When assessing an older client for indications of depression, the nurse bases the intervention on the knowledge that:

1. the older client’s symptoms may be atypical for the disorder.
2. depression is a common mental disorder among the older population.
3. the older client is generally willing to discuss his or her mental health symptoms.
4. depression is not as commonly seen in this population as are anxiety disorders.

A

The nurse preparing educational information on common mental health disorders among the older adult population should include:

a.methods for reducing anxiety.

b. a written depression screening tool.

c. local schizophrenia support groups. d. signs and symptoms of alcoholism.

b

When an older adult reports experiencing several different stressors over the last 6 months, the nurse demonstrates an understanding of the physiological effects of stress on the body by:

1. assessing the client using the Geriatric Depression Scale (GDS).
2. testing the client’s urine for red blood cells.
3. screening the client for abnormally high serum glucose levels.
4. inquiring as to whether the client has lost weight during that time period.

C

An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging?

1. Assessing the client for both depression and anxiety
2. Discussing the poor prognosis of this disorder with the client
3. Explaining the need for proper nutrition to minimize the effects of alcoholism
4. Identifying the effects of chronic alcoholism on the human body

A

In order to focus on the older population with the greatest risk for suicide, the nurse would conduct a depression screening that targets:

1. African American men.
2. white men.
3. white women.
4. African American women.

B

An older adult says to the nurse, “I don’t know why I can’t handle booze like I used to when I was younger.” The nurse’s response is based on the knowledge that:

1. older adults develop higher blood alcohol levels due to age-related changes in the neurological system.
2. older adults develop higher blood alcohol levels due to age-related changes thatalter absorption and distribution of alcohol.
3. older adults develop higher blood alcohol levels due to slowed reaction times.
4. older adults develop higher blood alcohol levels due to cognitive changes.

B

How should the nurse reply when an older adult asks, “How much alcohol is good for you?”

1. “Alcohol isn’t good for you so avoid it as a general rule.”
2. “Experts in the field recommend only one regular sized drink a day.”
3. “It’s been said that red wine has health benefits, but that doesn’t mean drink a whole bottle.”
4. “If you are only drinking on special occasions, limit yourself to two drinks.”

B

An older adult has recently experienced a number of stressful life events. The client comes to the ambulatory clinic and tells the nurse that, “On top of all I’ve had to endure, now I’ve got this flu!” In rendering care for this client, the nurse recognizes that:

1. the client is exhibiting attention-seeking behaviors to substitute for poor coping skills.
2. crisis and stressful situations may produce emotions that erode the health of the older people.
3. the client is exhibiting learned helplessness as a result of the recent stressors.
4. a period of crisis will ultimately lead to a lower level of physical and mental functioning.

B

An older client in an adult day care program tells the nurse, “I’m very stressed because another neighbor passed away.” The most therapeutic response by the nurse is:

1. “What do you mean by ‘stressed’?”
2. “Tell me what you did when your other neighbor passed away.”
3. “Are you worrying about your own death?”
4. “Let’s get involved in some activities and not think about sad things.”

B

A nurse who is caring for an older patient with bipolar disorder knows that the patient needs additional education when the patient states:

1. “Bipolar disorder often results in ‘a leveling out’ of symptoms as one ages.”
2. “Relapses in bipolar disorder tend to be precipitated by medical problems.”
3. “Older adults with bipolar disorder tend to be ‘rapid cyclers’.”
4. “Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults.”

D

A nurse administers the Short Michigan Alcohol Screening Test Geriatric Version (S-MAST-G) to an older adult. The older adult receives a score of “2.” The nurse knows that this score is indicative of:

1. no problem with alcohol.
2. a problem with alcohol.
3. a mild problem with alcohol.
4. a severe problem with alcohol.

B

When discussing electroconvulsive therapy (ECT) with an older, chronically depressed adult and his family, which statement will the nurse use to support this intervention? (Select all that apply.)

1. “This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications.”
2. “ECT has been found to be more effective in older adults than in younger adults.”
3. “ECT is a safe intervention for those with psychotic ideation.”
4. “While there may be some short-term memory loss, most individuals find that their memory comes back within a few days.”
5. “ECT results in a more immediate response to symptoms.”

A,D,E

A nurse is assisting an older adult to cope with the loss of a spouse. The nurse encourages the person to use an emotion-focused coping strategy. Which of the following actions should the nurse take? (Select all that apply.)

1. Encourage the person to cry if he or she feels like it.
2. Teach the person relaxation breathing exercises.
3. Encourage the person to make an action plan for the future.
4. Suggest that the person reach out to his or her clergyperson.
5. Suggest that the person attend a yoga class.

A,B,E

A nurse is conducting an assessment of an older adult in a geriatric clinic. The patient states that he drinks two to three alcoholic beverages daily. The patient has multiple chronic comorbid conditions and is on five different medications. Which of the following medications is the nurse concerned will interact with the alcohol? (Select all that apply.)

1. Naproxen for pain
2. Daily multivitamin
3. Prozac for depression
4. Celebrex for arthritis
5. Toprol XL for hypertension

A,C

A nurse in a long-term care facility is approached by an older resident who is crying and states: “You need to help me. The mean little men are in my room again. They are watching me from the corner and they are laughing at me. Make them go away.” The nurse accompanies the resident to the room and there is no one in the corner of the room. What is the best response by the nurse? (Select all that apply.)

1. “Yup, I see them. Let me call security to haul the men away.”
2. “Can you tell me what you are so frightened of?”
3. “I will do my best to keep you safe.”
4. “I understand that you are very frightened and upset.”
5. “You know that there is no one there. Stop carrying on like this.”

B,C,D

The nurse is caring for an older client who experienced a hip replacement surgery 10 hours ago. Which intervention will help minimize this client’s risk of developing delirium?

1. Requesting that staff offer fluids each time they interact with the client
2. Medicating the client to best facilitate restorative sleep
3. Encouraging the client to remain still and thus minimize pain
4. Suggesting that visitors are limited to family members only

A

Which intervention best addresses the principle that is the basis for communicating with a client experiencing postsurgical delirium?

A. Reminding the client that delirium is generally acute and reversible

B.Assuming that the client’s statements are an attempt to express needs

C.Allowing the client sufficient time to formulate an answer to questions

D.Using nonverbal communication techniques to communicate with the client

B

An older client admitted to the hospital after having sustained a fall at home is diagnosed with a right hip fracture and experienced a surgical reduction of the fracture. At 2:30 AM, she awakens from sleep insisting that her daughter is in the other room and wants to see her. Attempts to reorient her to the surroundings are unsuccessful. In reviewing the client’s record, what data would be considered a primary risk factor for the delirium?

1. History of dementia
2. Death of the client’s husband last month
3. The client’s age
4. History of cardiac disease

A

An older client diagnosed with dementia resides with his daughter. When the homecare nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, “I don’t know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him.” How will the nurse respond to the client’s daughter?

1. “Let’s think about what you may have done to anger your father?”
2. “Let’s try to figure out what your father was trying to say with his behavior.”
3. “Scratching is usually a sign of untreated pain. Do you think your father is in pain?”
4. “Maybe you should consider having a home health care provider take over responsibility for your father’s physical care.”

B

A nurse is caring for a patient with a diagnosis of delirium. Which of the following is an expected assessment finding for this patient?

1. Normal attention span
2. Fluctuation in symptoms
3. Normal sleep cycle
4. Increased appetite

B

Which intervention to manage wandering in clients in a long-term care facility should be implemented? (Select all that apply.)

1. Camouflaging doorways
2. Close observation to identify the person’s individual patterns
3. Engaging the person in social interactions
4. Using physical restraints to prevent wandering to maintain safety
5. Providing enclosed pathways for walking

A,B,C,E

Which information will the nurse manager include when discussing the major differentiation between delirium and dementia with novice nurses? (Select all that apply.)

1. The delirious client learns to make up answers to hide his or her confusion.
2. Delirium requires increased monitoring at night.
3. The client diagnosed with dementia generally looks frightened.
4. Dementia results in a steady decline in cognitive abilities.
5. Delirium is characterized by fluctuations in alertness.

B,D,E

A nurse is caring for a 92-year-old female patient who was admitted to the hospital 1 day after she had outpatient cataract surgery. The patient who lives in an assisted living facility became very confused and agitated and was found wandering in the lobby of the building in her nightgown. She refused to return to her room and stated that there were “bad men” in her room. The patient has a history of dementia, diabetes, heart failure, and is on seven different medications. She was widowed 1 year ago. The nurse suspects that she has delirium. What are the patient’s risk factors for delirium? (Select all that apply.)

1. Age of 92
2. Residing in an assisted living facility
3. History of dementia
4. Female gender
5. Recent cataract surgery

A,C,E

A nurse in a long term care facility is concerned that a 94-year-old resident with dementia is losing weight. Upon assessment, the nurse notes that the resident, who is able to feed herself independently, consumes less than 50% of each of her meal trays. Which of the following strategies can the nurse utilize to improve this resident’s intake? (Select all that apply.)

1. Assign a nursing assistant to feed the resident.
2. Assign a nursing assistant to sit with the resident as the resident eats.
3. Serve the resident finger foods.
4. Serve the resident one dish at a time.
5. Alter the dining ambience to reduce distractions.

B,C,D,E

A nurse is assessing an older patient with new onset confusion using the Confusion Assessment Method (CAM). The nurse understands that in order to have a diagnosis of delirium when using the CAM, the patient must exhibit which of the following? (Select all that apply.)

1. Acute onset of symptoms or fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered level of consciousness
5. Alteration in level of physical activity

A,B