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Advance directives are invoked when patients are unable to make their own health care decisions. The correct response is the most global answer. A diagnosis of cancer or Parkinson’s disease does not mean the patient is unable to make a decision. For a patient with amyotrophic lateral sclerosis, there are other ways to communicate beyond speaking.

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

REF: Pages 31-14, 15

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment eBay: testbanks_and_xanax

12. A patient asks, “What advantage does a durable power of attorney for health care have over a living will?” The nurse should reply, “A durable power of attorney for health care a. gives your agent authority to make decisions during any illness if you are incapacitated.” b. can be given only to a relative, usually the next of kin, who has your best interests at heart.” c. can be used only if you have a terminal illness and become incapacitated.” d. cannot be implemented until 30 days after the documents are signed.”

ANS: A

A durable power of attorney for health care is an instrument that appoints a person other than a health care provider to act as an individual's agent in the event that he or she is unable to make medical decisions. No waiting period is required for it to become effective, and the individual does not have to be terminally ill or incompetent for the person appointed to act on the individual’s behalf.

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

REF: Pages 31-14 to 16

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. Adult day care program b. Skilled nursing facility c. Partial hospitalization d. Group home

13. A physically frail elderly patient with mild cognitive impairments needs services of a facility that can provide supervision and safety as well as recreation and social interaction. The family cares for this patient during the evening and night. Which type of facility should the nurse suggest to meet this patient’s needs?

ANS: A

A day care program provides recreation and social interaction as well as supervision in a safe environment. Nursing, medical, and rehabilitative care are usually not provided. Skilled nursing facilities go beyond meeting recreational and social needs by providing medical interventions and nursing and rehabilitation services on a 24-hour basis. Partial hospitalization provides acute psychiatric hospital programs. A group home is inappropriate and would not meet the patient’s needs.

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

REF: Pages 31-26, 27

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment

14. A 79-year-old white male tells a nurse, “I have felt very sad lately. I do not have much to live for. My family and friends are all dead, and my own health is failing.” The nurse should analyze this comment as a. normal pessimism of the elderly. b. evidence of risks for suicide. c. a call for sympathy. d. normal grieving.

ANS: B

The patient describes loss of significant others, economic security, and health. He describes mood alteration and voices the thought that he has little to live for. Combined with his age, sex, and single status, each is a risk factor for suicide. Elderly white males have the highest risk for completed suicide.

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

REF: Pages 31-3 to 5, 8 (Evidence Based Practice)

TOP: Nursing Process: Analysis/Diagnosis

MSC: Client Needs: Psychosocial Integrity a. Risk for suicide related to recent deaths of significant others b. Anxiety related to sudden and abrupt lifestyle changes c. Social isolation related to loss of existing family d. Spiritual distress related to anger with God

15. In a sad voice, an elderly patient tells the nurse of the recent deaths of a spouse and close friend. The patient has no other family and only a few acquaintances in the community. The nurse’s priority is to determine whether which nursing diagnosis applies to this patient?

ANS: A

The patient appears to be experiencing normal grief related to the loss of her family, but because of age and social isolation, the risk for suicide should be determined and has high priority. No defining characteristics exist for the diagnoses of anxiety or spiritual distress. The patient’s social isolation is important, but the risk for suicide has higher priority.

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

REF: Pages 31-3 to 5, 8 (Evidence Based Practice)

TOP: Nursing Process: Analysis/Diagnosis

MSC: Client Needs: Psychosocial Integrity a. Evidence of spasticity or flaccidity b. The patient’s level of motor activity c. Medications the patient has recently taken d. Level of preoccupation with somatic symptoms

16. When making a distinction as to whether an elderly patient has confusion related to delirium or another problem, what information would be of particular value?

ANS: C

Delirium in the elderly produces symptoms of confusion. Medication interactions or adverse reactions are often a cause. The distracters do not give information important for delirium.

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

REF: Pages 31-3, 4, 6 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity