Question 1

The nurse is preparing to assess a 78-year-old client who has been diagnosed with major depression. Which would the nurse expect to assess as a normal finding?

Accepted Answer

With aging, the senses of taste, touch, and smell undergo a uniform dulling, body fat increases, muscle mass decreases, and visual acuity decreases.

Question 2

A group of nursing students is reviewing the physical changes that occur in older adults. The students demonstrate understanding of the information when they identify what as contributing to the client's risk for drug toxicity?

Accepted Answer

Liver function may be reduced because of decreased blood flow and enzyme activity, resulting in increased blood and tissue concentrations of medications. Changes in brain gray matter volume, lower metabolic rate, and decreased body water would not contribute to potential drug toxicity in older adults.

Question 3

An older client tells the nurse about being more forgetful. The nurse explains to the client that this is most likely related to what cause?

Accepted Answer

Threats to memory include medications, depression (impairs concentration and attention), poor nutrition, infection, heart and lung disease (lack of oxygen), thyroid problems (can cause symptoms of depression or confusion that mimic memory loss), alcohol use, and sensory loss (interferes with perception). It is important not to confuse memory decline with deficits in memory storage, such as those seen in dementias.

Question 4

While assessing an older adult, the nurse allows ample time for the client to respond based on what understanding of the aging process?

Accepted Answer

Mental processing speed and reaction time do gradually decrease from mid to late adulthood and may affect how quickly older adults respond to questions. This phenomenon has been labeled the speed-accuracy shift, by which older adults focus more on accuracy than speed in responding. Older adults are more likely to make errors of omission (leave out the answer) than errors of commission (make a guess). Memory impairment or decreased cerebral oxygen flow may be present, but this is not a universal phenomenon.

Question 5

The nurse is planning a presentation to a group of older adults on the topic of suicide in the population. One of the group participants asks who has the highest risk of suicide. Which response by the nurse would be most appropriate?

Accepted Answer

Suicide rates for men are highest for those 75 years of age and older. The rate of suicide attempts to completed suicides among adults ages 65 years and older is 4 to 1. Rates are the highest for divorced and widowed White men.

Question 6

The nurse is working with a client whose mobility is impaired secondary to a fall that resulted in a broken hip. In addition, the client, who has diabetes, is developing problems with vision and hearing. The client seems increasingly withdrawn and depressed. The nurse determines that the client is at risk for spiritual distress. Which intervention would be most appropriate?

Accepted Answer

The nurse can support a client's spiritual growth by exploring the meanings that a particular life change has for the older adult. In late life, existential issues, such as experiencing loss, redefining meanings in existence, and living in the present become the standard, replacing the performance and future orientation that characterize earlier adulthood. Spirituality does not necessarily imply religion. Talking about significant childhood religious experiences and reading Bible passages reflect a greater emphasis on religion than spirituality. Offering to take the client to the nurse's church meets the nurse's needs, not the client's needs.

Question 7

After having blood pressure taken, the client asks the nurse what changes should be expected when growing older. Which response by the nurse would be most appropriate?

Accepted Answer

Changes do occur with aging. Intelligence and personality are stable throughout the life span; however, reaction time slows with age.

Question 8

A nurse reviewing the medical records of several older adult clients determines that which individual would have the least chance of developing mental health problems with aging?

Accepted Answer

Protective factors for minimizing the occurrence of mental disorders in older adults are similar to those in younger adults. Evidence supports protective factors that include marriage, education and income level, resilience and positive outlook, healthy lifestyle, nutrition, and exercise. The client who is married, received a high level of education, and practices a healthy lifestyle has the least chance of developing mental health problems. The remaining options demonstrate mental and physical risk factors for the older adult.

Question 9

The nurse is presenting a community educational program focusing on older adults and mental health protective factors. One of the participants asks what the influence of co-parenting one's grandchild has on the mental health of the grandparent. Which response by the nurse would be most appropriate?

Accepted Answer

It is common for grandparents to assume some caregiving responsibilities for their grandchildren. Although some stresses are associated with grandparenting, the positive benefits appear to outweigh the negatives.

Question 10

A nursing student is reading an article about protective factors for older adults with mental illness. The article mentions the individual's ability to adapt successfully to stress, trauma, or chronic adversity. The student identifies this as which process?

Accepted Answer

Resilience is an individual's ability to adapt successfully to stress, trauma, or chronic adversity. Functional status is the extent to which a person can independently carry out personal care, home management, and social functions in everyday life, in a way that has meaning and purpose. Gerotranscendence is the ninth stage of development that provides for continued growth in dimensions, such as spirituality and inner strength. An empty nest is a home without children or caregiving responsibilities (common in middle-aged adults).

Question 11

A nurse is reviewing the medical records of several older adult clients who have come to the clinic for evaluation. The nurse would classify a client of which age as being in the middle-old stage?

Accepted Answer

Middle-old refers to those between the ages of 75 and 84 years. Young-old refers to those between the ages of 65 and 74 years. Old-old refers to those 85 years of age and older.

Question 12

While assessing an older adult client for mental health issues, the nurse pays special attention to the client's sensory function based on what understanding?

Accepted Answer

Sensory decline is important to consider when assessing psychiatrically ill older adults because diminished senses may affect information processing, potentially affecting interpretation of standard mental status examinations. Sensory function decline does not follow a standard pattern and does not lead to changes in other body systems, nor changes in cognitive abilities. Many cognitive abilities are preserved or even enhanced during aging.

Question 13

A group of nurses is reviewing information about the course of aging in future older adults, and qualities that contribute to successful mental aging. The nurses demonstrate the need for additional review when they identify which aspect as most important?

Accepted Answer

Research shows that four qualities contribute to successful aging: the capacity to adapt to change; engagement and involvement in life; the importance of stability and security with reliable social support; and least importantly, physical health.

Question 14

A nursing instructor is preparing for a class discussion on polypharmacy and older adults. What would the instructor expect to include?

Accepted Answer

The aging process affects pharmacokinetics and the strength and number of protein-binding sites. These changes place older adults at increased risk for adverse drug reactions. Medication misuse can easily occur and, in some combinations, lead to drug abuse. Most age-dependent pharmacokinetic changes lead to potential accumulation of the drug. Therefore, medication dosage should start low and go slow. Therapeutic effectiveness may or may not be affected.

Question 15

A group of nursing students is reviewing risk and protective factors associated with mental disorders in the older adult population. The students demonstrate understanding of the information when they identify what as a protective factor?

Accepted Answer

Education would be considered a protective factor. Education and income provide older adults with cognitive, economic, and coping reserves that support function and well-being, and are related to physical activity, as well as physical and cognitive function/disability. Poverty, loss, and chronic illness are considered risk factors.

Question 16

The nurse is working as part of a team to help reduce the stigma attached to mental health treatment for the older adult population. Which would be most appropriate to do to achieve this outcome?

Accepted Answer

Nurses can help reduce the stigma through educational interventions and facilitation of access to services. Initiating screening programs would help to allow for early recognition of symptoms, promoting prompt treatment. Ensuring integrated community care would help avoid premature institutionalization. Instituting a wide range of social support services would aid in transitioning older adults experiencing losses.

Question 17

A nurse is explaining the concept of cognitive aging to a group of seniors at the senior center when one asks, "So when does this type of aging begin?" Which response by the nurse would be most appropriate?

Accepted Answer

Cognitive aging is a process of gradual, ongoing, yet highly variable changes in cognitive functions that occur as people get older. Cognitive aging is a life-long process beginning in utero. Although the changes that occur are variable, the onset is not.

Question 18

A nurse is preparing to conduct an assessment of a 79-year-old woman who has come to the clinic for evaluation. When performing this assessment, what would be most appropriate for the nurse to do? Select all that apply.

Accepted Answer

When conducting an assessment, the nurse should reduce glare from room lighting by dimming lights that are too bright. The nurse should face the person directly when speaking to him or her, using short simple sentences; focusing on one topic at a time; and speaking slowly, clearly, and loudly (but not shouting).

Question 19

A nurse is developing a plan for establishing appropriate supportive community care services for older adults to promote independence. Which services would the nurse be most likely to include? Select all that apply.

Accepted Answer

Examples of supportive services that foster independent community living include information and referral services; transportation and nutrition services; legal and protective services; comprehensive senior centers; homemaker and handyman services; matching of older adults with younger individuals to share housing; and use of the supports available through churches, community groups, mental health agencies, and other community agencies (e.g., area agencies on aging). Child care services would be more appropriate for young adults.

Question 20

Assessment of an older adult reveals problems with the adult's working memory. When developing the adult's plan of care, which interventions would be most appropriate for the nurse to include? Select all that apply.

Accepted Answer

Working memory is the ability to temporarily hold information in one's mind while it is processed is central to many functions, such as remembering to take medication, processing language, solving problems, making decisions, and learning. Therefore, the nurse would institute interventions to address these areas, such as written reminders for medications, speaking slowly and clearly, and demonstrating simple ways for decision-making. The adult's level of orientation is not affected, so reorienting would be unnecessary. Although decision-making may be affected, it would be more appropriate for the nurse to assist the adult with decision-making or teach the adult strategies to assist with decision-making rather than not letting the adult make decisions.

Quiz 18: Mental Health Promotion for Older Adults