Chapter 41: Common Psychosocial Care Problems of the Elderly My Nursing Test Banks

Chapter 41: Common Psychosocial Care Problems of the Elderly

Test Bank

MULTIPLE CHOICE

1. The nurse is planning an instruction for an 84-year-old man relative to a significant change in his diet for diabetes. The nurse will plan her teaching around the idea that the elderly:

a.

need to have their family to hear the instruction.

b.

cannot learn complex information or skills.

c.

need more time to learn because of slower processing skills.

d.

are fixed in their ideas and reject information that does not agree with them.

ANS: C

The elderly patient needs more time to learn because of slower processing skills.

DIF: Cognitive Level: Comprehension REF: p. 829 OBJ: Theory #2

TOP: Changes in Cognitive Functioning KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

2. The nurse clarifies to a family of a resident with Alzheimers that dementia differs from confusion and delirium in that dementia is:

a.

usually rapid in onset.

b.

permanent.

c.

caused by depression.

d.

effectively treatable.

ANS: B

Dementia is generally a permanent condition characterized by cognitive deficits with a slow onset. It is primarily seen in Alzheimers patients but also occurs in persons with brain tumors.

DIF: Cognitive Level: Comprehension REF: p. 831 OBJ: Theory #3

TOP: Confusion KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

3. The home health nurse initiates an inexpensive noninvasive treatment that can decrease depression by the use of:

a.

placing the patient in front of a high action TV show for 1 hour.

b.

subscriptions to travel or hobby-oriented magazines.

c.

shining lights on the patient for 30 minutes a day.

d.

arrangements to have a high-calorie drink twice a day.

ANS: C

Use of a light therapy box that allows the patient to absorb the light for 20 to 30 minutes in the morning my help decrease depression.

DIF: Cognitive Level: Application REF: p. 831, Clinical Cues

OBJ: Theory #6 TOP: Delirium KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

4. The nurse in a long-term care facility emphasizes to the family of a resident recently admitted that one of the purposes of the creative behavioral therapies is to:

a.

entertain the residents who have become bored.

b.

stimulate an avid interest in music or art.

c.

keep the residents out of their rooms.

d.

slow the rate of deterioration.

ANS: D

The creative behavioral therapies of art, music, dancing, and humor are designed to delay the deterioration of the resident.

DIF: Cognitive Level: Knowledge REF: p. 831 OBJ: Theory #1

TOP: Creative Therapies KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

5. The family of a retired army veteran diagnosed with Alzheimers disease is concerned about obtaining care for the patient while away on vacation. The home health nurse informs the family that the Department of Veterans Affairs offers in-facility care for patients with dementia for up to _____ days a year.

a.

10

b.

15

c.

20

d.

30

ANS: D

The Department of Veterans Affairs offers in-facility care for demented patients who are veterans for up to 30 days a year.

DIF: Cognitive Level: Knowledge REF: p. 833, Clinical Cues

OBJ: Clinical Practice #1 TOP: Respite Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

6. When the nurse plans to use reminiscence as a psychosocial approach to managing confusion with cognitively impaired patients, the nurse should:

a.

use plants, pictures, and animals to encourage interactions in the group.

b.

use memory aids such as television, radio, clock, and calendar.

c.

encourage individual and group sharing of information about previous life experiences.

d.

increase socialization roles in the group, such as serving each other refreshments.

ANS: C

Reminiscence involves individual and group sharing about previous life experiences.

DIF: Cognitive Level: Application REF: p. 832, Box 41-2

OBJ: Clinical Practice #1 TOP: Psychosocial Approaches

KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

7. When a patient with dementia exhibits increasing agitation, hostility, and paranoia, the nurse anticipates the physician will prescribe a(n):

a.

anticonvulsant.

b.

antidepressant.

c.

minor tranquilizer.

d.

major tranquilizer.

ANS: D

Major tranquilizers are often prescribed to manage the anxiety, agitation, hostility, and paranoia associated with dementia. Minor tranquilizers may be used to treat symptoms that are less severe than the ones experienced by this patient. There are, however, many undesirable side effects.

DIF: Cognitive Level: Analysis REF: p. 832, Box 41-2

OBJ: Clinical Practice #1 TOP: Pharmacology

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

8. The family of a patient with Alzheimers indicates that they want to keep the patient at home but are not sure how much longer they can care for the patient because of stress on family members. A helpful suggestion by the home health nurse would be to:

a.

consider use of respite services.

b.

face the reality of need for long-term care.

c.

encourage the hiring of a full-time caregiver.

d.

encourage family counseling.

ANS: A

Respite care or adult day services can provide for much-needed psychological and physical rest for caregivers.

DIF: Cognitive Level: Application REF: p. 833 OBJ: Theory #2

TOP: Respite Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

9. A home health nurse working with an elderly patient assesses an early indication that this patient is developing Alzheimers disease. This early indication would be:

a.

wandering behavior.

b.

agitation.

c.

difficulty learning new things.

d.

deteriorating speech.

ANS: C

Early signs of Alzheimers disease are mild short-term memory loss, difficulty learning new things, and mild depression.

DIF: Cognitive Level: Comprehension REF: p. 833, Box 41-4

OBJ: Theory #3 TOP: Alzheimers Disease

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

10. An elderly patient with early Alzheimers disease is receiving the drug donepezil (Aricept). The nurse assesses the patient lab reports carefully for drug side effects because of the drugs potential toxicity to the:

a.

kidneys.

b.

liver.

c.

spleen.

d.

heart.

ANS: B

This drug has toxic effects on the liver and requires that the patient be monitored carefully.

DIF: Cognitive Level: Knowledge REF: p. 833 OBJ: Theory #5

TOP: Drug Therapy for Alzheimers Disease

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: pharmacological therapies

11. When a patient becomes violent and hits a table with his cane, the initial appropriate nursing approach is to:

a.

medicate the patient to help control his anxiety.

b.

call for assistance to apply restraints.

c.

attempt to distract the patient.

d.

direct the patient in a loud authoritarian voice to sit down.

ANS: C

A behavioral approach such as distraction might diffuse the situation until the cause can be determined. Chemical restraint (medication) or a restrictive restraint should not be the first intervention. Loud voices frequently increase the violent behavior.

DIF: Cognitive Level: Analysis REF: p. 834 OBJ: Theory #5

TOP: Hostility and Agitation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

12. The nurse adds to the plan of care for a cognitively impaired resident who has begun to wander night and day throughout the long-term care facility. An appropriate intervention to add to the plan of care for the resident with wandering behavior would be to:

a.

place the resident on a locked unit to prevent long-range wandering.

b.

obtain an order for wrist restraints or a vest restraint.

c.

apply a bracelet that alarms as the resident approaches an outside door.

d.

discuss with the physician the need for stronger medication.

ANS: C

Wanderers may be finding a means to combat boredom. Placing a door alarm bracelet will alert the staff if the resident is near an outside door. Frequent checks on the residents location can also help keep such a resident safe.

DIF: Cognitive Level: Application REF: p. 834 OBJ: Theory #5

TOP: Interventions for Wandering KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

13. The 64-year-old resident newly admitted to a long-term care facility refuses to sit down and eat, preferring to wander aimlessly through the facility. The initial intervention by the nursing staff should be to:

a.

apply an alarm bracelet to monitor wandering.

b.

offer high-protein malts to drink on the go.

c.

feed the resident in his room away from other residents.

d.

feed the patient rapidly before he begins to wander.

ANS: B

The offering of high-protein drinks or nutritious snacks to eat on the go may be an initial approach to the problem.

DIF: Cognitive Level: Analysis REF: p. 835, Patient Teaching

OBJ: Theory #5 TOP: Sundown Syndrome

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

14. In order to minimize the risk of aspiration in a resident with advanced Alzheimers, the person feeding the patient should:

a.

keep a suction machine available.

b.

have the patient consume only liquids.

c.

remind the patient to chew and swallow.

d.

offer large amounts of water after each bite.

ANS: C

Reminding the demented patient to chew and swallow will help prevent the resident from holding food in his mouth.

DIF: Cognitive Level: Application REF: p. 835, Patient Teaching

OBJ: Theory #5 TOP: Strategies to Prevent Aspiration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: reduction of risk potential

15. A depressed elderly patient was started on antidepressant drug therapy 3 weeks ago. The highest nursing priority when working with this patient at this time would be:

a.

stimulating appetite.

b.

providing reality orientation.

c.

encouraging socialization.

d.

protecting the patient from self-injury.

ANS: D

The primary nursing responsibility for a depressed patient is to protect him from self-injury, especially after the patient has been started on antidepressant therapy. Before that time, the patient may not have had the energy to commit self-injury.

DIF: Cognitive Level: Analysis REF: p. 837 OBJ: Clinical Practice #2

TOP: Depression KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

16. The behavior in a depressed elderly patient that would indicate that this patient is contemplating suicide is:

a.

giving away personal belongings.

b.

watching television in the activity room.

c.

talking with other patients.

d.

spending time sitting near the nurses station.

ANS: A

Signs of potential suicide include giving away treasured possessions, meticulous planning of personal affairs, sudden euphoria, and statements of death wishes. The other options do not indicate behaviors that warn of a possible upcoming suicide attempt.

DIF: Cognitive Level: Analysis REF: p. 837 OBJ: Clinical Practice #2

TOP: Suicide KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

17. The nurse would question a new order for a tricyclic antidepressant for a patient who has had a recent:

a.

peptic ulcer.

b.

myocardial infarct.

c.

abdominal surgery.

d.

diagnosis of diabetes.

ANS: B

Tricyclics are contraindicated in patients with recent myocardial infarctions because these drugs may cause cardiac arrhythmias.

DIF: Cognitive Level: Analysis REF: p. 837 OBJ: Clinical Practice #2

TOP: Depression KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

18. A family member tells a hospitalized elderly patient to cooperate better with the treatment plan or placement in a long-term care facility will result. The nurse recognizes this statement is consistent with ___________ elder abuse.

a.

physical

b.

material

c.

psychological

d.

neglect

ANS: C

Elder abuse can be inflicted physically, verbally, or emotionally.

DIF: Cognitive Level: Comprehension REF: p. 838, Box 41-8

OBJ: Theory #7 TOP: Elder Abuse KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

19. When the nurse determines that an elderly patient has a reasonable risk of being physically abused by family members, it is the nurses legal obligation to:

a.

report the suspected abuse to the proper authority.

b.

refer the family for counseling.

c.

advise the patient to leave the family home.

d.

tell the family to stop or face legal consequences.

ANS: A

It is a legal obligation under state-mandated reporting laws for suspected abuse for nurses to report instances in which there is a reasonable belief that an individual has been or is likely to be abused, neglected, or exploited.

DIF: Cognitive Level: Application REF: p. 838 OBJ: Theory #7

TOP: Elder Abuse KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

20. An elderly female adult is most at risk for becoming a victim of a crime by:

a.

having a peephole on the front door.

b.

keeping doors locked with dead bolts.

c.

having locks changed if keys are lost.

d.

telling a stranger on the phone that she is alone at home.

ANS: D

The riskiest behavior is telling strangers on the phone that she is alone.

DIF: Cognitive Level: Analysis REF: p. 839 OBJ: Clinical Practice #3

TOP: Crime KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

21. The elderly are vulnerable not only to crime, but also to scams. The best advice to give an elderly person in avoiding scams is to:

a.

travel with a group.

b.

hang up when a timesharing agent calls.

c.

lock windows at night.

d.

consider getting a pet for protection.

ANS: B

Scams are white-collar crimes such as timesharing, telemarketing, or funeral planning. Traveling in groups, locking windows, and acquiring a dog for protection are safety precautions. The best thing to do is to not talk to the caller.

DIF: Cognitive Level: Comprehension REF: p. 839, Box 41-9

OBJ: Clinical Practice #3 TOP: Crime KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

COMPLETION

22. The nurse clarifies that the diagnosis of nocturnal dementia refers to a syndrome also called _______________.

ANS:

sundowning

Sundowning is a syndrome in which confusion and agitation increases with the evening hours.

DIF: Cognitive Level: Knowledge REF: p. 830 OBJ: Theory #3

TOP: Sundowning KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

23. When the nurse observes the ____________ warning on the label on a bottle of antipsychotics, the nurse is aware that it is a very strong advisory from the Federal Drug Administration (FDA) prior to pulling the drug off the market.

ANS:

Black Box

The FDA may place the Black Box warning on a label of a drug connoting that the drug has been associated with an increased risk of death. It is a warning that may precede pulling the drug from the market. This practice was initiated in 2008 by the FDA.

DIF: Cognitive Level: Knowledge REF: p. 832, Box 41-2

OBJ: Theory #4 TOP: Black Box KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: pharmacological therapies

24. The nurse frequently refers to The _________________, a medication list that names drugs that are potentially harmful for use in elderly patients.

ANS:

Beers Criteria

The Beers Criteria lists drugs that are potentially harmful to the elderly.

DIF: Cognitive Level: Knowledge REF: p. 832, Box 41-2

OBJ: Theory #4 TOP: The Beers Criteria

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

MULTIPLE RESPONSE

25. The nurse is aware that the elderly of today face some functional psychosocial issues, which include: (Select all that apply.)

a.

altered mobility.

b.

becoming crime victims.

c.

housing.

d.

making provision for physical care.

e.

cognitive impairments.

ANS: A, D, E

Altered mobility, making provisions for physical care, and dealing with cognitive impairments are functional issues the elderly must resolve. Housing and crime are external issues.

DIF: Cognitive Level: Comprehension REF: p. 829 OBJ: Theory #9

TOP: Psychosocial Crises of the Elderly KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

26. The home health nurse counsels the family of a cognitively impaired man that to best provide for his welfare, the family should: (Select all that apply.)

a.

rearrange furniture and art to stimulate him.

b.

use concise and direct communication.

c.

enroll him in a Senior Activity Program.

d.

monitor nutrition for adequacy.

e.

install a door alarm that sounds when it is opened.

ANS: B, C, D, E

Using direct communication enhances the impaired persons perception. Making the environment safe by installing an alarm and providing for socialization and adequate nutrition are also part of the principles of the care of the cognitively impaired.

DIF: Cognitive Level: Application REF: p. 831, Box 41-3

OBJ: Theory #1 TOP: Care of the Cognitively Impaired

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

27. The nurse instructs a family of an 87-year-old resident in a long-term care facility that his nocturnal dementia is most likely caused by: (Select all that apply.)

a.

his schedule changing as a result of recent admission to the facility.

b.

lack of adequate medication for anxiety.

c.

increased shadows of the evening hours.

d.

dehydration.

e.

food allergy.

ANS: A, C, D

Nocturnal dementia is a disorder about which little is known. It is believed that among its many possible causes, the most prominent are fatigue, low lighting, increased shadows of the evening hours, disruption in the body clock, and dehydration.

DIF: Cognitive Level: Comprehension REF: p. 830 OBJ: Theory #3

TOP: Nocturnal Dementia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

OTHER

28. A recently widowed 80-year-old man has been admitted to a long-term care facility for complaints of anorexia, loss of energy, and loss of sleep. The nurse learns that the patient is recently widowed. Prioritize the nursing actions that might be needed for this patient. (Separate letters by a comma and a space as follows: A, B, C, D.)

A. Provide a quiet environment.

B. Involve him in some activity.

C. Be alert to suicidal tendencies.

D. Spend time with the patient at mealtime.

ANS:

C, B, D, A

The nurse must be alert to suicidal ideation or tendencies and assess for their effect on the resident. Involving the resident in some activity can generate socialization and reduce depressive thoughts. Spending time with the patient allows for assessment of his ideation as well as giving evidence of his worth. Provision of a quiet environment is restful for all residents, but is of low priority for a suicidal person.

DIF: Cognitive Level: Analysis REF: p. 836 OBJ: Clinical Practice #6

TOP: Suicide KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

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