Question 1

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?

Accepted Answer

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.

Question 2

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." The nurse should analyze this comment as:

Accepted Answer

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.

Question 3

An advance directive gives valid direction to health care providers when a patient is:

Accepted Answer

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.

Question 4

Recognizing the risk for acquired immunodeficiency syndrome (AIDS) among older adults, nurses should provide health teaching aimed at:

Accepted Answer

Safe sex continues to be important and should be taught to the older adult population. Because the risk for pregnancy is nonexistent in postmenopausal women, condom use is diminished, which places older adults at risk for AIDS and other sexually transmitted diseases. Sexual expression is a basic human need. Little to no danger exists from blood transfusions.

Question 5

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 that the resident:

Accepted Answer

A resident taking medications is at high risk for becoming confused because of medication side effects, drug interactions, and delayed excretion. The nurse should report the event and continue to assess for cognitive impairment. Symptoms of dementia develop slowly but persist over time. Alcohol abuse and withdrawal are not the nurse's first suspicion in this scenario.

Question 6

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?

Accepted Answer

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.

Question 7

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. A topic of high priority should be:

Accepted Answer

Depression is the most common, most debilitating, and also most treatable psychiatric disorder in the older adult. Home health staff are often better versed in the physical aspects of care and less knowledgeable about mental health topics. Statistics show that older adult patients with mental health problems are less likely than young adults to be diagnosed accurately. This is especially true for those with depression and anxiety, both of which are likely to be misinterpreted as normal aging. Undiagnosed and untreated depression and anxiety result in unnecessary suffering. The other options are of lesser importance.

Question 8

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?

Accepted Answer

Sadness may be a symptom of depression. Sad moods occurring with regularity should signal the need to assess further for other symptoms of depression. The incorrect options do not focus on mood.

Question 9

If an older adult patient must be physically restrained, who is responsible for the patient's safety?

Accepted Answer

Although restraint is ordered by a health care provider, it is carried out by a nursing staff member. The nurse caring for the patient is responsible for the 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 remain responsible for outcomes. Even when the family agrees to restraint, nurses are responsible for ensuring safe outcomes.

Question 10

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 reply, "A durable power of attorney for health care:

Accepted Answer

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. The patient does not have to be terminally ill or incompetent for the appointed person to act on his or her behalf.

Question 11

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?

Accepted Answer

Re-motivation therapy is designed to resocialize 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.

Question 12

A tricyclic antidepressant is prescribed for an older adult patient diagnosed with major depressive disorder. Nursing assessment should include careful collection of information regarding:

Accepted Answer

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.

Question 13

Which is the best comment for a nurse to use when beginning an interview with an older adult patient?

Accepted Answer

The correct response 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 a patient by name but should not assume the patient wants to be called by his or her first name. The nurse should always introduce himself or herself.

Question 14

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? The patient:

Accepted Answer

Alcohol addiction can develop at any age, and the geriatric population is particularly at risk. The geriatric problem drinker is defined as someone who has no history of alcohol-related problems but develops an alcohol-abuse pattern in response to the stresses of aging. The incorrect responses profile alcohol use that is not problematic.

Question 15

Which statement about aging provides the best rationale for focused assessment of older adult patients?

Accepted Answer

Only the correct answer is true and cues the nurse to assess carefully the sensory functions of the older adult patient. The incorrect options are myths about aging.

Question 16

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:

Accepted Answer

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.

Question 17

A 75-year-old patient comes to the clinic reporting frequent headaches. After an introduction at the beginning of the interview, the nurse should:

Accepted Answer

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.

Question 18

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?

Accepted Answer

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.

Question 19

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?

Accepted Answer

The patient appears to be experiencing normal grief related to the loss of the family; however, because of age and social isolation, the risk for suicide should be determined and has high priority. No defining characteristics exist for the diagnosis of anxiety or spiritual distress. Risk for suicide is a higher priority than social isolation.

Question 20

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?

Accepted Answer

The nurse uses therapeutic communication and empathic understanding to encourage the patient to express frustration and clarify the "struggle" for the nurse. The other options are non-therapeutic and block communication.

Quiz 28: Older Adults