28 - Mental Health Flashcards
A nurse in a long-term care facility is approached by an older resident who is crying and states: “You need to help me. The mean little men are in my room again. They are watching me from the corner and they are laughing at me. Make them go away.” The nurse accompanies the resident to the room and there is no one in the corner of the room. What is the best response by the nurse? (Select all that apply.)
a. ) “Yup, I see them. Let me call security to haul the men away.”
b. ) “Can you tell me what you are so frightened of?”
c. ) “I will do my best to keep you safe.”
d. ) “I understand that you are very frightened and upset.”
e. ) “You know that there is no one there. Stop carrying on like this.”
b, c, d
b.) “Can you tell me what you are so frightened of?”
c.) “I will do my best to keep you safe.”
d.) “I understand that you are very frightened and upset.”
When dealing with a patient with frightening delusion, the nurse needs to be understanding, but not pretend to agree with the delusions.
The nurse needs to ask what is troubling to the patient and provide a reassurance of safety. It is important to try and understand the patient’s level of distress and what the patient is experiencing.
Option A agrees with the delusion; option E does not provide reassurance or safety.
How should the nurse reply when an older adult asks, “How much alcohol is good for you?”
a. ) “Alcohol isn’t good for you so avoid it as a general rule.”
b. ) “Experts in the field recommend only one regular sized drink a day.”
c. ) “It’s been said that red wine has health benefits, but that doesn’t mean drink a whole bottle.”
d. ) “If you are only drinking on special occasions, limit yourself to two drinks.”
b.) “Experts in the field recommend only one regular sized drink a day.”
Clinically significant adverse effects can occur in some individuals consuming as little as two to three drinks per day over an extended period.
Because of the increased risk of adverse effects from alcohol use, the National Institute on Alcohol Abuse and Alcoholism has recommended that individuals over the age of 65 limit alcohol consumption to no more than one standard drink per day.
Although the Substance Abuse and Mental Health Services Administration (SAMSHA) recommends a maximum of two drinks on any drinking occasion (holidays or other celebrations), that option does not address the more pressing issue of the daily consumption of alcohol. The other options do not address the client’s question.
An older client in an adult day care program tells the nurse, “I’m very stressed because another neighbor passed away.” The most therapeutic response by the nurse is:
a. ) “What do you mean by ‘stressed’?”
b. ) “Tell me what you did when your other neighbor passed away.”
c. ) “Are you worrying about your own death?”
d. ) “Let’s get involved in some activities and not think about sad things.”
b.) “Tell me what you did when your other neighbor passed away.”
Application of what one has learned from previous situations can help dissipate the intensity of stress. Denial of the stressful event and focusing upon blessings or happiness will not lessen the stress and may in turn intensify it. While it is appropriate to ask the client to clarify what he or she is saying, it doesn’t help in this situation. This is not necessarily the time to initiate a conversation about the client’s feelings about death since doing so is likely to increase the level of stress.
The nurse preparing educational information on common mental health disorders among the older adult population should include:
a. ) methods for reducing anxiety.
b. ) a written depression screening tool.
c. ) local schizophrenia support groups.
d. ) signs and symptoms of alcoholism.
b.) a written depression screening tool.
Depression is the most common mental health disorder of later life. Anxiety disorder, schizophrenia, and alcoholism are all incorrect; although these disorders are present in older adults, they occur in far fewer numbers than depression.
A nurse administers the Short Michigan Alcohol Screening Test Geriatric Version (S-MAST- G) to an older adult. The older adult receives a score of “2.” The nurse knows that this score is indicative of:
a. ) no problem with alcohol.
b. ) a problem with alcohol.
c. ) a mild problem with alcohol.
d. ) a severe problem with alcohol.
b.) a problem with alcohol.
A score of 2 or more on the S-MAST-G indicates that there is an alcohol problem. This scale does not rate the severity of the problem.
An older adult says to the nurse, “I don’t know why I can’t handle booze like I used to when I was younger.” The nurse’s response is based on the knowledge that:
a. ) older adults develop higher blood alcohol levels due to age-related changes in the neurological system.
b. ) older adults develop higher blood alcohol levels due to age-related changes that alter absorption and distribution of alcohol.
c. ) older adults develop higher blood alcohol levels due to slowed reaction times.
d. ) older adults develop higher blood alcohol levels due to cognitive changes.
b.) older adults develop higher blood alcohol levels due to age-related changes that alter absorption and distribution of alcohol.
Age-related changes such as increased body fat, decreased lean muscle mass, and decreased total body water content alter absorption and distribution of alcohol, increasing blood alcohol levels.
Age-related neurological changes do not impact blood alcohol levels.
Slowed reaction time does not impact blood alcohol levels.
Cognitive changes do not impact blood alcohol levels; furthermore, not all older adults experience cognitive changes.
A nurse is conducting an assessment of an older adult in a geriatric clinic. The patient states that he drinks two to three alcoholic beverages daily. The patient has multiple chronic comorbid conditions and is on five different medications. Which of the following medications is the nurse concerned will interact with the alcohol? (Select all that apply.)
a. ) Naproxen for pain
b. ) Daily multivitamin
c. ) Prozac for depression
d. ) Celebrex for arthritis
e. ) Toprol XL for hypertension
a.) Naproxen for pain
c.) Prozac for depression
Classifications of medications that interact with alcohol include NSAIDs and antidepressants. There is no evidence that multivitamins, cyclooxygenase-2 (COX II) inhibitors, or beta- blockers interact with alcohol.
A nurse is assisting an older adult to cope with the loss of a spouse. The nurse encourages the person to use an emotion-focused coping strategy. Which of the following actions should the nurse take? (Select all that apply.)
a. ) Encourage the person to cry if he or she feels like it.
b. ) Teach the person relaxation breathing exercises.
c. ) Encourage the person to make an action plan for the future.
d. ) Suggest that the person reach out to his or her clergyperson.
e. ) Suggest that the person attend a yoga class.
a, b, e
a.) Encourage the person to cry if he or she feels like it.
b.) Teach the person relaxation breathing exercises.
e.) Suggest that the person attend a yoga class.
Expressing emotion, relaxation exercises, and exercise are all part of an emotion-focused coping strategy. Developing an action plan is part of a problem-focused coping strategy, and reaching out to clergy is part of a religious-focused coping strategy.
When assessing an older client for indications of depression, the nurse bases the intervention on the knowledge that:
a. ) the older client’s symptoms may be atypical for the disorder.
b. ) depression is a common mental disorder among the older population.
c. ) the older client is generally willing to discuss his or her mental health symptoms.
d. ) depression is not as commonly seen in this population as are anxiety disorders.
a.) the older client’s symptoms may be atypical for the disorder.
Somatic complaints are often the presenting symptoms of mental health disorders, such as depression, making diagnosis difficult.
Depression is a common disorder among this population but knowing that does not aid in identifying the clients who are depressed.
The remaining options are not true regarding the mental disorder of depression.
An older adult has recently experienced a number of stressful life events. The client comes to the ambulatory clinic and tells the nurse that, “On top of all I’ve had to endure, now I’ve got this flu!” In rendering care for this client, the nurse recognizes that:
a. ) the client is exhibiting attention-seeking behaviors to substitute for poor coping skills.
b. ) crisis and stressful situations may produce emotions that erode the health of the older people.
c. ) the client is exhibiting learned helplessness as a result of the recent stressors.
d. ) a period of crisis will ultimately lead to a lower level of physical and mental functioning.
b.) crisis and stressful situations may produce emotions that erode the health of the older people.
Sustained stress can lead to physical consequences, particularly in older adults who have less reserve than younger individuals. The client has experienced some major life stressors. Learned helplessness occurs when an individual has a perceived lack of control, which erodes the person’s personality. A period of crisis can in fact lead to a higher level of functioning.
In order to focus on the older population with the greatest risk for suicide, the nurse would conduct a depression screening that targets:
a. ) African American men.
b. ) white men.
c. ) white women.
d. ) African American women.
b.) white men.
White men older than age 85 have the highest rate of suicide in the United States; they commit suicide at approximately four times the national rate.
When discussing electroconvulsive therapy (ECT) with an older, chronically depressed adult and his family, which statement will the nurse use to support this intervention? (Select all that apply.)
a. ) “This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications.”
b. ) “ECT has been found to be more effective in older adults than in younger adults.”
c. ) “ECT is a safe intervention for those with psychotic ideation.”
d. ) “While there may be some short-term memory loss, most individuals find that their memory comes back within a few days.”
e. ) “ECT results in a more immediate response to symptoms.”
a, d, e
a.) “This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications.”
d.) “While there may be some short-term memory loss, most individuals find that their memory comes back within a few days.”
e.) “ECT results in a more immediate response to symptoms.”
ECT has been found to be effective in individuals who have psychotic depression and those who do not respond to antidepressant medications. ECT is equally effective in older adults as in younger adults. It is used for individuals with depression, not psychotic ideation. There is some short-term memory loss associated with ECT; however, it does resolve within a short time frame. ECT provides a more immediate response to symptoms than does medication.
An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging?
a. ) Assessing the client for both depression and anxiety
b. ) Discussing the poor prognosis of this disorder with the client
c. ) Explaining the need for proper nutrition to minimize the effects of alcoholism
d. ) Identifying the effects of chronic alcoholism on the human body
a.) Assessing the client for both depression and anxiety
Substance abuse in older adults is frequently a coping mechanism to deal with loss, anxiety, or depression.
There is no evidence about the success or lack of success of treatment programs for older adults because they have not been adequately investigated.
Nutritional counseling and the discussion of the long-term effects of alcoholism may be appropriate but not specific to the older adult client.
A nurse who is caring for an older patient with bipolar disorder knows that the patient needs additional education when the patient states:
a. ) “Bipolar disorder often results in ‘a leveling out’ of symptoms as one ages.”
b. ) “Relapses in bipolar disorder tend to be precipitated by medical problems.”
c. ) “Older adults with bipolar disorder tend to be ‘rapid cyclers’.”
d. ) “Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults.”
d.) “Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults.”
Depression is the most common psychiatric disorder in older adults. Bipolar disorders tend to level out in later life, and individuals tend to have longer periods of depression.
Relapses in older adults are usually precipitated by medical problems.
Older adults tend to be “rapid cyclers,” cycling from mania to deep depression in a much shorter period of time than they did when they were younger.
When an older adult reports experiencing several different stressors over the last 6 months, the nurse demonstrates an understanding of the physiological effects of stress on the body by:
a. ) assessing the client using the Geriatric Depression Scale (GDS).
b. ) testing the client’s urine for red blood cells.
c. ) screening the client for abnormally high serum glucose levels.
d. ) inquiring as to whether the client has lost weight during that time period.
c.) screening the client for abnormally high serum glucose levels.
Research on psychoneuroimmunology has explored the relationship between psychological stress and various health conditions such as type 2 diabetes. The production of proinflammatory cytokines influencing these and other conditions can be directly stimulated by negative emotions and stressful experiences. The GDS does not identify physiological problems.
There is no current research to support a connection between stress and urinary bleeding. Stress can result in either a weight gain or weight loss depending on the client’s relationship with food during the stressful period.
