Chapter 35: The Older Adult With a Mental Health Issue Mohr: Psychiatric Mental Health Nursing, 6th Edition,100% CORRECT

1. According to the National Institute of Aging, young old refers to people A) 62 to 70 years of age. B) 65 to 74 years of age. C) 60 to 64 years of age. D) 64 to 70 years of age. Ans: B Chapter: 35 Client Needs: B-1 Cognitive level: Knowledge Concepts & Processes: Cultural awareness Difficulty: Easy Objective: 01 Feedback: To be more precise about the relationship between a person's age and his or her particular needs, the National Institute on Aging has defined chronologic categories of the young old (65 to 74 years), the middle old (75 to 84 years), the old old (85 to 94 years), and the elite old (95 years or older). Page: 2 2. According to the National Institute of Aging, middle old refers to people A) 70 to 75 years of age. B) 75 to 80 years of age. C) 75 to 84 years of age. D) 62 to 75 years of age. Ans: C Chapter: 35 Client Needs: B-1 Cognitive level: Knowledge Concepts & Processes: Cultural awareness Difficulty: Easy Objective: 01 Feedback: To be more precise about the relationship between a person's age and his or her particular needs, the National Institute on Aging has defined chronologic categories of the young old (65 to 74 years), the middle old (75 to 84 years), the old old (85 to 94 years), and the elite old (95 years or older). Page: 2 3. Approximately what percentage of people 65 years of age and older reside in nursing homes? A) 5% B) 10% C) 12% D) 30% Ans: A Chapter: 35 Client Needs: B-1 Cognitive level: Knowledge Concepts & Processes: Cultural awareness Difficulty: Moderate Objective: 01 Feedback: Contrary to assumptions that many older Americans reside in institutions, approximately 4.5% of those 65 years or older live in nursing homes at any given time. The large majority of older people live in the community independently (30%), with a spouse (53.6%), or with other family members (11.9%) Page: 3 4. A 77-year-old widow who recently moved to a retirement community with nursing care facilities complains of feeling nervous and having difficulty sleeping. She states that she misses her garden and neighbors. Which of the following nursing diagnoses is most appropriate? A) Ineffective Coping related to situational crisis B) Relocation Stress Syndrome related to isolation from friends C) Anxiety related to change in role status D) Impaired Adjustment related to multiple stressors Ans: B Chapter: 35 Client Needs: B-2 Cognitive level: Analysis Concepts & Processes: Nursing process Difficulty: Moderate Objective: 02 Feedback: Giving up their homes and moving into a long-term care facility (eg, nursing home) is a transition for many older people. Some view moving to such facilities as a sign of relinquishing independence and assuming a dependent role. They may have difficulty coping with lost freedom. Some clients suffer from related depression. Page: 11 5. A nurse is counseling a 64-year-old married homemaker about health promotion and successful aging. The client mentions that her husband, a police officer, will retire next year. They have no particular plans following his retirement, but they are financially secure. Which of the following nursing interventions would be most appropriate? A) Suggest they plan for activities that they can enjoy jointly and separately. B) Suggest they consider traveling, because the husband will likely be bored at home. C) Suggest the husband do something completely different from police work, because he will need a break from the stress such a job likely carries. D) Advise the wife to be prepared to have her husband “underfoot” until he adjusts to his new role. Ans: A Chapter: 35 Client Needs: B-1 Cognitive level: Application Concepts & Processes: Self-care Difficulty: Moderate Objective: 04 Feedback: When working with older adult clients in helping them to prepare for retirement transitions, encourage that if married or in a long-term partnership, begin to establish renegotiated roles for married individuals. Plan to share household activities and responsibilities. Provide for separate and joint activities. Page: 816 6. Which of the following statements about bereavement and older adults is accurate? A) Mortality rates increase for women in the 2 years following the death of a spouse. B) The knowledge that death may occur at any time helps older adults prepare for the death of a spouse. C) Men have a greater increase in mortality rate than do women in the 2 years following the death of a spouse. D) Mortality rates do not change for men and women following the death of a spouse. Ans: C Chapter: 35 Client Needs: B-1 Cognitive level: Knowledge Concepts & Processes: Self-care Difficulty: Moderate Objective: 02 Feedback: Responses to the loss of significant relationships differ for men and women. In the 2 years following the death of a spouse, men tend to have a higher mortality rate than women. Page: 12 7. A psychiatric technician greets an older adult client by saying, “Hello, Bob. My name is Matt. I have to take some information from you. First, how many years young are you?” The nurse overhearing this exchange should A) do nothing. The technician's friendly manner will put the client at ease. B) interrupt the technician to point out that he should address the client by his surname. C) take the technician aside to explain that his words are inadvertently disrespectful. D) do nothing. Even though the technician's approach is a little too familiar, the client should be able to understand that the technician is trying to be respectful. Ans: C Chapter: 35 Client Needs: A-1 Cognitive level: Application Concepts & Processes: Caring Difficulty: Difficult Objective: 03 Feedback: Nurses and other healthcare professionals must take care to use respectful terms when talking with or about older people, regardless of diagnosis, symptoms, or both. They must avoid the degrading terminology associated with ageism in all cases. Many of these terms can decrease feelings of self-esteem, thus contributing to depression in older people. Page: 24 8. The nurse is interviewing an older adult. She makes an effort not to hurry or to interrupt the client. Which of the following rationales best supports this approach to effective communication? A) Hurrying or interrupting the client is disrespectful. B) Hurrying or interrupting the client discourages responses. C) Hurrying or interrupting the client may lead to confusion. D) Hurrying or interrupting the client does not demonstrate caring. Ans: B Chapter: 35 Client Needs: C-1 Cognitive level: Comprehension Concepts & Processes: Communication Difficulty: Moderate Objective: 03 Feedback: Useful communication skills with older adults include allowing time and waiting for responses. It may take a little longer than you expect. Do not interrupt the person; doing so discourages responses. Page: 43 9. A 72-year-old woman states that she has trouble sleeping and that her appetite has declined. She also tells the nurse she hasn't been getting out much lately. Findings from her physical examination and laboratory studies are normal. Based on these data, the nurse would A) collaborate with the physician to have a sleeping medication ordered and suggest that she get more exercise to stimulate her appetite. B) tell her that her symptoms are associated with the normal aging process but that exercise will help. C) schedule a follow-up appointment in 3 months to monitor her health. D) screen her for depression. Ans: D Chapter: 35 Client Needs: B-2 Cognitive level: Application Concepts & Processes: Nursing process Difficulty: Moderate Objective: 04 Feedback: Physical health and mental health are intertwined closely, especially in older adults. Clients with a psychiatric illness may first present with somatic symptoms such as fatigue, sleep disturbance, and weight loss. Physical illness such as vascular dementia and delirium (see Chapter 33) may appear with psychiatric symptoms of delusions, agitation, and mood and behavior changes. Similarly, chronic medical conditions are associated with psychiatric illness, particularly depression. Page: 6 10. An 80-year-old man brings his 74-year-old wife to the physician's office, stating that she doesn't seem to be herself. He relates that she has had bronchitis for 1 week and is taking antibiotics, but yesterday she was unusually forgetful, and her conversation seemed vague and confused. The nurse understands that these data suggest A) delirium. B) impaired gas exchange. C) anxiety. D) dementia. Ans: A Chapter: 35 Client Needs: B-2 Cognitive level: Analysis Concepts & Processes: Nursing process Difficulty: Moderate Objective: 05 Feedback: Disease or drug effects in any part of the body may present with central nervous system (CNS) changes. Any drug affecting the CNS puts the older adult at risk. The nurse must understand drug actions and the CNS effects in specific reference to the older adult. Toxicity from prescribed medications can cause delirium. Page: 8 11. Which of the following statements explains why diphenhydramine (Benadryl) should be used with extreme caution in clients with Alzheimer's disease? A) Diphenhydramine causes dry mouth and can lead to dehydration. B) Diphenhydramine interferes with the acetylcholine available for neural transmission. C) Diphenhydramine can cause respiratory distress secondary to histamine release. D) Diphenhydramine can impede cerebral blood flow in susceptible people. Ans: B Chapter: 35 Client Needs: D-2 Cognitive level: Knowledge Concepts & Processes: Nursing process Difficulty: Moderate Objective: 06 Feedback: One of the most common anticholinergic medications is diphenhydramine (Benadryl), now available over the counter and used for allergy reactions and as a sleep aid. Because of its side effects, many people who use diphenhydramine begin to feel dizzy and light- headed, get a dry mouth, and sometimes get confused and disoriented. An older adult who already has confusion and disorientation secondary to Alzheimer's disease will be compromised significantly if he or she takes an anticholinergic medication. In this case, the uptake of acetylcholine has been blocked physiologically. Page: 8-9 12. Which of the following issues related to pharmacotherapy represents the greatest possible risk to an older client's health? A) Problems administering medications secondary to swallowing difficulties B) Older adults' decreased ability to metabolize and excrete medications C) Polypharmacy D) Older adults' use of alternative remedies Ans: C Chapter: 35 Client Needs: B-1 Cognitive level: Knowledge Concepts & Processes: Self-care Difficulty: Moderate Objective: 06 Feedback: The term that describes the use of many drugs simultaneously in the same client is polypharmacy (see Chap. 14). Because the number of physical problems tends to increase with age, many clients have several different medical conditions that require treatment. Problems arise when no single physician oversees all the medications for compatibility and client adherence. When a client adds over-the-counter medications, medical repercussions can be severe. Page: 9 13. Which of the following interventions would be most effective in helping an older adult living alone to manage his medication regimen? A) Ensure that a responsible person prepours the medication for the week into medication containers marked with the name of each day. B) Ask a neighbor or family member to monitor the client's medications. C) Review dosages and times with the client and have him repeat the information. D) Create a medication administration record so that the client can check off his medications as he takes them each day. Ans: D Chapter: 35 Client Needs: D-2 Cognitive level: Application Concepts & Processes: Self-care Difficulty: Moderate Objective: 06 Feedback: Teaching clients about their medications is a serious responsibility. In addition to a medication list, a medication administration sheet might be helpful. This plan not only serves as a reminder about what the client should take and when, but also its check-off format enables supervision of medication adherence. Page: 27 14. A major barrier to an elderly person seeking adequate mental health care may be due to the myth that A) older people too often seek health assistance, particularly for mental or emotional disorders. B) depression, confusion, memory loss, and other mental or emotional problems are simply part of normal aging. C) often healthcare professionals tend to exaggerate the effects of mental problems. D) elderly clients tend to get frustrated and confused negotiating care within the array of mental health services available. Ans: B Chapter: 35 Client Needs: B-1 Cognitive level: Analysis Concepts & Processes: Cultural awareness Difficulty: Moderate Objective: 04 Feedback: Sometimes healthcare providers, family members, and older people themselves incorrectly believe that depression, confusion, memory loss, and other mental or emotional problems are simply part of normal aging. These attitudes prevent older people and their families from seeking treatment and, unfortunately, some providers from aggressive diagnosis and treatment. Page: 13 15. The nurse is giving a presentation to the community on healthy aging. At the conclusion, she asks each group member to state one health-promoting action he or she can take. Which of the following responses indicates the need for clarification? A) “I should drink plenty of fluids.” B) “I should get involved in community life.” C) “I should take a vitamin and mineral supplement.” D) “I should walk for 1 hour each day.” Ans: D Chapter: 35 Client Needs: B-1 Cognitive level: Application Concepts & Processes: Self-care Difficulty: Moderate Objective: 08 Feedback: Keeping active mentally is important by participating in volunteer organizations and activities in the community and being actively involved in church and political groups. Good nutrition and fluids are essential to physical health. Because of various factors related to aging, including decreased absorption of some substances, older people probably should take at least one basic multivitamin and mineral supplement. The nurse may wish to suggest to most clients (unless contraindicated because of other physical factors) that they exercise at least 30 minutes a day, three times a week. Page: 33-34