Chapter 37: Geropsychiatric Nursing My Nursing Test Banks

Chapter 37: Geropsychiatric Nursing

Test Bank

MULTIPLE CHOICE

1. Based on a biological programming framework, which statement about aging is accurate?

a.

So you see, its a matter of adding free radicals to your system through diet and supplements in order to stop the aging process.

b.

Although DNA programming isnt reversible, a healthy lifestyle and preventive health care can maximize cell function.

c.

Collagen delays aging. By increasing the collagen levels in the body, you improve flexibility and delay aging.

d.

The key is in the immune system, and once we solve the problem by gradually eliminating error cells, we extend youth.

ANS: B

The biological programming theory speculates that each cell has stored a biological clock and that the process of aging in DNA is not reversible. The remaining options are not related to the biological programming theory of aging.

DIF: Cognitive Level: Comprehension REF: Text Page: 716

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

2. Which would be the most effective approach for a nurse to take when assessing the self-care needs and activities of daily living (ADLs) for an older adult?

a.

Observe the level of grooming and dress that the patient demonstrates on a daily basis.

b.

Interview the patient with a focus on how daily toileting and bathing are typically achieved.

c.

Offer to provide the patient with the typical activities involved with bathing and grooming.

d.

Interact with the patient to determine his or her ability to bathe, toilet, eat, and dress independently.

ANS: D

Interacting with the patient during ADLs (bathing, grooming, toileting, eating, dressing) presents the best opportunity to assess independence and needs related to those activities.

DIF: Cognitive Level: Application REF: Text Page: 720

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

3. Which nursing technique would be most effective when assessing an older adult patients nutritional status?

a.

Interact with the patient during meals.

b.

Perform a comprehensive health assessment.

c.

Supplement the patients diet with preferred, nutritious snacks.

d.

Ask the patient to complete a 7-day inclusive nutritional recall.

ANS: B

A comprehensive health assessment would include oral assessment (checking swallowing, breathing, missing teeth, dry mouth, and any ulcerations in the mouth), vision, mental status, and other variables that might affect nutritional status.

DIF: Cognitive Level: Application REF: Text Page: 717

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

4. Which observation would be of greatest concern for an older adult patient who is taking several prescribed medications?

a.

Experiencing early-morning confusion

b.

Taking sugarless hard candy for dry mouth

c.

Dangling feet at the bedside to avoid dizziness

d.

Reporting frequent awakenings during the night

ANS: A

Older patients may experience sunrise syndrome. This may result from hangover effects of sedative-hypnotics and other nighttime medications that interact with drugs for sleep. The other options all demonstrate interventions for possible side effects.

DIF: Cognitive Level: Application REF: Text Page: 722

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A person who is the primary caregiver for a mother with Alzheimer disease says, Sometimes I hate my mother for living this long and Dad for dying and not caring for her. Which response is most therapeutic?

a.

What do you do to cope with these negative feelings?

b.

Its fairly common for a caregiver to feel such negative emotions.

c.

Have you ever felt angry enough to be abusive toward your mother?

d.

Please consider discussing these feelings with other members of your family.

ANS: A

The answer that invites the patient to share feelings and perceptions (thus facilitating emotions) is the most therapeutic communication. The correct response uses exploring, a therapeutic communication technique. The remaining options are either premature or make unsubstantiated assumptions.

DIF: Cognitive Level: Application REF: Text Page: 731

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

6. An older adult patient recently moved to a retirement community. Which behavior would prompt the nurse to suspect the patient is experiencing relocation stress syndrome?

a.

Episodic dyspnea

b.

Inappropriate affect

c.

Increased withdrawal

d.

Urinary incontinence

ANS: C

Relocation stress syndrome involves physical or psychosocial disturbances related to the transfer from one environment to another. The signs and symptoms may mimic depression. The remaining options are not typically related to relocation stress syndrome.

DIF: Cognitive Level: Application REF: Text Pages: 724-725

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

7. Which assessment finding best indicates that an older adult who resides at an assisted living center has functional mobility?

a.

The patient spends most of the day interacting with others in the dayroom.

b.

The patient spends weekends and holidays at the home of family members.

c.

The patient shows an interest in having his hair professionally styled.

d.

The patient dresses, bathes, and eats independently.

ANS: D

One can assess the functional ability of mobility and independence by observing the patients ability to dress, comb hair, bathe, and feed self without assistance as well as the patients ability to move within the milieu and maintain contact with others. The remaining options are not focused on physical ability as is the correct option.

DIF: Cognitive Level: Application REF: Text Page: 720

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

8. Which of these nursing communications would be most effective when teaching an older adult patient about aging through the disengagement theoretical framework?

a.

Its a natural result of growing older that your level of activity will decrease.

b.

Its important to maintain the same level of socialization throughout your lifetime, even though the type of activity may be changed to accommodate aging.

c.

Its important to maintain the familiarity of your environment to reflect your enduring competencies even though youre an older adult.

d.

Look to the ways in which your family of origin functions. If they are impaired it is more likely that you will be, too, as you age.

ANS: B

Instead of thinking that older adults will isolate and reduce socialization, the disengagement theory postulates that active individuals will remain active.

DIF: Cognitive Level: Comprehension REF: Text Page: 716

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

9. An older adult patient will be moved from a psychiatric inpatient unit to a nursing home. Which action should be given priority by the nurse to best facilitate the move?

a.

Have the patient visit the nursing home before actually moving.

b.

Administer a sedative-hypnotic to the patient before the patient moves.

c.

Place the patients belongings in the new room after they are inventoried.

d.

Hold all of the patients medications until after the move to minimize confusion.

ANS: A

Having the patient visit the nursing home before actually moving and having familiar staff visit the patient in the nursing home can reduce relocation stress syndrome. The other options will do little to make a safe and uneventful transition.

DIF: Cognitive Level: Application REF: Text Pages: 724-725

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

10. A 68-year-old being treated for depression has a history of a suicide attempt at age 26. When the patient reports feelings of uselessness related to selling the family business and retiring, the nurse should initially:

a.

notify the patients health care provider of the intensified feelings of despair.

b.

provide one-on-one time with the patient for the purpose of discussing the stated feelings.

c.

alert other staff members of the need to increase the visual monitoring of this patient.

d.

ask the patient if he is experiencing any suicidal ideations, including any plans to hurt himself.

ANS: D

Whenever there is a concern for suicide, the patient should be assessed immediately for ideations as well as plan. Risk is higher when there is a history of a suicide attempt and if the patient is over 65 years of age.

DIF: Cognitive Level: Application REF: Text Pages: 723-724

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

11. An older adult is grieving the loss of a loved one. Which approach is most therapeutic for the nurse to apply when caring for this patient?

a.

Assess past coping skills, the presence of support systems, and evidence of prolonged grieving.

b.

Provide anticipatory guidance to the patient, explaining that prolonged grieving is not a normal part of loss regardless of the patients age.

c.

Plan activities for the patient that include increasing socialization with others who have experienced similar losses until mourning is over.

d.

Intervene only when it becomes obvious that the patients period of mourning has the potential to affect the patient negatively both physically and emotionally.

ANS: A

Depression, grief, and loss are common in later life. Assessment of the patients reaction to the loss and the ability to grieve appropriately is the most therapeutic initial nursing intervention. If mourning and grief are prolonged, they should be treated as depression.

DIF: Cognitive Level: Application REF: Text Page: 723

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12. An older adult who recently learned that his last surviving sibling has died refuses to take medication and is fearful of allowing anyone other than a specific staff member to assist with bathing and dressing. The patient is exhibiting signs of:

a.

paranoia.

b.

confusion.

c.

depression.

d.

disorientation.

ANS: A

Paranoia, a classic organized and complicated delusional system that is rare in older adults, can be caused by sensory deprivation or loss, medications, social isolation, delirium, depression, and dementia. The older adult with a paranoid personality will exhibit withdrawal, aloofness, fearfulness, oversensitivity, or secretiveness.

DIF: Cognitive Level: Comprehension REF: Text Page: 723

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

13. An older adult newly diagnosed with depression says, Yesterday was such a busy day and with everything I had to remember I couldnt recall where I had parked my car. Am I getting Alzheimer disease? An appropriate response from the nurse would be:

a.

Would you like me to have your health care provider discuss your concerns with you?

b.

I do this all the time myself. It will get better after youve taken your antidepressant medication for a while.

c.

When people are very busy or depressed, its not unusual for them to be forgetful. Nevertheless, lets talk about your concerns.

d.

It sounds as if you may have some memory deficit for recent events. When did you first begin to notice your problem with forgetfulness?

ANS: C

People who are busy and people who have depression can experience short-term memory loss since both states are more likely to result in a shorter attention span and lack of mental focus.

DIF: Cognitive Level: Application REF: Text Page: 722

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14. When planning discharge care for an older adult who is divorced, recently retired, and diagnosed with situational depression, the nurse learns that the patients only child has moved 300 miles away. What is the nurses best initial action?

a.

Contact the child to discuss the parents care needs.

b.

Arrange for live-in help to provide for the patients care needs.

c.

Discuss the possibility of relocating to an assisted living center a reasonable distance from the child.

d.

Assess availability of other family members and social support systems to assist the patient in meeting care needs.

ANS: D

Until a comprehensive assessment of the patients family and social support systems is performed, it is impossible to consider any of the other options.

DIF: Cognitive Level: Application REF: Text Pages: 721-722

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

15. Which scenario indicates to the nurse that an older adult is at risk for falls?

a.

A 68-year-old retiree who moves in with family members to babysit their 3-year-old

b.

A 75-year-old who lives alone and uses a cane at night and when going outside

c.

An 80-year-old who marries and moves into the spouses home after selling his home

d.

A 92-year-old who moves to a retirement community after hip replacement surgery

ANS: D

Recent surgery, a move to unfamiliar surroundings, and increased age are all risk factors that would cause this patient to be at greatest risk for falling.

DIF: Cognitive Level: Application REF: Text Page: 720

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

16. Which older adult patient profile presents the highest risk for falls?

a.

A widowed older adult who takes an antidepressant at bedtime

b.

An older adult with diabetes who bicycles regularly as exercise

c.

An older retired adult who provides in-home care for a spouse

d.

An older single adult who wears corrective eyeglasses for myopia

ANS: A

Taking medications that cause sedation (drowsiness) and postural hypotension, such as antidepressant agents, is the primary risk factor mentioned, placing the widowed adult at the highest risk for falls. While the other options represent potential risk factors, medications account for the greatest risk for falls among the older adult population.

DIF: Cognitive Level: Analysis REF: Text Page: 720

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

17. Which nursing intervention would be most important initially when evaluating the physiological health status of an older adult being admitted to an assisted living center?

a.

Obtain a complete medication profile, including over-the-counter medications

b.

Ask the patient, How do you think your physical health has been overall?

c.

Observe the patient for indications of the degree of physical autonomy

d.

Ask the patients adult child, Does your parent have any health problems?

ANS: A

The intervention that provides complete information about the patients medications is the most effective and timely intervention and therefore the appropriate initial intervention. The remaining options are all interventions that the nurse might employ later.

DIF: Cognitive Level: Analysis REF: Text Page: 720

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. An older adult reports that I know that Im not the cheerful person I used to be but thats just a part of growing old. Using a psychological theoretical framework, the nurse might respond:

a.

When your life focuses on positive experiences from your adolescence, aging is reduced by that youthful mental status.

b.

There may be many causes for what you are feeling. Id suggest seeing your health care provider to rule out any physical causes.

c.

The best way to prepare for a good death is to systematically review your life and change any behaviors you feel might interfere with this process.

d.

You are in the last stage of development in your life, and its important that you attempt to correct anything about your life that dissatisfies or saddens you.

ANS: B

The psychological theory of aging states that an individuals personality is established by adulthood and remains stable, although adaptable, over time. Any major change may indicate physiological disease (e.g., brain or metabolic disease).

DIF: Cognitive Level: Application REF: Text Page: 716

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

19. When the nurse asks an older adult, Can you describe the events that led you to move to this assisted living center? the patient looks perplexed and does not respond. Which response would the nurse make initially in order to be most therapeutic?

a.

Did you want to sell your house and move here?

b.

We can talk about this at a later time if you wish.

c.

I can get this information from your medical record.

d.

Do you like living here at the assisted living center?

ANS: A

When interviewing an older adult, questions should be short and to the point, especially if the patient has difficulty with abstract thinking and conceptualization. The nurse should initially rephrase a question if the patient does not answer appropriately or hesitates when answering.

DIF: Cognitive Level: Application REF: Text Page: 717

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20. Which older adult is at greatest risk for falls based on the medication profile? An older adult taking:

a.

psyllium daily as a bulk-forming laxative.

b.

calcium daily after hip replacement surgery.

c.

an over-the-counter sleep aid an average of once per week.

d.

an angiotensin-converting enzyme inhibitor daily for mild hypertension.

ANS: D

Many medications taken by geriatric patients can cause drowsiness, confusion, orthostatic hypotension, lack of coordination, or reduced sensation, which in turn can increase risk of falls. The patient taking antihypertensive medications daily is at risk for falls caused by orthostatic hypotension.

DIF: Cognitive Level: Analysis REF: Text Page: 720

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

21. Which intervention by the nurse would be best when trying to create a therapeutic milieu for a group of older adult patients?

a.

Use soothing music, nonglare lighting, and the patients personal articles.

b.

Use bright colors and the patients personal articles, and plan frequent activities.

c.

Periodically rearrange the furniture for variety, but remove environmental barriers.

d.

Create a stable physical environment, but vary the daily routine to prevent boredom.

ANS: A

Older adults benefit from interesting and appropriate activities, a sense of calm and quiet (soft colors, soothing music, and use of personal articles), a consistent physical layout with no environmental barriers, and a structured daily routine.

DIF: Cognitive Level: Application REF: Text Pages: 726-727

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

22. A mildly confused older adult patient states, I am in the Mojave desert. A nurse who is using validation therapy with the patient would make which response?

a.

Are you feeling hot or thirsty?

b.

Can you tell me about a time in your past when you were in a desert?

c.

You are in a rehabilitation nursing center because you need help caring for yourself.

d.

Your medical record shows that you have hyperthyroidism, which is probably responsible for the confusion you are experiencing.

ANS: A

Validation therapy involves searching for emotion and/or meaning in the patients disoriented or confused words and behavior and validating them verbally with the patient.

DIF: Cognitive Level: Application REF: Text Pages: 730-731

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. Which strategy would be included in a nursing care plan for an older adult patient who has sundown syndrome? (Select all that apply.)

a.

Minimizing daytime sleep

b.

Increasing physical activity, such as walking

c.

Protecting the patient from exposure to sunlight

d.

Increasing social interaction with staff and others

e.

Engaging the patient in mentally stimulating activities

ANS: A, B, D, E

It is postulated that sundown syndrome is caused by deterioration of the suprachiasmatic nucleus of the hypothalamus. This interferes with the major pacemaker of circadian rhythms. One strategy to ameliorate it is to provide at least minimal exposure to direct sunlight each day to reset circadian rhythm. The other interventions are safe and effective.

DIF: Cognitive Level: Application REF: Text Page: 722

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. A nurse evaluates the outcomes of family education about expected age-related changes. Which statements indicate the teaching was effective? (Select all that apply.)

a.

It is normal for my parent to take longer to complete daily activities because of age.

b.

I should expect my parents gait to change a little because of arthritis in the hips.

c.

Depression is to be expected because of losses associated with getting older.

d.

I shouldnt worry about my parent waking up at night once in a while.

e.

Problems remembering events and people occur often as one ages.

ANS: A, B, D

Depression and memory loss are not normal events of aging. Slowed response time, altered gait, and interrupted sleep patterns are a few of the normal changes of aging that elders or their families may interpret as pathological.

DIF: Cognitive Level: Application REF: Text Page: 731

TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

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