Geriatrics 8 Flashcards
During a home visit, the nurse is concerned that an older patient is experiencing caregiver neglect. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. Agitation 2. Listlessness 3. Dry, cracked skin 4. Bruises on both arms 5. Skin irritation on both inner thighs
2: Listlessness is a manifestation of caregiver neglect.
3: Dry, cracked skin could indicate dehydration, which is a manifestation of caregiver neglect.
5: Skin irritation on both inner thighs could indicate urine burns, which is a manifestation of caregiver neglect.
An older patient who just celebrated an 85th birthday comes into the emergency department with a fractured arm and bruises over the chest and back. The nurse suspects the patient is a victim of physical abuse. Which individuals will the nurse specifically assess the patient as being the abuser? Standard Text: Select all that apply. 1. Spouse 2. Nephew 3. Granddaughter 4. Next door neighbor 5. Adult daughter caregiver
1: Spouses account for 11.3% of abuse cases.
2: Family members account for 21.5% of abuse cases.
3: Family members account for 21.5% of abuse cases.
5: The typical abuser is an adult child, accounting for 32.6% of abuse cases.
An older patient is accompanied by an adult daughter who is the patient's primary caregiver for a routine clinic visit. While in the waiting room, the adult daughter is observed sitting quietly and not talking with the patient. During the examination, what should the nurse assess the adult daughter for? Standard Text: Select all that apply. 1. Employment 2. Physical status 3. Caregiver stress 4. Substance abuse 5. History of psychopathology
3: Caregivers of older adults should be assessed at each primary care visit for caregiver stress.
4: Caregivers of older adults should be assessed at each primary care visit for substance abuse.
5: Caregivers of older adults should be assessed at each primary care visit for a history of psychopathology.
Which patients seen by a nurse working in the emergency department identify a situation that suggests a case of elder mistreatment?
- An 86-year-old patient who has three dime-size burned areas on the upper inner thigh
- A 77-year-old patient who fell at home after tripping over the dog and broke an arm about 30 minutes earlier
- A 73-year-old patient with a history of gastric ulcers who is found to be anemic after vomiting blood 3 hours earlier
- An 85-year-old patient who has several small areas of bruising on the back of the hands and is taking medication for platelets and coagulation
1: The patient who has skin burns suggestive of cigarette burns in an area normally covered by clothing is suggestive of abuse.
The nurse suspects that an older patient has been physically abused. What must be included in the medical workup for this patient?
- Pelvic examination
- Toxicological screening
- Complete blood count and blood chemistries
- Complete visual examination with clothing removed
4: If you suspect elder mistreatment or abuse, a complete visual examination of the older person without clothing is necessary. Abusers may strike where clothing hides the resulting bruises. You can protect privacy by assessing the older person’s body one area at a time from head to toe.
The nurse is concerned that specific families in a community are at increased risk for transgenerational violence. Which family situation exemplifies the transgenerational theory of violence?
- Family with a daughter who abuses alcohol
- Family with a daughter who has severe arthritis and finds it increasingly difficult to deal with her forgetful, frail mother
- Family with a son who, as a teenager and young adult, had serious arguments with his parents, who were emotionally abusive to him
- Family with a daughter who is working two jobs with significant debts and cares for her father, who is becoming more confused and dependent
3: The theory of transgenerational violence involves a continuum of family violence. A child grows up in a home where a contentious family relationship and some form of abuse is the norm. The child who was abused grows up and later becomes aggressive and abusive to the elderly parent.
An older patient tearfully tells a nurse that she must buy the neighbor’s groceries or the neighbor will not drive the patient to the store. The nurse recognizes this situation as being which type of elder mistreatment?
- Abuse
- Neglect
- Exploitation
- Abandonment
3: Elder mistreatment by exploitation involves the abuser taking advantage of the older person for monetary or personal benefit. This is the case in which the older patient is being coerced to buy the neighbor’s groceries.
In which situations is institutional mistreatment of older patients most likely to occur? Standard Text: Select all that apply. 1. Staff burnout 2. Staffing shortage 3. Patient aggressiveness 4. Inadequate staff training 5. Family members frequently visit
1: Staff burnout may be a precipitating factor in the mistreatment of nursing home residents.
2: Staffing shortages may be a precipitating factor in the mistreatment of nursing home residents.
3: Patient aggressiveness was found to be a predictor of physical and psychological abuse by staff members.
4: Inadequate staff training may be a precipitating factor in the mistreatment of nursing home residents.
Which older patient is at greatest risk for mistreatment in the home?
- An active older patient with well-controlled diabetes who lives alone
- A healthy older patient who is retired from owning a business and lives with an adult son
- An older patient with a history of coronary bypass surgery, is active, and lives with the spouse
- An older patient with severe osteoarthritis and macular degeneration who lives with a single daughter who has an adult son with cerebral palsy
4: Risk factors for elder mistreatment include being female, over the age of 75, having a dependent functional status, having a poor social network, poverty, minority, cognitive impairment, and having less than an 8th grade education. An older patient with severe osteoarthritis and macular degeneration who lives with a single daughter who has a son with a health problem is at the greatest risk for mistreatment in the home.
An older patient lives alone and has not bathed or changed clothing for several days. An investigator for adult protective services visits and determines this patient is experiencing which type of elder mistreatment?
- Self-neglect
- Physical abuse
- Psychological abuse
- Financial exploitation
1: Self-neglect occurs when mentally competent patients engage in behaviors that threaten their own safety and well-being. Failure to maintain proper hygiene practices falls into this category of elder mistreatment.
A visitor to a long-term care institution witnesses an attendant scolding a patient with dementia about being incontinent. What type of abuse is the visitor witnessing?
- Neglect
- Exploitation
- Caregiver burnout
- Psychological abuse
4: A caregiver who scolds and ridicules a patient who is unable to care for him- or herself is committing psychological abuse by inflicting anguish and psychological pain.
An older patient is being abused by family members in the home and asks about adult protective services. What should the nurse explain about these services?
- They punish persons who abuse the elderly.
- They provide services to protect older people who may be abused or neglected.
- They provide a way to permanently keep the older patient separated from the abuser.
- They place older patients who cannot adequately care for themselves in nursing homes.
2: Adult protective services (APS) programs are social services organized to protect vulnerable older adults who may be abused, neglected, or exploited.
What will the nurse keep in mind when documenting the suspected abuse of an older patient?
- Photo documentation is not usually included as part of the documentation.
- Documentation should include objective data of the older patient’s reaction when the suspected abuser is present.
- It is important to include the nurse’s personal opinion of the suspected abuser and the nurse’s prior experience in similar cases.
- The details of the documentation should not be reported to the adult protective services; it is important that they come to an independent conclusion about the issue of abuse.
2: Older adults who appear fearful when in the presence of a suspected abuser will need careful assessment as this may be a warning sign of mistreatment. Physical indicators of elder mistreatment that are clearly described will assist interdisciplinary members with diagnosis as well as with planning goals of patient care.
An older patient is accompanied to a physician’s office visit with an adult daughter who walks with an assistive device. The older patient is hard of hearing, has osteoarthritis, and has difficulty completing activities of daily living. Which nursing diagnosis would the nurse identify as being the priority at this time?
- Social isolation
- Caregiver role strain
- Ineffective protection
- Situational low self-esteem
2: Caregiver role strain is the priority since the daughter walks with an assistive device and needs to help the older patient who is hard of hearing, has osteoarthritis, and has difficulty completing activities of daily living. The daughter may become stressed with having to help the older patient as well as herself with care needs.
An older patient has been brought into the emergency department with injuries caused by suspected physical abuse. Which tools could the nurse use to assess this patient’s injuries?
Standard Text: Select all that apply.
1. Indicators of abuse screen
2. AMA assessment protocol
3. Adult protective services report
4. Brief abuse screen for the elderly
5. Hwalek-Sengstock elder abuse screening test
1: The indicators of abuse screen is a 29-item set of indicators for use by social service agency practitioners to identify elder mistreatment.
2: The AMA assessment protocol is a checklist used if abuse is suspected.
4: The brief abuse screen for the elderly asks five standard questions that focus on abuse.
5: The Hwalek-Sengstock elder abuse screening test is one 15-item assessment screen for detecting suspected elder abuse and neglect.
