Question 1

Select the best comment for a nurse to begin an interview with an elderly patient.

Accepted Answer

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 himself or herself.

Question 2

A nurse wants to assess for suicidal ideation in an elderly patient. Select the best question to begin this assessment.

Accepted Answer

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.

Question 3

A 76-year-old is regressed, indifferent, and responds to others only when they initiate an interaction. What form of group therapy would be most useful to promote resocialization?

Accepted Answer

Remotivation therapy helps to resocialize regressed and apathetic patients 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 members acceptance and appreciation. Group psychotherapy would not be effective for this patient. An activity group does not address the patient's problem.

Question 4

What is considered the Silent Geriatric Giant?

Accepted Answer

Anxiety disorders in late life are referred to as the "Silent Geriatric Giant."

Question 5

When determining whether an elderly patient's confusion is related to delirium or another problem, what information would be of particular value?

Accepted Answer

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.

Question 6

A physically frail elderly patient with mild cognitive impairments needs the 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?

Accepted Answer

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. Nursing homes 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.

Question 7

A new nurse says, "My elderly patient has Lewy body disease. What should I do about assessing for pain?" Select the best response from the nurse manager.

Accepted Answer

Lewy body disease is a form of dementia. There are special scales to assess the presence and severity of pain in patients with dementia. The Pain Assessment in Advanced Dementia (PAINAD) scale evaluates breathing, negative vocalizations, body language, and consolability. A patient with dementia would be 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.

Question 8

A nurse assesses four patients between the ages of 70 and 80. Which patient has the highest risk for alcohol abuse?

Accepted Answer

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.

Question 9

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?

Accepted Answer

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.

Question 10

A student nurse visiting a seniors centre 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 which of the following?

Accepted Answer

Ageism is a bias against older people because of their age. None of the other options applies to the ideas expressed by the student.

Question 11

A nurse assesses an elderly patient. The nurse should complete the Geriatric Depression Scale if the patient answers which question affirmatively?

Accepted Answer

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.

Question 12

Which information is most important to obtain during assessment of an older adult diagnosed with a mental disorder?

Accepted Answer

Information related to functional ability and emotional status provides an overview of patient 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.

Question 13

For which of the following reasons is it difficult to diagnosis alcohol abuse in the older adult?

Accepted Answer

Identifying alcohol and substance abuse is often difficult because personality and behavioural changes frequently go unrecognized in older adults.

Question 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 which of the following?

Accepted Answer

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.

Question 15

An elderly patient must be physically restrained. Who is responsible for the patient's safety?

Accepted Answer

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. Even when family agree to restraint, nurses are responsible for providing safe outcomes.

Question 16

A health care provider writes these new orders for a resident in a nursing home: 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 days. What should the nurse do?

Accepted Answer

Restraints may be imposed but the nurse should question the indications for use with this patient as well as the time frame of use. The other orders are appropriate and specific.

Question 17

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

Accepted Answer

Only the correct option 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.

Question 18

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.

Accepted Answer

The nurse uses empathic understanding to permit the patient to express frustration and clarify her "struggle" for the nurse. The distracters block communication.

Question 19

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?

Accepted Answer

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.

Question 20

A 75-year-old patient comes to the clinic reporting frequent headaches. As the nurse begins the interaction, which action is most important?

Accepted Answer

Before proceeding with any further assessment, the nurse should assess the patient's ability to hear questions. Impaired hearing could lead to inaccurate answers.

Quiz 30: Psychosocial Needs of the Older Adult