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17. An 85-year-old has difficulty walking after a knee replacement. The patient tells the nurse, “It’s awful to be old. Every day is a struggle. No one cares about old people.” Select the nurse’s best response.

a. “Everyone here cares about old people. That’s why we work here.” b. “It sounds like you’re having a difficult time. Tell me about it.” c. “Let’s not focus on the negative. Tell me something good.” d. “You are still able to get around, and your mind is alert.”

ANS: B

The nurse uses empathetic understanding to permit the patient to express frustration and clarify her “struggle” for the nurse. The distracters block communication.

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

REF: Pages 31-17, 18 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Orientation b. Activity group c. Psychotherapy d. Reminiscence

18. A 76-year-old is indifferent and responds to others only when they initiate an interaction. What form of group therapy would be most useful to promote resocialization?

ANS: D

Reminiscence therapy in a group setting can help to resocialize regressed and apathetic patients. The nurse can encourage discussion about past pleasant events or memories: first car, favorite memory from school, favorite band or song, seasonal activities growing up, etc. Assisting to evoke pleasant feelings or memories is an effective method to improve mood particularly in those with memory impairment. Group psychotherapy would not be effective for this patient. An activity group does not address the patient’s problem. Orientation groups can exacerbate a patient’s distress.

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

REF: Page 31-22 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

19. A nurse assesses four patients between the ages of 70 and 80. Which patient has the highest risk for alcohol abuse? The patient who a. consumes 1 glass of wine nightly with dinner. b. began drinking alcohol daily after retirement and says, “A few drinks keep my mind off my arthritis.” c. drank socially throughout adult life and continues this pattern, saying “I’ve earned the right to do as I please.” d. abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends Alcoholics Anonymous (AA).

ANS: B

Alcohol abuse and dependence can develop at any age, and the geriatric population is particularly at risk. Losses, such as retirement, widowhood, and loneliness, are often related. The distracters describe patients with a lower risk for alcohol abuse.

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

REF: Pages 31-7, 35 (Box 31-1) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. “Are there any things going on in your life that would cause you to consider suicide?” b. “What are your beliefs about a person’s right to take his or her own life?” c. “Do you think you are vulnerable to developing a depressed mood?” d. “If you felt suicidal, would you tell someone about your feelings?”

20. A nurse wants to assess for suicidal ideation in an elderly patient. Select the best question to begin this assessment.

ANS: B

This question is clear, direct, and respectful. It will produce information relative to the acceptability of suicide as an option to the patient. If the patient deems suicide unacceptable, no further assessment is necessary. If the patient deems suicide as acceptable, the nurse can continue to assess intent, plan, means to carry out the plan, lethality of the chosen method, and so forth. The other options are less direct, may produce responses that may be unclear, or are appropriate for later in this discussion.

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

REF: Pages 31-8 (Evidence Based Practice), 20, 45 (Box 31-8)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Assess whether this patient is drinking and driving. b. Advise the person not to drink alone because the risks for injury increase. c. Teach the person about risks for alcoholism and suggest other coping strategies. d. Arrange for the person to attend an AA meeting for older adults.

21. A community health nurse visits an elderly person whose spouse died 6 months ago. Two vodka bottles are in the trash. When the nurse asks about alcohol use, this person says, “I get lonely and drink a little to help me forget.” Select the nurse’s most therapeutic intervention.

ANS: D

This person needs help with alcohol abuse as well as social involvement. An AA meeting for older adults will provide an opportunity for peer bonding as well as strategies for coping with stress without abusing alcohol. The distracters will not be therapeutic in this instance.

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

REF: Page 31-7 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Behavioral health home care b. A skilled nursing facility c. Partial hospitalization d. A halfway house

22. Discharge planning begins for an elderly patient hospitalized for 2 weeks diagnosed with major depressive disorder. The patient needs ongoing assessment and socialization opportunities as well as education about medication and relapse prevention. The patient lives with a daughter, who works during the week. Select the best referral for this patient.

ANS: C