Chapter 27 My Nursing Test Banks

 

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank
Chapter 27

Question 1

Type: MCSA

A young nurse charted that a 70-year-old client was unable to perform ADLs due to old age. What should the nursing supervisor do in response to this attitude?

1. Reassign the nurse to another unit with younger clients

2. Explain how aging does not prevent one from performing ADLs

3. Reprimand the nurse for charting opinions rather than facts

4. Suggest the young nurse encourage the client to be more independent

Correct Answer: 2

Rationale 1: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 2: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 3: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 4: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify the age-related demographic projections that have implications for planning future mental health services for elders.

Question 2

Type: MCSA

Which of the following statements should the nurse include in a presentation to the community regarding mental health care resources for elders?

1. Better pharmacological treatments have increased the normal life span of individuals afflicted with mental illness.

2. Medicare coverage will pay for most mental health services provided to elders.

3. Most elders require frequent hospitalization due to chronic illness and mental disability.

4. More long-term care facilities are admitting geropsychiatric clients.

Correct Answer: 1

Rationale 1: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many long-term care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 2: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many long-term care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 3: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many long-term care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 4: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many long-term care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Identify the age-related demographic projections that have implications for planning future mental health services for elders.

Question 3

Type: MCSA

Which of the following biopsychosocial theories of aging is the nurse using when taking a small group of older adults out in the community to a local restaurant for dinner and dancing?

1. Wear-and-tear theory

2. Activity theory

3. Nutritional theory

4. Environmental theory

Correct Answer: 2

Rationale 1: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-and-tear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 2: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-and-tear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 3: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-and-tear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 4: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-and-tear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Discuss the major theories of aging and the ideas associated with each one.

Question 4

Type: MCMA

The nurse is teaching a seminar for health professionals on the differences between the normal aging process and Alzheimers disease. Which of the following biopsychosocial theories of normal aging should be discussed regarding cellular changes?

Standard Text: Select all that apply.

1. Genetic theory

2. Immunology theory

3. Wear-and-tear theory

4. Environmental theory

5. Disengagement theory

Correct Answer: 1,2,3

Rationale 1: Genetic theory: According to this theory, harmful genes activate in late life to stop cell growth and division; aging is programmed by genetic makeup.

Rationale 2: Immunology theory: Higher susceptibility to disease occurs as the bodys defensive ability declines with age, causing old irregular cells to be misidentified as foreign bodies and attacked by the body.

Rationale 3: Wear-and-tear theory: In this theory, cells eventually wear out with age; however, individual rates of cellular decline can be hastened by abuse and lack of care.

Rationale 4: Environmental theory: Various environmental substances such as pesticides, smog, and smoking can seriously harm health and cause cellular damage affecting ones ability to fight disease.

Rationale 5: Disengagement theory: Aging is an inevitable process in which older adults withdraw from social contacts and responsibilities. Psychosocial rather than cellular changes are responsible.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Discuss the major theories of aging and the ideas associated with each one.

Question 5

Type: MCSA

The nurse is teaching staff at a long-term health care facility about depression in older adults. Which comment by staff indicates to the nurse the need for further teaching?

1. Inability to organize and abstract information may indicate depression in older adults.

2. Depressed older adults may exhibit an excessive preoccupation with chronic constipation or pain.

3. Sadness or feeling blue are normal aspects of the aging process and are not a cause for concern.

4. Lack of interest or apathy may be a sign of depression in older adults.

Correct Answer: 3

Rationale 1: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 2: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 3: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 4: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 6

Type: MCSA

The nurse suspects a 75-year-old male client with a recent diagnosis of cancer is contemplating suicide. Which one of the following cues indicates the highest suicide potential?

1. Yearly updating his will

2. Complaining of chronic pain

3. Vague statements about future funeral plans

4. Buying a hand revolver

Correct Answer: 4

Rationale 1: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide. Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 2: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide. Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 3: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide. Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 4: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide. Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 7

Type: MCMA

The nurse suspects a 75-year-old male client is contemplating suicide. Which of the following factors place him at greater risk for suicide?

Standard Text: Select all that apply.

1. Being non-Hispanic Black

2. Frequent alcohol consumption

3. Being married

4. High socio-economic status

5. Having chronic pain caused by cancer

Correct Answer: 2,3,5

Rationale 1: Being non-Hispanic Black. Non-Hispanic Blacks have the lowest suicide rate. Non-Hispanic Whites have the highest suicide rates followed by Native Americans and Alaskan Natives.

Rationale 2: Frequent alcohol consumption. Alcohol abuse impairs decision making and increases the risk for suicide in any age.

Rationale 3: Being married. A close intimate relationship with a significant other decreases the risk for suicide. Widowed or divorced individuals are actually at greater risk.

Rationale 4: High socio-economic status. Financial stress due to lower socioeconomic status rather than higher income increases risk for suicide.

Rationale 5: Having chronic pain caused by cancer. A terminal illness such as cancer and chronic pain increase the risk for suicide in any age group.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 8

Type: MCSA

During the nursing assessment of the older adult female client, the nurse finds the client believes others are poisoning her food. Which of the following psychiatric disorders would not be indicated?

1. Delirium

2. Adjustment disorder

3. Anxiety disorder

4. Dementia

Correct Answer: 2

Rationale 1: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 2: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 3: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 4: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 9

Type: MCSA

The wife of an older client is concerned that her husband has recently experienced memory lapses, is unusually aggressive and was involved in three traffic accidents in the past month. In planning a response, the nurse is guided by the knowledge that:

1. Further intervention is needed to prevent elder abuse of the wife.

2. Further assessment is needed to determine if alcohol abuse is possible.

3. These are normal responses to aging.

4. These are signs of depression or dementia.

Correct Answer: 2

Rationale 1: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 2: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 3: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 4: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 10

Type: MCSA

The nurse is teaching a group of older adults about changes in sleep patterns due to the aging process. Which statement by older adults indicates understanding of the nurses teaching regarding the use of nonpharmacologic therapies for sleep?

1. We should avoid coffee, tea, or other fluids in the evening hours.

2. An herbal remedy such as melatonin can help us sleep better.

3. Taking long naps during the day will help us sleep better at night.

4. Taking a sleeping pill every night will improve our total sleep time.

Correct Answer: 1

Rationale 1: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 2: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 3: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 4: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 11

Type: MCSA

When interviewing elders the psychiatric nurse is guided by the knowledge that:

1. Shame may inhibit the expression of feelings in elders.

2. Touch is inappropriate during the interview.

3. Family and staff members may provide inaccurate information.

4. Less time may be needed with elders than with other age groups.

Correct Answer: 1

Rationale 1: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 2: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 3: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 4: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 12

Type: MCMA

A thorough biopsychosocial assessment of elders includes:

Standard Text: Select all that apply.

1. Spirituality

2. Social supports

3. Coping strategies

4. Sexuality

5. Early childhood interactions

Correct Answer: 1,3,4

Rationale 1: Spirituality. Spiritual integrity is a basic human power that becomes especially important in later stages of life.

Rationale 2: Early childhood interactions. Early childhood interactions are more consistent with earlier psychological theories of mental disorder and are not needed.

Rationale 3: Coping strategies. Coping strategies are important data to collect from elders to obtain information regarding their reactions to stress.

Rationale 4: Sexuality. Sexuality is an important often overlooked area in elders and should be approached in a tactful, caring and nonjudgmental manner.

Rationale 5: Social supports. Interpersonal relationships and social networks of elders are important for optimal functioning especially with psychiatric disorders or confusion.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 13

Type: MCSA

The nurse is assessing the social and financial status of an older adult. Which of the following questions would be appropriate to ask?

1. Do you have transportation to get to doctors appointments?

2. Do you have problems with your family taking advantage of you?

3. How often do you forget to pay your bills?

4. How much money do you get from social security?

Correct Answer: 1

Rationale 1: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 2: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 3: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 4: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 14

Type: MCSA

Which of the following signs would lead the nurse to suspect elder abuse is occurring?

1. Leaving a competent elder at the doctors office to wait for an appointment

2. Leaving a confused elder at home alone

3. Complaints of a person poisoning their food or robbing them

4. Skin tears on the arms and hands

Correct Answer: 2

Rationale 1: Leaving a confused elder unattended for long periods of time is a form of mistreatment. However, leaving a competent elder at the doctors office to await an appointment is not neglect or abandonment. Abrasions, sprains, and dislocations can be signs of coercion; however, most elders skin is very friable and skin tears are often the result of unintentionally hitting a sharp object. Suspiciousness or persecutory complaints may be a sign of dementia or delusions and should be further investigated if dementia or delusions are ruled out; but are not automatic signs of elder abuse.

Rationale 2: Leaving a confused elder unattended for long periods of time is a form of mistreatment. However, leaving a competent elder at the doctors office to await an appointment is not neglect or abandonment. Abrasions, sprains, and dislocations can be signs of coercion; however, most elders skin is very friable and skin tears are often the result of unintentionally hitting a sharp object. Suspiciousness or persecutory complaints may be a sign of dementia or delusions and should be further investigated if dementia or delusions are ruled out; but are not automatic signs of elder abuse.

Rationale 3: Leaving a confused elder unattended for long periods of time is a form of mistreatment. However, leaving a competent elder at the doctors office to await an appointment is not neglect or abandonment. Abrasions, sprains, and dislocations can be signs of coercion; however, most elders skin is very friable and skin tears are often the result of unintentionally hitting a sharp object. Suspiciousness or persecutory complaints may be a sign of dementia or delusions and should be further investigated if dementia or delusions are ruled out; but are not automatic signs of elder abuse.

Rationale 4: Leaving a confused elder unattended for long periods of time is a form of mistreatment. However, leaving a competent elder at the doctors office to await an appointment is not neglect or abandonment. Abrasions, sprains, and dislocations can be signs of coercion; however, most elders skin is very friable and skin tears are often the result of unintentionally hitting a sharp object. Suspiciousness or persecutory complaints may be a sign of dementia or delusions and should be further investigated if dementia or delusions are ruled out; but are not automatic signs of elder abuse.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 15

Type: MCSA

An elderly client has presented to the clinic with multiple physical complaints. Biologic assessment information must be obtained before any physical illnesses can be ruled out. Which of the following objective measurements would be most helpful?

1. Electroencephalogram (EEG)

2. Standard diagnostic laboratory analyses

3. Lumbar puncture

4. Drug toxicology screening

Correct Answer: 2

Rationale 1: Standard diagnostic laboratory analyses including: complete blood chemistry, electrolytes, glucose tolerance, CBC, urinalysis, thyroid levels, BUN, creatinine, and liver function tests would provide the most useful information regarding possible disease processes. A lumbar puncture, drug toxicology screening, and an EEG would not be performed unless standard diagnostic laboratory analyses revealed specific abnormalities warranting these tests.

Rationale 2: Standard diagnostic laboratory analyses including: complete blood chemistry, electrolytes, glucose tolerance, CBC, urinalysis, thyroid levels, BUN, creatinine, and liver function tests would provide the most useful information regarding possible disease processes. A lumbar puncture, drug toxicology screening, and an EEG would not be performed unless standard diagnostic laboratory analyses revealed specific abnormalities warranting these tests.

Rationale 3: Standard diagnostic laboratory analyses including: complete blood chemistry, electrolytes, glucose tolerance, CBC, urinalysis, thyroid levels, BUN, creatinine, and liver function tests would provide the most useful information regarding possible disease processes. A lumbar puncture, drug toxicology screening, and an EEG would not be performed unless standard diagnostic laboratory analyses revealed specific abnormalities warranting these tests.

Rationale 4: Standard diagnostic laboratory analyses including: complete blood chemistry, electrolytes, glucose tolerance, CBC, urinalysis, thyroid levels, BUN, creatinine, and liver function tests would provide the most useful information regarding possible disease processes. A lumbar puncture, drug toxicology screening, and an EEG would not be performed unless standard diagnostic laboratory analyses revealed specific abnormalities warranting these tests.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 16

Type: MCSA

Which of the following nursing diagnoses would be most appropriate for an older adult who recently lost his wife of 50 years after a long history of breast cancer?

1. Activity Intolerance

2. Ineffective Role Performance

3. Feeding Self-Care Deficit

4. Risk for Other-Directed Violence

Correct Answer: 2

Rationale 1: The recent loss of his wife will almost certainly lead to ineffective role performance due to a change in social interaction and ability to manage on his own after 50 years of marriage. Social withdrawal, loneliness, and mental status changes can also occur due to lack of social stimulation. A risk for self-directed violence or suicide attempt would be a greater concern than violence directed toward others. A deficit in self-care activities and intolerance for activity are remote possibilities if the client loses interest in performing self care activities or withdraws completely.

Rationale 2: The recent loss of his wife will almost certainly lead to ineffective role performance due to a change in social interaction and ability to manage on his own after 50 years of marriage. Social withdrawal, loneliness, and mental status changes can also occur due to lack of social stimulation. A risk for self-directed violence or suicide attempt would be a greater concern than violence directed toward others. A deficit in self-care activities and intolerance for activity are remote possibilities if the client loses interest in performing self care activities or withdraws completely.

Rationale 3: The recent loss of his wife will almost certainly lead to ineffective role performance due to a change in social interaction and ability to manage on his own after 50 years of marriage. Social withdrawal, loneliness, and mental status changes can also occur due to lack of social stimulation. A risk for self-directed violence or suicide attempt would be a greater concern than violence directed toward others. A deficit in self-care activities and intolerance for activity are remote possibilities if the client loses interest in performing self care activities or withdraws completely.

Rationale 4: The recent loss of his wife will almost certainly lead to ineffective role performance due to a change in social interaction and ability to manage on his own after 50 years of marriage. Social withdrawal, loneliness, and mental status changes can also occur due to lack of social stimulation. A risk for self-directed violence or suicide attempt would be a greater concern than violence directed toward others. A deficit in self-care activities and intolerance for activity are remote possibilities if the client loses interest in performing self care activities or withdraws completely.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 17

Type: MCSA

Which of the following outcomes would be the most important for an older adult who recently lost his wife of 50 years after a long history of breast cancer?

1. Ability to recognize behaviors that reduce feelings of hopelessness

2. Ability to focus on specific stimuli

3. Ability to acquire, organize, and use information

4. Ability to dress self and maintain own hygiene

Correct Answer: 1

Rationale 1: Depression, loneliness, and hopelessness are common reactions to loss; therefore, the ability to identify ways to reduce hopelessness would be the most important outcome for this client. Altered thought processes and self-care deficits would not be expected in this situation; therefore, the ability to process information or attend to stimuli would not be appropriate. Neither would the ability to dress or perform other self-care activities.

Rationale 2: Depression, loneliness, and hopelessness are common reactions to loss; therefore, the ability to identify ways to reduce hopelessness would be the most important outcome for this client. Altered thought processes and self-care deficits would not be expected in this situation; therefore, the ability to process information or attend to stimuli would not be appropriate. Neither would the ability to dress or perform other self-care activities.

Rationale 3: Depression, loneliness, and hopelessness are common reactions to loss; therefore, the ability to identify ways to reduce hopelessness would be the most important outcome for this client. Altered thought processes and self-care deficits would not be expected in this situation; therefore, the ability to process information or attend to stimuli would not be appropriate. Neither would the ability to dress or perform other self-care activities.

Rationale 4: Depression, loneliness, and hopelessness are common reactions to loss; therefore, the ability to identify ways to reduce hopelessness would be the most important outcome for this client. Altered thought processes and self-care deficits would not be expected in this situation; therefore, the ability to process information or attend to stimuli would not be appropriate. Neither would the ability to dress or perform other self-care activities.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 18

Type: MCSA

The nurse plans to implement health promotion activities at the local senior citizen center. Which one of the following strategies should the nurse include to meet the goal of promoting relaxation and restoring balance?

1. Pet therapy

2. Tai Chi exercises

3. Social support groups

4. Reality orientation

Correct Answer: 2

Rationale 1: Exercise and movement therapies such as Tai Chi can help induce relaxation, maintain flexibility, and restore balance in older clients. Pet therapy and social support groups are more commonly used with older adults who lack social supports or effective coping skills and do not restore balance. Older adults living in the community tend to have higher functional ability, greater social interaction, and cognitive abilities than older adults in long-term care facilities and are less likely to require reality orientation.

Rationale 2: Exercise and movement therapies such as Tai Chi can help induce relaxation, maintain flexibility, and restore balance in older clients. Pet therapy and social support groups are more commonly used with older adults who lack social supports or effective coping skills and do not restore balance. Older adults living in the community tend to have higher functional ability, greater social interaction, and cognitive abilities than older adults in long-term care facilities and are less likely to require reality orientation.

Rationale 3: Exercise and movement therapies such as Tai Chi can help induce relaxation, maintain flexibility, and restore balance in older clients. Pet therapy and social support groups are more commonly used with older adults who lack social supports or effective coping skills and do not restore balance. Older adults living in the community tend to have higher functional ability, greater social interaction, and cognitive abilities than older adults in long-term care facilities and are less likely to require reality orientation.

Rationale 4: Exercise and movement therapies such as Tai Chi can help induce relaxation, maintain flexibility, and restore balance in older clients. Pet therapy and social support groups are more commonly used with older adults who lack social supports or effective coping skills and do not restore balance. Older adults living in the community tend to have higher functional ability, greater social interaction, and cognitive abilities than older adults in long-term care facilities and are less likely to require reality orientation.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 19

Type: MCSA

The nurse is planning teaching for a staff seminar regarding psychiatric medication administration. The nurses teaching should be guided by the knowledge that:

1. Sedation is a desirable side effect for older adults.

2. Falls and choking risk are increased by psychiatric medications.

3. Older adults are less prone to side effects than other age groups.

4. Standard adult dosages are well tolerated by older adults.

Correct Answer: 2

Rationale 1: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking. Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 2: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking. Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 3: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking. Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 4: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking. Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 20

Type: MCSA

The nurses evaluation of the outcomes of care for an older adult mentally ill client should be guided by the knowledge that:

1. Cultural preferences that conflict with treatment goals take precedence.

2. Complete absence of psychiatric symptoms is the gold standard.

3. Clients values and preferences should be honored whenever possible.

4. Families and significant others are not routinely involved in this process.

Correct Answer: 3

Rationale 1: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 2: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 3: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 4: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 21

Type: MCSA

The nurse plans to increase self-esteem and reduce social isolation for residents living at the long-term care facility. Which one of the following strategies should the nurse include to meet these goals?

1. Reality orientation

2. Reminiscence therapy

3. Respite services

4. Restorative care

Correct Answer: 2

Rationale 1: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments. Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 2: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments. Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 3: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments. Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 4: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments. Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 22

Type: MCSA

Which of the following behaviors would indicate that the nurses remotivation therapy group for long-term care residents was effective?

1. Orientation to time, place, and person

2. Active discussion of dating practices in teenage years

3. Active discussion of presidential candidates in the next election

4. Orientation to the long-term care surroundings

Correct Answer: 3

Rationale 1: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 2: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 3: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 4: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 23

Type: MCSA

Which of the following outcomes would indicate successful reality orientation of an older adult client?

1. Ability to identify personal strengths

2. Ability to perform basic tasks and personal care activities

3. Ability to identify place and person

4. Ability to express faith and meaning in life

Correct Answer: 3

Rationale 1: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 2: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 3: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 4: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 24

Type: MCMA

The nurse is a case manager for several older adults living in the community. Which of the following goals are relevant for community or home based nursing care?

Standard Text: Select all that apply.

1. Educate clients and caregivers about adult daycare programs

2. Diagnose and treat psychiatric illnesses

3. Coordinate supportive services to compensate for deficits

4. Encourage relocation to assisted living or skilled nursing facilities

5. Maintain safety and optimal functional independence

Correct Answer: 1,3,5

Rationale 1: Educate clients and caregivers about adult daycare programs: Education about community-based programs such as adult daycare programs can provide respite for stressed and overwhelmed caregivers.

Rationale 2: Diagnose and treat psychiatric illnesses: Nurses need to monitor elders for signs of psychiatric illness and report them to the primary care physician, but nurses do not diagnose and treat unless they obtain advanced training and certification.

Rationale 3: Coordinate supportive services to compensate for deficits: When physical or mental deficits are present supportive services can help older adults stay in the home longer.

Rationale 4: Encourage relocation to assisted living or skilled nursing facilities: Delaying institutionalization is preferred by most elders and the nurse should support their desire to age in place unless the home environment becomes unsafe.

Rationale 5: Maintain safety and optimal functional independence: Safety and independence are key factors to remaining in the community.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 25

Type: MCMA

Which of the following nursing interventions would be useful when caring for elders with behavioral disturbances who bite, hit, kick, or scream at caregivers during delivery of care?

Standard Text: Select all that apply.

1. Return at a later time to resume care when clients are calmer.

2. Order clients to stop biting, hitting, and screaming.

3. Continue the activity by restraining their hands and feet.

4. Allow clients to refuse bathing if no body odor is present.

5. Distract clients by encouraging them to sing with you.

Correct Answer: 1,4,5

Rationale 1: Return at a later time to resume care when clients are calmer. Research suggests that waiting and returning to resume care at a later time can be effective when dealing with resisting clients.

Rationale 2: Order clients to stop biting, hitting, and screaming. Ordering clients is ineffective. Talking and reasoning with them may be more effective.

Rationale 3: Continue the activity by restraining their hands and feet. Restraining the client unnecessarily is called battery and should only be used when someone is in imminent danger of harm.

Rationale 4: Allow clients to refuse bathing if no body odor is present. Dressing and bathing have few adverse health consequences and allow clients a form of control.

Rationale 5: Distract clients by encouraging them to sing with you. Research suggests that distracting clients with a social activity is helpful when dealing with resisting clients.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living to elders and their families into your plan of care.

Question 26

Type: MCSA

The nurse case manager has become concerned that an older adult confused client is no longer safe at home due to wandering outside when the caregiver is not watching. Which of the following community-based programs would be most appropriate for referral?

1. Long-term care facilities

2. Assisted living communities

3. Senior citizen centers

4. Residential care facilities

Correct Answer: 1

Rationale 1: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 2: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 3: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 4: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 27

Type: MCSA

The wife of a man with early stage Parkinsons disease expresses frustration and despair while caring for him at home because she is unable to leave him while she plays bridge with her friends twice a week. Which of the following community-based resources would be most appropriate in this situation?

1. Hospice care

2. Long-term care

3. Respite care

4. Restorative care

Correct Answer: 3

Rationale 1: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 2: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 3: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 4: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 28

Type: MCSA

A nurse is discussing the demanding and dependent behavior of an older, depressed female client with the treatment team. Which of the following comments indicates ageism?

1. She is demanding and dependent because she is lonely and not receiving enough attention from staff members.

2. She is feeling depressed and could benefit from counseling or an antidepressant.

3. She should be encouraged to attend more activities and do as much as possible by herself.

4. She should be encouraged to spend more time with people her own age instead of trying to look or act younger.

Correct Answer: 4

Rationale 1: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 2: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 3: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 4: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Analyze personal biases, feelings, and attitudes that may be experienced in professional practice when caring for elders who suffer from mental disorders.

Question 29

Type: MCSA

Which of the following statements represents a myth about aging?

1. Advancing age does not condemn one to dependence and isolation.

2. Older adults do not benefit from supportive psychosocial services.

3. Senility and sadness are not inevitable outcomes with advancing age.

4. Aging itself is not a problem.

Correct Answer: 2

Rationale 1: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 2: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 3: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 4: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Analyze personal biases, feelings, and attitudes that may be experienced in professional practice when caring for elders who suffer from mental disorders.

Question 30

Type: MCSA

Which of the following statements is true regarding financial roadblocks to mental health care services for people over the age of 65?

1. Medicare covers inpatient but not community mental health services.

2. Medicare Part D provides simple options for prescription coverage.

3. Medicare provides little coverage for long-term care services.

4. Medicare offers low copayments for most psychotropic medications.

Correct Answer: 3

Rationale 1: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 2: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 3: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 4: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Analyze personal biases, feelings, and attitudes that may be experienced in professional practice when caring for elders who suffer from mental disorders.

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank

Copyright 2012 by Pearson Education, Inc.

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