Mental Health Ch. 16

_____% of older adults are living at the poverty level.

a. Twelve

b. Eighteen

c. Twenty six

d. Twenty three

a. Twelve

-This is similar to the economic status of other ages

A 55-year-old man is extremely fearful of the effects of growing old. He is experiencing:

a. Ageism

b. Gerontophobia

c. An age phobia

d. Elder phobia

b. Gerontophobia

-This term also includes refusal to accept the elderly into the mainstream of society. Ageism is stereotyping the elderly as weak, dependent, and nonproductive. Age phobia and elder phobia are not used terms.

Physical signs of aging usually begin in the late 30s. Physical signs of aging begin to slow after one reaches the age of approximately:

a. 35

b. 45

c. 65

d. 85

d. 85

-Signs of aging continue to show themselves until around 85 years. Physical aging is affected by genetics, health care, lifestyle, and attitude.

An elderly man has serious vision problems and is no longer allowed to obtain a drivers license. He has been very independent until this time. Which nursing diagnosis is most appropriate for this situation?

a. Confusion, chronic

b. Coping, ineffective

c. Self-esteem, risk for situational low

d. Grieving, dysfunctional

c. Self-esteem, risk for situational low

-Self-esteem, risk for situational low is most appropriate because of his previous independence. The other options are also nursing diagnoses, but the situation does not lend itself to these diagnoses.

The home health nurse is caring for a 79-year-old man with the diagnosis of hypertension who is on a fixed income. He was discharged from the hospital a few weeks ago with his newly prescribed medication to keep his BP under control. His BP measurements have been gradually increasing over the last few visits, with no other changes in status assessed. Which nurse statement would be most appropriate?

a. Have you been taking your medication as often as you are supposed to?

b. I dont understand why your BP is up.

c. Maybe I should check your BP at another time.

d. I hope you are taking your medication. Otherwise, I am wasting my time.

a. Have you been taking your medication as often as you are supposed to?

-clients on fixed incomes often take less of their medications so they will last longer. None of the other options meets the need of the situation, and saying that the client is wasting the nurses time is an inappropriate statement.

A 2006 survey indicates a ____% increase in elder abuse.

a. 5

b. 10

c. 19

d. 27

c. 19

-The reported 19% increase represents only documented cases; rates are most likely higher.

7. Which intervention will be most effective when one is teaching a client about his or her medications and their administration?

a. Pointing out the colors of the medications for easier identification

b. Referring to medications by name and providing written instructions

c. Quizzing the client on each medications purpose, side effects, and drug interactions

d. Encouraging the client to hold all questions until the end of the discussion so the nurse will not have to repeat information

b. Referring to medications by name and providing written instructions

-referring to the medications by name and providing written instructions will lead to less confusion. Pointing out colors can be a problem if there is visual impairment; quizzing the client is not necessary; and encouraging the client to hold questions may cause questions to be forgotten.

The nurse is caring for a 79-year-old client with dementia. The client worked as an obstetrics nurse before retiring. Despite her dementia, she still remembers terms and procedures and basic nursing care interventions from her past career. This is an example of:

a. Working memory

b. Reasoning

c. Information processing

d. Crystallized intelligence

d. Crystallized intelligence

-Crystallized intelligence is specialized accumulated knowledge, and it is common for individuals to remember this specialized information, even if they experience dementia. Working memory is the random access memory to which one refers. Reasoning is the ability to solve problems and make choices, and information processing is the ability to relate to, store, and retrieve information.

An elderly client states that she paid $10,000 to a nice repairman for fixing her broken window and fence. This is an example of elder abuse known as:

a. Violation of rights

b. Exploitation

c. Psychological abuse

d. Neglect

b. Exploitation

-It is estimated that approximately 10% of the elderly population are victims of this type of abuse.

The nurse must be aware of physical signs and symptoms of depression because these are often the first, sometimes overlooked, signs of the disorder. Physical signs and symptoms of depression include:

a. Decreased or slowed memory

b. Fatigue

c. Changes in appetite

d. Abdominal pain

d. Abdominal pain

-Abdominal pain, muscle aches, and dry mouth are common physical symptoms of depression in the older adult. Other physical causes of these symptoms must be ruled out, and further assessment of other signs of depression must be noted. Decreased or slowed memory is cognitive; fatigue is emotional; change in appetite is behavioral.

The nurse is implementing validation therapy with an elderly male client to assist him in resolving old conflicts and making peace with himself. Which is one of the techniques used?

a. Sympathy

b. Empathy

c. Helping the client write a paragraph about his life

d. Contacting old acquaintances for their interpretation of the clients life

b. Empathy

-Empathy and several other interventions constitute validation therapy. The other options are not used in validation therapy.

It is important for the nurse to be aware that ____% of individuals over 45 years old take prescription, over-the-counter, or a combination of these medications.

a. 35

b. 55

c. 75

d. 95

c. 75

-Seventy-five percent of individuals over 45 years old take prescription, over-the-counter, or a combination of medications. This is important to know when one is planning interventions.

One of the ways that nursing care of the elderly is ensured is by the enactment and monitoring of:

a. DSM-IV-TR standards

b. State boards of health

c. Standards of geriatric nursing practice

d. State nurse practice acts

c. Standards of geriatric nursing practice

-Standards of geriatric nursing practice were developed to specifically address the needs of the elderly population.

What percentage of the population has reached 65 years of age?

a. 13%

b. 21%

c. 30%

d. 42%

a. 13%

-As of the year 2009, 13% of the people in the United States reached age 65. This figure is estimated to double in 30 years.

The visiting nurse is at the home of an 88-year-old woman whose physician is concerned that she is losing weight. While performing an assessment, the nurse discovers that the clients dentures are ill-fitting and this makes eating painful. The client claimed she informed her daughter of this, but the daughter is too busy to take her to the dentist. The nurse is concerned that this is a possible sign of:

a. Abuse

b. Neglect

c. Domestic violence

d. Depression

b. Neglect

-Neglect is defined as failing to meet basic physical needs. Abuse and domestic violence are evidence of actual physical harm. This situation does not describe depression.

The nurse is completing an admission interview with an older adult on a busy medical unit. What action is most appropriate for the nurse to take?

a. Complete the admission interview with the clients son.

b. Shout at the client so he or she can hear.

c. Provide pen and paper and let the client write his answers.

d. Allow the client time to respond to the questions regarding health history.

d. Allow the client time to respond to the questions regarding health history.

-Information processing speed decreases with age, and it may take longer for the client to retrieve the information and respond.

A 70-year-old woman who was recently widowed expresses a desire to go back to school and finish the degree she started before her children were born. What response is most appropriate?

a. Why would you want to stress yourself at your age?

b. That may not be possible. As you age, your ability to learn decreases.

c. Going back to school will keep you engaged and active.

d. Lets do a cognitive function test to see if you are eligible.

c. Going back to school will keep you engaged and active.

-It is important for older adults to stay active and engaged. Encouraging the woman in her pursuit is an appropriate response. The other options may all discourage the client from remaining engaged in society.

A 78-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She appears to be confused and combative at times. Her daughter is concerned because her mother was alert and oriented prior to being diagnosed with pneumonia. Her altered mental status is related to:

a. The onset of Alzheimers disease

b. Alteration in oxygenation

c. Result of family neglect

d. Dysfunctional coping

b. Alteration in oxygenation

-Physical problems can lead to changes in mental status. Early assessment and intervention are key for keeping older adults minor problems from becoming major ones. An alteration of the patients oxygenation can affect a clients behavior.

Which conditions most commonly place older adults at risk for overdose from medications and severe reactions? (Select all that apply.)

a. Depression

b. Higher rate of metabolism

c. Interaction with other medications

d. Problems with sight and memory

C, D

-Older adults often are taking numerous medications prescribed by several specialists, and sight and memory can cause errors in taking medications. Depression is not a common cause of overdose, and metabolism is usually slower in this age group.

Which emotional signs and symptoms of depression in the elderly must the nurse be aware of and monitor for? (Select all that apply.)

a. Increased anxiety or dependence

b. Fatigue

c. Feels he or she has no purpose

d. Withdraws from people

A, B, C

-Increased anxiety or dependence, fatigue, and feelings of purposelessness are emotional signs and symptoms of depression. Withdrawal from people is a behavioral sign of depression.

To respectfully and effectively provide health teaching to the older adult, which of the following actions should be employed? (Select all that apply.)

a. Speak very loudly and in high-pitched tones.

b. Ask clients to repeat your message.

c. Break complex tasks into small, pertinent steps.

d. Refer to medications by color.

B, C

-When teaching an older adult, it is important to have them repeat your message back to you to ensure that they understand. It is also helpful to break complex tasks into smaller manageable steps to help the client remember. Speaking loudly and in high-pitched tones will not assist the client in learning. A nurse should refer to medications by name rather than color.