Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 6

Type: MCSA

The nurse suspects a 75-year-old male client with a recent diagnosis of cancer is contemplating suicide. Which one of the following cues indicates the highest suicide potential?

1. Yearly updating his will

2. Complaining of chronic pain

3. Vague statements about future funeral plans

4. Buying a hand revolver

Correct Answer: 4

Rationale 1: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide.

Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 2: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide. Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 3: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide.

Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 4: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide. Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 7

Type: MCMA

The nurse suspects a 75-year-old male client is contemplating suicide. Which of the following factors place him at greater risk for suicide?

Standard Text: Select all that apply.

1. Being non-Hispanic Black

2. Frequent alcohol consumption

3. Being married

4. High socio-economic status

5. Having chronic pain caused by cancer

Correct Answer: 2,3,5

Rationale 1: Being non-Hispanic Black. Non-Hispanic Blacks have the lowest suicide rate. Non-Hispanic Whites have the highest suicide rates followed by Native Americans and Alaskan Natives.

Rationale 2: Frequent alcohol consumption. Alcohol abuse impairs decision making and increases the risk for suicide in any age.

Rationale 3: Being married. A close intimate relationship with a significant other decreases the risk for suicide. Widowed or divorced individuals are actually at greater risk.

Rationale 4: High socio-economic status. Financial stress due to lower socioeconomic status rather than higher income increases risk for suicide.

Rationale 5: Having chronic pain caused by cancer. A terminal illness such as cancer and chronic pain increase the risk for suicide in any age group.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 8

Type: MCSA

During the nursing assessment of the older adult female client, the nurse finds the client believes others are poisoning her food. Which of the following psychiatric disorders would not be indicated?

1. Delirium

2. Adjustment disorder

3. Anxiety disorder

4. Dementia

Correct Answer: 2

Rationale 1: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 2: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 3: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 4: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 9

Type: MCSA

The wife of an older client is concerned that her husband has recently experienced memory lapses, is unusually aggressive and was involved in three traffic accidents in the past month. In planning a response, the nurse is guided by the knowledge that:

1. Further intervention is needed to prevent elder abuse of the wife.

2. Further assessment is needed to determine if alcohol abuse is possible.

3. These are normal responses to aging.

4. These are signs of depression or dementia.

Correct Answer: 2

Rationale 1: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 2: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 3: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 4: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 10

Type: MCSA

The nurse is teaching a group of older adults about changes in sleep patterns due to the aging process. Which statement by older adults indicates understanding of the nurses teaching regarding the use of nonpharmacologic therapies for sleep?

1. We should avoid coffee, tea, or other fluids in the evening hours.

2. An herbal remedy such as melatonin can help us sleep better.

3. Taking long naps during the day will help us sleep better at night.

4. Taking a sleeping pill every night will improve our total sleep time.

Correct Answer: 1

Rationale 1: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 2: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 3: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 4: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 11

Type: MCSA

When interviewing elders the psychiatric nurse is guided by the knowledge that:

1. Shame may inhibit the expression of feelings in elders.

2. Touch is inappropriate during the interview.

3. Family and staff members may provide inaccurate information.

4. Less time may be needed with elders than with other age groups.

Correct Answer: 1

Rationale 1: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 2: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 3: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 4: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 12

Type: MCMA

A thorough biopsychosocial assessment of elders includes:

Standard Text: Select all that apply.

1. Spirituality

2. Social supports

3. Coping strategies

4. Sexuality

5. Early childhood interactions

Correct Answer: 1,3,4

Rationale 1: Spirituality. Spiritual integrity is a basic human power that becomes especially important in later stages of life.

Rationale 2: Early childhood interactions. Early childhood interactions are more consistent with earlier psychological theories of mental disorder and are not needed.

Rationale 3: Coping strategies. Coping strategies are important data to collect from elders to obtain information regarding their reactions to stress.

Rationale 4: Sexuality. Sexuality is an important often overlooked area in elders and should be approached in a tactful, caring and nonjudgmental manner.

Rationale 5: Social supports. Interpersonal relationships and social networks of elders are important for optimal functioning especially with psychiatric disorders or confusion.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 13

Type: MCSA

The nurse is assessing the social and financial status of an older adult. Which of the following questions would be appropriate to ask?

1. Do you have transportation to get to doctors appointments?

2. Do you have problems with your family taking advantage of you?

3. How often do you forget to pay your bills?

4. How much money do you get from social security?

Correct Answer: 1

Rationale 1: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 2: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 3: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 4: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub: