Gerontological Nursing 8th Edition by Charlotte Eliopoulos Test Bank

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Gerontological Nursing 8th Edition by Charlotte Eliopoulos Test Bank

Description

CHAPTER 7
Psychological and Cognitive Function

7.1A 70-year-old client comes into the clinic for his pneumonia vaccine. During the client interview, he seems to have mild difficulty with some words and tells you he forgets the names of people at times. He is alert, and oriented to time, person, and place. His responses seem appropriate. The nurse determines the cognitive changes that the client describes are

1. early symptoms of dementia.
2. indicators of depression in the elderly.
3. normal signs of aging.
4. memory impairment that may be related to cerebral ischemia.
Answer: 3

Rationale: Cognitive changes vary widely in the elderly; however, most older people will not suffer significant memory impairment. Many may experience mild problems with word finding and remembering names. The changes described by this client are normal signs of aging and not symptoms of dementia, depression, or ischemia. Dementia may present with additional symptoms of memory loss related to orientation and completing day-to-day tasks. Depression would show signs of flat affect, or withdrawal, and ischemia may show additional neurological deficits.
Assessment
Physiological Integrity
Analysis

7.2A 75-year-old client on a medical unit awakens from sleep with confusion about where she is. She insists her daughter is in the other room and wants to see her. The nurse reorients the patient to her surroundings and get the client to return to sleep. In reviewing the clients record, what data would be considered a source of the patients confusion?

1. pain medication received
2. the clients husband died last month
3. the clients age
4. history of cardiac disease
Answer: 1

Rationale: Certain medications, such as sleeping pills, tranquilizers, and pain medications, can cause symptoms similar to dementia. Therefore, the clients medication must be reviewed to determine the effects of drugs and cognitive changes. Although loss of a loved one may result in depression, it is unlikely to be the source of confusion. Age merely does not cause confusion, and cardiac disease alone would not cause confusion.
Assessment
Physiological Integrity
Application
7.3The nurse is reviewing with a 78-year-old client the discharge instructions for administration of insulin. In order to adjust to the normal changes experienced with aging, the nurse incorporates which activity into the teaching plan?

1. using tools that repeat the information until the information is understood
2. giving written materials to compensate for short-term memory losses
3. providing instruction to relatives so that the client will not need to learn everything
4. considering holding sessions for longer periods than usual so the client can learn
Answer: 1

Rationale: Normal age-related changes include a slowing of information processing, which results in the need for repetition of information. Short-term memory, or primary memory, remains relatively stable. Assuming the client cannot learn everything is stereotypical of the aging process. Another age-related change includes the inability to maintain sustained attention. Therefore, long teaching sessions would not be appropriate.
Planning
Health Promotion and Maintenance
Application

7.4An 82-year-old client is admitted to the hospital for surgery. During the admission assessment the daughter of the client describes difficulties that she has observed in the client. The daughter tells you that the client used to be a wonderful cook but now cannot even remember for what a blender is used. You consider this finding a

1. cognitive change that requires further assessment.
2. long-term memory loss.
3. short-term memory loss.
4. normal cognitive change in the elderly.
Answer: 1

Rationale: This type of memory loss cannot be determined by the information provided. It is not normal for a healthy individual to forget what the use of a commonly known object is, therefore, further assessment is warranted.
Implementation
Psychosocial Integrity
Analysis

7.5A 78-year-old client expresses concern to the nurse about how she will remember to take all of the medications recently prescribed. What intervention might the nurse incorporate into the teaching plan?

1. asking family to administer the medications to the client
2. placing the client in a personal care home
3. consulting the physician to alter the drug list prescribed
4. getting the client a weekly pill box and developing a written medication schedule
Answer: 4

Rationale: Methods to aid with normal cognitive changes include using tools and written notes to enhance memory. The nurse can be instrumental in aiding the client with these techniques. To ask the family would be burdensome and to place the patient in a personal care home without allowing the client to try on her own first violates the clients right to independence. Consulting the healthcare provider to alter the drug schedule may be necessary but would be considered an intervention used after other mechanisms have been tried.
Planning
Health Promotion and Maintenance
Application

7.6A 75-year-old client with cardiac disease describes a decline in the amount of sleep he gets and difficulty falling asleep at night. You consider these findings

1. signs of anxiety and depression.
2. normal signs of aging.
3. normal signs of cardiac disease.
4. normal signs of respiratory disease.
Answer: 1

Rationale: Drastic changes in sleep patterns may be early signs of underlying anxiety and depression, should be investigated and not written off as normal changes of aging. Pain, respiratory disease, and cardiac disease can also interfere with sleep but sleep pattern disturbances need to be assessed further to determine if there is an underlying psychiatric problem.
Assessment
Physiological Integrity
Analysis

7.7The nurse is caring for a 78-year-old woman who is brought to the emergency department from home. The client has a diagnosis of dementia and is being treated for abdominal pain. During the assessment, the nurse identifies multiple bruises on the extremities that appear to be 1 to 2 weeks old. The nurse also has resistance from the client during the insertion of a urinary catheter. The clients son is the caregiver and tells you the bruises are from the patient falling. The assessment of the physical injuries and the clients behavior indicate what intervention by the nurse?

1. obtain an order for disturbance in blood clotting
2. investigate for potential elder abuse
3. provide physical restraint to prevent the client from pulling out the catheter
4. sedate the patient to increase cooperation
Answer: 2

Rationale: Elder abuse is more likely to occur when the older person is cognitively impaired. Unexplained bruises, resistance to pelvic exams, and perineal procedures may be signs of sexual abuse. Bruises are naturally occurring with extremity injuries and do not always warrant coagulation studies. Physical and chemical restraints could mask client symptoms and violate patient rights.
Assessment
Psychosocial Integrity
Analysis

7.8A 75-year-old client is admitted to the medical unit for treatment of abdominal pain. Despite the administration of prescribed pain medication, the client reports no relief of pain and continues to describe multiple somatic complaints. The nurse identifies the need for which of the following?

1. further assessment and treatment for depression
2. review of the clients lab values
3. obtaining an order for different pain medication
4. contacting the family to talk to the patient
Answer: 1

Rationale: A major clue to depression in the older person includes multiple somatic complaints and reports of persistent chronic pain. Many older people have more physical than emotional complaints. Therefore, further assessment for depression is warranted. The lab values are not indicated in this case, and obtaining different pain medication would not treat potential psychological problems. The family may also be ineffective in determining the clients psychological need.
Assessment
Psychosocial Integrity
Analysis

7.9A home care nurse is completing the follow-up visit of a 92-year-old client. During the visit the client describes feelings that everyone is out to get him. He continues to describe paranoid thoughts and seems to become increasingly angry and frustrated. The nurses assessment of this behavior indicates the need to

1. call the family to come and calm the client.
2. avoid further discussion of the problem because the client is upset.
3. contact the clients physician to obtain further psychological assessment of the paranoia.
4. no intervention, this is a normal finding in the elderly as a result of hearing loss.
Answer: 3

Rationale: Paranoia is the most common form of psychosis in later years. Although it may be caused by hearing loss and social isolation, it is not a normal finding. You may want to avoid probing into the discussion to avoid a confrontation at that time, but the condition needs further evaluation. The family may be the source of the paranoia and unable to calm the patient without professional intervention.
Intervention
Psychosocial Integrity
Application

7.10A nurse is caring for a 70-year-old man who describes his choices for coping with stress as drinking alcohol occasionally and talking to his daughter on the phone. He states he simply has not adjusted to life since retirement. It has been worse since his wife died 2 months ago. He admits to the nurse that he feels helpless. The nurse identifies this client is at risk for

1. paranoia.
2. suicide.
3. dementia.
4. liver failure.
Answer: 2

Rationale: Older persons aged 65 and over have the highest suicide rates of all age groups. Older white men have the highest death rates of all groups of old people. Therefore, this client is at highest risk for suicide. There are no symptoms that would indicate dementia or paranoia. Although alcohol consumption must be monitored in the elderly, there is no indication that liver disease is a problem for this client.
Assessment
Psychosocial Integrity
Analysis

7.11A group of student nurses is discussing cognitive changes that are considered to be
normal age-related changes with the nursing instructor. Which statement by a student
would indicate a need for further education from the instructor?

1. Older clients may need information repeated to them several times.
2. Older clients may have a harder time switching their attention from one person to another if they are both speaking to the client at the same time.
3. Older clients may have difficulty in filtering out irrelevant information.
4. An older clients vocabulary may decrease with age.
Answer: 4
Rationale: A clients vocabulary improves with age. Other normal age-related changes include declines in the ability to filter out irrelevant information and the ability to switch attention rapidly from one auditory input to another. Information-processing speed also declines with age, resulting in a slower learning rate and greater need for repetition of information.
Planning; Health Promotion and Maintenance; Analysis

7.12A nurse is preparing an educational program for residents of an assisted living facility regarding methods for coping with age-associated cognitive changes. Which of the following information should the nurse include? Select all that apply.

1. Making lists, posting appointments on calendars, and writing notes to self
2. Playing computer games
3. Keeping the mind active by doing things like playing bridge, completing a crossword puzzle, reading daily
4. Using assistive devices such as a pill box for medications
5. Not relying on habits; challenging your mind to remember new things
Answer: 1, 2, 3, 4
Rationale: Methods for coping with age-associated cognitive changes include making lists, playing computer games, keeping your mind active, using assistive devices, and relying on habits to reduce the chances of forgetting vital information.
Planning; Health Promotion and Maintenance; Application

7.13An emergency room nurse is caring for an elderly client. The clients son has been caring for the client at home and has become increasingly worried about his fathers forgetfulness. The son asks the nurse, What could be wrong with my father? What is the most appropriate response by the nurse?

1. Memory difficulties can be due to several different issues, including anxiety, chronic pain, depression, or Alzheimers disease.
2. Forgetfulness is common in older adults. Its nothing you need to worry about.
3. My father is the same age as yours, and he cant remember anything.
4. Memory difficulties are hard for family members to deal with.
Answer: 1
Rationale: Cognitive changes can be due to anxiety, chronic pain, depression, or Alzheimers disease. Forgetfulness is common in older adults, but this statement is not therapeutic. The nurse is discounting the sons feelings. The nurse is showing sympathy with the statement about her father but is not addressing the clients feelings. Memory difficulties are difficult for family members to deal with, but this is not the most appropriate statement at this time.
Planning; Physiological Integrity; Analysis

7.14A nurse is preparing an educational program for the nursing assistants at the long-term care facility concerning potential psychiatric issues in the elderly. Which symptoms should the nurse include? Select all that apply.

1. Changes in sleep patterns
2. Delusions and hallucinations
3. Clients speaking about a fear of death
4. Clients who have a flat affect
5. Clients who have difficulty in performing their ADLs
Answer 1, 2, 3, 4
Rationale: Psychiatric symptoms that should be investigated and not written off as normal changes of aging include: memory and intellectual difficulties, changes in sleep pattern, changes in sexual interest and capacity, fear of death, delusions, hallucinations, disordered thinking, and problems with emotional expression. Difficulty in performing ADLs does not necessarily indicate a psychiatric issue.
Planning; Physiological Integrity; Application

7.15A newly licensed nurse is working on a psychiatric health unit. The nurse observes that many elderly clients suffer from paranoia. The nurse is aware that this may be due to

1. loss of independence.
2. hearing loss.
3. vision loss.
4. low life satisfaction.
Answer: 2
Rationale: Hearing loss may place older persons at risk for developing paranoia, as they may misinterpret casual conversation of others and believe they are the focus of the conversation. Other risk factors include social isolation, underlying personality disorder, cognitive impairment, and delirium.
Assessment; Physiological Integrity; Application

7.16A home health care nurse is working with an elderly client whose husband passed away 4 years ago. The couple had been married 56 years. The client still sets a place at the dinner table for her husband. She has never removed any of his clothing or other personal items from her house. The nurse understands that this client is suffering from

1. normal grief.
2. pathological grief.
3. survivor guilt.
4. hopelessness.
Answer: 2
Rationale: Grief persisting longer than 2 years is considered pathological in the United States. The length of the grief process is culturally determined and usually is considered normal within a 2-year time frame. Survivor guilt is associated with a traumatic event where a person survives when another loved one does not. In hopelessness, the client sees no hope in his or her life.
Assessment; Psychosocial Integrity; Comprehension

7.17A nursing student is preparing a presentation for the class regarding grief. What information should be included regarding factors that can affect the duration and course of grieving?

1. Centrality of loss
2. Health of survivor
3. Cultural and ethnic influences
4. Nature of death
5. Survivors religious or spiritual belief system
Answer: 1, 2, 3, 4, 5
Rationale: All are factors that influence the course and duration of grieving.
Planning; Psychosocial Integrity; Application

7.18A gerontological nurse is caring for a client who reports having lots of stress in her life. The client complains of feeling like her heart is racing at times. The nurse is aware that the client is experiencing a flight-or-fight response. Which chemical is associated with this response?

1. Dopamine
2. Serotonin
3. Acetylcholine
4. Epinephrine
Answer: 4
Rationale: The fight-or-flight response stimulates epinephrine release and increases pulse, blood pressure, bold glucose, and muscle tension. Serotonin is associated with sleep and depression. Acetylcholine is associated with Alzheimers disease. Dopamine is associated with schizophrenia.
Planning; Physiological Integrity; Comprehension

7.19A nurse is volunteering at a local retirement community. She is attempting to organize a walking program. A resident asks, Why should I exercise at my age? What is the best response by the nurse?

1. Exercise has not been shown have any benefits for people over 80.
2. Exercise can help reduce the negative effects of stress, which can impact your physical health.
3. Exercise can help increase your blood pressure.
4. You arent too old to exercise.
Answer: 2
Rationale: Exercise can help to break the cycle of long-term negative effects of stress. Other activities that can help with stress are support groups, stress-reduction clinics, and helping clients identify and strengthen positive coping skills.
Planning; Psychosocial Integrity; Analysis

7.20A long-term care nurse is organizing a depression screening program for the residents. One of the nurses peers questions why they need to do this, stating, we are busy enough all ready. What is the best response by the nurse?

1. Studies show that as many as 43% of institutionalized elderly adults show symptoms of clinical depression. Depression symptoms are often associated with chronic illness and pain.
2. Studies show that as many at 63% of institutionalized elderly adults show symptoms of clinical depression. Depression symptoms are often associated with chronic illness and pain.
3. Depression is uncommon in elderly clients, but we need to screen all of our clients to find the few that have symptoms.
4. Screening our clients for various diseases will show their families that we are trying to give them the best care possible.
Answer: 1
Rationale: Depression is the mental health problem of greatest frequency and magnitude in the older population. Studies show that as many as 43% of institutionalized elderly adults show symptoms of clinical depression. Depression symptoms are often associated with chronic illness and pain.
Planning; Health Promotion and Maintenance; Application

7.21A student nurse is preparing to assess a client admitted with depression. Which symptoms would the student expect to find?
1. Flat affect
2. Labile mood
3. Pressured speech
4. Hyperactivity
Answer: 1
Rationale: Depression can include mild sadness over long periods of time, brief periods of sadness, intense reaction to loss, severe psychotic depression, or profound regression or pseudodementia. The client may barely cooperate with mental status testing. The client may have a flat affect, or lack of emotion. Depressed clients often appear hopeless and respond slowly. Labile mood is when a client quickly moves from one mood to another. Pressured speech is when a client cant get words out quickly enough, typically seen in a client with mania.
Assessment; Physiologic Integrity; Application

7.22A nurse working in an assisted care facility is preparing an educational program regarding suicide for the colleagues on the unit. What information will need to be included? Select all that apply.

1. Suicide rates are the highest in people age 65 and older.
2. Suicide rates are the highest in teens.
3. You should never question a person about suicide intent.
4. An older person who contemplates suicide is more likely to complete the act than a younger person.
5. Approximately 70% of older adults who commit suicide had visited their primary care physician within the previous month.
Answer: 1, 4, 5
Rationale: A major risk factor for suicide is depression. Suicide rates are the highest in older persons age 64 and over. An older person who contemplates suicide is more likely to complete the act than a younger person. Approximately 70% of older adults who commit suicide had visited their primary care physician within the previous month. A nurse should ask about suicidal intent. Many nurses are hesitant to do this because of fear of placing the idea in the older persons mind. This is rarely the case.

Planning; Psychosocial Integrity; Application
7.23A newly licensed nurse is completing a suicide assessment on an elderly client with lung cancer. Which statement by a client could be considered suicidal?

1. God will take me when its my time.
2. Im ready to go when God calls me.
3. I wish I could stop all of this pain.
4. Im no use to anyone. I might as well be dead.
Answer: 4
Rationale: Some nurses confuse an older patients desire to have a natural death with suicidal intent. Statements like options 1 and 2 are not considered suicidal statements. In option 3, the client is expressing that he would like to stop the pain, but not necessarily die. Option 4 does express a wish to die.
Evaluation; Psychological Integrity; Application

7.24An elderly client has recently been prescribed an MAOI medication. Which meal choice would indicate a need for further education regarding this medication?

1. Baked chicken, green beans, and cherry pie
2. Pepperoni pizza and diet soda
3. Fried chicken, creamed corn, and French fries
4. Chicken salad on a croissant, carrot sticks, and fresh fruit
Answer: 2
Rationale: MAOIs have several side effects and food restrictions. Clients should not consume foods that contain tyramine, such as aged cheeses, red wine, and processed meats. Consumption of these foods could cause a hypertensive crisis. Pepperoni is a processed meat. While the fried chicken and French fries are high in fat, they are not contraindicated while taking an MAOI. The other meal options are relatively healthy choices.
Assessment; Physiologic Integrity; Analysis

7.25A nurse is completing a care plan for an elderly client who lives alone and was admitted with major depression with suicidal ideations. The client states, I cant sleep; the voices keep me awake and keep telling me to kill myself. Which of the following would be the priority nursing diagnosis?
1. Social isolation
2. Risk for suicide
3. Disturbed sleep pattern
4. Altered sensory perception
Answer: 2
Rationale: Although all diagnoses listed would be appropriate for this client, Risk for suicide would be the priority diagnosis.
Diagnosis; Psychological Integrity; Application

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