Question 1

The nurse is caring for a frail older adult patient who is admitted to the hospital after falling. The patient has been living alone independently and appears reluctant to accept assistance. The nurse recognizes that the patient's reluctance to accept assistance is most likely caused by fear of what?

Accepted Answer

Independence is something most people take for granted as a younger adult, but it becomes a significant issue for older adults, Nurses need to be sensitive to the often-unexpressed fears of older adults around surrendering their independence. Formal support services in the community, meals on wheels, home health aides, medical alerts, and informal family supports can be critical factors in enabling frail older adults to remain independent. Nurses can help older identify and access these supports. There often is a delicate balance between the older adult's perceived, and actual need for safety in health care. Restrictions, and supports needed for safety can and should be negotiated, not simply imposed. While all may concern the client, the greatest fear tends to be the loss on independence.

Question 2

When communicating with older adult patients, the nurse recognizes what age related changes that affect hearing?

Accepted Answer

There is perhaps nothing more socially isolating than not being able to hear, and respond in social situations. Hearing problems can diminish an older person's ability to interact with others, attend concerts and other social functions, and understand medical directions. Hearing loss associated with normal aging begins after age 50 due to loss of hair cells (which are not replaced) in the organ of Corti in the inner ear. This change leads initially to a loss in the ability to hear high-frequency sounds (e.g., f, s, th, sh, ch) and is called presbycusis. Lower-frequency sounds of vowels are preserved longer. Older adults have special difficulty in distinguishing sounds against background noises and in understanding fast-paced speech.

Question 3

What intervention should the nurse use to assess the cognition of an illiterate patient?

Accepted Answer

The nurse should determine the patient's level of formal education. If the patient never learned to spell, it will be impossible to spell "world" backwards. Saying the days of the week backwards is a good alternative. Spelling and use of serial 7s would not be an appropriate alternative with this patient's level of formal education.

Question 4

The nurse is caring for an older adult patient who has early moderate cognitive impairment and has been diagnosed with dementia. When interacting with the patient's family, the nurse should include what information when providing teaching to family members regarding the patient's memory issues?

Accepted Answer

Remote memory (recall of past events) is retained longer than memory for recent events. For the patient, the experience of connecting with another person is more important than having an in-depth conversation. Family members can be encouraged to reminisce with dementia patients. This can be a meaningful experience for the family member, even when the patient cannot actively engage in the discussion, because it is a means of connecting. Asking mild to early moderate cognitively impaired older adults about their past life experiences serves as a way to connect verbally with those who might have difficulty telling you what they had for breakfast 2 hours ago.

Question 5

The nurse is caring for an older adult patient who has been diagnosed with dementia. The nurse recognizes which is true in relation to the use of touch with this patient?

Accepted Answer

Touch is something patients with dementia can no longer ask for, create for themselves, or tell another of its meaning. Touch is a form of communication that immediately acknowledges a dementia patient's stress, calm an agitated patient, and provides a sense of security, particularly if accompanied by a smile, or a compliment, and a gentle approach. As dementia progresses, informal and professional care givers can use gentle touch to gain a patient's attention, to guide a person toward an activity, or simply as an expression of caring. In general, patients with dementia appreciate the use of touch. But to some, it can be frightening particularly if you move in too fast. Before using touch, make sure that the patient is open to it.

Question 6

When caring for this patient, the nurse should What intervention is usually effective when caring for a patient experiencing a catastrophic reaction to an environmental stimulus?

Accepted Answer

Instead of focusing on the behavior, the nurse should try to identify and eliminate the cause(s). The nurse can use distraction to move older adults away from the offending stimuli in the environment. Older adults with memory loss lack the cognitive ability to develop alternatives. They emotionally overreact to situations and can have what look like temper tantrums in response to real or perceived frustration. Older adult tantrums are called catastrophic reactions and represent a completely disorganized set of responses. Usually there is something in the immediate environment that precipitates the reaction. Fatigue, multiple demands, overstimulation, misinterpretations, or an inability to meet expectations are contributing factors.

Question 7

The nurse is caring for an older adult patient who has recently experienced losses associated with deaths of important people in her life. The nurse recognizes that this type of problem challenges which of Maslow's hierarchy of needs?

Accepted Answer

Maslow's hierarchy of needs helps nurses prioritize nursing actions, beginning with basic survival needs. Physiological integrity, followed by safety and security, emerge as the most basic critical issues for older adults. They need to be addressed first. Love and belonging needs are challenged by increased losses associated with death of important people. Esteem needs, especially those associated with meaningful purpose, and independence remain important issues in later life. Abraham Maslow believed that self-actualization occurs more often in middle aged and older adults. Love and belonging needs are challenged by increased losses associated with death of important people. Esteem needs, especially those associated with meaningful purpose, and independence remain important issues in later life. Abraham Maslow believed that self-actualization occurs more often in middle-aged and older adults.

Question 8

A patient diagnosed with dementia is becoming increasingly unable to express complete thoughts and is having difficulty engaging in simple conversations. When communicating with this patient, the nurse should implement what intervention to help maintain communication skills

Accepted Answer

Instead of using abstract prompts (like a specific time), the nurse should use words directly applicable to the patient's daily routine, like "before lunch," can anchor the patient's recognition of time frames better than saving a specific time, such as 11 a.m. The nurse should restate ideas using the same words and sequence and validate the meaning of a patient's response. As dementia progresses, patients become increasingly unable to express complete thoughts and eventually cannot carry on even simple conversations. The nurse should use plain language and simple questions that can be answered with a yes or no for patients with less verbal skill. The nurse should note whether the patient's behavior is consistent with the yes or no answer and follow up if the behavior is incongruent with the words.

Question 9

The nurse has just completed a care plan on a visually impaired patient. Which intervention is most appropriate in facilitating the client's maximum visual acuity?

Accepted Answer

Adaptive communication strategies for vision loss include providing bright lighting with no glare, having the nurse stand in front of the patient, and considering the font and letter size for readability when using written materials. Upper- and lower-case letters rather than all capitals should be used. Solid paper with sharp, contrasting writing and a lot of white space should also be used. Adaptive strategies for vision loss also include verbally explaining all written information while allowing time for the patient to ask questions.

Question 10

When assessing an older adult patient, the nurse recognizes the patient has a significant hearing loss and wears a hearing aide. What is the most appropriate intervention by the nurse to minimize the effects of this loss?

Accepted Answer

The nurse should make sure the patient's hearing aids are turned on. If difficulties persist, the nurse should then check the batteries and change them is necessary. Adaptive strategies for hearing loss include addressing the person by name before beginning to speak (it focuses attention) and speaking slowly and distinctly. If the nurse's voice is high pitched, the nurse should lower it and rephrase rather than repeat words if the older adult doesn't understand certain words.

Question 11

When assessing an older adult patient, the nurse notes that the patient demonstrates an inability to take purposeful action even when the muscles, senses, and vocabulary appear to be intact. The patient appears to register on a command but acts in a way that suggests little understanding of what transpired verbally. The nurse recognizes these assessment findings as consistent with which of the following conditions?

Accepted Answer

Apraxia, defined as the loss of the ability to take purposeful action even when the muscles, senses, and vocabulary seem intact, is a common feature of dementia. The person appears to register on a command but acts in ways that suggest he or she has little understanding of what transpired verbally. Presbycusis is the most common type of sensorineural hearing loss caused by the natural aging of the auditory system. The patient is said to have intact senses. Somatization is a mental health problem that produces recurrent and multiple medical symptoms with no discernible organic cause. Polypharmacy occurs when a client has many multiple medications needed to maintain a healthy lifestyle. Polypharmacy places older adults at risk for side effects and drug interactions because of age-related changes in metabolism. None of the remaining options is as likely to cause the patient's symptoms as apraxia.

Question 12

When visiting a patient, the home health nurse notes that the patient frequently shifts the conversation to reminisce. Which communication techniques would be most effective for the nurse to use with this patient?

Accepted Answer

Asking patients to share something about themselves and their life history helps to establish rapport and increases the patient's comfort level. Listen for the facts, but also pay attention to what the patient identifies as his or her most important concern(s). While all the options are effective means of communication, reminiscing is especially supported by information gathering.

Question 13

The nurse is performing an admission assessment on a patient diagnosed with cognitive impairment. When developing a plan of care for this patient, the nurse should plan to implement what intervention to best support the patient's independence?

Accepted Answer

Cognitively impaired patients have trouble following instructions consisting of multiple steps. Breaking instructions into single steps helps these patients master tasks that otherwise are beyond their comprehension. Keep the conversation simple and focused on one step at a time. Remote memory (recall of past events) is retained longer than memory for recent events. ADLs should be addressed when the patient is most relaxed and focused; regardless of the time of day.

Question 14

An older adult patient tells the nurse, "My life has been a waste." The nurse recognizes this statement as demonstrating which aspect of psychosocial development?

Accepted Answer

Erikson's ego development model of psychosocial development is used to describe older adult psychosocial development. His is one of the only developmental models that specifically addresses later adulthood (> 60 years) as a stage of ego development. Erikson portrays the maturational crisis of old age as that of ego integrity versus ego despair. Awareness of one's personal mortality leads to the psychosocial crisis identified with this last stage of ego development. Ego despair describes the failure of a person to accept one's life as appropriate and meaningful. Left unresolved, despair leads to feelings of emotional desolation and bitterness. Ego integrity relates to the capacity of older adults to look back on their lives with satisfaction and few regrets, coupled with a willingness to let the next generation carry on their legacy. Lack of generativity and isolation are not stages found in the older adult patient.

Question 15

The nurse is caring for an older adult patient. The nurse recognizes that what factor is most closely associated with the older adult's inability to live independently?

Accepted Answer

More than any other factor, impaired functional status is a determinant of an older adult's inability to live independently. Stress, acute and chronic illness, and age-related physiologic changes will influence a person's functional status. Functional status, rather than chronologic age, should be the stronger indicator of disability-related needs in older adults because functional impairment is not associated solely with age.

Question 16

An older adult patient has a prescription for a new medication. When preparing to administer the medication to the patient for the first time, the nurse gets ready to educate the patient and the patient's daughter about the medication. When educating the patient and the daughter, the nurse should avoid which intervention?

Accepted Answer

Assuming the cognitively intact older adults lacks the capacity to understand instructions is a common error. Health care providers often direct instruction to the older adult patient's younger companion, even when the patient has no cognitive impairment. This action invalidates the patient and diminishes self-worth. All the remaining options are appropriate since they are involving the patient and are respectful of the common needs of the older adult.

Quiz 19: Communicating With Older Adults