at night, which occurs more often with dementia than with depression, will help distinguish whether depression or dementia is producing the confused behavior. The other options are not necessarily true. An 80-year-old patient has difficulty walking because of arthritis and says, "It's awful to be old. Every day is a struggle. No one cares about old people." Which is the nurse's most therapeutic response? a. "Everyone here cares about old people. That's why we work here." b. "It sounds like you're having a difficult time. Tell me about it." c. "Let's not focus on the negative. Tell me something good." d. "You are still able to get around, and your mind is alert." b. "It sounds like you're having a difficult time. Tell me about it." A 74-year-old patient is regressed and apathetic. This patient responds to others only when they initiate the interaction. Which therapy would be most useful to promote resocialization? a. Medication b. Re-motivation c. Group psychotherapy d. Individual psychotherapy b. Re-motivation Re-motivation therapy is designed to re-socialize patients who are regressed and apathetic by focusing on a single topic, creating a bridge to reality as group members talk about the world in which they live and work, and hobbies related to the topic. Group leaders give group members acceptance and appreciation. A clinic nurse interviews four patients between 70 and 80 years of age. Which patient should have further assessment regarding the risk of alcohol addiction? a. One with a history of intermittent problems of alcohol misuse early in life and who now consumes one glass of wine nightly with dinner. b. One with no history of alcohol-related problems until age 65 years, when the patient began to drink alcohol daily "to keep my mind off my arthritis." c. One who drank socially throughout adult life and continues this pattern, saying, "I've earned the right to do as I please."

d. One who abused alcohol between the ages of 25 and 40 years but now abstains and occasionally attends Alcoholics Anonymous. b. One with no history of alcohol-related problems until age 65 years, when the patient began to drink alcohol daily "to keep my mind off my arthritis." A tricyclic antidepressant is prescribed for an older adult patient diagnosed with major depressive disorder. Nursing assessment should include careful collection of information regarding what focus? a. Use of other prescribed medications and over-the-counter products b. Evidence of pseudoparkinsonism or tardive dyskinesia c. A history of psoriasis and any other skin disorders d. A current immunization status a. Use of other prescribed medications and over-the-counter products Drug interactions, with both prescription and over-the-counter products, can be problematic for the geriatric patient taking tricyclic antidepressant medications. Careful collection of information is important. The incorrect options do not pose problems with tricyclic antidepressant medications An older adult with a history of major depressive disorder has taken an antidepressant daily for 3 years. The patient tells the nurse, "I want to stop taking this medication. I don't think I need it anymore." What is the nurse's best response to assure safety the patient's safety? a. "Why do you think you don't need this medication anymore?" b. "Have you talked with your family members about this decision?" c. "If you stop the medication, your depression will return worse than ever." d. "This medication should be gradually stopped. Let's talk to your health care provider about a plan." d. "This medication should be gradually stopped. Let's talk to your health care provider about a plan." When admitting older adult patients, health care agencies receiving federal funds must provide written information about what topic? a. Advance health care directives b. The financial status of the institution c. How to sign out against medical advice d. The institution's policy on the use of restraints a. Advance health care directives The Patient Self-Determination Act of 1990 requires that patients have the opportunity to prepare advance directives. None of the distractors are addressed by this Act. What is the highest priority for assessment by nurses caring for older adults who self-administer medications? a. Use of multiple drugs with anticholinergic effects b. Overuse of medications for erectile dysfunction

c. Misuse of antihypertensive medications d. Trading medications with others a. Use of multiple drugs with anticholinergic effects Anticholinergic effects are cumulative in older adults and often have adverse consequences related to accidents and injuries. The incorrect options may be relevant but are not of the highest priority. A nurse and social worker co-lead a reminiscence group for six "baby boomer" adults. Which activity is appropriate to include in the group? a. Post-World War II music b. Learning to send and receive email c. Discussing national leadership during the Vietnam War d. Identifying the most troubling story in today's newspaper a. Post-World War II music A nurse wants to perform a preliminary assessment for suicidal ideation in an older adult patient. Which question would obtain the desired data? a. "What thoughts do you have about a person's right to take his or her own life?" b. "If you felt suicidal, would you communicate your feelings to anyone?" c. "Do you have any risk factors that potentially contribute to suicide?" d. "Do you think you are vulnerable to developing a depressed mood?" a. "What thoughts do you have about a person's right to take his or her own life?" We have an expert-written solution to this problem! A nurse and social worker co-lead a reminiscence group for eight adults aged 65 to 70. Which activity is most appropriate to include in the group? a. Singing a song from World War II b. Learning how to join an online social network c. Discussing national leadership during the Vietnam War d. Identifying the most troubling story in today's newspaper c. Discussing national leadership during the Vietnam War "Young-old" adults are persons 65 to 74 years of age. These adults were attuned to conflicts in national leadership associated with the Vietnam War. Reminiscence groups share memories of the past. Learning how to join a social network would not be an aspect of reminiscence. Singing a song from World War II is more appropriate for an elite old reminiscence group. The other incorrect option is less relevant to this age group.

A nurse leads a staff development session about ageism among health care workers. What information should the nurse include about the consequences of ageism? (Select all that apply.) a. Failure of older adults to receive necessary medical information b. Development of public policy that favors programs for older adults c. Staff shortages because caregivers prefer working with younger adults d. Perception that older adults consume a small share of medical resources e. More ancillary than professional personnel discriminate with regard to age a. Failure of older adults to receive necessary medical information c. Staff shortages because caregivers prefer working with younger adults Which beliefs facilitate provision of safe, effective care for older adult patients? (Select all that apply.) a. Sexual interest declines with aging. b. Older adults are able to learn new tasks. c. Aging results in a decline in restorative sleep. d. Older adults are prone to become crime victims. e. Older adults are usually lonely and socially isolated. b. Older adults are able to learn new tasks. c. Aging results in a decline in restorative sleep. d. Older adults are prone to become crime victims. A nurse assessing an older adult patient for depression should include questions about mood as well as which other symptoms? (Select all that apply.) a. Increased appetite b. Sleep pattern changes c. Anhedonia and anergia d. Increased social isolation e. Increased concern with bodily functions b. Sleep pattern changes c. Anhedonia and anergia d. Increased social isolation e. Increased concern with bodily functions These symptoms are often noted in older adult patients experiencing depression. Somatic symptoms are often present but are missed by nurses as being related to depression. Anorexia, rather than polyphagia (increased eating), is observed in major depressive disorder. Low self-esteem is more often associated with major depressive disorder. An older patient reports drinking a six-pack of beer daily. The patient tells the community health nurse, "I've been having trouble with my arthritis lately, so I take acetaminophen four times a day for pain." What are the nurse's priority interventions? (Select all that apply.) a. Inquiring about sleep disturbances caused by mixing alcohol and analgesic medications b. Determining the safety of the daily acetaminophen dose the patient is ingesting

c. Advising the patient of harmful effects of alcohol and acetaminophen on the liver d. Suggesting an increase in the acetaminophen dose because alcohol produces faster excretion e. Assessing the patient for declining functional status associated with medication-induced dementia b. Determining the safety of the daily acetaminophen dose the patient is ingesting c. Advising the patient of harmful effects of alcohol and acetaminophen on the liver A nurse caring for an older adult patient population should be familiar with which legal and ethical issues that are common concerns for this group? (Select all that apply.) a. Physical abuse b. Autonomous decision making c. Emotional abuse d. Financial abuse e. Need for medication therapy a. Physical abuse c. Emotional abuse Among the most important of many legal and ethical issues for practicing nurses to be familiar with are the following are decision making about health care and the various forms of elder abuse. Medication therapy does not appear as a common source of concern for this age group.