Deck 32: Older Adults

Question 1

A 73-year-old patient with bipolar disorder tells the nurse, "No one will take care of me the way I want when I get older. I can't make sure I don't get treatment I don't want." Which is the best response by the nurse?

A) Suggest that he see a lawyer to make a will.
B) Assist him with creating an advanced directive.
C) Suggest that he tell his family members what he wants.
D) Assure him that the health care system will care for him well.

Answer 1

Assist him with creating an advanced directive.

Question 2

An older adult patient is brought to the emergency department (ED) by family members. The patient is disoriented and confused and has difficulty with attention. Family members report that the symptoms came on suddenly. Which is the nurse's priority for assessment?

A) Risk factors for depression
B) Risk factors for dementia
C) Risk factors for schizophrenia
D) Risk factors for delirium

Answer 2

Risk factors for delirium

Question 3

A 77-year-old patient reveals to the nurse that the patient takes several medications prescribed by several different providers. The patient doesn't always inform each provider about all the different medications. Which will the nurse discuss with the patient as risks of polypharmacy? Select all that apply.

A) Neuropathy
B) Poor quality of life
C) Decreased mobility
D) Difficulties thinking
E) Increased morbidity and mortality

Answer 3

Poor quality of life
Decreased mobility
Difficulties thinking
Increased morbidity and mortality

Question 4

The nurse is teaching staff at a long-term health care facility about depression in older adults. Which comment by a staff member indicates the need for further teaching?

A) "Lack of interest or apathy may be a sign of depression in older adults."
B) "Inability to organize and extract information may indicate depression in older adults."
C) "Sadness or feeling blue are normal aspects of the aging process and are not a cause for concern."
D) "Older adults with depression may exhibit an excessive preoccupation with chronic constipation or pain."

Question 5

A nurse is planning a presentation to the staff at a senior center. What factor that affects mental health in older adults should the nurse emphasize in the discussion?

A) Job loss
B) Divorce
C) Work stressors
D) Multiple losses

Question 6

A 64-year-old patient is worried about having dementia. The patient tells the nurse that it is taking her longer to solve problems, multi-tasking is becoming more difficult, and she sometimes has difficulty remembering what to get at the grocery store. Which is the appropriate response by the nurse? Select all that apply.

A) "The ability to multitask might decline with age, but this is not an indication of dementia."
B) "Many people have episodic memory problems as they age. These do not indicate serious cognitive dysfunction."
C) "If it is taking you longer to solve problems than it used to, you may need to be assessed for other signs of dementia."
D) "Forgetting what you wanted to get at the store is a matter of concern. I think you should have a cognitive evaluation."
E) "A decline in mental processing speed is a normal part of aging, so taking longer with problem solving is not unusual as we get older."

Question 7

A 77-year-old Hispanic woman is concerned that her 80-year-old husband, who has dementia is no longer able to speak English, and will therefore not be able to get care if she dies. Which is the best response by the nurse?

A) Offer to try to locate services that provide Spanish speaking clinicians.
B) Suggest that the family might want to pray for a solution to the problem.
C) Explain that the family will need to provide the care because care for Spanish-speaking patients is not readily available.
D) Explain that the idea of care that addresses a dementia patient's declining language abilities is unreasonable and it is important that the spouse adjust her expectations.

Question 8

A new patient in a skilled nursing facility refuses to participate in any social activities and tells the nurse, "I don't want to meet anyone new. They'll just die anyway." What is the best response the nurse might make?

A) "I know just what you mean. My brother died recently and sometimes I wish I didn't care so much."
B) "Will you tell me more about what has happened to make you say that? Have you lost people you care about?"
C) "Even if you are worried about losing people you care about, it is important to always stay engaged in living and not just give up."
D) "If you don't participate, I will have to get the psychiatrist to see you and decide whether or not you need some medication to help improve your mood."

Question 9

The nurse is planning teaching for a staff seminar regarding psychiatric medication administration. Which information will the nurse plan to discuss in the seminar?

A) Falls and choking risk are increased by psychiatric medications.
B) Sedation is a desirable side effect of psychiatric medications in older adults.
C) Standard adult dosages of psychiatric medications are well tolerated by older adults.
D) Older adults are less prone to side effects of psychiatric medications than other age groups.

Question 10

A 66-year-old patient with Parkinson disease was recently admitted to a nursing home. The patient tells the nurse that she had to come to the home when her spouse, who was her primary caregiver, died. What are some of the issues that the nurse should expect to address with this patient? Select all that apply.

A) Financial stress
B) Mobility challenges
C) Overwhelming grief
D) Loss of support system
E) Sense of disconnection from a familiar life

Question 11

A nurse suspects that her patient, who has diabetes, may also be suffering from depression. What patient statement might lead to the nurse to suspect depression?

A) "I'm concerned about the swelling in my ankles."
B) "I'm tired all the time and I really hate my life."
C) "My spouse and I can't seem to agree on anything."
D) "Growing old is hard. Have you got a pill for that?"

Question 12

A nurse is assessing an older adult patient with cardiovascular disease who has been prescribed a calcium channel blocker. Why does the nurse consider that the patient may be at risk for depression?

A) Use of a calcium channel blocker increases risk for depression.
B) Chronic illness increases risk for depression.
C) Older age increases risk for depression.
D) Cardiac rehabilitation increases risk for depression.

Question 13

An 82-year-old patient is experiencing anxiety and has requested a prescription for Valium saying, "I remember I took it years ago and it worked just fine." What instruction would the nurse provide to this patient about the risks of this medication?

A) It can increase the risk of falls.
B) It can increase the risk of strokes.
C) It can increase the risk of seizures.
D) It can increase the risk of constipation.

Question 14

A 71-year-old patient has primary responsibility for a 47-year-old son, who is diagnosed with schizophrenia. The patient is concerned that her health is suffering from the aggravation she feels because her son is reluctant to take his medication and complains about the food she prepares for him. She is also worried about what will happen to him is she does become ill. Which factor will the nurse discuss with the patient?

A) Depression
B) Elder abuse
C) Palliative care
D) Caregiver burden

Question 15

A patient tells the nurse of concern that the patient's spouse might be suffering from dementia. The patient describes the spouse as experiencing memory loss. What other indicator described by the patient or caregiver would indicate the need for further evaluation for dementia?

A) Pain
B) Insomnia
C) Depression
D) Personality changes

Question 16

A 67-year-old patient was forced to retire at age 6

A) Role
B) Health
C) Support system
D) Cognitive functions
E) The patient reports that age has interfered with getting another job and the retirement income does not cover expenses. The patient does not want to be a retiree. Which loss should the nurse address as a treatment priority?

Question 17

An 82-year-old patient tells the nurse that his reports of pain in his legs were dismissed by a new physician in the practice as "just what happens to everyone." What is an appropriate response for the nurse to make?

A) "Are you really in that much pain? Perhaps you just need to be more active."
B) "I think the doctor is just trying to help you get used to the effects of old age."
C) "It might be useful for you to tell the physician how you feel. Do you feel comfortable doing that?"
D) "That doctor shouldn't treat you so poorly. You should complain to the office manager."

Question 18

A 78-year-old patient diagnosed with depression presents for a follow-up appointment. At the previous appointment six weeks ago, the patient was prescribed paroxetine (Paxil). Which symptom reported by the patient would indicate to the nurse that the patient is experiencing paroxetine toxicity?

A) Constipation
B) Neuropathy
C) Sexual dysfunction
D) Urinary tract infections (UTI)

Question 19

A nurse in a long-term care facility is seeing a 79-year-old patient who has schizophrenia and has been prescribed a benzodiazepine for agitation. For which factor will the nurse assess the patient following administration of the benzodiazepine? Select all that apply.

A) Mobility issues
B) Physical decline
C) Tardive dyskinesia
D) Cognitive impairment
E) Long-term memory loss

Question 20

A nurse is assessing a patient in an assisted living facility. What statement by the patient would indicate disconnection from familiar life?

A) "I always like to eat dinner at the same time every day."
B) "My family really doesn't have a lot of time to visit me."
C) "This place would be better if there were more musical activities."
D) "This place has nothing like the beautiful porch that I used to sit on in my home."

Question 21

A patient with end stage pancreatic cancer and dementia is assigned to a nurse for hospice care. How can the nurse effectively provide an ongoing assessment of this patient's pain?

A) Periodically ask the patient to rank the pain on a scale of one to ten.
B) Observe the patient regularly and write anecdotal reports.
C) Observe the patient regularly and score on a scale of observable reactions.
D) Periodically ask the patient to rank the pain on a visual scale from high to low.

Question 22

A nurse is providing an in-service training on elder abuse for the staff at an urban clinic. Which will she include as risk factors for elder abuse? Select all that apply.

A) Cancer
B) Diabetes
C) Dementia
D) Paraplegia
E) Mental illness

Question 23

A nurse is preparing a training program for newly hired hospice nurses. What end-of-life needs are should the nurse address in this training? Select all that apply.

A) Spiritual
B) Housing
C) Physical
D) Financial
E) Emotional

Question 24

The nurse is caring for a group of older adults. Which patients would the nurse recognize as being at greater risk for elder abuse? Select all that apply.

A) The patient with dementia who is cared for by family members.
B) The patient with dementia who is cared for by a paid caregiver.
C) The patient with depression who is cared for by family members.
D) The patient who is experiencing chronic anxiety and is cared for family members.
E) The patient who is grieving the loss of a spouse and is cared for by a paid caregiver.

Question 25

The spouse of an older adult patient is concerned that the patient has recently experienced memory lapses, is unusually aggressive, and has had three traffic accidents in the past month. Which will the nurse include as part of the assessment? Select all that apply.

A) Depression screening
B) Substance abuse assessment
C) Nutrition screening
D) Mental status examination
E) Anxiety screening

Question 26

A patient in hospice care asks the nurse to contact an estranged son and inform him of the patient's impending death. Which response to the patient's request is most appropriate?

A) Refuse because the son might not be interested.
B) Contact the son because he has an obligation to his dying parent.
C) Refuse because contacting the son is not part of the nurse's responsibilities.
D) Contact the son and attempt to assist the patient with end-of-life tasks.

Question 27

A nurse suspects that a patient is using prescription medications provided by a variety of practitioners. What might be the most useful method of screening for this?

A) Ask the patient to list the drugs the patient is taking.
B) Ask if patient is abusing any medications.
C) Request that the patient bring all medications to the next appointment.
D) Call all the patient's providers and request information on medications prescribed for the patient.

Question 28

A patient with schizophrenia has just been assigned to hospice care. When contacting the health care provider for medication on admission of the patient to hospice, what orders should the nurse request in addition to medication for pain control?

A) Antipsychotic medication should be continued at the same dosage.
B) Antipsychotic medication should be immediately discontinued.
C) Antipsychotic medication dosage should be increased.
D) Antipsychotic medication should be discontinued after one to two weeks in hospice.

Question 29

The nurse is caring for an older adult patient who has recently moved into a skilled nursing facility. The patient is displaying anxiety, fear, and loneliness after the change in living environment. Which actions by the nurse will help to decrease the patient's stress of transition? Select all that apply.

A) Provide the patient with decisions in a direct manner.
B) Accommodate the patient's normal routines and preferences.
C) Provide the patient with resources to help in making decisions.
D) Encourage the patient to discuss feelings related to relocation.
E) Assist the patient to communicate with family members.

Question 30

A nurse is seeing a patient who reports having had panic attacks "for years." What are some appropriate nursing interventions? Select all that apply.

A) Provide relaxation training.
B) Suggest an exercise program.
C) Recommend a medication consultation.
D) Teach the patient how to use diversion tactics.
E) Tell the patient that benzodiazepines would be helpful.

Question 31

During the winter, an 85-year-old patient is brought to the office wearing a light sweater and sandals. What question should the nurse ask to collect data to confirm a suspicion of abuse/neglect?

A) "Do you like your attendant?"
B) "Does your attendant do any nice things for you?"
C) "Did your attendant decide what clothing you should wear ?"
D) "Does your attendant ever make you feel bad about yourself?"

Question 32

A 92-year-old patient who lives alone comes to an appointment with a new neighbor. She reports that she just bought the neighbor a new car so that the neighbor would be more comfortable bringing the patient to appointments. The nurse suspects financial abuse. What should the nurse do?

A) Tell the neighbor that you are watching her.
B) Tell the patient to stop relying on the neighbor.
C) Tell the patient to move to a skilled nursing facility
D) Tell the state's protective agency the nurse suspects financial abuse.