NSG 4067 FINAL EXAM STUDY GUIDE
1. A nurse monitors older adults in a long-term care facility. Which of the
following symptoms would require follow-up by the nurse to assess for depression
in the older adult?
A) Anorexia
B) Weakness
C) Labile affect
D) Impaired perceptions
Ans: A
Feedback:
Appetite disturbances, particularly anorexia, are among the most common physical
complaints of depressed older adults. Individuals with dementia have the following
symptoms: vague fatigue, labile affect, and physical complaints that are easily
forgotten.
2. A nurse is reviewing the side effects of antidepressants with a group of older
adults. Which of the following statements by a member of the group indicates that
the nurse's teaching has been effective?
A) "I will start on the dose that I will take for life."
B) "Fluoxetine should be given in the evening because it may help me sleep."
C) "I need to maintain my fluid intake while on antidepressant medication."
D) "The length of antidepressant treatment is usually 3 months for a first-time
depression."
Ans: C
Feedback:
An increase in fluid intake helps prevent the risk of postural hypotension. Dosages
can be increased gradually until maximal therapeutic levels are reached, while
observing for adverse effects. Fluoxetine should be given in the afternoon because
of agitation. The length of treatment is usually 6 months for a first-time depression.
,3. A nurse monitors for depression in the older adult population. Which of the
following are a risk factor and a functional consequence of depression in the older
adult? (Select all that apply.)
A) Chronic pain
B) Functional impairment
C) Hypernatremia
D) Nutritional deficiencies
E) Renal impairment
Ans: A, B, D
Feedback:
Chronic pain, functional impairment, and nutritional deficiencies are both
contributing factors and consequences of depression in the older adult. Renal
impairment and hypernatremia are not specifically related to depression.
4. A nurse educator teaches about theories of late-life depression. Which of the
following statements by a student shows that the material is understood?
A) "Adverse events impair your ability to evaluate yourself."
B) "Depression is caused by decreased activity in the hypothalamic–pituitary–
adrenal axis."
C) "Older adults with depression and chronic illness have more serious negative
functional consequences."
D) "Researchers have identified a cause-and-effect relationship between
depression and dementia."
Ans: C
Feedback:
Studies consistently find that the co-occurrence of depression with chronic
conditions in older adults is associated with more serious negative functional
consequences. Cognitive theory says that distorted perceptions, not adverse
(unfavorable) events, impair one's ability to appraise oneself and the event
constructively. Increased plasma cortisol levels and increased activity of the
hypothalamic–pituitary–adrenal axis can lead to depression. Researchers have
identified neuropathologic changes but have not identified a specific cause-and-
effect relationship between dementia and depression.
,5. When risk factors to potential suicide have been identified, a nurse must further
assess the actual risk for a suicide attempt. Which of the following questions would
be appropriate for initial assessment to determine the presence or absence of
suicidal thoughts in an older adult with risk factors?
A) "Under what circumstances would you take your life? Have you ever started
to act on a plan to harm yourself?"
B) "Do you have a plan for taking your life? What action would you take if you
were to harm yourself?"
C) "Does your life feel worthless? Do you ever think about escaping from your
problems?"
D) "Do you think about harming yourself? Do you ever think about committing
suicide?"
Ans: C
Feedback:
Suicide assessment is multilevel, and each level of questions depends on the
response the client gives to the previous level's questions. Level 1 questions
determine the presence or absence of suicidal thoughts. Level 1 questions are
indirect; at level 2, they become more direct. Level 2 determines the presence or
absence of thoughts about self-harm. Level 3 questions determine whether the
client has a realistic suicide plan.
6. A gerontological nurse conducts an assessment of an older adult who has a
history of depression. Assessment reveals that the client has been drinking up to
two bottles of wine each day for the last several months. What should the nurse
teach the client about alcohol use and depression?
A) "If you choose to use alcohol to address your depression, it's best to limit it
to four to five drinks each day."
B) "We recommend that everyone over the age of 70 abstain from drinking
alcohol."
C) "Alcohol has been shown to contribute to depression and vice versa."
D) "If you quit drinking, your depression will likely improve."
Ans: C
Feedback:
, Alcohol and depression have a synergistic relationship: alcohol causes depression,
depression leads to alcohol abuse, which, in turn, exacerbates the depression. Four
or five drinks daily is excessive, but abstinence is not necessary for all older adults.
Abstinence is not guaranteed to improve symptoms of depression.
7. An older adult has been accompanied by an adult child to visit a primary care
provider. The child has expressed concern about the client's increasing apathy,
isolation, and apparent sadness over the past several months; and the client
acknowledges many of the symptoms of depression. Which of the following
assessments should the nurse prioritize?
A) Functional assessment
B) Medication assessment
C) Musculoskeletal assessment
D) Cardiovascular assessment
Ans: B
Feedback:
Medications may be risk factors for depression in numerous ways. A functional
assessment is necessary, but this is more likely to ascertain the effects, rather than
causes, of her depression. Musculoskeletal and cardiovascular assessments are
secondary.
8. Which of the following statements by residents of a nursing home should
prompt a nurse to assess for depression?
A) "Lately I wake up for the day at 4:00 or 5:00 in the morning and can't fall
asleep again."
B) "I've got these cravings for sugary and salty snacks more than I used to."
C) "I've never been too prone to headaches, but these days I always seem to
have one."
D) "I don't know why this sore on my ankle just won't heal this time."
Ans: A
Feedback:
1. A nurse monitors older adults in a long-term care facility. Which of the
following symptoms would require follow-up by the nurse to assess for depression
in the older adult?
A) Anorexia
B) Weakness
C) Labile affect
D) Impaired perceptions
Ans: A
Feedback:
Appetite disturbances, particularly anorexia, are among the most common physical
complaints of depressed older adults. Individuals with dementia have the following
symptoms: vague fatigue, labile affect, and physical complaints that are easily
forgotten.
2. A nurse is reviewing the side effects of antidepressants with a group of older
adults. Which of the following statements by a member of the group indicates that
the nurse's teaching has been effective?
A) "I will start on the dose that I will take for life."
B) "Fluoxetine should be given in the evening because it may help me sleep."
C) "I need to maintain my fluid intake while on antidepressant medication."
D) "The length of antidepressant treatment is usually 3 months for a first-time
depression."
Ans: C
Feedback:
An increase in fluid intake helps prevent the risk of postural hypotension. Dosages
can be increased gradually until maximal therapeutic levels are reached, while
observing for adverse effects. Fluoxetine should be given in the afternoon because
of agitation. The length of treatment is usually 6 months for a first-time depression.
,3. A nurse monitors for depression in the older adult population. Which of the
following are a risk factor and a functional consequence of depression in the older
adult? (Select all that apply.)
A) Chronic pain
B) Functional impairment
C) Hypernatremia
D) Nutritional deficiencies
E) Renal impairment
Ans: A, B, D
Feedback:
Chronic pain, functional impairment, and nutritional deficiencies are both
contributing factors and consequences of depression in the older adult. Renal
impairment and hypernatremia are not specifically related to depression.
4. A nurse educator teaches about theories of late-life depression. Which of the
following statements by a student shows that the material is understood?
A) "Adverse events impair your ability to evaluate yourself."
B) "Depression is caused by decreased activity in the hypothalamic–pituitary–
adrenal axis."
C) "Older adults with depression and chronic illness have more serious negative
functional consequences."
D) "Researchers have identified a cause-and-effect relationship between
depression and dementia."
Ans: C
Feedback:
Studies consistently find that the co-occurrence of depression with chronic
conditions in older adults is associated with more serious negative functional
consequences. Cognitive theory says that distorted perceptions, not adverse
(unfavorable) events, impair one's ability to appraise oneself and the event
constructively. Increased plasma cortisol levels and increased activity of the
hypothalamic–pituitary–adrenal axis can lead to depression. Researchers have
identified neuropathologic changes but have not identified a specific cause-and-
effect relationship between dementia and depression.
,5. When risk factors to potential suicide have been identified, a nurse must further
assess the actual risk for a suicide attempt. Which of the following questions would
be appropriate for initial assessment to determine the presence or absence of
suicidal thoughts in an older adult with risk factors?
A) "Under what circumstances would you take your life? Have you ever started
to act on a plan to harm yourself?"
B) "Do you have a plan for taking your life? What action would you take if you
were to harm yourself?"
C) "Does your life feel worthless? Do you ever think about escaping from your
problems?"
D) "Do you think about harming yourself? Do you ever think about committing
suicide?"
Ans: C
Feedback:
Suicide assessment is multilevel, and each level of questions depends on the
response the client gives to the previous level's questions. Level 1 questions
determine the presence or absence of suicidal thoughts. Level 1 questions are
indirect; at level 2, they become more direct. Level 2 determines the presence or
absence of thoughts about self-harm. Level 3 questions determine whether the
client has a realistic suicide plan.
6. A gerontological nurse conducts an assessment of an older adult who has a
history of depression. Assessment reveals that the client has been drinking up to
two bottles of wine each day for the last several months. What should the nurse
teach the client about alcohol use and depression?
A) "If you choose to use alcohol to address your depression, it's best to limit it
to four to five drinks each day."
B) "We recommend that everyone over the age of 70 abstain from drinking
alcohol."
C) "Alcohol has been shown to contribute to depression and vice versa."
D) "If you quit drinking, your depression will likely improve."
Ans: C
Feedback:
, Alcohol and depression have a synergistic relationship: alcohol causes depression,
depression leads to alcohol abuse, which, in turn, exacerbates the depression. Four
or five drinks daily is excessive, but abstinence is not necessary for all older adults.
Abstinence is not guaranteed to improve symptoms of depression.
7. An older adult has been accompanied by an adult child to visit a primary care
provider. The child has expressed concern about the client's increasing apathy,
isolation, and apparent sadness over the past several months; and the client
acknowledges many of the symptoms of depression. Which of the following
assessments should the nurse prioritize?
A) Functional assessment
B) Medication assessment
C) Musculoskeletal assessment
D) Cardiovascular assessment
Ans: B
Feedback:
Medications may be risk factors for depression in numerous ways. A functional
assessment is necessary, but this is more likely to ascertain the effects, rather than
causes, of her depression. Musculoskeletal and cardiovascular assessments are
secondary.
8. Which of the following statements by residents of a nursing home should
prompt a nurse to assess for depression?
A) "Lately I wake up for the day at 4:00 or 5:00 in the morning and can't fall
asleep again."
B) "I've got these cravings for sugary and salty snacks more than I used to."
C) "I've never been too prone to headaches, but these days I always seem to
have one."
D) "I don't know why this sore on my ankle just won't heal this time."
Ans: A
Feedback:
