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b. Fostering personal control c. Explaining curative options d. Supporting the patient’s spirituality e. Offering interventions that convey respect f. Providing answers to the patient’s questions about spirituality

ANS: A, B, D, E

The correct answers support the rights and choices of the dying individual. Acting on false information robs a patient of the opportunity for honest dialogue and places barriers to achieving end-of-life developmental opportunities. The nurse supports the patient’s spirituality but does not have the answers to all questions.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 30-6, 11 to 13, 42 (Box 30-5)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. A 92-year-old diagnosed with acute pneumonia and late-stage Alzheimer’s disease b. A 54-year-old diagnosed with glioblastoma and life expectancy of 8 to 10 weeks c. A 16-year-old with type 1 diabetes, multiple infections, and substance abuse d. A 74-year-old newly diagnosed with chronic obstructive pulmonary disease (COPD) and life expectancy of 2 years e. A 36-year-old diagnosed with multiple sclerosis complicated by major depressive disorder and pain associated with muscle spasms

2. Which patients meet criteria for hospice services? (Select all that apply.)

ANS: A, B

Hospice services are available to patients with terminal illnesses and a life expectancy of less than 6 months. The patient must choose hospice care, rather than curative treatments. Although patients with other health problems may experience complications, treatments focusing on cure would exclude them from hospice services.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 30-5 TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Encourage the patient to reconsider this decision so that interested and caring friends can provide support. b. Support the patient to share the request with the parents and sister. c. Assist family to inform the patient’s friends of the request. d. Suggest that the patient discuss these wishes with clergy. e. Place a “No Visitors” sign on the patient’s door.

3. As death approaches, a patient diagnosed with AIDS says, “I do not have enough energy for many visitors anymore and I am embarrassed about how I look. I only want to see my parents and sister.” Which actions should the nurse take? (Select all that apply.)

ANS: B, C

The correct responses empower the patient to maintain dignity, control, personal space, and confidentiality. As some patients approach death, they begin to withdraw. In the stage of acceptance, many patients are exhausted and tired, and interactions of a social nature are a burden. Many prefer to have someone present at the bedside who will sit without talking constantly.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 30-6, 9 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. “Her possessions still have her scent. We should dispose of them.” b. “Let’s take turns selecting items of hers we would each like to have.” c. “When I die, I hope someone who loved me goes through my things.” d. “This was her favorite jacket. If we donate it to charity, someone else can enjoy it too.” e. “We’re violating her privacy by looking through her things. Let’s call a charity to come pick up everything.”

4. One month ago, an adult died from cancer. Family members now gather at the adult’s home to dispose of the deceased’s belongings. Which comments demonstrate the family member is coping with the loss in an effective way? (Select all that apply.)

ANS: B, C, D PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 30-21 to 23, 35 (Table 30-3) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

Chapter 31: Older Adults

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. A student nurse visiting a senior center says, “It’s depressing to see these old people. They are weak and frail. I doubt any of them can engage in a discussion.” The student is expressing a. reality. b. ageism. c. empathy. d. vulnerability.

ANS: B

Ageism is a bias against older people because of their age. None of the other options applies to the ideas expressed by the student.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 31-14 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Pain assessment techniques for older adults b. Psychosocial stimulation for those who live alone c. Preparation of psychiatric advance directives in the elderly d. Ways to manage disinhibition in elderly persons with dementia

2. A nurse plans an educational program for staff of a home health agency specializing in care of the elderly. Which topic is the highest priority to include?

ANS: A

The topic of greatest immediacy is the assessment of pain in older adults. Unmanaged pain can precipitate other problems, such as substance abuse and depression. Elderly patients are less likely to be accurately diagnosed and adequately treated for pain. The distracters are unrelated or of lesser importance.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 31-9, 10 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. “I am a nurse. Are you familiar with what nurses do?” b. “Hello. I am going to ask you some questions to get to know you better.” c. “You look comfortable and ready to participate in an admission interview. Shall we get started?” d. “Hello. My name is _______ and I am a nurse. How you would like to be addressed by staff?”

3. Select the best comment for a nurse to begin an interview with an elderly patient.

ANS: D

The correct opening identifies the nurse’s role and politely seeks direction for addressing the patient in a way that will make him or her comfortable. This is particularly important when a considerable age difference exists between the nurse and the patient. The nurse should address patients by name and not assume patients want to be called by a first name. The nurse should always introduce self.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 31-17, 18, 21, 45 (Box 31-8) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Functional ability and emotional status b. Chronological age and sexual function c. Economic status and sources of income d. Developmental history, interests, and activities

4. Which information is most important to obtain during assessment of an older adult diagnosed with health problems?

ANS: A

Information related to functional ability and emotional status provides an overview of a patient’s problems and abilities. It guides selection of interventions and services to meet identified needs. The distracters reflect information of relevance, but are not of highest priority.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 31-12, 20 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Complete a neurological assessment. b. Determine whether the patient can hear as the nurse speaks. c. Suggest that the patient lie down in a darkened room for a few minutes. d. Administer medication to relieve the patient’s pain before continuing the assessment.

5. A 75-year-old patient comes to the clinic reporting frequent headaches. As the nurse begins the interaction, which action is most important?

ANS: B

Before proceeding with any further assessment, the nurse should assess the patient’s ability to hear questions. Impaired hearing could lead to inaccurate answers.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 31-3, 18, 43 (Box 31-6)

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. The elderly are usually socially isolated and lonely. b. Vision, hearing, touch, taste, and smell decline with age. c. The majority of elderly patients have some form of early dementia. d. As people age, thinking becomes more rigid and learning is impaired.

6. Which statement about aging provides the best rationale for focused assessment of elderly patients?

ANS: B

Only the key is a true statement. It cues the nurse to assess sensory function in the elderly patient. Correcting vision and hearing are critical to providing safe care. The distracters are myths about aging.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 31-3, 18, 43 (Box 31-6) TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance a. “Would you say your mood is often sad?” b. “Are you having any trouble with your memory?” c. “Have you noticed an increase in your alcohol use?” d. “Do you often experience moderate to severe pain?”

7. A nurse assesses an elderly patient. The nurse should complete the Geriatric Depression Scale if the patient answers which question affirmatively.

ANS: A

Feeling low may be a symptom of depression. Low moods occurring with regularity should signal the need for further assessment for other symptoms of depression. The other options do not focus on mood.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 31-3, 44 (Box 31-7) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

8. A health care provider writes these new prescriptions for a resident in a skilled nursing facility: 2 g sodium diet, restraint as needed, limit fluids to 1800 mL daily, continue antihypertensive medication, milk of magnesia 30 mL PO once if no bowel movement for 3 days. The nurse should a. question the fluid restriction. b. question the order for restraint. c. transcribe the prescriptions as written. d. assess the resident’s bowel elimination.

ANS: B

Restraints may be imposed only on a written order of the health care provider that specifies the duration during which the restraints can be used. The Joint Commission guidelines and Omnibus Budget Reconciliation Act regulations also mandate a number of other conditions that must be considered and documented before restraints are used. The other prescriptions are appropriate.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 31-25 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. The nurse assigned to care for the patient b. Unlicensed assistive personnel who apply the restraint c. Family member who agrees to application of the restraint d. Health care provider who prescribed application of restraint

9. An elderly patient must be physically restrained. Who is responsible for the patient’s safety?

ANS: A

Although restraint is prescribed by a health care provider, the restraint is a measure carried out by nursing staff. The nurse caring for the patient is responsible for safe application of restraining devices and for providing safe care while the patient is restrained. Nurses may delegate the application of restraining devices and the care of the patient in restraint, but the nurse remains responsible for outcomes. Even when family agree to restraint, nurses are responsible for providing safe outcomes.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 31-25 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. “Ask the patient’s family if they think the patient is experiencing pain.” b. “Use a visual analog scale to help the patient determine the presence and severity of pain.” c. “There are special scales for assessing patients with dementia. Let’s review how to use them.” d. “The perception of pain is diminished by this type of dementia. Focus your assessment on the patient’s mental status.”

10. A new nurse asks, “My elderly patient’s CT scan of the head shows many Lewy bodies are present. What should I do about assessing for pain?” Select the best response from the nurse manager.

ANS: C

Lewy bodies associated with dementia [Faculty note: Lewy bodies are defined and addressed in Chapter 23]. There are special scales to assess the presence and severity of pain in patients with dementia. The Pain Assessment in Advanced Dementia Scale evaluates breathing, negative vocalizations, body language, and consolability. A patient with dementia would be unable to use a visual analog scale. The family may be able to help the nurse gain perspective about the pain, but this strategy alone is inadequate. The other distracters are myths.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 31-9, 10, 34 (Figure 31-4) | Page 31-37 (Box 31-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment

11. An advance directive gives legally binding direction for health care interventions when a patient a. has a new diagnosis of cancer. b. is diagnosed with Parkinson’s disease. c. is unable to make decisions for self because of illness. d. diagnosed with amyotrophic lateral sclerosis is unable to speak.

ANS: C