Chapter 28: Older Adults

Question 1

A student nurse visiting a senior center tells the instructor, Its so depressing to see all these old people. They are so weak and frail. They are probably all confused. The student is expressing:

a. reality.
b. ageism.
c. empathy.
d. advocacy.

Answer 1

ANS: B

Ageism is defined as a bias against older people because of their age. None of the other options can be identified from the ideas expressed by the student.

Question 2

A community mental health nurse plans an educational program for staff members at a home health agency
that specializes in the care of older adults. A topic of high priority should be:

a. identifying clinical depression in older adults.
b. providing cost-effective foot care for older adults.
c. identifying nutritional deficiencies in older adults.
d. psychosocial stimulation for those who live alone.

Answer 2

ANS: A

The topic of greatest immediacy is identification of clinical depression in older adults. Home health staff are often better versed in the physical aspects of care and less knowledgeable about mental health topics. Statistics show that older adult patients with mental health problems are less likely than young adults to be diagnosed accurately. This is especially true for those with depression and anxiety, both of which are likely to be
misinterpreted as normal aging. Undiagnosed and untreated depression and anxiety result in unnecessary suffering. The other options are of lesser importance.

Question 3

Which is the best comment for a nurse to use when beginning an interview with an older adult patient?

a. Hello, [call patient by first name]. I am going to ask you some questions to get to know you better.
b. Hello. My name is [nurses name]. I am a nurse. Please tell me how you would like to be addressed by the
staff.
c. I am going to ask you some questions about yourself. I would like to call you by your first name if you dont
mind.
d. You look as though you are comfortable and ready to participate in an admission interview. Shall we get
started?

Answer 3

ANS: B

The correct response identifies the nurses role and politely seeks direction for addressing the patient in a way that will make him or her comfortable. This is particularly important when a considerable age difference exists between the nurse and the patient. The nurse should address a patient by name, but should not assume the patient wants to be called by his or her first name. The nurse should always introduce himself or herself.

Question 4

A 75-year-old patient comes to the clinic reporting frequent headaches. After an introduction at the
beginning of the interview, the nurse should:

a. initiate a neurologic assessment.
b. ask if the patient can hear clearly as the nurse speaks.
c. suggest that the patient lie down in a darkened room for a few minutes.
d. administer medication to relieve the patients pain before performing the assessment.

Answer 4

ANS: B

Before proceeding, the nurse should assess the patients ability to hear questions. Hearing ability often declines with age. Impaired hearing could lead to inaccurate answers. The nurse should not administer medication (an intervention) until after the assessment is complete.

Question 5

Which statement about aging provides the best rationale for focused assessment of older adult patients?

a. Older adults are often socially isolated and lonely.
b. As people age, they become more rigid in their thinking.
c. The majority of older adults sleep more than 12 hours per day.
d. The senses of vision, hearing, touch, taste, and smell decline with age.

Answer 5

ANS: D

Only the correct answer is true and cues the nurse to assess carefully the sensory functions of the older adult patient. The incorrect options are myths about aging.

Question 6

A nurse asks the following questions while assessing an older adult. The nurse will add the Geriatric Depression Scale as part of the assessment if the patient answers yes to which question?

a. Would you say your mood is often sad?
b. Are you having any trouble with your memory?
c. Have you noticed an increase in your alcohol use?
d. Do you often experience moderate-to-severe pain?

Answer 6

ANS: A

Sadness may be a symptom of depression. Sad moods occurring with regularity should signal the need to assess further for other symptoms of depression. The incorrect options do not focus on mood.

Question 7

A 78-year-old nursing home resident diagnosed with hypertension and cardiac disease is usually alert and
oriented. This morning, however, the resident says, My family visited during the night. They stood by the bed
and talked to me. In reality, the patients family lives 200 miles away. The nurse should first suspect that the resident:

a. may be experiencing side effects associated with medications.
b. may be developing Alzheimer disease associated with advanced age.
c. had a transient ischemic attack and developed sensory perceptual alterations.
d. has previously unidentified alcohol abuse and is beginning alcohol withdrawal delirium.

Answer 7

ANS: A

A resident taking medications is at high risk for becoming confused because of medication side effects, drug interactions, and delayed excretion. The nurse should report the event and continue to assess for cognitive impairment. Symptoms of dementia develop slowly but persist over time. Alcohol abuse and withdrawal are not the nurses first suspicion in this scenario.

Question 8

A health care provider writes these new prescriptions for a resident in a skilled care facility: 2 g sodium diet; restraint as needed; limit fluids to 2000 ml daily; 1 dose milk of magnesia 30 ml orally if no bowel movement occurs for 3 days. Which prescription should the nurse question?

a. Restraint
b. Fluid restriction
c. Milk of magnesia
d. Sodium restriction

Answer 8

ANS: A

Restraints may be applied only on the written order of the health care provider that specifies the duration
during which the restraints can be used. The Joint Commission guidelines and Omnibus Budget Reconciliation Act regulations also mandate a number of other conditions that must be considered and documented before restraints are used. The other orders may be appropriate for implementation.

Question 9

If an older adult patient must be physically restrained, who is responsible for the patients safety?

a. Nurse assigned to care for the patient
b. Nursing assistant who applies the restraint
c. Health care provider who ordered the application of restraint
d. Family member who agrees to the application of the restraint

Answer 9

ANS: A

Although restraint is ordered by a health care provider, it is carried out by a nursing staff member. The nurse
caring for the patient is responsible for the safe application of restraining devices and for providing safe care while the patient is restrained. Nurses may delegate the application of restraining devices and the care of the
patient in restraint but remain responsible for outcomes. Even when the family agrees to restraint, nurses are
responsible for ensuring safe outcomes.

Question 10

An older adult patient brings a bag of medication to the clinic. The nurse finds one bottle labeled Ativan and one labeled lorazepam, and both are labeled Take two times daily. Bottles of hydrochlorothiazide, Inderal, and rofecoxib, each labeled Take one daily, are also included. Which conclusion is accurate?

a. Rofecoxib should not be taken with Ativan.
b. The patients blood pressure is likely to be very high.
c. This patient should not self-administer any medication.
d. Lorazepam and Ativan are the same drug; consequently, the dose is excessive.

Answer 10

ANS: D

Lorazepam and Ativan are generic and trade names for the same drug, creating an accidental overdose
situation. The patient needs medication education and help with proper, consistent labeling of bottles. No evidence suggests that the patient is unable to self-administer medication. The distractors are not factual
statements.

Question 11

An advance directive gives valid direction to health care providers when a patient is:

a. aggressive.
b. dehydrated.
c. unable to verbally communicate.
d. unable to make decisions for himself or herself.

Answer 11

ANS: D

Advance directives are invoked when patients are unable to make their own decisions. Aggression, dehydration, or an inability to speak does not mean the patient is unable to make a decision.

Question 12

A patient asks the nurse, What advantage does a durable power of attorney for health care have over a living will? The nurse should reply, A durable power of attorney for health care:

a. gives your agent the authority to make decisions about your care if you are unable to during any illness.
b. can be given only to a relative, usually the next of kin, who has your best interests at heart.
c. authorizes your physician to make decisions about your care that are in your best interest.
d. can be used only if you have a terminal illness and become incapacitated.

Answer 12

ANS: A

A durable power of attorney for health care is an instrument that appoints a person other than a health care provider to act as an individuals agent in the event that he or she is unable to make medical decisions. The
patient does not have to be terminally ill or incompetent for the appointed person to act on his or her behalf.

Question 13

Recognizing the risk for acquired immunodeficiency syndrome (AIDS) among older adults, nurses should
provide health teaching aimed at:

a. discouraging sexual expression.
b. using birth control measures.
c. avoiding blood transfusions.
d. encouraging condom use.

Answer 13

ANS: D

Safe sex continues to be important and should be taught to the older adult population. Because the risk for
pregnancy is nonexistent in postmenopausal women, condom use is diminished, which places older adults at
risk for AIDS and other sexually transmitted diseases. Sexual expression is a basic human need. Little to no danger exists from blood transfusions.

Question 14

A 79-year-old white man tells a visiting nurse, Ive been feeling down lately. My family and friends are all dead. My money is running out, and my health is failing. The nurse should analyze this comment as:

a. normal negativity of older adults.
b. evidence of suicide risk.
c. a cry for sympathy.
d. normal grieving.

Answer 14

ANS: B

The patient describes the loss of significant others, economic insecurity, and declining health. He describes mood alteration and expresses the thought that he has little to live for. Combined with his age, sex, and single status, each is a risk factor for suicide. Older adult white men have the highest risk for completed suicide.

Question 15

In a sad voice, a patient tells the nurse of the recent deaths of a spouse of 50 years as well as an adult child in an automobile accident. The patient has no other family and only a few friends in the community. What is the priority nursing diagnosis?

a. Spiritual distress, related to being angry with God for taking the family
b. Risk for suicide, related to recent deaths of significant others
c. Anxiety, related to sudden and abrupt lifestyle changes
d. Social isolation, related to loss of existing family

Answer 15

ANS: B

The patient appears to be experiencing normal grief related to the loss of the family; however, because of age
and social isolation, the risk for suicide should be determined and has high priority. No defining characteristics
exist for the diagnosis of anxiety or spiritual distress. Risk for suicide is a higher priority than social isolation.

Question 16

When making a distinction as to whether a patient is experiencing confusion related to depression or dementia, what information would be most important for the nurse to consider?

a. The patient with dementia is persistently angry and hostile.
b. Early morning agitation and hyperactivity occur in dementia.
c. Confusion seems to worsen at night when dementia is present.
d. A patient who is depressed is constantly preoccupied with somatic symptoms.

Answer 16

ANS: C

Both dementia and depression in older adults may produce symptoms of confusion. Noting whether the confusion seems to increase at night, which occurs more often with dementia than with depression, will help
distinguish whether depression or dementia is producing the confused behavior. The other options are not necessarily true.

Question 17

An 80-year-old patient has difficulty walking because of arthritis and says, Its awful to be old. Every day is a struggle. No one cares about old people. Which is the nurses most therapeutic response?

a. Everyone here cares about old people. Thats why we work here.
b. It sounds like youre having a difficult time. Tell me about it.
c. Lets not focus on the negative. Tell me something good.
d. You are still able to get around, and your mind is alert.

Answer 17

ANS: B

The nurse uses empathic understanding to permit the patient to express frustration and clarify the struggle for
the nurse. The other options are nontherapeutic and block communication.

Question 18

A 74-year-old patient is regressed and apathetic. This patient responds to others only when they initiate the
interaction. Which therapy would be most useful to promote resocialization?

a. Life review
b. Remotivation
c. Group psychotherapy
d. Individual psychotherapy

Answer 18

ANS: B

Remotivation therapy is designed to resocialize patients who are regressed and apathetic by focusing on a single topic, creating a bridge to reality as group members talk about the world in which they live and work, and hobbies related to the topic. Group leaders give group members acceptance and appreciation.

Question 19

A clinic nurse interviews four patients between 70 and 80 years of age. Which patient should have further
assessment regarding the risk of alcohol addiction? The patient:

a. with a history of intermittent problems of alcohol misuse early in life and who now consumes one glass of
wine nightly with dinner.
b. with no history of alcohol-related problems until age 65 years, when the patient began to drink alcohol daily
to keep my mind off my arthritis.
c. who drank socially throughout adult life and continues this pattern, saying, Ive earned the right to do as I
please.
d. who abused alcohol between the ages of 25 and 40 years but now abstains and occasionally attends Alcoholics Anonymous.

Answer 19

ANS: B

Alcohol addiction can develop at any age, and the geriatric population is particularly at risk. The geriatric problem drinker is defined as someone who has no history of alcohol-related problems but develops an
alcohol-abuse pattern in response to the stresses of aging. The incorrect responses profile alcohol use that is not
problematic.

Question 20

A selective serotonin reuptake inhibitor (SSRI) is prescribed for an older adult patient diagnosed with major depressive disorder. Nursing assessment should include careful collection of information regarding:

a. use of other prescribed medications and over-the-counter products.
b. evidence of pseudoparkinsonism or tardive dyskinesia.
c. history of psoriasis and any other skin disorders.
d. history of diarrhea and electrolyte imbalances.

Answer 20

ANS: A

Drug interactions, with both prescription and over-the-counter products, can be problematic for the geriatric
patient taking an SSRI. Careful collection of information is important. The incorrect options do not pose problems with SSRIs.

Question 21

An older adult patient diagnosed with major depressive disorder is being treated with sertraline (Zoloft).
This medication is often chosen for older adult patients because it:

a. has a high degree of sedation.
b. is effective when given in smaller doses.
c. has few adverse interactions with other drugs.
d. is less affected by changes associated with aging.

Answer 21

ANS: D

Older adults are particularly susceptible to side effects, so selecting a drug with a low side-effect profile is desirable. The pharmacokinetics of sertraline are less affected by changes associated with aging. The other
options are either incorrect or of lesser relevance.

Question 22

When admitting older adult patients, health care agencies receiving federal funds must provide written
information about:

a. advance health care directives.
b. the financial status of the institution.
c. how to sign out against medical advice.
d. the institutions policy on the use of restraints.

Answer 22

ANS: A

The Patient Self-Determination Act of 1990 requires that patients have the opportunity to prepare advance directives.

Question 23

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. misuse of antihypertensive medications.
d. trading medications with acquaintances.

Answer 23

ANS: A

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

Question 24

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

a. Singing a song from World War II
b. Learning to send and receive email
c. Discussing national leadership during the Vietnam War
d. Identifying the most troubling story in todays newspaper

Answer 24

ANS: A

Elite-old adults are persons over 94 years of age; they were young during World War II. Reminiscence groups
share memories of the past. Sending and receiving email is not an aspect of reminiscence. The other incorrect options are less relevant to this age group.

Question 25

A nurse wants to perform a preliminary assessment for suicidal ideation in an older adult patient. Which
question would obtain the desired data?

a. What thoughts do you have about a persons right to take his or her own life?
b. If you felt suicidal, would you communicate your feelings to anyone?
c. Do you have any risk factors that potentially contribute to suicide?
d. Do you think you are vulnerable to developing a depressed mood?

Answer 25

ANS: A

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, then no further assessment is necessary. If
the patient deems suicide as acceptable, then the nurse can continue to assess the patients intent, plan, and means to carry out the plan, as well as the lethality of the chosen method. The incorrect options are less direct.

Question 26

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?

a. Singing a song from World War II
b. Learning how to join an online social network
c. Discussing national leadership during the Vietnam War
d. Identifying the most troubling story in todays newspaper

Answer 26

ANS: C

Young-old adults are persons 65 to 74 years of age. These adults were attuned to conflicts in national leadership associated with the Vietnam War. Reminiscence groups share memories of the past. Learning how to join a social network would not be an aspect of reminiscence. Singing a song from World War II is more
appropriate for an elite old reminiscence group. The other incorrect option is less relevant to this age group.

Question 27

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 older adults to receive necessary medical information
b. Development of public policy that favors programs for older adults
c. Staff shortages because caregivers prefer working with younger adults
d. Perception that older adults consume a small share of medical resources
e. More ancillary than professional personnel discriminate with regard to age

Answer 27

ANS: A, C

Because of societys negative stereotyping of older adults as having little to offer, some staff members avoid working with older patients. Staff shortages in long-term care facilities are often greater than those for acute care settings. Older adult patients often receive less information about their conditions and are offered fewer
treatment options than younger patients; some health care staff members perceive them as less able to understand. This problem exists among professional and ancillary personnel. Public policy discriminates against programs for older adults. Societal anger exists because older adults are perceived to consume a
disproportionately large share of the medical resources.

Question 28

Which beliefs facilitate provision of safe, effective care for older adult patients? Select all that apply.

a. Sexual interest declines with aging.
b. Older adults are able to learn new tasks.
c. Aging results in a decline in restorative sleep.
d. Older adults are prone to become crime victims.
e. Older adults are usually lonely and socially isolated.

Answer 28

ANS: B, C, D

Myths about aging are common and can negatively impact the quality of care older patients receive. Older individuals are more prone to become crime victims. A decline in restorative sleep occurs as one ages.
Learning continues long into life. These factors affect care delivery.

Question 29

A nurse assessing an older adult patient for depression should include questions about mood as well as which other symptoms? Select all that apply.

a. Increased appetite
b. Sleep pattern changes
c. Anhedonia and anergia
d. Increased social isolation
e. Increased concern with bodily functions

Answer 29

ANS: B, C, D, E

These symptoms are often noted in older adult patients experiencing depression. Somatic symptoms are often
present but are missed by nurses as being related to depression. Anorexia, rather than hyperphagia, is observed
in major depressive disorder. Low self-esteem is more often associated with major depressive disorder.

Question 30

An older patient drinks a six-pack of beer daily. The patient tells the community health nurse, Ive been having trouble with my arthritis lately, so I take acetaminophen four times a day for pain. What are the nurses priority interventions? Select all that apply.

a. Inquiring about sleep disturbances caused by mixing alcohol and analgesic medications.
b. Determining the safety of the daily acetaminophen dose the patient is ingesting.
c. Advising the patient of harmful effects of alcohol and acetaminophen on the liver.
d. Suggesting an increase in the acetaminophen dose because alcohol causes faster excretion.
e. Assessing the patient for declining functional status associated with medication-induced dementia.

Answer 30

ANS: B, C

The nurse should be concerned with the patients use of alcohol and acetaminophen because the toxicity of acetaminophen is enhanced by alcohol and by the age-related decrease in clearance. The nurse must determine whether the acetaminophen dose is within safe limits or is excessive and provide this information to the
patient. Next, the nurse must provide health education regarding the danger of combined use of acetaminophen
and alcohol. The patient will need to discontinue or reduce alcohol intake. Another analgesic with less hepatotoxicity could be used. Additional acetaminophen would cause greater liver damage. The scenario does
not suggest dementia.

Question 31

A health care provider decided that the emotional distress of an older adult patient warrants the use of risperidone (Risperdal). Which interventions should the nurse add to the patients plan of care? Select all that apply.

a. Monitor for signs and symptoms of diabetes.
b. Use disposable briefs for incontinence.
c. Monitor for cerebrovascular changes.
d. Implement a tyramine-free diet.
e. Monitor for dehydration.

Answer 31

ANS: A, C

Use of atypical antipsychotic medications increases the risk of diabetes and cerebrovascular events in the older adult population; therefore, the nurse should carefully monitor the patient for changes suggestive of these problems. This medication does not place the patient at great risk for the other options.