Chapter 31 Older Adults PDF

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Varcarolis' Foundations of Psychiatric-Mental Health Nursing 8th Edition Test Banks...

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VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Chapter 31: Older Adults Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition MULTIPLE CHOICE 1. A student nurse visiting a senior center says, “It’s depressing to see these old people. They are

weak and frail. I doubt any of them can engage in a discussion.” The student is expressing a. reality. b. ageism. c. empathy. d. vulnerability. ANS: B

Ageism is a bias against older people because of their age. None of the other options applies to the ideas expressed by the student. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 31-14 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. A nurse plans an educational program for staff of a home health agency specializing in care of

the elderly. Which topic is the highest priority to include? a. Pain assessment techniques for older adults b. Psychosocial stimulation for those who live alone c. Preparation of psychiatric advance directives in the elderly NURSINGTB.COM d. Ways to manage disinhibition in elderly persons with dementia ANS: A

The topic of greatest immediacy is the assessment of pain in older adults. Unmanaged pain can precipitate other problems, such as substance abuse and depression. Elderly patients are less likely to be accurately diagnosed and adequately treated for pain. The distracters are unrelated or of lesser importance. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 31-9, 10 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity 3. Select the best comment for a nurse to begin an interview with an elderly patient. a. “I am a nurse. Are you familiar with what nurses do?” b. “Hello. I am going to ask you some questions to get to know you better.” c. “You look comfortable and ready to participate in an admission interview. Shall

we get started?” d. “Hello. My name is _______ and I am a nurse. How you would like to be

addressed by staff?” ANS: D

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

The correct opening identifies the nurse’s role and politely seeks direction for addressing the patient in a way that will make him or her comfortable. This is particularly important when a considerable age difference exists between the nurse and the patient. The nurse should address patients by name and not assume patients want to be called by a first name. The nurse should always introduce self. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 31-17, 18, 21, 45 (Box 31-8) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 4. Which information is most important to obtain during assessment of an older adult diagnosed

with health problems? a. Functional ability and emotional status b. Chronological age and sexual function c. Economic status and sources of income d. Developmental history, interests, and activities ANS: A

Information related to functional ability and emotional status provides an overview of a patient’s problems and abilities. It guides selection of interventions and services to meet identified needs. The distracters reflect information of relevance, but are not of highest priority. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 31-12, 20 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. A 75-year-old patient comes to theNURSINGTB.COM clinic reporting frequent headaches. As the nurse begins

the interaction, which action is most important? a. Complete a neurological assessment. b. Determine whether the patient can hear as the nurse speaks. c. Suggest that the patient lie down in a darkened room for a few minutes. d. Administer medication to relieve the patient’s pain before continuing the assessment. ANS: B

Before proceeding with any further assessment, the nurse should assess the patient’s ability to hear questions. Impaired hearing could lead to inaccurate answers. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 31-3, 18, 43 (Box 31-6) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 6. Which statement about aging provides the best rationale for focused assessment of elderly

patients? The elderly are usually socially isolated and lonely. Vision, hearing, touch, taste, and smell decline with age. The majority of elderly patients have some form of early dementia. As people age, thinking becomes more rigid and learning is impaired.

a. b. c. d.

ANS: B

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Only the key is a true statement. It cues the nurse to assess sensory function in the elderly patient. Correcting vision and hearing are critical to providing safe care. The distracters are myths about aging. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 31-3, 18, 43 (Box 31-6) TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 7. A nurse assesses an elderly patient. The nurse should complete the Geriatric Depression Scale

if the patient answers which question affirmatively. “Would you say your mood is often sad?” “Are you having any trouble with your memory?” “Have you noticed an increase in your alcohol use?” “Do you often experience moderate to severe pain?”

a. b. c. d.

ANS: A

Feeling low may be a symptom of depression. Low moods occurring with regularity should signal the need for further assessment for other symptoms of depression. The other options do not focus on mood. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 31-3, 44 (Box 31-7) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 8. A health care provider writes these new prescriptions for a resident in a skilled nursing

facility: 2 g sodium diet, restraint as needed, limit fluids to 1800 mL daily, continue antihypertensive medication, milk of magnesia 30 mL PO once if no bowel movement for 3 NURSINGTB.COM days. The nurse should a. question the fluid restriction. b. question the order for restraint. c. transcribe the prescriptions as written. d. assess the resident’s bowel elimination. ANS: B

Restraints may be imposed only on a 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 prescriptions are appropriate. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 31-25 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 9. An elderly patient must be physically restrained. Who is responsible for the patient’s safety? a. The nurse assigned to care for the patient b. Unlicensed assistive personnel who apply the restraint c. Family member who agrees to application of the restraint d. Health care provider who prescribed application of restraint ANS: A

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Although restraint is prescribed by a health care provider, the restraint is a measure carried out by nursing staff. The nurse caring for the patient is responsible for safe application of restraining devices and for providing safe care while the patient is restrained. Nurses may delegate the application of restraining devices and the care of the patient in restraint, but the nurse remains responsible for outcomes. Even when family agree to restraint, nurses are responsible for providing safe outcomes. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 31-25 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 10. A new nurse asks, “My elderly patient’s CT scan of the head shows many Lewy bodies are

present. What should I do about assessing for pain?” Select the best response from the nurse manager. a. “Ask the patient’s family if they think the patient is experiencing pain.” b. “Use a visual analog scale to help the patient determine the presence and severity of pain.” c. “There are special scales for assessing patients with dementia. Let’s review how to use them.” d. “The perception of pain is diminished by this type of dementia. Focus your assessment on the patient’s mental status.” ANS: C

Lewy bodies associated with dementia [Faculty note: Lewy bodies are defined and addressed in Chapter 23]. There are special scales to assess the presence and severity of pain in patients with dementia. The Pain Assessment in Advanced Dementia Scale evaluates breathing, negative vocalizations, body language, and consolability. A patient with dementia would be NURSINGTB.COM unable to use a visual analog scale. The family may be able to help the nurse gain perspective about the pain, but this strategy alone is inadequate. The other distracters are myths. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 31-9, 10, 34 (Figure 31-4) | Page 31-37 (Box 31-2) TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment 11. An advance directive gives legally binding direction for health care interventions when a

patient a. has a new diagnosis of cancer. b. is diagnosed with Parkinson’s disease. c. is unable to make decisions for self because of illness. d. diagnosed with amyotrophic lateral sclerosis is unable to speak. ANS: C

Advance directives are invoked when patients are unable to make their own health care decisions. The correct response is the most global answer. A diagnosis of cancer or Parkinson’s disease does not mean the patient is unable to make a decision. For a patient with amyotrophic lateral sclerosis, there are other ways to communicate beyond speaking. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 31-14, 15 TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

12. A patient asks, “What advantage does a durable power of attorney for health care have over a

living will?” The nurse should reply, “A durable power of attorney for health care a. gives your agent authority to make decisions during any illness if you are incapacitated.” b. can be given only to a relative, usually the next of kin, who has your best interests at heart.” c. can be used only if you have a terminal illness and become incapacitated.” d. cannot be implemented until 30 days after the documents are signed.” ANS: A

A durable power of attorney for health care is an instrument that appoints a person other than a health care provider to act as an individual's agent in the event that he or she is unable to make medical decisions. No waiting period is required for it to become effective, and the individual does not have to be terminally ill or incompetent for the person appointed to act on the individual’s behalf. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 31-14 to 16 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 13. A physically frail elderly patient with mild cognitive impairments needs services of a facility

that can provide supervision and safety as well as recreation and social interaction. The family cares for this patient during the evening and night. Which type of facility should the nurse suggest to meet this patient’s needs? a. Adult day care program b. Skilled nursing facility c. Partial hospitalization NURSINGTB.COM d. Group home ANS: A

A day care program provides recreation and social interaction as well as supervision in a safe environment. Nursing, medical, and rehabilitative care are usually not provided. Skilled nursing facilities go beyond meeting recreational and social needs by providing medical interventions and nursing and rehabilitation services on a 24-hour basis. Partial hospitalization provides acute psychiatric hospital programs. A group home is inappropriate and would not meet the patient’s needs. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 31-26, 27 TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 14. A 79-year-old white male tells a nurse, “I have felt very sad lately. I do not have much to live

for. My family and friends are all dead, and my own health is failing.” The nurse should analyze this comment as a. normal pessimism of the elderly. b. evidence of risks for suicide. c. a call for sympathy. d. normal grieving. ANS: B

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

The patient describes loss of significant others, economic security, and health. He describes mood alteration and voices the thought that he has little to live for. Combined with his age, sex, and single status, each is a risk factor for suicide. Elderly white males have the highest risk for completed suicide. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Understand (Comprehension) Pages 31-3 to 5, 8 (Evidence Based Practice) Nursing Process: Analysis/Diagnosis Client Needs: Psychosocial Integrity

15. In a sad voice, an elderly patient tells the nurse of the recent deaths of a spouse and close

friend. The patient has no other family and only a few acquaintances in the community. The nurse’s priority is to determine whether which nursing diagnosis applies to this patient? a. Risk for suicide related to recent deaths of significant others b. Anxiety related to sudden and abrupt lifestyle changes c. Social isolation related to loss of existing family d. Spiritual distress related to anger with God ANS: A

The patient appears to be experiencing normal grief related to the loss of her family, but because of age and social isolation, the risk for suicide should be determined and has high priority. No defining characteristics exist for the diagnoses of anxiety or spiritual distress. The patient’s social isolation is important, but the risk for suicide has higher priority. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Analyze (Analysis) Pages 31-3 to 5, 8 (Evidence Based Practice) Nursing Process: Analysis/Diagnosis NURSINGTB.COM Client Needs: Psychosocial Integrity

16. When making a distinction as to whether an elderly patient has confusion related to delirium

or another problem, what information would be of particular value? Evidence of spasticity or flaccidity The patient’s level of motor activity Medications the patient has recently taken Level of preoccupation with somatic symptoms

a. b. c. d.

ANS: C

Delirium in the elderly produces symptoms of confusion. Medication interactions or adverse reactions are often a cause. The distracters do not give information important for delirium. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 31-3, 4, 6 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 17. An 85-year-old has difficulty walking after a knee replacement. The patient tells the nurse,

“It’s awful to be old. Every day is a struggle. No one cares about old people.” Select the nurse’s best 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.”

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

ANS: B

The nurse uses empathetic understanding to permit the patient to express frustration and clarify her “struggle” for the nurse. The distracters block communication. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 31-17, 18 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 18. A 76-year-old is indifferent and responds to others only when they initiate an interaction.

What form of group therapy would be most useful to promote resocialization? a. Orientation b. Activity group c. Psychotherapy d. Reminiscence ANS: D

Reminiscence therapy in a group setting can help to resocialize regressed and apathetic patients. The nurse can encourage discussion about past pleasant events or memories: first car, favorite memory from school, favorite band or song, seasonal activities growing up, etc. Assisting to evoke pleasant feelings or memories is an effective method to improve mood particularly in those with memory impairment. Group psychotherapy would not be effective for this patient. An activity group does not address the patient’s problem. Orientation groups can exacerbate a patient’s distress. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 31-22 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity NURSINGTB.COM

19. A nurse assesses four patients between the ages of 70 and 80. Which patient has the highest

risk for alcohol abuse? The patient who a. consumes 1 glass of wine nightly with dinner. b. began drinking alcohol daily after retirement and says, “A few drinks keep my mind off my arthritis.” c. drank socially throughout adult life and continues this pattern, saying “I’ve earned the right to do as I please.” d. abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends Alcoholics Anonymous (AA). ANS: B

Alcohol abuse and dependence can develop at any age, and the geriatric population is particularly at risk. Losses, such as retirement, widowhood, and loneliness, are often related. The distracters describe patients with a lower risk for alcohol abuse. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 31-7, 35 (Box 31-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 20. A nurse wants to assess for suicidal ideation in an elderly patient. Select the best question to

begin this assessment. a. “Are there any things going on in your life that would cause you to consider suicide?”

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

b. “What are your beliefs about a person’s right to take his or her own life?” c. “Do you think you are vulnerable to developing a depressed mood?” d. “If you felt suicidal, would you tell someone about your feelings?” ANS: B

This question is clear, direct, and respectful. It will produce information relative to the acceptability of suicide as an option to the patient. If the patient deems suicide unacceptable, no further assessment is necessary. If the patient deems suicide as acceptable, the nurse can continue to assess intent, plan, means to carry out the plan, lethality of the chosen method, and so forth. The other options are less direct, may produce responses that may be unclear, or are appropriate for later in this discussion. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 31-8 (Evidence Based Practice), 20, 45 (Box 31-8) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 21. A community health nurse visits an elderly person whose spouse died 6 months ago. Two

vodka bottles are in the trash. When the nurse asks about alcohol use, this person says, “I get lonely and drink a little to help me forget.” Select the nurse’s most therapeutic intervention. a. Assess whether this patient is drinking and driving. b. Advise the person not to drink alone because the risks for injury increase. c. Teach the person about risks for alcoholism and suggest other coping strategies. d. Arrange for the person to attend an AA meeting for older adults. ANS: D

This person needs help with alcohol a...