SHERPATH Mental Health Care for Older Adults

Which observation of Mrs. M's condition would cause the nurse to suspect acute delirium?

SELECT ALL THAT APPLY

a.) Mrs. M's disorganized speech

b.) Finding Mrs. M's purse in the oven

c.) Mrs. M calling Elsa by her daughter's name

d.) Mrs. M presenting with dry mucous membranes

e.) Failure to note a fever during Mrs. M's physical assessment

a.) Mrs. M's disorganized speech

Disorganized, tangential speech, as a change from baseline, is a finding associated with acute delirium in the setting of a clinical infection such as a urinary tract infection (UTI).

b.) Finding Mrs. M's purse in the oven

Acute confusion, disorientation, and sudden change from routine behaviors are findings that would cause the nurse to suspect acute delirium in the setting of a clinical infection such as a UTI.

c.) Mrs. M calling Elsa by her daughter's name

Acute onset confusion, as a change from baseline, is associated with acute delirium in the presence of clinical signs of infection

Which statement, if made by a nursing student, indicates that additional learning regarding aging is needed?

a.) Older adults are often the victims of crime.

b.) Adults over 65 years tend to be financially stable.

c.) The quality of sleep declines significantly with aging.

d.) Older adults who lose a spouse adjust to the loss better than younger adults.

b.) Adults over 65 years tend to be financially stable.

Many older adults continue to work well past retirement age due to financial instability; lack of savings; and increased cost of living, including spending for health care, especially prescription medications.

A nurse educating staff at an adult day care facility would discuss which conditions as placing an older adult at increased risk for suicide?

SELECT ALL THAT APPLY

a.) Female sex

b.) Alcohol misuse

c.) Professional retirement

d.) Having a physical disability

e.) Living with chronic pain

b.) Alcohol misuse

Alcohol misuse is a risk factor for suicide in older adults because alcohol may be used to "self-medicate" to blunt feelings of loneliness or hopelessness.

d.) Having a physical disability

A physical disability, such as paraplegia, is a risk factor for suicide in older adults. The older adult may not be able to overcome the loss of power and independence caused by the disability.

e.) Living with chronic pain.

Chronic and/or uncontrollable pain is a risk factor for suicide in older adults. The change in health status, loss of power, and sense of hopelessness make death more attractive than life for some in this situation.

Which conditions would the nurse be concerned about in an older adult patient who reports consuming four to five alcohol drinks every evening?

SELECT ALL THAT APPLY

a.) Mania

b.) Dementia

c.) Homelessness

d.) Physical injury

e.) Increased appetite

f.) Nutritional imbalance

b.) Dementia

The older adult with excessive, prolonged alcohol use can develop alcohol-related diseases including alcoholic dementia, in which the chronic exposure to alcohol causes brain damage and results in symptoms similar to those seen with neurocognitive dementia.

d.) Physical injury

The older adult who misuses alcohol is at high risk for falls related to intoxication, and/or drug-alcohol interactions.

f.) Nutritional imbalance

The older adult who misuses alcohol is at high risk for nutritional imbalances because the alcohol decreases the absorption of important nutrients and contains empty calories.

The nurse is collecting an admission history from an older adult patient who was brought to the health care provider's office by their child, who is concerned that their parent may be depressed following the recent death of their spouse. Which assessment strategies would the nurse use to obtain an accurate history?

SELECT ALL THAT APPLY

a.) Ask the patient why they are depressed.

b.) Allow the patient's child to add supplemental information.

c.) Go at a pace that allows the patient time to answer questions.

d.) Ask the patient "Can you tell me how you have been doing recently?"

e.) Reassure the patient before the interview that everything is going to be fine.

b.) Allow the patient's child to add supplemental information.

Including family in the interview allows for clarification of information and additional data and provides support to the older adult patient.

c.) Go at a pace that allows the patient time to answer questions.

Pacing the interview questions in a way that is comfortable for the patient allows time to formulate answers. The nurse would also avoid interrupting the patient or answering for them.

d.) Ask the patient "Can you tell me how you have been doing recently?"

Open-ended questions that allow the patient to use their own words provide the most information, while also giving the nurse an opportunity to assess affect, mood, behavior, and quality of speech.

Which physical assessment finding would alert the nurse to further assess the cognitive status of an older adult patient seen in the emergency department following a fall at home?

a.) Kyphosis

b.) Cyanotic nail beds

c.) Blood pressure of 152/94 mm Hg

d.) Bilateral lower extremity edema

b.) Cyanotic nail beds

Cyanotic nail beds are a sign of hypoperfusion and decreased oxygenation. Lack of blood and oxygen may be affecting the patient's cognitive status and may have contributed to the fall. Further assessment is warranted.

When teaching nursing students about the Patient Self-Determination Act of 1990, which responsibilities of the health care institution would the instructor include in the discussion?

SELECT ALL THAT APPLY

a.) Provide consistent, safe, equitable care to all patients.

b.) Include documentation in the medical record regarding a patient's existing advance directives.

c.) Mandate that all patients complete an advance directive within 24 hours of admission to the facility.

d.) Maintain policies pertaining to provision of information to all patients regarding advance directives.

e.) Provide verbal information to the patient regarding their right to make decisions about their medical care.

a.) Provide consistent, safe, equitable care to all patients.

Health care institutions cannot provide differing levels of care or discriminate in any way based on whether a patient has an advance directive.

b.) Include documentation in the medical record regarding a patient's existing advance directives.

Documentation of any existing advance directives must be included in the patient's medical record.

d.) Maintain policies pertaining to provision of information to all patients regarding advance directives.

Policies that govern the dissemination of information on advanced directives to all patients interfacing with the institution is a responsibility of the institution.

Which misperception about depression in the older adult exists and may cause the condition to go untreated?

a.) Depression is difficult to diagnose in the older adult patient.

b.) Depressive symptoms are mistaken as symptoms of dementia.

c.) The medications to treat depression cause dangerous adverse effects in the older adult patient.

d.) Older adult patients do not see their health care provider routinely enough to confirm a diagnosis

b.) Depressive symptoms are mistaken as symptoms of dementia.

Depression in the older adult may be misinterpreted as dementia and therefore considered inevitable and unchanging.

Which statements, if made by a nursing student, indicate an understanding of the challenges of managing pain in the older adult patient?

SELECT ALL THAT APPLY

a.) The patient's bowel status will need to be carefully assessed.

b.) Interactions between the pain medication and existing medications create challenges.

c.) Acetaminophen should be avoided because it does not provide adequate pain relief in older adult patients.

d.) Confusion may not necessarily be related to analgesics, and the patient should be fully assessed for a source.

e.) The therapeutic effect of analgesics is shorter in duration in older adults, so they need to be medicated more frequently.

a.) The patient's bowel status will need to be carefully assessed.

Older adults on opiates are at risk for constipation, especially if mobility is already decreased. This statement indicates understanding.

b.) Interactions between the pain

Safe administration of analgesics in older adult patients is complicated because of possible interactions with drugs used to treat multiple chronic disorders. This statement indicates understanding.

d.) Confusion may not necessarily be related to analgesics, and the patient should be fully assessed for a source.

If acute confusion occurs, the nurse would assess for other contributing factors before changing the medication or stopping analgesic use. Confusion may be associated with unrelieved pain rather than with opiate use. This statement indicates understanding.

In addition to physiologic issues, the nurse understands that an older adult patient who misuses alcohol is at risk for which problems?

SELECT ALL THAT APPLY

a.) Self-neglect

b.) Legal difficulty

c.) Family discord

d.) Difficulty making friends

e.) Nonadherence with medical treatments

a.) Self-neglect

When alcohol becomes the patient's priority, self-care, including hygiene, nutrition, and sleep, become secondary concerns.

b.) Legal difficulty

Older adults who misuse alcohol may be at risk for legal trouble, including driving while intoxicated.

c.) Family discord

The use of alcohol by the older adult may cause distress for family members who are concerned about the individual.

Which assessment findings would cause the nurse to suspect that a patient is experiencing acute delirium?

SELECT ALL THAT APPLY

a.) Changes in behavior occur rapidly.

b.) The patient appears distressed and agitated.

c.) The patient reports forgetting how to get home from the store.

d.) The patient is not anxious about the symptoms being experienced.

e.) The patient's family reports that the patient was found wandering outside one evening.

a.) Changes in behavior occur rapidly.

Being an acute process, change is rapid, and the patient cannot express what is happening.

b.) The patient appears distressed and agitated.

The older adult with acute delirium is highly anxious, and while they are unable to clearly verbalize what is happening, they are significantly distressed.

Which patient outcome is most important for the nurse to write in the plan of care for an older adult patient with depression?

a.) The patient will eat regular meals every day and maintain a healthy weight.

b.) The patient will spend at least 2 hours a day socializing with friends and family.

c.) The patient's quality of life will be optimized as measured by the patient's verbalization of satisfaction.

d.) The patient will maintain adherence to the treatment plan as measured by taking all prescribed medications and attending scheduled office visits.

c.) The patient's quality of life will be optimized as measured by the patient's verbalization of satisfaction.

The most important goal when planning care for an older adult patient with any mental health concern is to optimize the quality of their life in a way that is meaningful and satisfying to them.

The nurse is caring for an older adult patient with acute delirium who is unable to ambulate independently. When left alone in the room, the patient attempts to get out of bed. Which action would the nurse take first?

a.) Apply a pressure-sensitive alarm to the patient's bed.

b.) Request an order for an anxiolytic to help calm the patient.

c.) Ask the family to be available to stay with the patient when the staff is not in the room.

d.) Apply soft wrist restraints to the patient and attach them to the frame of the bed with a quick-release knot.

a.) Apply a pressure-sensitive alarm to the patient's bed.

Before applying any restraint to a patient, the nurse attempts to provide the least restrictive environment first. This would include applying a pressure sensitive alarm to the patient's bed.

In an older adult patient diagnosed with dementia, which aspect of the plan of care would the nurse adjust to decrease patient agitation?

a.) Help the patient to bathe and dress each morning at 9:00 AM.

b.) Avoid asking the patient to deliver menus to other resident rooms.

c.) Allow the patient to go to the dining room for meals anytime it is open.

d.) Provide the patient 10 minutes of quiet time after breakfast before morning exercise in the day room.

c.) Allow the patient to go to the dining room for meals anytime it is open.

Patients with dementia can become agitated when it is unclear what is needed or expected of them. Having a repetitive routine, including posting a visible schedule can be helpful in decreasing agitation. The aspect of the plan of care that allows the resident with dementia to go to meals at any time would be adjusted.

Which explanation would the instructor provide to the nursing student when asked why medication reconciliation is part of the hospital discharge process?

a.) Redundancies in medication are eliminated.

b.) The nurse can adjust the dosing if needed based on overall medication profile.

c.) It ensures that the patient is paying the lowest price for all prescription medications.

d.) The medications covered by insurance are separated from those that have to be paid for out of pocket.

a.) Redundancies in medication are eliminated.

Reconciliation of current medication is important to ensure the individual is taking exactly what is prescribed safely and that redundancies are discovered in a timely manner. The older adult may have multiple medications from different providers, leading to duplicate medications, which creates a dangerous situation for the patient.