Chapter 22: Mental Health My Nursing Test Banks

Chapter 22: Mental Health

Test Bank

MULTIPLE CHOICE

1. The nurse prepares to discharge an older man who has heart failure and is in stable condition, when his wife states that she will avoid sexual activities with him because of his heart disease. Which of the following factors should the nurse use in patient teaching about sexual activity for an older adult with heart failure?

a.

An older adult with heart failure should avoid sexual relations because of the demand it places on the heart.

b.

Sexual relations and climbing six flights of stairs expend the same amount of energy.

c.

Fear and lack of knowledge can cause older people to reduce their sexual activity unnecessarily.

d.

Sexuality is a private matter between the older man and his wife.

ANS: C

Sex is not restricted to young and healthy individuals; therefore the nurse provides the patient and his wife with information about safely resuming sexual intimacy. With appropriate cardiac rehabilitation, much of his capacity for exertion, such as sexual activity, can be restored. The energy expenditure for sexual activity varies; but, typically, it takes less energy than climbing six flights of stairs. The nurse must be prepared to discuss sexual issues with patients and seeks opportunities for discussion about sexual health.

PTS: 1 DIF: Apply REF: 3| 7-11| 20 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

2. An older woman recently lost her brother, provides care for her husband who has health needs, and must move to a new location after 35 years in the same home. When she comes to the primary care facility with clinical indicators of influenza, the nurse recognizes which of the following?

a.

She is exhibiting attention-seeking behaviors.

b.

Crises and stressors can impair physical health.

c.

Her greatest need is respite care for her husband.

d.

Crisis leads to a lower functional status for the victim.

ANS: B

Her resistance to disease is likely to be lower as a result of the effects of heavy stresses acting simultaneously. She may be seeking attention, but that does not make the stress and illness any less real. Her greatest need at this moment is to be treated for influenza. Respite care may be necessary, but it is not sufficient. Successful coping with a crisis may lead to a higher level of functioning.

PTS:1DIF:UnderstandREF:2-9| 17-22

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

3. Which of the following statements is true about the mental health of older adults?

a.

Nurses should discourage denial and regression so older adults can directly face underlying causes of anxiety.

b.

Anxiety is easily distinguished from depression, dementia, and the effects of disease or medication.

c.

Compulsive rituals surrounding toileting and sleep are signs of a serious mental disorder.

d.

The nurse avoids antianxiety medications without an assessment for factors associated with anxiety.

ANS: D

Without an adequate assessment, medications can exacerbate a problem. Denial and regression may be necessary to enable an older person to cope with underlying stressors. Depression, dementia, disease, and medications can produce anxious behavior, and the resultant anxiety can be manifested in a similar manner, regardless of the cause. Compulsive rituals can be a way of coping with challenges leading to anxiety.

PTS:1DIF:UnderstandREF:6-9

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

4. An older female resident lowers her voice and tells the nurse that another female resident is looking at her behind her back and is going to make her move tonight with a male staff member. Which ideas should the nurse include in the response to this individual?

a.

The staff receives training in ethics.

b.

Validate the womans impression.

c.

Avoid suspicious, paranoid thinking.

d.

Use the call bell if she becomes frightened.

ANS: D

Telling the resident to use the call bell if she becomes frightened offers assurances to the patient that she will be protected, but it neither confirms her suspicions nor makes a promise that cannot be kept. Replying that the staff receives training in ethics sounds as if the nurse is arguing in defense of the male staff member and does not help alleviate the residents fear, which can lead her to suspect that the nurse is also a part of the plot. Validating the womans impression contributes to the residents suspicions; in addition, the nurse increases professional liability risks by speaking about another resident in a negative manner. Telling the resident to avoid suspicious, paranoid thinking only aggravates the struggle for control.

PTS: 1 DIF: Apply REF: 11-15 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

5. Which of the following is a true statement about psychotic behavior in older adults?

a.

Usually, hallucinations in older patients are the result of psychological conflicts.

b.

Illusion, delusion, and hallucination are different terms for the same phenomenon.

c.

An older adult with psychotic behavior should be assessed for a variety of causes.

d.

Regardless of the cause, dissimilar hallucinations are treated with similar therapies.

ANS: C

The nurse assesses an older adult who is exhibiting psychotic behavior by searching for a reason from a wide variety of potential causes for the behavior. For example, neuroleptic medications can cause extrapyramidal side effects, which can result in movement disorders that are similar to psychotic behavior.

Hallucinations in older patients are usually the result of physical disorders, dementias, or sensory function loss. A delusion is a belief that is maintained, although facts can prove that it is incorrect. A hallucination or illusion is the sensory perception of a stimulus that does not exist in the external world. Treatments for hallucinatory states vary according to the cause.

PTS:1DIF:UnderstandREF:11-15

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

6. Which of the following is a true statement concerning suicide among older adults?

a.

Older adults and younger adults manifest a suicidal intent in a similar manner.

b.

Older African-American women have the highest risk of suicide among older adults.

c.

Ethics require that the nurse respects a persons intent to terminate his or her own life.

d.

A major crisis experienced by the patient can contribute to the risk of suicide.

ANS: D

Major crises or transitions, such as retirement or relocation to an assisted living or nursing facility, can contribute to the risk of suicide. Putting personal affairs in order, distributing possessions, making a will, or saying something similar to, I wont be around much longer, can indicate a risk for suicide in a young person but can be a rational and mature act in older age. Men in all countries have a higher suicide rate, and white men are more likely to evaluate their worth solely in terms of their present economic productivity. Health care professionals are obligated to prevent the destruction of life as a permanent solution to what may be a temporary problem.

PTS:1DIF:UnderstandREF:24-28| 50-51

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

7. You are evaluating the plan of care for an older adult who is alcohol-dependent. Which patient documentation indicates the need for follow-up nursing interventions by the nurse?

a.

Patient states that he intends to decrease his alcohol consumption.

b.

Patient arrives at his group session on time and well-groomed.

c.

Patient states, I am an alcoholic because I drink 10 beers a day.

d.

Patient states that he understands that he needs continued treatment.

ANS: A

When a patient states that he or she intends to decrease alcohol consumption, this response indicates that the patient continues to believe that his or her alcohol consumption is under his or her control. If the patient arrives at a group session on time and is well-groomed; taking pride in his or her appearance and participating in a group activity are positive signs. Acknowledging that he or she has a problem is a positive sign; older adults cannot be helped until the problem is acknowledged. Acknowledging the need for continuing treatment is a positive sign.

PTS: 1 DIF: Apply REF: 26-27| 53-55 TOP: Nursing Process: Evaluation

MSC: Psychosocial Integrity

8. An older man, who has activity intolerance as a result pulmonary fibrosis, barks orders and commands at the nursing staff when he cannot help himself. Which of the following is the nurses first priority patient outcome for planning care to resolve this problem?

a.

Verbalizes requests in a calm, respectful, and appreciative manner.

b.

Identifies potential triggers of anger, and positively redirects energy.

c.

Expresses an understanding of the need to balance rest and exercise.

d.

Resolves the pulmonary fibrosis to restore baseline activity tolerance.

ANS: C

This individual becomes frustrated and angry when activity intolerance limits his independence and ability to perform activities of daily living. Although pulmonary fibrosis cannot be cured, expressing an understanding of the need to balance rest and exercise and helping this older adult manage his physiological limitations by balancing rest and exercise, along with other strategies, is the nurses priority patient outcome. Potential behavioral disorders cannot be effectively managed until the physiological needs of the patient are met according to Maslows Hierarchy of Human Needs.

Verbalizing requests in a calm, respectful, and appreciative manner is not the nurses priority patient outcome; the physiological need is more important to resolve; lower basic human needs must be met before higher level needs can be effectively managed. Identifying potential triggers of anger and positively redirecting energy is not the nurses priority; physiological needs must be met first. Pulmonary fibrosis is not curable; therefore the patient will have pulmonary fibrosis until death.

PTS: 1 DIF: Analyze REF: 2-9| 17-22 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

9. An older woman with dementia exhibits new behaviors including crying and repeatedly verbalizing the same phrase; further, the behavior has increased over 2 days. Which intervention should the nurse implement in response to this behavior?

a.

Tell her you will remember what she says if she stops crying.

b.

Attribute these findings to a deterioration in cognitive function.

c.

Check the medication administration record for missed doses.

d.

Present probing questions to the patient about her behavior.

ANS: C

New behaviors with increasing frequency warrant further investigation by the nurse to ensure that effective nursing care can be planned and implemented. Crying and repeated verbalizations from a patient with dementia can indicate anxiety, but the cognitive disorder makes anxiety difficult to detect. In addition to checking for missed doses, the nurse checks the medication record for medications that are likely to cause anxiety, such as beta-adrenergic agonists, which are used to reverse bronchoconstriction. The nurse should also check for risk factors for anxiety and perform a comprehensive assessment to identify potential causes.

The nurse should avoid making a veiled threat to the patient. Giving the patient the incentive to stop crying can be suitable; however, the incentive should never be attention; the duty of the nurse is to pay close attention to the patient. The new behavior can be deteriorating cognitive function, but the nurse must first assess the patient further before making that determination. One aspect of the assessment is to question the patient. Depending on the stage of dementia, the patient can be an unreliable source of information about herself.

PTS: 1 DIF: Apply REF: 6-14 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

10. Which assessment finding of an older adult living in an assisted-living facility indicates the highest risk for suicide?

a.

Liver failure is due to alcohol abuse; older adult is popular at meals.

b.

Older adult declines company; is preoccupied with lethal weapons.

c.

Refuses to allow a large, extended family to help him.

d.

Older adult had an overdose of acetaminophen 20 years ago; is in a sewing group.

ANS: B

The older adult who prefers to be alone and is preoccupied with lethal weapons has two risk factors for suicide. This individual warrants close observation for additional risk factors and verbalization and indicators of future suicide attempts. The nurse should also increase the frequency of observations and account for his whereabouts at all times.

The individual who has a serious illness and a history of alcohol abuse has two risk factors for suicide. However, this older adult also relishes social interaction, which is an indication that suicide is less likely to be imminent or even in the individuals thoughts. The older adult who will not accept help from the family exhibits a potential risk factor for suicide or is an exceedingly proud individual who wants to be self-sufficient. History of a suicide attempt is a risk factor for suicide; however, the acetaminophen overdose could have been accidental.

PTS:1DIF:UnderstandREF:24-28| 50-51

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

11. An older man who had radical surgery for oral cancer is refusing to see visitors and is losing weight, despite aggressive nutrition therapy. The nurse assesses this man for ineffective coping, related to dysfunctional grieving. Which of the following patient outcomes of nursing care is the most important to implement in response to his mental health status?

a.

Is able to discuss how his coping mechanisms are overwhelmed.

b.

Performs daily self-feedings through a gastrostomy tube.

c.

Effectively uses nonverbal forms of communication.

d.

Exhibits self-confidence in regaining a sense of control.

ANS: D

The most important element of the nursing plan of care for this older adult is to create and strengthen self-confidence to improve his sense of control; doing so is likely to help him effectively manage the other aspects of his health care. The nurse helps create and improve this self-confidence by observing for strengths and integrating them into his daily care and by responding with empathy and encouragement to his expressions of fears, emotions, and desirable goals. Helping this patient gain self-confidence is the most important outcome because this man has clinical indicators for depressionsocial isolation and weight loss.

Before this patient can benefit from discussing his stressors or from patient teaching, the nurse must establish a trusting, caring relationship and build some self-confidence because, at this point, this individual feels hopeless and believes that he has no control. The patient displays a lack of readiness for expressions about emotions, coping, or his stressors; by enhancing his self-confidence, the nurse prepares him to discuss coping mechanisms and stressors. This patient also displays a lack of readiness for learning a new psychomotor activity. Performing daily self-feeding is an outcome that gains importance as the day for discharge approaches. Effectively using nonverbal forms of communication is important for basic communication; however, he displays a lack of readiness for receiving help to achieve this outcome.

PTS: 1 DIF: Analyze REF: 33 | 50 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

12. To help older adults maintain a healthy mental state, the nurse plans activities at a community center to promote the developmental stages of older adulthood. Which nursing intervention is suitable for the nurses plan?

a.

Screen for communicable diseases common among older adults.

b.

Participate at a soup kitchen for other people who are homeless.

c.

Plan a safety program about falls, fire safety, and home security.

d.

Have speakers emphasize the need for isolated self-exploration.

ANS: B

Eriksons developmental stages for older adulthood include generativity, which is the concern for the establishment and guidance of the next generation. The nurse helps older adults accomplish this task by organizing their participation at a soup kitchen; socially valued work is a method of expressing generativity. This activity is likely to improve an older adults self-concept because it demonstrates that the individual is able to extend the self for the benefit of others.

Screening for communicable diseases can help maintain a healthy mental outlook by avoiding major illnesses and the consequences of those illnesses that can lead to depression and anxiety; however, this intervention is unrelated to the tasks associated with Eriksons stages of development. Planning a safety program helps instill peace of mind and prevent injury, but it is also unrelated to the stages of development. Promoting isolated self-exploration is counterintuitive to Eriksons stages of intimacy versus isolation.

PTS: 1 DIF: Apply REF: 23| 33| 50 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

13. Which older adult is most likely to have normal mental health?

a.

The older adult who grieves over the loss of a spouse for 2 years but is traveling again

b.

The older adult who exhibits long periods of depression with occasional manic episodes

c.

The older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt

d.

The older adult who has been treated for chronic depression and whose brother killed himself 1 year ago

ANS: A

The older adult who grieves after suffering a major loss for 2 years, which is a length of time for grief that is within normal limits, is beginning to enjoy life again. This individual is most likely to have normal mental health because he or she has worked through the grief and has had the strength to resume normal activities.

The older adult who exhibits long periods of depression with occasional manic episodes has clinical indicators of bipolar disorder. The older adult who has lost two friends in a war, has had three failed marriages, and is bankrupt is unlikely to enjoy normal mental health; this older adults life displays an inability to cope effectively with tragedy, relationships, and personal matters. The older adult who has been treated for chronic depression and whose brother killed himself 1 year ago is at risk for suicide and is unlikely to have normal mental health.

PTS:1DIF:UnderstandREF:17-23| 33| 50

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

14. Although the older man who was forced to retire from law enforcement has multiple physical complaints, the primary care health care provider finds nothing abnormal. After the man tells the nurse that his girlfriend just left him, which of the following is the priority nursing intervention to complete before the older adult leaves?

a.

Ask him how he plans to cope with his loss.

b.

Use direct questions about access to firearms.

c.

Collaborate with his provider for antidepressants.

d.

Allow him to express himself by intently listening.

ANS: B

The nurses priority intervention is to ask him directly about his access to firearms; he has familiarity with guns, and the risk factors for suicide in older adults include male gender, physical complaints of unknown causes, and having suffered a recent loss.

Asking him how he plans to cope with his loss is a reasonable intervention for the nurse to include in the plan of care for this older adult in light of his risk factors for suicide. Collaborating with his provider for antidepressants is a reasonable intervention for the nurse to include after a comprehensive assessment of this older adult. Allowing him to express himself by intently listening is a reasonable intervention for the nurse to include because it helps the nurse establish a trusting, caring relationship with this older adult.

PTS:1DIF:AnalyzeREF:24-28| 50-51

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. Which of the following is(are) true statement(s) about depression or depression therapy? (Select all that apply.)

a.

An older adult who lived through the depression is unlikely to develop depression.

b.

Complaining and not complaining can be symptomatic of depression.

c.

Serotonin-reuptake inhibitors are used to resolve depression in 2 weeks.

d.

The nurse should avoid trying to bolster a depressed persons mood.

ANS: B, D

An older adult can complain because of having no positive feelings, or the older adult may not bother complaining because of having no hope. The nurse should not deny the older adults depressed feelings or grief.

Older adults who have endured the horrors of the mid-twentieth century (e.g., the Great Depression, the Holocaust, and World War II) are as prone to depression as other older adults, but they can consider it shameful to acknowledge depressive feelings. Serotonin-reuptake inhibitors, usually the drug of choice for depression, can be unsuitable for a specific individual. Most antidepressant medications take 6 weeks to resolve symptoms completely.

PTS:1DIF:UnderstandREF:17-23| 33| 50

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

2. Which factors interfere with the mental health of older adults because of the effect on adaptation? (Select all that apply.)

a.

Culture

b.

Life events

c.

Physical illness

d.

Substance abuse

e.

Cognitive impairment

f.

Developmental transitions

ANS: B, C, E, F

A life event can interfere with the mental health of an older adult because the experience can interfere with the older adults ability to adapt to the situation. Physical illness can interfere with the mental health of an older adult because the illness can interfere with the individuals adaptive ability. A cognitive impairment can interfere with the mental health of an older adult because this impairment can destroy the older adults ability to adapt to new situations. Development transitions can interfere with the mental health of an older adult because the individual can lack the suitable skills necessary for adaptation through the transitional period.

Culture is likely to influence the mental health of an older adult and influence how the individual adapts but does not necessarily interfere with adaptation. Substance abuse is likely to interfere with the mental health of an older adult but has a variable impact on the ability to of the older adult to adapt.

PTS:1DIF:RememberREF:2-5

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

3. When planning care for a patient that has a history of alcohol abuse, the nurse recognizes which of the following medication(s) will interact with alcohol? (Select all that apply.)

a.

Analgesics

c.

Antidepressants

b.

Antibiotics

d.

Antipyretics

ANS: A, B, C

Many drugs that older adults use for chronic illnesses cause adverse effects when combined with alcohol. Alcohol interacts with at least 50% of prescription drugs. (Naegle, 2008) Medications that interact with alcohol include analgesics, antibiotics, antidepressants, antipsychotics, benzodiazepines, H2-receptor antagonists, nonsteroidal antiinflammatory drugs (NSAIDs), and herbal medications (e.g., Echinacea, valerian). Acetaminophen taken on a regular basis, when combined with alcohol, may lead to liver failure. Alcohol diminishes the effects of oral hypoglycemics, anticoagulants, and anticonvulsants. All older people should be given precise instructions regarding the interaction of alcohol with their medications.

PTS: 1 DIF: Understand REF: 27-28 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

4. Alcohol diminishes the effects of what type(s) of medications? (Select all that apply.)

a.

Oral hypoglycemic

c.

Anticonvulsants

b.

Anticoagulant

d.

Tricyclic antidepressants

ANS: A, B, C

Alcohol diminishes the effects of oral hypoglycemics, anticoagulants, and anticonvulsants. Alcohol increases the effect of tricyclic antidepressants.

PTS: 1 DIF: Understand REF: 27-28 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

OTHER

1. An older woman fell at home while trying to get to the bathroom in time to prevent urinary leakage. Rank the following suitable nursing interventions in order according to the ability of each intervention to prevent patient injury at home in the future. Start with the intervention that is most likely to prevent injury in the home.

A. Discharge to home while attending an alcohol prevention program.

B. Perform home safety inspection to identify modifiable safety hazards.

C. Instruct the older woman on pelvic floor exercises and other incontinence strategies.

D. Explore depression, alcohol abuse, and physiological contributors to falls.

ANS:

D, C, B, A

The nurse begins planning for home injury prevention by assessing the older adult for risk factors for alcohol abuse and for contributors to alcohol abuse or falls. Assessment data help identify areas for intervention; falling and incontinence, especially in women, are risk factors for alcohol abuse. Second, the nurse helps this woman improve incontinence by teaching her strategies to use to improve bladder control. Alcohol abuse increases the risk of incontinence by relaxing the bladders muscle tone and by increasing an older adults instability or mobility impairment; therefore the nurse includes plans to control alcohol intake. Next, before discharge, the womans home is inspected for potential safety hazards to prevent future falls and injury and to remove a safety hazard as a contributor to falls. Finally, an alcohol prevention program can be a suitable intervention for this older adult if alcohol abuse is a contributing factor. Depending on the assessment data, the willingness to avoid alcohol can determine whether she has the capacity to live at home or should be in a residential facility to maintain safety.

PTS: 1 DIF: Analyze REF: 26-27| 53-55 TOP: Nursing Process: Planning

MSC: Safe, Effective Care Environment

2. An older adult who has Alzheimer disease exhibits new behaviors including shouting in the hallways and hallucinations. Rank the following nursing interventions in order, beginning with the first intervention the nurse should implement in response to the new behavior.

A. Review the medication list for potential causes.

B. Plan nursing care to promote a trusting relationship.

C. Look for the likely causes for psychotic manifestations.

D. Consult with her health care provider about medications.

ANS:

C, A, B, D

The nurses first task is to identify the likely causes of psychotic behaviors to provide a framework for planning suitable nursing interventions. Second, as a potential cause of the new behaviors, the nurse reviews the medication list and looks for new medications, missed or increased doses, polypharmacy, and medications likely to cause psychotic behavior. Third, after identifying possible pharmacological reasons, the nurse consults with the health care provider to consider adjustments to the pharmacotherapy. Finally, to supplement the removal of offending medications, the nurse promotes a trusting relationship with the older adult by expressing respect and concern.

PTS: 1 DIF: Apply REF: 11-15 TOP: Nursing Process: Planning

MSC: Psychosocial Integrity

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