Deck 30: Psychosocial Needs of the Older Adult

Question 1

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

A) "Ask the patient's family if they think the patient is experiencing pain."
B) "Use a visual analog scale to help the patient determine the presence and severity of pain."
C) "There are special scales for assessing patients with dementia. Let's review how to use them."
D) "The perception of pain is diminished by this type of dementia. Focus your assessment on the patient's mental status."

Answer 1

"There are special scales for assessing patients with dementia. Let's review how to use them."

Question 2

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

A) "Are there any things going on in your life that would cause you to consider suicide?"
B) "What are your beliefs about a person's right to take his or her own life?"
C) "Do you think you are vulnerable to developing a depressed mood?"
D) "If you felt suicidal, would you tell someone about your feelings?"

Answer 2

"What are your beliefs about a person's right to take his or her own life?"

Question 3

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

A) "Would you say your mood is often sad?"
B) "Are you having any trouble with your memory?"
C) "Have you noticed an increase in your alcohol use?"
D) "Do you often experience moderate to severe pain?"

Answer 3

"Would you say your mood is often sad?"

Question 4

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

A) consumes 1 glass of wine nightly with dinner.
B) began drinking alcohol daily after retirement and says, "A few drinks keep my mind off my arthritis."
C) drank socially throughout adult life and continues this pattern, saying "I've earned the right to do as I please."
D) abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends Alcoholics Anonymous (AA).

Question 5

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.

A) "Everyone here cares about old people. That's why we work here."
B) "It sounds like you're having a difficult time. Tell me about it."
C) "Let's not focus on the negative. Tell me something good."
D) "You are still able to get around, and your mind is alert."

Question 6

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?

A) Risk for suicide related to recent deaths of significant others
B) Anxiety related to sudden and abrupt lifestyle changes
C) Social isolation related to loss of existing family
D) Spiritual distress related to anger with God

Question 7

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?

A) Remotivation
B) Activity group
C) Psychotherapy
D) Reminiscence (life review)

Question 8

A physically frail elderly patient with mild cognitive impairments needs 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?

A) Adult day care program
B) Skilled nursing facility
C) Partial hospitalization
D) Group home

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?

A) Pain assessment techniques for older adults
B) Psychosocial stimulation for those who live alone
C) Preparation of psychiatric advance directives in the elderly
D) Ways to manage disinhibition in elderly persons with dementia

Question 10

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

A) Functional ability and emotional status
B) Chronological age and sexual function
C) Economic status and sources of income
D) Developmental history, interests, and activities

Question 11

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:

A) normal pessimism of the elderly.
B) evidence of risks for suicide.
C) a call for sympathy.
D) normal grieving.

Question 12

A patient asks,"What advantage does a durable power of attorney for health care have over a living will?" The nurse should reply,"A durable power of attorney for health care:

A) gives your agent authority to make decisions during any illness if you are incapacitated."
B) can be given only to a relative, usually the next of kin, who has your best interests at heart."
C) can be used only if you have a terminal illness and become incapacitated."
D) cannot be implemented until 30 days after the documents are signed."

Question 13

A student nurse visiting a senior center 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:

A) reality.
B) ageism.
C) empathy.
D) vulnerability.

Question 14

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

A) The elderly are usually socially isolated and lonely.
B) Vision, hearing, touch, taste, and smell decline with age.
C) The majority of elderly patients have some form of early dementia.
D) As people age, thinking becomes more rigid and learning is impaired.

Question 15

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

A) The nurse assigned to care for the patient
B) Unlicensed assistive personnel who apply the restraint
C) Family member who agrees to application of the restraint
D) Health care provider who prescribed application of restraint

Question 16

A health care provider writes these new prescriptions for a resident in a skilled nursing facility: 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.The nurse should:

A) question the fluid restriction.
B) question the order for restraint.
C) transcribe the prescriptions as written.
D) assess the resident's bowel elimination.

Question 17

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

A) Complete a neurological assessment.
B) Determine whether the patient can hear as the nurse speaks.
C) Suggest that the patient lie down in a darkened room for a few minutes.
D) Administer medication to relieve the patient's pain before continuing the assessment.

Question 18

An advance directive gives legally binding direction for health care interventions when a patient:

A) has a new diagnosis of cancer.
B) is diagnosed with Parkinson's disease.
C) is unable to make decisions for self because of illness.
D) diagnosed with amyotrophic lateral sclerosis is unable to speak.

Question 19

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

A) "I am a nurse. Are you familiar with what nurses do?"
B) "Hello. I am going to ask you some questions to get to know you better."
C) "You look comfortable and ready to participate in an admission interview. Shall we get started?"
D) "Hello. My name is _______ and I am a nurse. How you would like to be addressed by staff?"

Question 20

When making a distinction as to whether an elderly patient has confusion related to delirium or another problem,what information would be of particular value?

A) Evidence of spasticity or flaccidity
B) The patient's level of motor activity
C) Medications the patient has recently taken
D) Level of preoccupation with somatic symptoms

Question 21

A nurse assessing an elderly patient for depression and suicide potential should include questions about mood as well as: (select all that apply)

A) anhedonia.
B) increased appetite.
C) sleep pattern changes.
D) evidence of grandiosity.
E) increased concerns with bodily functions.

Question 22

Which assessment findings would alert the nurse that an older patient may have an increased risk for development of geriatric alcohol abuse? Select all that apply.

A) Mild recent memory impairment
B) Eighth grade education
C) Death of spouse
D) Retirement
E) Loneliness

Question 23

An older adult patient was diagnosed with schizophrenia at age 18.A nurse at the outpatient medication clinic interviews this patient.Which communication strategy will be most helpful?

A) Ask questions that can be answered with "yes" or "no."
B) Ask clear, simple questions using concrete language.
C) Use silence often and let the patient take the lead.
D) Use open-ended, indirect questions.

Question 24

Which remarks by a 72-year-old patient should prompt the nurse to assess for depression? Select all that apply.

A) "Lately I have had a lot of aches and pains and just haven't felt very well."
B) "People are in and out of my room all day and all night taking my things."
C) "Don't ask me to eat. I can't because my stomach is upset all the time."
D) "I'm eating more than usual, and I am sleeping about 6 hours a night."
E) "Life seems more organized now that I don't live in my own home."

Question 25

A community health nurse visits an elderly person whose spouse died 6 months ago.Two vodka bottles are in the trash.When the nurse asks about alcohol use,this person says,"I get lonely and drink a little to help me forget." Select the nurse's most therapeutic intervention.

A) Assess whether this patient is drinking and driving.
B) Advise the person not to drink alone because the risks for injury increase.
C) Teach the person about risks for alcoholism and suggest other coping strategies.
D) Arrange for the person to attend an Alcoholics Anonymous meeting for older adults.

Question 26

A nurse and social worker co-lead a reminiscence group for eight young-old adults.Which activity is most appropriate to include in the group?

A) Mild aerobic exercise
B) Singing a song from World War II
C) Discussing national leadership during the Vietnam War
D) Identifying the most troubling story in today's newspaper

Question 27

A nurse leads a staff development session about ageism among health care workers.What information should the nurse include about the consequences of ageism? Select all that apply.

A) Failure of the elderly to receive necessary medical information
B) Development of public policy that discriminates against the elderly
C) Staff shortages because caregivers prefer working with younger adults
D) The perception that elderly consume a smaller share of medical resources
E) More ancillary than professional personnel discriminate with regard to age

Question 28

Which beliefs by a nurse facilitate provision of safe,effective care for older adult patients? Select all that apply.

A) Sexual interest declines with aging.
B) Older adults are able to learn new tasks.
C) Aging results in a decline in restorative sleep.
D) Older adults are prone to become crime victims.
E) Older adults are usually lonely and socially isolated.

Question 29

A nurse and social worker co-lead a reminiscence group for eight elite-old adults.Which activity is appropriate to include in the group?

A) Mild aerobic exercise
B) Singing a song from World War II
C) Discussing national leadership during the Vietnam War
D) Identifying the most troubling story in today's newspaper

Question 30

The highest priority for assessment by nurses caring for older adults who self-administer medications is:

A) use of multiple drugs with anticholinergic effects.
B) overuse of medications for erectile dysfunction.
C) missed doses of medications for arthritis.
D) trading medications with acquaintances.

Question 31

A patient living in community housing for the elderly says,"I don't go to the senior citizens club.They play cards and talk about the past because that's all they can do." The nurse analyzes these remarks to represent:

A) failure to achieve developmental tasks.
B) thinking associated with ageism.
C) hypercritical behavior.
D) paranoid thinking.

Question 32

A nurse plans a staff education program for employees of a senior living community.Which topic has priority?

A) Late-onset schizophrenia
B) Depression and suicide
C) Dementia
D) Delirium

Question 33

Discharge planning begins for an elderly patient hospitalized for 2 weeks diagnosed with major depression.The patient needs ongoing assessment and socialization opportunities as well as education about medication and relapse prevention.The patient lives with a daughter,who works during the week.Select the best referral for this patient.

A) Behavioral health home care
B) A skilled nursing facility
C) Partial hospitalization
D) A halfway house

Question 34

An elderly patient brings a bag of medications to the clinic.The nurse finds a bottle labeled "Ativan" and one labeled "lorazepam," both of which are to be taken BID.There are also bottles labeled "hydrochlorothiazide," "Inderal," and "rofecoxib," each to be taken once daily.Which conclusion is accurate?

A) Rofecoxib should not be taken with Ativan.
B) Lorazepam interferes with the action of Inderal.
C) The patient should not self-administer medication.
D) Lorazepam and Ativan are the same drug, so the dose is excessive.