D346 (NURS 6439) - Advanced Psychiatric Mental Health Care of Adults and Older Adults Across Care Settings Practice TEST STUDY GUIDE 2026/2027 COMPLETE QUESTIONS WITH CORRECT DETAILED ANSWERS || 100% GUARANTEED PASS LATEST VERSION

D346 (NURS 6439) - Advanced Psychiatric Mental Health Care of Adults and Older Adults Across Care Settings Practice TEST STUDY GUIDE 2026/2027 COMPLETE QUESTIONS WITH CORRECT DETAILED ANSWERS || 100% GUARANTEED PASS LATEST VERSION 1. Which patient outcome is most important for the nurse to write in the plan of care for an older adult patient with depression? - ANSWER The patient's quality of life will be optimized as measured by the patient's verbalization of satisfaction. 2. Aging - ANSWER begins at birth and is a process of getting older that happens to everyone. 3. Gerontology - ANSWER The study of older adults. 4. Geriatrics - ANSWER A branch of medicine that specializes in older adults. 5. Aging Population - ANSWER By the year 2030, all Baby-Boomers will be 65 years of age according to the Pew Report. 6. Population Increase - ANSWER According to the Department of Health and Human Services, the population of 65+ will increase from 35 million in 2000 to 55 million in 2020. 7. Mental Health of Older Adults - ANSWER Most people 65 and over are intellectually intact and mentally healthy. 8. Challenges of Aging - ANSWER include spouse and family, employment, lifestyle, social group, and all of the above. 9. Prevalent Illnesses in Aging - ANSWER Certain illnesses such as CAD, Alzheimer's, and PNE are more prevalent and less responsive to treatment. 10.Visual and Hearing Acuity - ANSWER diminish with aging. 11.Losses in Aging - ANSWER may include employment, income/lifestyle, social group, and spouse/family. 12.Ageism - ANSWER Discrimination based on age that assumes most people over 65 are incapable of functioning and/or contributing to society. 13.Intimacy in Aging - ANSWER never leaves us, despite social stigma surrounding older people having sex or living together. 14.Elder Abuse - ANSWER often at the hands of family or health-care providers. 15.Omnibus Budget Reconciliation Act (OBRA) - ANSWER A federal act that provides standards of care for the older population and monitors long- term care facilities. 16.Common Illnesses in Aging - ANSWER CAD, Alzheimer's, CVA, aphasia, depression, insomnia, and paranoid thinking. 17.Which statements, if made by a nursing student, indicate an understanding of the challenges of managing pain in the older adult patient? - ANSWER The patient's bowel status will need to be carefully assessed. a. Interactions between the pain medication and existing medications create challenges. b. Confusion may not necessarily be related to analgesics, and the patient should be fully assessed for a source. 18.In addition to physiologic issues, the nurse understands that an older adult patient who misuses alcohol is at risk for which problems? - ANSWER Self-neglect a. Legal difficulty Family discord 19.A nurse is caring for a client who has schizophrenia. Which of the following findings should the nurse identify as a cognitive symptom? a. Unable to express emotions b. Hearing voices c. Unable to concentrate d. Withdrawing from social situations - ANSWER c. Unable to concentrate Rational: The nurse should identify an inability to concentrate as a cognitive symptom of schizophrenia. Other cognitive symptoms can include the inability to remember and difficulty learning. 20.A nurse is caring for a client who is experiencing psychosis and states that they are the president of the United States. The nurse should identify that they client is experiencing which of the following? a. Visual hallucinations b. Auditory hallucinations c. Disorganized speech d. Delusions - ANSWER d. Delusions Rational: The nurse should identify that the client is experiencing delusions. Delusions are false beliefs that a client might have that cannot be influenced by logic. 21.A nurse is providing discharge instructions for a client who is prescribed clozapine. Which of the following information should the nurse include? a. This medication only treats negative symptoms b. The medication takes full effect in one week c. Weekly blood draws will need to be done while taking this medication d. The medication requires the monitoring of red blood cells - ANSWER c. Weekly blood draws will need to be done while taking this medication Rational: It is critical that the nurse discuss the need for weekly blood draws. Clozapine can cause agranulocytosis and place the client at risk for infection. The client should report manifestations of infection to the provider immediately. Alzheimer's Disease - ANSWER An alteration in cognitive thinking with debilitating effects that are not reversible, characterized by plaques and tangles. Which patient outcome is most important for the nurse to write in the plan of care for an older adult patient with depression? - ANSWER The patient's quality of life will be optimized as measured by the patient's verbalization of satisfaction. Aging - ANSWER begins at birth and is a process of getting older that happens to everyone. Gerontology - ANSWER The study of older adults. Geriatrics - ANSWER A branch of medicine that specializes in older adults. Aging Population - ANSWER By the year 2030, all Baby-Boomers will be 65 years of age according to the Pew Report. Population Increase - ANSWER According to the Department of Health and Human Services, the population of 65+ will increase from 35 million in 2000 to 55 million in 2020. Mental Health of Older Adults - ANSWER Most people 65 and over are intellectually intact and mentally healthy. Challenges of Aging - ANSWER include spouse and family, employment, lifestyle, social group, and all of the above. Prevalent Illnesses in Aging - ANSWER Certain illnesses such as CAD, Alzheimer's, and PNE are more prevalent and less responsive to treatment. Visual and Hearing Acuity - ANSWER diminish with aging. Losses in Aging - ANSWER may include employment, income/lifestyle, social group, and spouse/family. Ageism - ANSWER Discrimination based on age that assumes most people over 65 are incapable of functioning and/or contributing to society. Intimacy in Aging - ANSWER never leaves us, despite social stigma surrounding older people having sex or living together. Elder Abuse - ANSWER often at the hands of family or health-care providers. Omnibus Budget Reconciliation Act (OBRA) - ANSWER A federal act that provides standards of care for the older population and monitors long-term care facilities. Common Illnesses in Aging - ANSWER CAD, Alzheimer's, CVA, aphasia, depression, insomnia, and paranoid thinking. Alzheimer's Disease - ANSWER An alteration in cognitive thinking with debilitating effects that are not reversible, characterized by plaques and tangles. 22.What are potential side effects of stimulant medications? - ANSWER Insomnia, anxiety, decreased appetite, weight loss, and addiction. 23.What is a 'drug holiday' in the context of ADHD medication? - ANSWER A supervised break from medication to assess effectiveness and increase sensitivity to the medication. Which misperception about depression in the older adult exists and may cause the condition to go untreated? - ANSWER Depressive symptoms are mistaken as symptoms of dementia. 24.A nurse is reviewing assessment findings for a 22 year old client who was found wandering in the street. Which of the following manifestations suggests the client is experiencing positive symptoms of psychosis? a. Clanging speech b. Positive toxicology screen for opioids c. Flat affect d. Large bruise to right side of face - ANSWER a. Clanging speech Rational: Clanging speech reflects disorganized thought and speech patterns. This is a positive symptom of psychosis. 25.A nurse is talking with a client about mental health care and services. The client asks, "What is the difference between psychosis and schizophrenia?" Which of the following responses should the nurse make? a. "Psychosis describes conditions where a person loses contact with what is real. Schizophrenia is a mental health illness where the person can show manifestations of psychosis." b. "Psychosis and schizophrenia are the same thing, and most providers use these terms interchangeably." c. "Psychosis is a mental health which includes manifestations of schizophrenia, delirium, and hysteria." d. "Schizophrenia is a type of multiple personality disorder in which a person displays psychosis or illogical thoughts or beliefs." - ANSWER a. "Psychosis describes conditions where a person loses contact with what is real. Schizophrenia is a mental health illness where the person can show manifestations of psychosis." Rational: Psychosis is a condition in which a person has lost contact with reality and displays manifestations such as delusions and hallucinations. Schizophrenia is a serious mental health disorder where people experience psychosis and behaviors that impair their ability to function. 26.A nurse is caring for a client who has been diagnosed with schizophrenia. The client is exhibiting delusional behavior stating that a new nurse is from the FBI and is stealing their thoughts and ideas. Which of the following statements should the nurse make? a. "Wow, since the FBI is involved now, you are safe. Tell me more about the FBI wanting to take your thoughts." b. "Don't worry, you are perfectly safe. The walls and ceiling are lined with lead and can't be penetrated." c. "You should stop these thoughts because they are making things worse for you. Take a deep breath." d. "I can see you are very concerned. The new nurse is not from the FBI and will not harm you." - ANSWER d. "I can see you are very concerned. The new nurse is not from the FBI and will not harm you." 27.Rational: Acknowledging the client's experience and making observations about the client's feelings, as well as stating who the new nurse is and reassuring the client that the nurse will not hurt them, provides a connection to what is real. This is the most appropriate response. 28.A nurse is caring for a client in a Veterans' Administration facility. Drag 1 condition and 1 client finding to fill in each blank in the following sentence. 1. The nurse should first address the client's a. personal relationships b. fear of strangers c. living situation d. perception of self e. access to medications 2. Due to a. esteem needs b. safety needs c. love and belonging needs d. self-actualization e. physiological needs - ANSWER 1. c. living situation 3. e. physiological needs Rational: Living situation is correct. When using the greatest risk priority framework, the nurse should recognize that the greatest risk to the client is the lack of adequate shelter. According to Maslow's hierarchy, the most basic needs are physiological needs, such as food, water, air, and shelter. These needs must be met before the client can progress further up the hierarchy and improve self-functioning. The client's current living situation does not meet the physiological need of shelter as evidenced by the frostbite the client experienced. Physiological needs is correct. When using the greatest risk priority framework, the nurse should recognize that the greatest risk to the client is the lack of adequate shelter. According to Maslow's hierarchy, the most basic needs are physiological needs, such as food, water, air, and shelter. These needs must be met before the client can progress further up the hierarchy and improve self-functioning. The client's current living situation does not meet the physiological need of shelter as evidenced by the frostbite the client experienced. 29.A nurse is caring for a client who has schizophrenia. The nurse is reviewing the client's medical record. Select the "3" findings that require immediate follow-up by the nurse. a. Temperature b. Stupor-like state c. Restlessness d. Muscle rigidity e. Appetite - ANSWER a, b, d Rational: When analyzing cues, the nurse should identify that the client's temperature, stupor-like state, and muscle rigidity require immediate follow- up by the nurse. The client's temperature, which is outside the expected reference range, can be related to the client's level of catatonia due to infection or another related issue, which can lead to blood coagulation, pneumonia, or organ failure; therefore, this finding requires immediate follow-up by the nurse. The nurse should identify the client is experiencing stupor-like state by lying in bed unable to move with eyes open and staring; therefore, this finding requires immediate follow-up by the nurse. The nurse should identify the client is experiencing muscle rigidity by lying in bed unable to move with eyes open and staring in a catatonic state; therefore, this finding requires immediate follow-up by the nurse. Which assessment findings would cause the nurse to suspect that a patient is experiencing acute delirium? - ANSWER Changes in behavior occur rapidly. The patient appears distressed and agitated. Match the issue faced by older adult patients with mental health concerns with the explanation as to why it presents a challenge. - ANSWER Prescriptions may go unfilled to pay for necessities. =financ Access to a vehicle and driving ability are limited. =social Medicaid may limit where a patient can receive care. =access Fixed income may necessitate selling the family home. = home Cerebrovascular Accident (CVA) - ANSWER A stroke due to vascular changes of aging, often associated with depression. Depression in Aging - ANSWER Often associated with CVA; it is not a normal part of the aging process. Insomnia in Aging - ANSWER Often caused by depression and CVA. Paranoid Thinking - ANSWER cognitive concern that may arise in older adults. Insomnia - ANSWER Sleep disturbance due to depression, fear, pain, incontinence, daytime napping, or sundowners. Suicide rate in older adults - ANSWER Higher in individuals aged 65 and older compared to all other age groups. Highest suicide rate - ANSWER Observed in white men aged 85 and older. End of Life issues - ANSWER Consideration of religious and cultural beliefs is essential. Medical Treatment for the Aging Population - ANSWER Relation to specific symptoms and diagnosis. Medication monitoring - ANSWER Meds need to be monitored carefully for correct doses, side effects, and patient compliance. Pharmacokinetics - ANSWER The process by which a drug is absorbed, distributed, metabolized, and excreted in the body, noted to be slower in older populations. Polypharmacy - ANSWER The concurrent use of multiple medications by a patient, often seen in older adults. Medication Compliance - ANSWER The degree to which a patient correctly follows medical advice regarding medication intake. Medication Toxicity - ANSWER A condition resulting from excessive medication levels in the body, leading to harmful effects. Medication Side Effects - ANSWER Unintended effects of medications, which may include dry mouth, orthostatic hypotension, fatigue, irritability, and urinary complications. AGS Beer's Criteria - ANSWER A set of guidelines developed by the American Geriatrics Society to identify potentially inappropriate medications for older adults. STOPP - ANSWER Screening Tool of Older Persons Prescriptions, a tool used to assess medication appropriateness in older populations. START - ANSWER Screening Tool to Alert to Right Treatment, a tool used to assess medication appropriateness in older populations. Common Medication Side Effects - ANSWER dry mouth, constipation, orthostatic hypotension, urinary complications, confusion/disorientation, fatigue, and mood swings. Nursing Interventions - ANSWER Techniques used by nurses to support patients, including showing respect, setting realistic goals, displaying patience, ensuring safety, and promoting independence. Restorative Nursing - ANSWER A nursing approach focused on maintaining dignity and achieving maximum function for patients, promoting independence and self-esteem. Restorative Team - ANSWER A designated team in skilled nursing facilities that includes specially trained nursing assistants and nurses focused on restorative care. Palliative Care - ANSWER Specialized care for individuals with serious illness, focusing on symptom management and quality of life. End-of-Life Care - ANSWER Care provided to individuals who are nearing the end of their life, emphasizing comfort and quality of life. Palliative Care Issues - ANSWER Concerns in palliative care that may include pain management, sedation, opioid medication, artificial nutrition, and assisted suicide. Communication Skills in Nursing - ANSWER Skills that nurses need to develop to effectively communicate with patients, especially regarding sensitive issues like heavy medications and assisted suicide. The nurse is caring for an older adult patient with acute delirium who is unable to ambulate independently. When left alone in the room, the patient attempts to get out of bed. Which action would the nurse take first? - ANSWER Apply a pressure-sensitive alarm to the patient's bed. In an older adult patient diagnosed with dementia, which aspect of the plan of care would the nurse adjust to decrease patient agitation? - ANSWER Allow the patient to go to the dining room for meals anytime it is open. Which explanation would the instructor provide to the nursing student when asked why medication reconciliation is part of the hospital discharge process? - ANSWER Redundancies in medication are eliminated. Match the appropriate care setting with the description of the older adult patient. - ANSWER Lives alone but needs help with everyday tasks Lives at home with a caregiver who works outside the home Requires skilled assistance with all aspects of care Requires full-time supervision and has no other health care concerns What are some common eating disorders in children? - ANSWER PICA, rumination, and avoidant or restrictive food intake disorders. What is Disruptive Mood Dysregulation Disorder? - ANSWER A childhood condition characterized by severe temper outbursts and irritability. What are some examples of anxiety disorders in children? - ANSWER Separation anxiety, mutism, and specific phobias. What is the significance of good parenting in a child's resilience? - ANSWER It provides guidance and support that helps children transition successfully through crises. What are some behavioral cues for children with Conduct Disorder? - ANSWER Bullying, physical fights, cruelty to animals, and destruction of property. What is the importance of a supportive environment for children with autism? - ANSWER It helps reduce sensory overload and provides safe sensory input. What are some nursing priorities for children with ADHD? - ANSWER Safety, impaired socialization, ineffective coping, and alteration in sleep. What is the impact of trauma on children's mental health? - ANSWER It can lead to neurodevelopmental disorders and increase vulnerability to mental health issues. What is the role of positive reinforcement in treating children with behavioral disorders? - ANSWER It encourages and facilitates social interaction and appropriate behaviors. What are some common symptoms of Bipolar Disorder in children? - ANSWER Anger, irritability, acting out, and somatic symptoms. What is the significance of early diagnosis in childhood mental health? - ANSWER It allows for timely intervention and support, potentially improving long-term outcomes. What is the primary benefit of nonstimulant medications? - ANSWER They improve attention and focus while addressing abuse risk and reducing impulsiveness. What does NRI stand for in the context of medication? - ANSWER Norepinephrine Reuptake Inhibitor. Name a nonstimulant medication used for ADHD. - ANSWER Atomoxetine (Strattera). What is a key characteristic of antidepressants? - ANSWER They may take several weeks to take full effect. What should be considered first in treatment interventions? - ANSWER Nonpharmacological options. Which medications are commonly used for disruptive and conduct disorders? - ANSWER Quanfacine and Clonidine. What type of medications are used to reduce aggression and irritability in autism spectrum disorders? - ANSWER Antipsychotic medications like risperidone (Risperdal) or aripiprazole (Abilify). What is the first line treatment for anxiety and depression? - ANSWER SSRIs, with a need for suicide assessment due to black box warnings. What are some nonpharmacological interventions for mental health care? - ANSWER Family involvement, group therapy, milieu therapy, play therapy, and recreational therapy techniques. What is a common consideration for medication management in older adults? - ANSWER Respect and addressing patients' individual needs. What are some common sleep disorders and their treatments? - ANSWER Insomnia treated with zolpidem (Ambien) and cognitive behavioral therapy. What is a significant risk associated with benzodiazepines in older adults? - ANSWER Increased risk for dementia. What should be monitored in older adults regarding mental health? - ANSWER Depression and safety issues. What are the 4 M's to consider in older adult care? - ANSWER What matters, Mentation, Mobility, and Medication. What is a myth about aging regarding learning? - ANSWER That older adults are not able to learn new tasks. What is the impact of aging on sensory perception? - ANSWER The senses of vision, hearing, touch, taste, and smell decline with age. What is the importance of regular sexual expression in older adults? - ANSWER It helps maintain sexual capacity and effective sexual performance. What is a common misconception about older adults and social isolation? - ANSWER That most older adults are socially isolated and lonely. What should be addressed in the assessment process for older adults regarding alcohol? - ANSWER Needs for safety and decreased tolerance concerns. What is the goal of interventions in mental health care? - ANSWER To increase awareness, understanding, and ability. What is a recommended strategy for managing tasks for individuals with ADHD? - ANSWER Break tasks into small, manageable steps. What should be considered when treating impulse control disorders? - ANSWER Individual needs and the least restrictive treatment options. What are some treatment options for paraphilia disorders? - ANSWER Medications for hormone levels and psychotherapy. What is a common treatment for narcolepsy? - ANSWER Stimulants. What is the significance of sleep hygiene in mental health? - ANSWER It helps improve sleep quality and overall mental health. What is a common side effect of sleep medications? - ANSWER Grogginess, impaired coordination, and increased fall risk. What is mental health? - ANSWER Mental health is a person's ability to cope and adjust to everyday stresses. What is a suicide attempt protocol for patients? - ANSWER Patients require 1:1 supervision, meaning a staff member must remain with them at all times. How does age affect suicide risk? - ANSWER Suicide risk increases with age, with older adults committing suicide more frequently than younger depressed individuals. What is the estimated prevalence of mental disorders in the U.S.? - ANSWER It is estimated that 1 in 2 or 50% of people in the United States will develop a mental disorder during their lifetime. What are the three components of Freud's personality theory? - ANSWER The three components are Ego (operates on reality principles), ID (operates on pleasure principles), and Superego (mediates between right and wrong). What is regression in the context of defense mechanisms? - ANSWER Regression is a behavior that reflects a return to an earlier form of coping, such as an adult behaving like a child. What does rationalization refer to? - ANSWER Rationalization offers a reasonable explanation for an event rather than facing reality. What is projection in psychological terms? - ANSWER Projection is attributing one's own undesirable characteristics to others. What distinguishes neurosis from psychosis? - ANSWER Individuals with neurosis have insight into their emotional problems, while those with psychosis are out of touch with reality. What is delirium? - ANSWER Delirium is an organic mental disorder often triggered by severe physical illness, such as fever. What is sundowning syndrome? - ANSWER Sundowning syndrome is a condition where a patient displays increased disorientation and agitation during the evening and nighttime. What characterizes schizophrenia? - ANSWER Schizophrenia is a thought process disorder marked by bizarre, non-reality thinking, with symptoms categorized as positive (excessive) or negative (absent). What is the prodromal phase of schizophrenia? - ANSWER The prodromal phase is the beginning stage of schizophrenia where early symptoms like hallucinations and delusions may occur. What is bipolar disorder? - ANSWER Bipolar disorder involves sudden shifts in emotion from one extreme to another. What is the therapeutic range for lithium? - ANSWER Lithium has a narrow therapeutic window of 1.0 to 1.5 mEq/L and requires close monitoring. What defines a panic attack? - ANSWER A panic attack is an episode of acute, intense anxiety with symptoms like accelerated heart rate and chest pain. What are the two features of obsessive-compulsive disorders? - ANSWER Obsessive-compulsive disorders feature recurrent, intrusive thoughts and ritualistic behaviors performed repeatedly. What is posttraumatic stress disorder (PTSD)? - ANSWER PTSD is a response to an intense traumatic experience beyond the usual range of human experience. What is electroconvulsive therapy (ECT)? - ANSWER ECT involves sending electric currents through the brain to relieve severe symptoms of mental health problems. What is the duty to warn in mental health care? - ANSWER The duty to warn is the provider's responsibility to inform an identified third party of a potential serious threat to their health. What are warning signs of suicide? - ANSWER Warning signs include talking about suicide, decreased social interactions, substance abuse, difficulty concentrating, and personality changes. What are monoamine oxidase inhibitors (MAOIs) used for? - ANSWER MAOIs are used to treat depression and other nervous system disorders but have many food and drug interactions. What is a hypertensive crisis? - ANSWER A hypertensive crisis is a major potential complication of MAOIs, with symptoms including severe headache and elevated blood pressure. What is informed consent in healthcare? - ANSWER Informed consent involves explaining the procedure, alternatives, and consequences, with the nurse signing as a witness. What is the DRG program? - ANSWER The DRG program is a government- mandated system that determines Medicare reimbursement based on medical condition classifications. What does geriatrics study? - ANSWER Geriatrics studies the biological, psychological, physiological, and sociological aspects of aging. What are the Healthy People 2020 goals for young adults? - ANSWER Goals include maintaining physical activity, nutrition, family planning, and reducing tobacco and alcohol use. What health goals does Healthy People 2020 set for older adults? - ANSWER Goals include preventing vaccine-preventable illnesses, reducing hip fractures, promoting healthy lifestyles, and early diagnosis of dementia. What are some signs of Intimate Partner Violence (IPV)? - ANSWER Erratic prenatal care, history of substance abuse, abuse as a child, minor battering incidents, evidence of bruises and lacerations, and the victim accepting blame for marital problems. What symptoms often accompany menopause? - ANSWER Hot flashes and palpitations. What medication is associated with an increased risk of fractures in older adults? - ANSWER Proton pump inhibitor omeprazole (Prilosec). How does reduced estrogen affect post-menopausal women? - ANSWER It decreases bone density, increasing the risk for osteoporosis. What is the recommended screening for middle-aged men regarding cancer? - ANSWER Annual screening for prostate cancer. What does the term 'climacteric' refer to? - ANSWER A period when reproductive ability slows and ceases in females, and libido decreases in males. What is generativity in middle adulthood? - ANSWER The concept of contributing positively to community and family through personal achievements. Who should receive cardiovascular screening? - ANSWER Persons who smoke daily, have hypertension, or high lipid levels. What is a major developmental task of old age? - ANSWER Adjustment to retirement. Define middle adulthood. - ANSWER The life period between the ages of 40 and 60 years. What is essential for successful teaching of middle-aged adults? - ANSWER Understanding their concerns and incorporating their independence and competencies. How can excessive exercise affect middle-aged men? - ANSWER It may decrease testosterone levels. What happens to body composition with aging? - ANSWER Lean body mass and total body water decrease, while total fat content increases. What are essential Activities of Daily Living (ADLs) for the elderly? - ANSWER Managing eating, toileting, bathing, grooming, cooking, shopping, and taking medications. What is one role of healthcare workers at the time of death? - ANSWER To provide support to grieving families and allow privacy with the deceased. What is the senescence stage? - ANSWER The end-of-life cycle. What does the dying person's bill of rights state? - ANSWER The right to die in comfort, peace, and dignity. What nursing interventions are recommended for the dying? - ANSWER Administering analgesics, particularly opioids, around the clock for pain management. What is psychological death? - ANSWER The phenomenon that begins when a person is informed of their terminal illness. What are signs of impending death? - ANSWER Weakness, weight loss, decreased appetite, sweating, altered breathing, and mottled, cold extremities. What is palliative care? - ANSWER Total care for patients whose disorder does not respond to curative therapy, focusing on comfort measures. What cultural practice is associated with the Jewish religion regarding death? - ANSWER The body must be buried within 24 hours of death and not left alone. What is denial in the context of terminal illness? - ANSWER A common adaptive response that allows individuals to function through the grief process. What does the durable power of attorney for health care do? - ANSWER Names a person to make medical decisions for a patient unable to do so. How does aging affect drug absorption? - ANSWER Older adults have reduced acid production, affecting the absorption of drugs that require an acidic medium. What is the focus of person-centered care for individuals with neurocognitive disorders? - ANSWER To guide health promotion strategies in the older adult population. What are the 3 Ds of cognitive impairment? - ANSWER Depression, delirium, and mild and major neurocognitive disorders (dementia). How does delirium differ from dementia? - ANSWER Delirium has an acute or subacute onset with symptoms developing over a short period, while dementia has a gradual onset and a slow, steady decline. What are the predisposing factors for delirium? - ANSWER Underlying cognitive impairment, functional impairment, depression, acute illness, and sensory impairment. What percentage of older patients have delirium present upon hospital admission? - ANSWER 10%-31%. What is the highest incidence of delirium found? - ANSWER In intensive care units and subacute settings. How much more likely are older patients with neurocognitive disorders to develop delirium? - ANSWER Three to five times more likely. What is the significance of recognizing delirium in older adults? - ANSWER Delirium is a medical emergency and failure to recognize it can lead to negative outcomes. What are common precipitating factors for delirium? - ANSWER Older age, cognitive impairment, severe illness, current hip fracture, presence of infection, and polypharmacy. What are the clinical subtypes of delirium? - ANSWER Hyperactive, hypoactive, and mixed. What are the consequences of delirium? - ANSWER Increased length of hospital stay, readmissions, morbidity, mortality, and institutionalization. What tools are used for cognitive assessment in older adults? - ANSWER MoCA (Montreal Cognitive Assessment) and Confusion Assessment Method (CAM). What is the primary goal in caring for older adults with dementia? - ANSWER To maintain stability and function while compensating for losses associated with the disease. What communication strategies are important when interacting with individuals experiencing neurocognitive disorders? - ANSWER Adapt approaches based on the person's ability to understand and the purpose of the interaction. What is the need-driven dementia-compromised behavior (NDDB) model? - ANSWER A model that emphasizes understanding the unmet needs of individuals with dementia to address their behavior. What is the role of nonpharmacological interventions in managing behavioral symptoms of dementia? - ANSWER They should be prioritized over pharmacological treatments and integrated with medical care. What challenges do caregivers face when providing activities of daily living (ADLs) for individuals with dementia? - ANSWER Bathing and other personal care tasks can be perceived as personal attacks, causing distress for both the person and caregiver. What is the importance of ongoing assessment in younger-onset dementia? - ANSWER Younger individuals may have different needs that are not addressed by services designed for older adults. What is anomia, and how does it relate to neurocognitive disorders? - ANSWER Anomia is difficulty in word finding, which is common in the early stages of dementia. What should be the focus of communication with individuals experiencing cognitive decline? - ANSWER To believe that the person is trying to communicate something important. What is the significance of the Beers' Criteria in delirium prevention? - ANSWER It lists medications that may contribute to delirium and helps identify high-risk patients. What is the role of the Hospital Elder Life Program? - ANSWER To implement nonpharmacological interventions to prevent delirium in hospitalized older adults. What is the impact of delirium superimposed on dementia? - ANSWER It can accelerate cognitive decline and is associated with higher mortality. Why is it essential to identify high-risk patients for delirium? - ANSWER Early identification allows for timely interventions that can prevent negative outcomes. What is the significance of understanding triggers for behavior in individuals with dementia? - ANSWER It is essential for developing interventions that address the individual's unmet needs. What are some examples of behavioral and environmental modification strategies for managing BPSD? - ANSWER Strategies include creating a calm environment and using consistent routines. What is the role of antipsychotics in managing dementia-related behaviors? - ANSWER They are often used as a first-line response despite recommendations for comprehensive assessment and nonpharmacological interventions. What is wandering in the context of dementia? - ANSWER A syndrome of dementia-related locomotion behavior characterized by frequent, repetitive, temporarily disordered, and/or spatially disoriented patterns. What are common triggers for wandering behavior in individuals with dementia? - ANSWER Physical problems such as acute illness, exacerbations of chronic illness, fatigue, medication effects, and constipation. What is a major risk for older adults with dementia regarding nutrition? - ANSWER They are particularly at risk for weight loss and inadequate nutrition. What are some complications associated with enteral feeding? - ANSWER Complications can include infection, aspiration, and gastrointestinal issues. What defines chronic illness? - ANSWER A condition that persists regardless of treatment, is of long duration, and usually progresses slowly. What are the most common chronic diseases? - ANSWER Heart disease, stroke, cancer, diabetes, obesity, and osteoarthritis. What lifestyle factors contribute to the development of chronic diseases? - ANSWER Tobacco use, unhealthy diet, physical inactivity, and alcohol abuse. What is the trajectory model in chronic illness management? - ANSWER A model that aids healthcare providers in understanding the realities of chronic illness and its effects on individuals. What are the stages of the trajectory model for chronic illness? - ANSWER Pre- trajectory, trajectory onset, stable, unstable, acute, crisis, comeback, downward, and dying. What is frailty in older adults? - ANSWER A multidimensional syndrome characterized by decreased reserves and diminished resistance to stressors. What cues indicate the frailty phenotype? - ANSWER Unintentional weight loss of 5%, self-report of exhaustion/fatigue, low activity level, low grip strength, and slow gait speed. What is the Frailty Index for Elders (FIFE)? - ANSWER A tool used to assess frailty in older adults. How does frailty affect the chronic illness trajectory? - ANSWER The frailer an individual is, the faster they proceed along the trajectory, with less likelihood of moving back toward stability and greater risk for death during instability. What is the significance of caregiver singing and background music during ADL care? - ANSWER It is an innovative approach to enhance the quality of care for individuals with dementia. What are some interventions for managing wandering behavior in dementia patients? - ANSWER Careful assessment of triggers and creating safe environments to prevent individuals from getting lost. What percentage of older adults globally experience depression? - ANSWER 5%-7% What are the most prevalent mental health problems in later life? - ANSWER Anxiety, severe cognitive impairment, and mood disorders What is a growing concern regarding substance use in older adults? - ANSWER Alcohol abuse and dependence What factors can predict well-being in late life? - ANSWER Cognitive and affective functioning earlier in life What is the role of social relationships in stress management for older adults? - ANSWER Social relationships and social support are crucial for stress management and coping. What internal state accompanies threats to self in older adults? - ANSWER The experience of stress What factors influence the ability to manage stress in older adults? - ANSWER Cognitive style, coping strategies, social resources, personal efficacy, and personality characteristics What is the significance of the psychosocial assessment in older adults? - ANSWER It distinguishes among normal aging characteristics and pathological conditions. What are some important nursing interventions to enhance coping ability in older adults? - ANSWER Enhancing functional status, promoting a sense of control, fostering social supports, and connecting to resources. What is the prevalence of anxiety disorders among adults aged 65 and over? - ANSWER 17% What are some consequences of anxiety in older adults? - ANSWER Increased hospitalizations, decreased physical activity, sleep disturbances, and decreased life satisfaction. What is the relationship between late-life anxiety and other mental health conditions? - ANSWER Late-life anxiety is often comorbid with major depressive disorder, cognitive decline, and substance abuse. What reasons contribute to older adults' reluctance to seek mental health help? - ANSWER Pride of independence, stoic acceptance of difficulty, unawareness of resources, and lack of geriatric mental health professionals. What is geropsychiatric nursing? - ANSWER A master's level subspecialty within adult-psychiatric mental health nursing focused on older adults. How does culture influence the perception of mental health? - ANSWER What may be defined as mental illness in one culture may be viewed as normal in another. What is the role of the DSM-5 regarding culture and mental health? - ANSWER It emphasizes cultural variations in psychopathology and includes components for cultural assessment. What challenges do nursing homes face in providing mental health care? - ANSWER Shortage of trained personnel, limited access to psychiatric services, and inadequate reimbursement. What is the importance of integrating mental health with other health services for older adults? - ANSWER It is critical for addressing the comprehensive needs of older adults with mental health and substance abuse issues. What is the impact of stress overload in older adults? - ANSWER It can result from the narrowing range of bio-psychosocial homeostatic resilience and changing environmental needs. What are mind-body therapies that can enhance coping ability? - ANSWER Meditation, yoga, mindfulness, exercise, spirituality, and religiosity. What is the significance of obtaining assessment data from elders? - ANSWER It is best done during short sessions after establishing rapport. What is the relationship between anxiety disorders and physical illnesses in older adults? - ANSWER The prevalence of anxiety disorders is higher among individuals with physical illnesses. What are the common symptoms of anxiety disorders in older adults? - ANSWER Unpleasant feelings of apprehension, which may include physical symptoms. What is the role of nurses in managing anxiety in older adults? - ANSWER Nurses can identify anxiety-related symptoms and initiate assessments for appropriate treatment. What is a common side effect of drugs in older adults? - ANSWER Anxiety What are the first-line pharmacological treatments for anxiety? - ANSWER Selective serotonin reuptake inhibitors What are the second-line pharmacological treatments for anxiety? - ANSWER Short-acting benzodiazepines What nonpharmacological therapies are recommended for anxiety? - ANSWER Cognitive behavioral therapy, exposure therapy, interpersonal therapy What is PTSD classified as in the DSM-5? - ANSWER A Trauma- and Stressor-Related Disorder What are some common causes of PTSD? - ANSWER Combat, terrorist attacks, natural disasters, serious accidents, assault/abuse, major emotional losses What are the four major symptom clusters of PTSD according to DSM-5? - ANSWER Reexperiencing, avoidance, persistent negative alterations in cognition and mood, alterations in arousal and reactivity What is the prevalence of PTSD among war veterans? - ANSWER High prevalence What is the relationship between PTSD and depression? - ANSWER Depression is present in half of individuals with PTSD What assessment tool is recommended for PTSD? - ANSWER Impact of Event Scale-Revised (IES-R) What is the prevalence of schizophrenia in older adults? - ANSWER Older adults are the fastest growing segment of the schizophrenic population What are the positive symptoms of schizophrenia? - ANSWER Delusions, hallucinations, disorganized speech, disorganized behavior What are the negative symptoms of schizophrenia? - ANSWER Flat or blunted affect, anhedonia, avolition What is the life expectancy of individuals with schizophrenia compared to unaffected individuals? - ANSWER 15 years shorter What is the DSM-5 definition of Bipolar Disorder? - ANSWER A recurrent mood disorder that includes periods of mania and/or hypomania or major depression What percentage of older adults with Bipolar Disorder experience their first episode after age 50? - ANSWER 20% What are common interventions for Bipolar Disorder? - ANSWER Pharmacotherapy, intensive psychotherapy, cognitive behavior therapy, family- focused therapy What is the misconception about depression in older adults? - ANSWER That it is a normal part of aging What are the consequences of untreated depression in older adults? - ANSWER Delayed recovery, cognitive impairment, exacerbation of medical illnesses, decreased quality of life What is the projected prevalence of depression in older adults by 2050? - ANSWER Likely to double What factors contribute to the underdiagnosis of depression in older adults? - ANSWER Stigma, expectations of health professionals, and societal beliefs What are the common symptoms of PTSD in older adults? - ANSWER Dreams, agitation, fear of loud noises What should be considered when assessing older adults with PTSD? - ANSWER Past history and life experiences What are the key components of treatment for schizophrenia? - ANSWER Pharmacological and nonpharmacological interventions What is a significant risk factor for developing PTSD in older adults? - ANSWER History of rape or abuse as a child What is the importance of understanding a patient's past history in treating PTSD? - ANSWER It helps in understanding behavior and implementing appropriate interventions What are the cognitive symptoms of schizophrenia? - ANSWER Poor executive functioning and limited attention span What is the role of cognitive behavioral therapy in treating PTSD? - ANSWER It helps in understanding and managing symptoms What is the impact of depression on health care utilization in older adults? - ANSWER Increased health care utilization What framework should be used to examine the causes of depression? - ANSWER A bio-psychosocial framework. What factors contribute to the development of depression in later life? - ANSWER Health, gender, developmental needs, socioeconomics, environment, personality, losses, and functional decline. What is strongly associated with many depressive disorders? - ANSWER Neurotransmitter imbalances. What common symptoms do older adults report when depressed? - ANSWER Somatic complaints such as insomnia, loss of appetite, weight loss, memory loss, and chronic pain. What should be incorporated into routine health assessments for older adults? - ANSWER Screening for depression. What are the goals of depression treatment in older adults? - ANSWER Decrease symptoms, reduce relapse and recurrence, improve function and quality of life, and reduce mortality and healthcare costs. What are some nonpharmacological interventions for depression? - ANSWER Exercise and integrated care. What pharmacological treatments are available for depression? - ANSWER Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). What demographic has a high suicide rate among older adults? - ANSWER White males aged 85 years and older. What factors contribute to suicide risk in older adults? - ANSWER Depression, anxiety, economic downturn, and substance use. What assessment tool is used for suicide risk? - ANSWER The Columbia- Suicide Severity Rating Scale (C-SSRS). What should be done if a positive response is obtained during suicide assessment? - ANSWER Have a suicide protocol in place and do not leave the person alone until help arrives. What is the trend in substance use disorders among older adults? - ANSWER It is a growing public health concern. What percentage of adults aged 54-64 report alcohol use disorders? - ANSWER 11%. What is the most prevalent psychiatric disorder among older men? - ANSWER Alcoholism. What are common consequences of alcohol use disorder in older adults? - ANSWER Cirrhosis of the liver, cancer, immune disorders, cardiomyopathy, cerebral atrophy, dementia, and delirium. What reasons contribute to the low rate of alcohol detection in older adults? - ANSWER Poor symptom recognition, inadequate knowledge about screening instruments, lack of age-appropriate diagnostic criteria, and ageism. What is a recommended assessment tool for alcohol use disorder? - ANSWER Short Michigan Alcoholism Screening Test. What are some treatment strategies for alcohol use disorder? - ANSWER Cognitive-behavioral approaches, counseling, Alcoholics Anonymous, family therapy, and community home care services. What is a life-threatening emergency related to alcohol use? - ANSWER Acute alcohol withdrawal. What screening instrument is recommended for assessing alcohol withdrawal? - ANSWER Clinical Institute Withdrawal Assessment scale. What are some concerns regarding substance use among older adults? - ANSWER Cannabis use, opioid drug use, and prescription drug misuse. What toolkit addresses prescription drug misuse and abuse? - ANSWER STAMP Out Prescription Drug Misuse and Abuse Toolkit. What is informed consent? - ANSWER A process that documents or expresses self-determination, usually implied when a person accepts or cooperates with care. What is required for informed consent to be possible? - ANSWER The assumption that adults have decision-making capacity. What is the difference between legally determined incapacity and day-to-day decision-making? - ANSWER Legally determined incapacity refers to a formal legal status, while day-to-day decision-making involves an individual's ability to make choices in everyday situations. What is a power of attorney? - ANSWER A legal document that appoints someone to act on behalf of another person in specified ways. What is a health care proxy? - ANSWER Authority granted to act on a person's behalf when they have lost the capacity to make decisions and have not documented their wishes. Who are guardians and conservators? - ANSWER Individuals, agencies, or corporations appointed to care for and control an incapacitated person, ensuring their needs are met. What is neglect in the context of caregiving? - ANSWER Failure of action by a caregiver or through one's own behavior choices. What is self-neglect? - ANSWER When individuals fail to meet their own basic needs in a manner that the average person would in similar circumstances. What is required for mistreatment of older adults to occur? - ANSWER A trusting relationship must exist between the perpetrator and the vulnerable elder. What are some risk factors for becoming an abuser or being abused? - ANSWER Risk factors are often interconnected and can include social, economic, and psychological elements. What are the types of abuse of older adults? - ANSWER Physical abuse, psychological abuse, medical abuse, financial abuse, confinement, and sexual abuse. What is undue influence? - ANSWER A means of financial or material exploitation, often involving isolation of the victim from family and friends. What are some signs of undue influence? - ANSWER False affection or marriage offered to a lonely person for the purpose of defrauding them of assets. What impact can abuse have on older adults? - ANSWER It can lead to posttraumatic syndrome, lowered self-efficacy, and a significantly higher risk of death. What health problems are associated with violence against older adults? - ANSWER Bone or joint problems, digestive problems, depression or anxiety, chronic pain, hypertension, and cardiovascular disease. What is the nurse's responsibility regarding decision-making capacity? - ANSWER To assess potential incapacity and ensure safety and security for those under their care. What should nurses do if they suspect abuse? - ANSWER Report suspicions to the authorities as mandatory reporters. What role do ombudsmen play in elder care? - ANSWER They act as advocates for vulnerable residents in institutions, either as volunteers or paid staff. How can gerontological nurses prevent abuse? - ANSWER By being alert to potential mistreatment and familiarizing themselves with relevant laws affecting older adults. What is the role of an advocate in nursing? - ANSWER To maintain or promote a cause, defend, plead, or act on behalf of another, especially those who cannot advocate for themselves. In what arenas do nurse advocates function? - ANSWER Within their own discipline, with other agencies, physicians, families, and community representatives. What are universal events of the human experience? - ANSWER Loss, dying, and death What can trigger grief and mourning? - ANSWER Loss of any kind How are the terms grief, mourning, and bereavement often used? - ANSWER Interchangeably What is the Loss Response Model? - ANSWER A model used to improve understanding of grieving and assist nurses in caring for those experiencing loss In the Loss Response Model, how are grievers viewed? - ANSWER As part of a system striving to maintain equilibrium or stability What are the types of grief? - ANSWER Anticipatory grief, acute grief, shadow grief, complicated grief, disenfranchised grief What factors affect coping with loss? - ANSWER Physical, emotional, and social factors What is the goal of grief assessment? - ANSWER To differentiate those who are likely to cope effectively from those who are less likely What is the role of palliative care? - ANSWER To improve the quality of life for patients and families facing life-threatening illness What does palliative care focus on? - ANSWER Prevention, assessment, and treatment of pain and other physical, psychological, and spiritual problems What is hospice care? - ANSWER Care provided to support individuals with a prognosis of 6 months or less to live What are the 6 C's approach in promoting a good death? - ANSWER Care, Control, Composure, Communication, Continuity, Closure What does the spiritual dimension of dying involve? - ANSWER The relationship between the dying person and their god or significant others What is the hope of individuals as death approaches? - ANSWER For a good death, one that is symptom-free What is physician-assisted suicide? - ANSWER A legal confirmation of a person's right to refuse unwanted treatment What is palliative sedation? - ANSWER Sedation intended to provide comfort without hastening death What is the importance of nursing skills in palliative care? - ANSWER To provide relief of symptoms and support the grieving and dying processes Shift in psychiatric care - ANSWER A shift from custodial care in asylums to treatment-based, medical and social approaches for mental illness. First organized training school - ANSWER Established by Dr. Edward Cowles in 1882 within a hospital for the insane. First nurse-organized psychiatric nursing course - ANSWER Developed by Effie Jane Taylor at Johns Hopkins Hospital in 1913. World War I impact on nursing - ANSWER Led to the inclusion of 'nursing in nervous and mental diseases' in nursing curricula. World War II impact on psychiatric nursing - ANSWER Development of training standards for psychiatric nurses and improved care quality advocated by Laura Fitzsimmons. 1946 National Mental Health Act - ANSWER Recognized psychiatric nursing as one of four core disciplines and expanded funding for psychiatric nursing education. First graduate program in psychiatric nursing - ANSWER Founded by Hildegarde Peplau at Rutgers University in 1954. Community Mental Health Centers Act - ANSWER 1963 law that expanded the psychiatric nursing role into community care. Nurse practitioner role introduction - ANSWER Introduced in 1965 by Loretta Ford, RN, and Henry Silver, MD. ANA Standards of Psychiatric-Mental Health Nursing Practice - ANSWER Published in 1973. Prescriptive authority for APRNs - ANSWER Began to be granted in the 1980s. PMHNP certification exams unification - ANSWER Unified into one across- the-lifespan exam in 2015. Current focus of psychiatric nursing practice - ANSWER Integrated, person- centered care addressing co-occurring medical, psychiatric, and substance use disorders. PMHNP model of care - ANSWER The biopsychosocial, person-centered model. 3 Ps in PMHNP education - ANSWER Advanced Pathophysiology, Pharmacology, and Health Assessment. Fourth P in PMHNP education - ANSWER Psychotherapy. Certification exam criteria for PMHNPs - ANSWER Set by the American Nurses Credentialing Center (ANCC). Consensus Model for APRN Regulation - ANSWER Defines Standards for Licensure, Accreditation, Certification, and Education (LACE). PMHNP clinical roles - ANSWER Psychotherapy, psychopharmacological management, and case management. Assertive Community Treatment (ACT) - ANSWER A team-based model providing 24/7 community-based treatment for clients with severe mental illness. Residential services in PMHNP care - ANSWER Provides 24-hour housing and training for ADLs. Partial hospitalization or intensive outpatient treatment (IOP) - ANSWER Setting that provides intensive treatment for clients not needing 24-hour care. Short-term stabilization - ANSWER For clients at risk of harm to self or others. Forensic mental health nursing - ANSWER Providing psychiatric services within the criminal justice system to victims or offenders. Disaster psychiatric-mental health nursing - ANSWER Providing psychological first aid and crisis care during disasters. Integrative psychiatric programs - ANSWER To coordinate care between primary and behavioral health providers. Telehealth - ANSWER To provide therapy and medication management through secure telecommunications. Psychiatric consultation-liaison nursing (PCLN) - ANSWER Providing psychiatric expertise to patients with co-occurring physical illnesses in medical settings. ANA Code of Ethics for Nurses - ANSWER Contains nine provisions. First three provisions of ANA Code - ANSWER Focus on fundamental values and commitments. Last three provisions of ANA Code - ANSWER Focus on collaboration and duties to the profession and society. Respect for the Individual - ANSWER Affirming the dignity and worth of all persons and combating mental health stigma. Commitment to the healthcare consumer - ANSWER Involves balancing human rights with safety. Advocacy for the healthcare consumer - ANSWER Prohibits sexual or intimate relationships with clients or their family members. Responsibility and accountability for practice - ANSWER Prevents delegating tasks outside another's scope of practice. Duties to self and others - ANSWER Emphasizes PMHNP self-care and stress management. Contributions to healthcare environments - ANSWER Requires reporting impaired colleagues. Advancement of the nursing profession - ANSWER Giving a professional presentation on evidence-based care demonstrates this principle. Collaboration to meet health needs - ANSWER Membership in NAMI and ANA workgroups supports this ethical principle. Promotion of the nursing profession - ANSWER Speaking at a school board meeting to advocate for youth mental health demonstrates this ethical principle. Psychotherapy - ANSWER A PMHNP provides mindfulness training to a client with depression. Pharmacologic intervention - ANSWER A client starts on an SSRI for depression. Crisis intervention - ANSWER A suicidal client is admitted under involuntary status. Partial hospitalization/intensive outpatient treatment - ANSWER A client receives 4 hours of therapy per day at a community center. Case management - ANSWER A PMHNP coordinates a team for a client's mental health plan. Self-employment - ANSWER A PMHNP runs her own private clinic. What does the phrase 'Nurses don't just add years to life, they add life to years' imply? - ANSWER The role of nurses in enhancing the quality of life for patients Which observation of Mrs. M's condition would cause the nurse to suspect acute delirium? - ANSWER Mrs. M's disorganized speech Disorganized, tangential speech, as a change from baseline, is a finding associated with acute delirium in the setting of a clinical infection such as a urinary tract infection (UTI). Finding Mrs. M's purse in the oven Acute confusion, disorientation, and sudden change from routine behaviors are findings that would cause the nurse to suspect acute delirium in the setting of a clinical infection such as a UTI. Mrs. M calling Elsa by her daughter's name Acute onset confusion, as a change from baseline, is associated with acute delirium in the presence of clinical signs of infection. Which statement, if made by a nursing student, indicates that additional learning regarding aging is needed? - ANSWER Adults over 65 years tend to be financially stable. Many older adults continue to work well past retirement age due to financial instability; lack of savings; and increased cost of living, including spending for health care, especially prescription medications. A nurse educating staff at an adult day care facility would discuss which conditions as placing an older adult at increased risk for suicide? - ANSWER Alcohol misuse Alcohol misuse is a risk factor for suicide in older adults because alcohol may be used to "self-medicate" to blunt feelings of loneliness or hopelessness. Having a physical disability A physical disability, such as paraplegia, is a risk factor for suicide in older adults. The older adult may not be able to overcome the loss of power and independence caused by the disability. Living with chronic pain Chronic and/or uncontrollable pain is a risk factor for suicide in older adults. The change in health status, loss of power, and sense of hopelessness make death more attractive than life for some in this situation. Which conditions would the nurse be concerned about in an older adult patient who reports consuming four to five alcohol drinks every evening? - ANSWER Dementia The older adult with excessive, prolonged alcohol use can develop alcohol-related diseases including alcoholic dementia, in which the chronic exposure to alcohol causes brain damage and results in symptoms similar to those seen with neurocognitive dementia. Physical injury The older adult who misuses alcohol is at high risk for falls related to intoxication, and/or drug-alcohol interactions. Nutritional imbalance The older adult who misuses alcohol is at high risk for nutritional imbalances because the alcohol decreases the absorption of important nutrients and contains empty calories. The nurse is collecting an admission history from an older adult patient who was brought to the health care provider's office by their child, who is concerned that their parent may be depressed following the recent death of their spouse. Which assessment strategies would the nurse use to obtain an accurate history? - ANSWER Allow the patient's child to add supplemental information. Including family in the interview allows for clarification of information and additional data and provides support to the older adult patient. Go at a pace that allows the patient time to answer questions. Pacing the interview questions in a way that is comfortable for the patient allows time to formulate answers. The nurse would also avoid interrupting the patient or answering for them. Ask the patient "Can you tell me how you have been doing recently?" Open-ended questions that allow the patient to use their own words provide the most information, while also giving the nurse an opportunity to assess affect, mood, behavior, and quality of speech. Which physical assessment finding would alert the nurse to further assess the cognitive status of an older adult patient seen in the emergency department following a fall at home? - ANSWER Cyanotic nail beds Cyanotic nail beds are a sign of hypoperfusion and decreased oxygenation. Lack of blood and oxygen may be affecting the patient's cognitive status and may have contributed to the fall. Further assessment is warranted. When teaching nursing students about the Patient Self-Determination Act of 1990, which responsibilities of the health care institution would the instructor include in the discussion? - ANSWER Provide consistent, safe, equitable care to all patients. Health care institutions cannot provide differing levels of care or discriminate in any way based on whether a patient has an advance directive. Include documentation in the medical record regarding a patient's existing advance directives. Documentation of any existing advance directives must be included in the patient's medical record. Maintain policies pertaining to provision