Deck 29: Psychosocial Needs of the Older Adult

Question 1

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) Ask if the patient can hear clearly 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.

Answer 1

Ask if the patient can hear clearly as the nurse speaks.

Question 2

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.

Answer 2

Vision,hearing,touch,taste,and smell decline with age.

Question 3

The nurse should complete the Geriatric Depression Scale as part of the assessment if an elderly patient answers which question affirmatively?

A) "Would you say your mood is often low?"
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 low?"

Question 4

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) "Pain is diminished by dementia.Focus your assessment on the patient's mental status."
C) "Use a visual analog scale to help the patient determine the presence of pain and its severity."
D) "There are special scales for assessing persons with dementia.Let's review how to use them."

Question 5

A physically frail elderly patient with mild cognitive impairments needs services of a facility that can provide supervision,safety,and recreational and social interaction during the day.Family cares for the patient during the evening and night.Which type of facility would meet this patient's needs?

A) Adult day care program
B) Skilled nursing facility
C) Partial hospitalization
D) Psychotherapy group

Question 6

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

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

Question 7

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) abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends AA.
C) began to drink large amounts of alcohol daily after retirement "to keep my mind off my arthritis."
D) drank socially throughout adult life and continues this pattern,saying "I've earned the right to do as I please."

Question 8

An 80-year-old with arthritis has difficulty walking.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 9

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 10

A 78-year-old resident of a skilled nursing facility has hypertension and cardiac disease.This resident is usually alert and oriented but this morning tells the nurse,"My family visited during the night.They brought flowers and candy to me." In reality,the patient's family lives 200 miles away.The nurse should first suspect that the resident:

A) may be developing Alzheimer's disease associated with advanced age.
B) may have a cognitive impairment associated with medication actions.
C) had a stroke and developed sensory perceptual alteration.
D) has an alcohol-related cognitive impairment.

Question 11

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 12

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 taken recently
D) Level of preoccupation with somatic symptoms

Question 13

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 suicide risk.
C) a cry for sympathy.
D) normal grieving.

Question 14

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 15

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

A) Nurse assigned to care for the patient
B) Nursing assistant who applies 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 decides that an elderly patient's pain warrants use of a narcotic analgesic.Nursing staff must take action to reduce the risk of:

A) falls.
B) seizures.
C) dehydration.
D) incontinence.

Question 17

In a sad voice,an elderly patient tells the nurse of the recent deaths of a spouse and daughter in an automobile accident.The patient has no other family,only a few acquaintances in the community.The nurse's priority is to gather additional assessment data to determine whether which nursing diagnosis applies to this patient?

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

Question 18

A health care provider writes these new prescriptions for a skilled nursing facility resident:
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 19

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 papers are signed."

Question 20

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) Psychotherapy
C) Reminiscence (life review)
D) Group therapy would not be effective for this patient.

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) increased appetite.
B) enhanced self-esteem.
C) sleep pattern changes.
D) anhedonia and anergia.
E) increased concerns with bodily functions.

Question 22

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

A) "What thoughts do you have about a person's right to take his or her life?"
B) "Do you have any risk factors that potentially contribute to suicide?"
C) "Do you think you are vulnerable to developing depressed mood?"
D) "If you felt suicidal,would you tell someone about your feelings?"

Question 23

Discharge planning begins for an elderly patient hospitalized for 2 weeks with major depression.The patient needs ongoing assessment,socialization opportunities,and 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 24

A selective serotonin reuptake inhibitor is prescribed for an elderly patient with depression.Nursing assessment should include careful collection of information regarding:

A) other prescribed medications and over-the-counter products used.
B) evidence of pseudoparkinsonism or tardive dyskinesia.
C) history of psoriasis and any other skin disorders.
D) history of diarrhea and electrolyte imbalances.

Question 25

Which risk factors predispose a patient to development of geriatric alcohol abuse? Select all that apply.

A) Stopped attending school in the eighth grade
B) Mild recent memory impairment
C) Death of spouse
D) Retirement
E) Loneliness

Question 26

Health care agencies receiving federal funds must provide patients written information about:

A) advance health care directives.
B) the financial status of the institution.
C) how to sign out against medical advice.
D) the institution's policy on resuscitation of individuals.

Question 27

A nurse is asked to explain why ageism is a problem among health care workers.The nurse should cite that ageism results in: (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

A homebound patient drinks a six-pack of beer daily.The patient tells the nurse,"I've been having pain from my arthritis lately,so I take acetaminophen four times a day." The nurse's priority interventions include: (Select all that apply. )

A) determining the safety of the dose the patient is ingesting daily.
B) inquiring about sleep disturbances caused by mixing alcohol and analgesics.
C) advising the patient of the harmful effect of alcohol and acetaminophen on the liver.
D) suggesting increasing the acetaminophen dose,since alcohol causes faster excretion.
E) assessing for declining functional status associated with medication-induced dementia.