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Partial hospitalization will provide services the patient needs as well as give supervision and meals to the patient while the daughter is at work. Home care would not provide socialization. The patient does not need the intensity of a skilled nursing facility. A halfway house provides 24-hour care and usually expects involvement in off-campus programs.

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

REF: Page 31-26

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment

23. A patient living in community housing for the elderly says, “I don’t go to the senior citizen’s club. They play cards and talk about the past because that’s all they can do.” The nurse analyzes these remarks to represent a. failure to achieve developmental tasks. b. thinking associated with ageism. c. hypercritical behavior. d. paranoid thinking.

ANS: B

Ageism is negative stereotyping and devaluation of people based on their age. Older adults might be as guilty of ageism as younger individuals. The other options are not substantiated by the information given in the scenario.

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

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

MSC: Client Needs: Psychosocial Integrity a. Late-onset schizophrenia b. Depression and suicide c. Dementia d. Delirium

24. A nurse plans a staff education program for employees of a senior living community. Which topic has priority?

ANS: B

Older Americans frequently experience undiagnosed depression and are disproportionately more likely to commit suicide. Educating staff about signs and symptoms of high-risk patients and early intervention strategies will decrease morbidity and mortality. The other conditions have a lower prevalence.

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

REF: Pages 31-3 to 5, 8 (Evidence Based Practice), 43 (Box 31-6), 45 (Box 31-8)

TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance a. Ask questions that can be answered with “yes” or “no.” b Ask clear, simple questions using concrete language. c. Use silence often and let the patient take the lead. d. Use open-ended, indirect questions.

25. An older adult patient was diagnosed with schizophrenia at age 18. A nurse at the outpatient medication clinic interviews this patient. Which communication strategy will be most helpful?

ANS: B

Communication with individuals with a long history of schizophrenia might be difficult because of the individual’s various thought disorders. The nurse can be most effective by using simple language, keeping to concrete concepts, and clarifying and validating as needed. The nurse needs more information than “yes” or “no” questions will provide.

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

REF: Pages 31-25, 45 (Box 31-8) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Dispose of all medications that are not in properly labeled bottles. b. Confer with a family member about the patient’s management of medication. c. Engage the patient in education about safe storage and labeling of medication. d. Ask the patient to name the purpose and date of expiration of each medication not in a bottle.

26. An elderly patient brings a bag of medications to the clinic. The nurse finds bottles of medications as well as assorted pills in no containers in the bag. What is the nurse’s priority action?

ANS: C

The patient needs medication education and help with proper, safe, and consistent labeling of medications. There is no evidence that the patient cannot self-administer medication. The nurse does not have the authority to dispose of the patient’s property. The nurse would first need to obtain the patient’s consent to confer with family. While the patient may be able to name the purpose of each unbottled medication, naming the expiration date is unlikely and may frustrate the patient.

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

REF: Pages 31-23, 46 (Box 31-9) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment

27. The highest priority for assessment by nurses caring for older adults who self-administer medications is a. use of multiple drugs with anticholinergic effects. b. overuse of medications for erectile dysfunction. c. missed doses of medications for arthritis. d. trading medications with acquaintances.

ANS: A

Anticholinergic effects are cumulative in older adults and often have adverse consequences related to accidents and injuries. The distracters may be relevant but are not the highest priority.

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

REF: Page 31-19 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. Mild aerobic exercise b. Singing a song from World War II c. Discussing national leadership during the Vietnam War d. Identifying the most troubling story in today’s newspaper

28. A nurse and social worker co-lead a reminiscence group for eight old-old and centenarian adults. Which activity is appropriate to include in the group?

ANS: B

Old-old adults and centenarians are persons 85 to 104 years of age. They were young people during World War II. Reminiscence groups share memories of the past. The incorrect options are less relevant to this age group or reminiscence.

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

REF: Pages 31-2, 22 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity eBay: testbanks_and_xanax a. Mild aerobic exercise b. Singing a song from World War II c. Discussing national leadership during the Vietnam War d. Identifying the most troubling story in today’s newspaper

29. A nurse and social worker co-lead a reminiscence group for eight young-old adults. Which activity is most appropriate to include in the group?

ANS: C

Young-old adults are persons 65 to 75 years of age. These adults were attuned to conflicts in national leadership associated with the Vietnam War. Reminiscence groups share memories of the past. The incorrect options are less relevant to this age group or reminiscence.

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

REF: Pages 31-2, 22 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A nurse leads a staff development session about ageism among health care workers. What information should the nurse include about the consequences of ageism? (Select all that apply.)

a. Failure of the elderly to receive necessary medical information b. Development of public policy that discriminates against the elderly c. Staff shortages because caregivers prefer working with younger adults d. The perception that elderly consume a smaller share of medical resources e. More ancillary than professional personnel discriminate with regard to age

ANS: A, B, C

Because of society’s negative stereotyping of the elderly as having little to offer, some staff persons avoid working with older patients. Staff shortages in long-term care are common. Elderly patients are often provided less information about their conditions and fewer treatment options than younger patients are because some health care staff members perceive them as less able to understand. This problem exists among both professional and ancillary personnel. Public policy discriminates against programs for the elderly. Anger exists because the elderly are perceived to consume a disproportionately large share of medical resources.

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

REF: Pages 31-14, 43 (Box 31-6) TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. personal hygiene. b. increased appetite. c. sleep pattern changes. d. evidence of grandiosity. e. increased concerns with bodily functions.

2. A nurse assessing an elderly patient for depression and suicide potential should include questions about mood as well as (Select all that apply.)

ANS: A, C, E

The correct responses relate to symptoms often noted in elderly patients with depression. Somatic symptoms are often present but missed by nurses as related to depression. Anorexia, rather than hyperphagia, occurs in major depression. Grandiosity is associated with bipolar disorder.

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

REF: Pages 31-3 to 5, 9, 25, 44 (Box 31-7) | Page 31-45 (Box 31-8)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Mild recent memory impairment b. Eighth grade education c. Death of spouse d. Retirement e. Loneliness

3. Which assessment findings would alert the nurse that an older patient may have an increased risk for development of geriatric alcohol abuse? (Select all that apply.)

ANS: B, C, D, E

The geriatric problem drinker begins drinking in later life, often in response to stressors such as retirement, loss of spouse, and loneliness. Once the demands of job, career, and care of a family and household are gone, the structure of daily life is disrupted. Mild cognitive impairment is not a predisposing factor in the development of geriatric problem drinking. Other risk factors include less than a high school education, smoking, low income, and male gender.

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

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

MSC: Client Needs: Psychosocial Integrity a. “Lately I have had a lot of aches and pains and just haven’t felt very well.” b. “People are in and out of my room all day and all night taking my things.” c. “Don’t ask me to eat. I can’t because my stomach is upset all the time.” d. “I’m eating more than usual, and I am sleeping about 6 hours a night.” e. “Life seems more organized now that I don’t live in my own home.”

4. Which remarks by a 72-year-old patient should prompt the nurse to assess for depression? (Select all that apply.)

ANS: A, B, C

Any of the remarks listed as correct should be enough to trigger use of an assessment tool for depression. Somatic symptoms, delusions of persecution, and nihilistic delusions are more common in late-onset depression than in early-onset depression. The distracters do not suggest symptoms of depression.

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

REF: Pages 31-3 to 5, 9, 25, 44 (Box 31-7) | Page 31-45 (Box 31-8)