Deck 28: Older Adults

Question 1

When making a distinction as to whether a patient is experiencing confusion related to depression or dementia, what information would be most important for the nurse to consider?

A) The patient with dementia is persistently angry and hostile.
B) Early morning agitation and hyperactivity occur in dementia.
C) Confusion seems to worsen at night when dementia is present.
D) A patient who is depressed is preoccupied with somatic symptoms.

Answer 1

Confusion seems to worsen at night when dementia is present.

Question 2

A 79-year-old white man tells a visiting nurse, "I've been feeling sad lately. My family and friends are all dead. My money is running out, and my health is failing." The nurse should analyze this comment as:

A) normal negativity of older adults.
B) evidence of suicide risk.
C) a cry for sympathy.
D) normal grieving.

Answer 2

evidence of suicide risk.

Question 3

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

A) aggressive.
B) dehydrated.
C) unable to verbally communicate.
D) unable to make health care decisions.

Answer 3

unable to make health care decisions.

Question 4

Recognizing the risk for acquired immunodeficiency syndrome (AIDS) among older adults, nurses should provide health teaching aimed at:

A) discouraging sexual expression.
B) using birth control measures.
C) avoiding blood transfusions.
D) encouraging condom use.

Question 5

A 78-year-old nursing home resident diagnosed with hypertension and cardiac disease is usually alert and oriented. This morning, however, the resident says, "My family visited during the night. They stood by the bed and talked to me." In reality, the patient's family lives 200 miles away. The nurse should first suspect that the resident:

A) may be experiencing side effects associated with medications.
B) may be developing Alzheimer disease associated with advanced age.
C) had a transient ischemic attack and developed sensory perceptual alterations.
D) has previously unidentified alcohol abuse and is beginning alcohol withdrawal delirium.

Question 6

An older adult patient brings a bag of medication to the clinic. The nurse finds one bottle labeled "Ativan" and one labeled "lorazepam," and both are labeled "Take two times daily." Bottles of hydrochlorothiazide, Inderal, and rofecoxib, each labeled "Take one daily," are also included. Which conclusion is accurate?

A) Rofecoxib should not be taken with Ativan.
B) The patient's blood pressure is likely to be very high.
C) This patient should not self-administer any medication.
D) Lorazepam and Ativan are the same drug; consequently, the dose is excessive.

Question 7

A community mental health nurse plans an educational program for staff members at a home health agency that specializes in the care of older adults. A topic of high priority should be:

A) identifying depression in older adults.
B) providing cost-effective foot care for older adults.
C) identifying nutritional deficiencies in older adults.
D) psychosocial stimulation for those who live alone.

Question 8

A nurse asks the following questions while assessing an older adult. The nurse will add the Geriatric Depression Scale as part of the assessment if the patient answers "yes" to which question?

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?"

Question 9

If an older adult 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) Health care provider who ordered the application of the restraint
D) Family member who agrees to the application of the restraint

Question 10

A patient asks the nurse, "I already have a living will. Why should I have a durable power of attorney for health care also?" The nurse should reply, "A durable power of attorney for health care:

A) gives your agent the authority to make decisions about your care if you are unable to during any illness."
B) can be given only to a relative, usually the next of kin, who has your best interests at heart."
C) authorizes your physician to make decisions about your care that are in your best interest."
D) can be used only if you have a terminal illness and become incapacitated."

Question 11

A 74-year-old patient is regressed and apathetic. This patient responds to others only when they initiate the interaction. Which therapy would be most useful to promote resocialization?

A) Medication
B) Re-motivation
C) Group psychotherapy
D) Individual psychotherapy

Question 12

A tricyclic antidepressant is prescribed for an older adult patient diagnosed with major depressive disorder. Nursing assessment should include careful collection of information regarding:

A) use of other prescribed medications and over-the-counter products.
B) evidence of pseudoparkinsonism or tardive dyskinesia.
C) history of psoriasis and any other skin disorders.
D) current immunization status.

Question 13

Which is the best comment for a nurse to use when beginning an interview with an older adult patient?

A) "Hello, [call patient by first name]. I am going to ask you some questions to get to know you better."
B) "Hello. My name is [nurse's name]. I am a nurse. Please tell me how you would like to be addressed by the staff."
C) "I am going to ask you some questions about yourself. I would like to call you by your first name if you don't mind."
D) "You look as though you are comfortable and ready to participate in an admission interview. Shall we get started?"

Question 14

A clinic nurse interviews four patients between 70 and 80 years of age. Which patient should have further assessment regarding the risk of alcohol addiction? The patient:

A) with a history of intermittent problems of alcohol misuse early in life and who now consumes one glass of wine nightly with dinner.
B) with no history of alcohol-related problems until age 65 years, when the patient began to drink alcohol daily "to keep my mind off my arthritis."
C) who drank socially throughout adult life and continues this pattern, saying, "I've earned the right to do as I please."
D) who abused alcohol between the ages of 25 and 40 years but now abstains and occasionally attends Alcoholics Anonymous.

Question 15

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

A) Older adults are often socially isolated and lonely.
B) As people age, they become more rigid in their thinking.
C) The majority of older adults sleep more than 12 hours per day.
D) The senses of vision, hearing, touch, taste, and smell decline with age.

Question 16

A student nurse visiting a senior center tells the instructor, "It's so depressing to see all these old people. They are so weak and frail. They are probably all confused." The student is expressing:

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

Question 17

A 75-year-old patient comes to the clinic reporting frequent headaches. After an introduction at the beginning of the interview, the nurse should:

A) initiate a neurologic 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 performing the assessment.

Question 18

A health care provider writes these new prescriptions for a resident in a skilled care facility: "2 g sodium diet; restraint as needed; limit fluids to 2000 ml daily; 1 dose milk of magnesia 30 ml orally if no bowel movement occurs for 3 days." Which prescription should the nurse question?

A) Restraint
B) Fluid restriction
C) Milk of magnesia
D) Sodium restriction

Question 19

A patient tells the nurse of the recent deaths of a spouse of 50 years as well as an adult child in an automobile accident. The patient has no other family and only a few friends in the community. What is the priority nursing diagnosis?

A) Spiritual distress, related to being angry with God for taking the 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 20

An 80-year-old patient has difficulty walking because of arthritis and says, "It's awful to be old. Every day is a struggle. No one cares about old people." Which is the nurse's most therapeutic 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 21

A health care provider decided that the emotional distress in an older adult patient warranted the prescription of risperidone (Risperdal). Which interventions should the nurse add to the patient's plan of care? (Select all that apply.)

A) Monitor for signs and symptoms of diabetes.
B) Use disposable briefs for incontinence.
C) Monitor for cerebrovascular changes.
D) Implement a tyramine-free diet.
E) Monitor for dehydration.

Question 22

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) misuse of antihypertensive medications.
D) trading medications with others.

Question 23

An older patient reports drinking a six-pack of beer daily. The patient tells the community health nurse, "I've been having trouble with my arthritis lately, so I take acetaminophen four times a day for pain." What are the nurse's priority interventions? (Select all that apply.)

A) Inquiring about sleep disturbances caused by mixing alcohol and analgesic medications.
B) Determining the safety of the daily acetaminophen dose the patient is ingesting.
C) Advising the patient of harmful effects of alcohol and acetaminophen on the liver.
D) Suggesting an increase in the acetaminophen dose because alcohol produces faster excretion.
E) Assessing the patient for declining functional status associated with medication-induced dementia.

Question 24

An older adult with a history of major depressive disorder has taken sertraline (Zoloft) daily for three years. The patient tells the nurse, "I want to stop taking this medication. I don't think I need it anymore." Select the nurse's best response.

A) "Why do you think you don't need this medication anymore?"
B) "Have you talked with your family members about this decision?"
C) "If you stop the medication, your depression will return worse than ever."
D) "This medication should be gradually stopped. Let's talk to your health care provider about a plan."

Question 25

When admitting older adult patients, health care agencies receiving federal funds must provide 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 the use of restraints.

Question 26

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

A) Singing a song from World War II
B) Learning to send and receive email
C) Discussing national leadership during the Vietnam War
D) Identifying the most troubling story in today's newspaper

Question 27

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) Singing a song from World War II
B) Learning how to join an online social network
C) Discussing national leadership during the Vietnam War
D) Identifying the most troubling story in today's newspaper

Question 28

A nurse wants to perform a preliminary assessment for suicidal ideation in an older adult patient. Which question would obtain the desired data?

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

Question 29

A nurse assessing an older adult patient for depression should include questions about mood as well as which other symptoms? (Select all that apply.)

A) Increased appetite
B) Sleep pattern changes
C) Anhedonia and anergia
D) Increased social isolation
E) Increased concern with bodily functions

Question 30

Which beliefs 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 31

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 older adults to receive necessary medical information
B) Development of public policy that favors programs for older adults
C) Staff shortages because caregivers prefer working with younger adults
D) Perception that older adults consume a small share of medical resources
E) More ancillary than professional personnel discriminate with regard to age