Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Conduct an assessment of a child with a mental health problem.

Question 19

Type: MCSA

The parents of a child with a spectrum disorder are asking the nurse about what kind of social expectations are realistic for their child. Which of the following is the overall outcome for a child diagnosed with a spectrum disorder?

1. To acknowledge the effects of ones own behavior on others

2. To function more effectively in social and emotional interactions

3. To stay on task

4. To acknowledge personal strengths

Correct Answer: 2

Rationale 1: Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity. Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.

Rationale 2: Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity.

Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.

Rationale 3: Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity. Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.

Rationale 4: Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity. Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with children.

Question 20

Type: MCSA

The school nurse recommends that the parents of a student seek help because the student is constantly in trouble and recently has set several small fires on school grounds. The nurse is concerned because the child is manifesting signs of:

1. Conduct disorder.

2. Depression.

3. Oppositional defiant disorder.

4. Attention deficit hyperactivity disorder.

Correct Answer: 1

Rationale 1: Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder (ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Rationale 2: Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder (ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Rationale 3: Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder (ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Rationale 4: Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder

(ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with children.

Question 21

Type: MCSA

In working with a preschool-age child, which intervention would be considered as part of an effective plan for time-outs?

1. Identify in advance, situations that lead to anger

2. Explanations are not important to the child who is out of control

3. Length of time depends upon how long it takes the child to calm down

4. Incorporate a token economy

Correct Answer: 3

Rationale 1: When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.

Rationale 2: When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.

Rationale 3: When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.

Rationale 4: When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with children.

Question 22

Type: MCSA

The nurse works with both the child and parents to help the child develop interpersonal skills. Which of the following general outcomes facilitates engaging the parents in the process?

1. Increasing knowledge of the childs psychopathology

2. Understanding the childs unique temperament and needs

3. Responding to separation anxiety

4. Administering PRN medications effectively

Correct Answer: 2

Rationale 1: A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the childs psychopathology.

Rationale 2: A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the childs psychopathology.

Rationale 3: A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the childs psychopathology.

Rationale 4: A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the childs psychopathology.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with the parents of child clients.

Question 23

Type: MCSA

The new stepfather of a child diagnosed with a conduct disorder wants to know the reason for including him in family therapy sessions. The nurse explains that the goal of family therapy is to:

1. Increase the probability that the childs mental health will improve.

2. Help the child relive past events and related feelings.

3. Provide an opportunity for the parents to interact with their child in a safe environment.

4. Speak for the child so the parents can become more aware of the childs potential.

Correct Answer: 1

Rationale 1: The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.

Rationale 2: The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.

Rationale 3: The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.

Rationale 4: The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with the parents of child clients.

Question 24

Type: MCSA

A client, age 8, has just been prescribed pemoline (Cylert). The childs parents ask about the long-term effects of this medication. The nurse conducting patient teaching for the parents about this medication will include which of the following statements?

1. Photosensitivity is a problem with long-term use.

2. This is one of the drugs found to be safe for long-term use.

3. At the present time, there is limited information about this.

4. There seems to be a better outcome when the higher dose is given at bedtime.

Correct Answer: 3

Rationale 1: There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.

Rationale 2: There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.

Rationale 3: There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.

Rationale 4: There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Compare and contrast the various psychopharmacologic agents for children at each major developmental level.

Question 25

Type: MCMA

The charge nurse is assigned a float nurse to help on the childrens unit. The nurse normally works with adults and says she feels out of place working with the children. In making the assignments, which of the following activities would the charge nurse NOT assign to the float nurse?

Standard Text: Select all that apply.

1. Administering daily medications

2. Administering PRN medications

3. Obtaining vital signs

4. Making rounds with the psychiatrist

5. Monitoring the children under close observation

Correct Answer: 1,2,4,5

Rationale 1: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Rationale 2: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Rationale 3: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Rationale 4: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Rationale 5: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Compare and contrast the various psychopharmacologic agents for children at each major developmental level.

Question 26

Type: MCSA

The nurse administering a lithium carbonate (Lithobid) to a child with mental retardation monitors the child for which of the following therapeutic effects?

1. Weight loss

2. Decreased agitation

3. Weight gain

4. Elevated mood

Correct Answer: 2

Rationale 1: Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).

Rationale 2: Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).

Rationale 3: Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).

Rationale 4: Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast the various psychopharmacologic agents for children at each major developmental level.

Question 27

Type: MCSA

When caring for children in the mental health setting, nurses may become aware of unresolved issues about their own family. If left unaddressed, care for the child may be affected because:

1. This experience should not affect nurses.

2. There is an increased potential for regression.

3. This opportunity will help the nurses heal.

4. Nurses feelings may become activated.

Correct Answer: 4

Rationale 1: It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.

Rationale 2: It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.

Rationale 3: It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.

Rationale 4: It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.

Global Rationale:

Cognitive Level: Creating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Analyze your own attitudes and behavior toward child psychiatric clients and their parents.

Question 28

Type: MCSA

A nurse caring for a child is concerned about remaining therapeutic when working with a child with anger management issues. Which of the following must the nurse avoid in order to remain therapeutic?

1. Examining personal feelings about the child

2. Reflecting back on a situation

3. Projecting his/her feelings onto the child

4. Sharing his/her concerns with peers and colleagues

Correct Answer: 3

Rationale 1: Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.

Rationale 2: Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.

Rationale 3: Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.

Rationale 4: Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Analyze your own attitudes and behavior toward child psychiatric clients and their parents

Question 29

Type: MCMA

Self-awareness is an important aspect of nursing practice in any specialty. Which of the following questions would the nurse ask to build self-awareness when working with child psychiatric clients?

Standard Text: Select all that apply.

1. What dont I like about this child?

2. How can I use this opportunity to learn more about myself?

3. What am I learning about myself as I work with this child?

4. How do I avoid working with the parents?

Correct Answer: 1,2,3

Rationale 1: All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.

Rationale 2: All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.

Rationale 3: All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.

Rationale 4: All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.

Question 1

Type: MCSA

A young nurse charted that a 70-year-old client was unable to perform ADLs due to old age. What should the nursing supervisor do in response to this attitude?

1. Reassign the nurse to another unit with younger clients

2. Explain how aging does not prevent one from performing ADLs

3. Reprimand the nurse for charting opinions rather than facts

4. Suggest the young nurse encourage the client to be more independent

Correct Answer: 2

Rationale 1: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 2: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 3: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 4: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify the age-related demographic projections that have implications for planning future mental health services for elders.

Question 2

Type: MCSA

Which of the following statements should the nurse include in a presentation to the community regarding mental health care resources for elders?

1. Better pharmacological treatments have increased the normal life span of individuals afflicted with mental illness.

2. Medicare coverage will pay for most mental health services provided to elders.

3. Most elders require frequent hospitalization due to chronic illness and mental disability.

4. More long-term care facilities are admitting geropsychiatric clients.

Correct Answer: 1

Rationale 1: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many longterm care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 2: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many longterm care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 3: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many longterm care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 4: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many longterm care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Identify the age-related demographic projections that have implications for planning future mental health services for elders.

Question 3

Type: MCSA

Which of the following biopsychosocial theories of aging is the nurse using when taking a small group of older adults out in the community to a local restaurant for dinner and dancing?

1. Wear-and-tear theory

2. Activity theory

3. Nutritional theory

4. Environmental theory

Correct Answer: 2

Rationale 1: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-andtear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 2: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-andtear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 3: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-andtear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 4: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-andtear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Discuss the major theories of aging and the ideas associated with each one.

Question 4

Type: MCMA

The nurse is teaching a seminar for health professionals on the differences between the normal aging process and Alzheimers disease. Which of the following biopsychosocial theories of normal aging should be discussed regarding cellular changes?

Standard Text: Select all that apply.

1. Genetic theory

2. Immunology theory

3. Wear-and-tear theory

4. Environmental theory

5. Disengagement theory

Correct Answer: 1,2,3

Rationale 1: Genetic theory: According to this theory, harmful genes activate in late life to stop cell growth and division; aging is programmed by genetic makeup.

Rationale 2: Immunology theory: Higher susceptibility to disease occurs as the bodys defensive ability declines with age, causing old irregular cells to be misidentified as foreign bodies and attacked by the body.

Rationale 3: Wear-and-tear theory: In this theory, cells eventually wear out with age; however, individual rates of cellular decline can be hastened by abuse and lack of care.

Rationale 4: Environmental theory: Various environmental substances such as pesticides, smog, and smoking can seriously harm health and cause cellular damage affecting ones ability to fight disease.

Rationale 5: Disengagement theory: Aging is an inevitable process in which older adults withdraw from social contacts and responsibilities. Psychosocial rather than cellular changes are responsible.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Discuss the major theories of aging and the ideas associated with each one.

Question 5

Type: MCSA

The nurse is teaching staff at a long-term health care facility about depression in older adults. Which comment by staff indicates to the nurse the need for further teaching?

1. Inability to organize and abstract information may indicate depression in older adults.

2. Depressed older adults may exhibit an excessive preoccupation with chronic constipation or pain.

3. Sadness or feeling blue are normal aspects of the aging process and are not a cause for concern.

4. Lack of interest or apathy may be a sign of depression in older adults.

Correct Answer: 3

Rationale 1: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 2: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 3: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 4: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub: