A client has recently been placed in a long-term care facility, because of marked confusion and inability to perform most activities of daily living (ADLs). Which nursing intervention is most appropriate to maintain the client’s self-esteem?
- Leave the client alone in the bathroom to test ability to perform self-care.
- Assign a variety of caregivers to increase potential for socialization.
- Allow client to choose between two different outfits when dressing for the day.
- Modify the daily schedule often to maintain variety and decrease boredom.
Rationale: The most appropriate nursing intervention to maintain this client’s self-esteem is to allow the client to choose between two different outfits when dressing for the day. The nurse should also provide appropriate supervision to keep the client safe, maintain consistency of caregivers, and maintain a structured daily routine to minimize confusion.
A son, who recently brought his extremely confused parent to a nursing home for admission, reports feelings of guilt. Which is the appropriate nursing response?
- “Support groups are held here on Mondays for children of residents in similar situations.”
- “You did what you had to do. I wouldn’t feel guilty if I were you.”
- “Support groups are available to low-income families.”
- “Your parent is doing just fine. We’ll take very good care of him.”
Rationale: The most appropriate response by the nurse is to offer support to the son by presenting available support groups. Caregivers can often experience negative emotions and guilt. Release of these emotions can serve to prevent caregivers from developing psychopathology such a depression.
A family asks why their father is attending activity groups at the long-term care facility. The son states, “My father worked hard all of his life. He just needs some rest at this point.” Which is the appropriate nursing response?
- “I’m glad we discussed this. We’ll excuse him from the activity groups.”
- “The groups benefit your father by providing social interaction, sensory stimulation, and reality orientation.”
- “The groups are optional. Only clients at high functioning levels would benefit.”
- “If your father doesn’t go to these activity groups, he will be at high risk for developing cognitive problems.”
Rationale: The most appropriate nursing response is to educate the family that the purpose of activity groups is to provide social interaction, sensory stimulation, and reality orientation. Groups can also serve to increase self-esteem and reduce depression.
A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred?
- “Reminiscence therapy is a group in which participants create collages representing significant aspects of their lives.”
- “Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution.”
- “Reminiscence therapy is a social group where members chat about past events and future plans.”
- “Reminiscence therapy encourages members to share positive memories of significant life transitions.”
Rationale: Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution. Stimulation of life memories serve to help older clients work through their losses and maintain self-esteem. Reminiscence therapy can take place in one-on-one or group settings.
A couple both reside in a long-term care facility. The husband is admitted to the psychiatric unit after physically abusing his wife. He states, “My wife is having an affair with a young man, and I want it investigated.” Which is the appropriate nursing response?
- “Your wife is not having an affair. What makes you think that?”
- “Why do you think that your wife is having an affair?”
- “Your wife has told us that these thoughts have no basis in fact.”
- “I understand that you are upset. We will talk about it.”
Rationale: The most appropriate response by the nurse is to empathize with the client and encourage the client to talk about the situation. The nurse should remain nonjudgmental and help maintain client’s orientation, memory, and recognition.
A student nurse asks the instructor, “Which psychiatric disorder is most likely initially diagnosed in the elderly?” Which instructor response gives the student accurate information?
- “Schizophrenia is most likely diagnosed later in life.”
- “Major depressive disorder is most likely diagnosed later in life.”
- “Phobic disorder is most likely diagnosed later in life.”
- “Dependent personality disorder is most likely diagnosed later in life.”
Rationale: Major depressive disorder is most likely to be identified later in life. Depression among older adults can be increased by physical illness, functional disability, cognitive impairment, and loss of a spouse.
An older client attending an adult day care program suddenly begins reporting dizziness, weakness, and confusion. What should be the initial nursing intervention?
- Implement complete bedrest.
- Advocate for a complete physical exam.
- Address self-esteem needs.
- Advocate for individual psychotherapy.
Rationale: The initial nursing intervention should be to advocate for a complete physical exam. Sudden onset of dizziness, weakness, and confusion could indicate a problem with the client’s cardiovascular or respiratory symptoms. Physical symptoms should be thoroughly assessed prior to attributing symptoms to psychological causes.
An older client who lives with a caregiver is admitted to an emergency department with a fractured arm. The client is soaked in urine and has dried fecal matter on lower extremities. The client is 6 feet tall and weighs 120 pounds. Which condition should the nurse suspect?
- Inability for the client to meet self-care needs
- Alzheimer’s disease
- Abuse and/or neglect
- Caregiver role strain
Rationale: The nurse should expect that this client is a victim of elder abuse or neglect. Indicators of elder physical abuse include bruises, fractures, burns, and other physical injury. Neglect may be manifested as hunger, poor hygiene, unattended physical problems, or abandonment.
An older, emaciated client is brought to an emergency department by the client’s caregiver. The client has bruises and abrasions on shoulders and back in multiple stages of healing. When directly asked about these symptoms, which type of client response should a nurse anticipate?
- The client will honestly reveal the nature of the injuries.
- The client may deny or minimize the injuries.
- The client may have forgotten what caused the injuries.
- The client will ask to be placed in a nursing home.
Rationale: The nurse should anticipate that the client may deny or minimize the injuries. The older client may be unwilling to disclose information, because of fear of retaliation, embarrassment about the existence of abuse in the family, protectiveness toward a family member, or unwillingness to bring about legal action.
A client in the middle stage of Alzheimer’s disease has difficulty communicating because of cognitive deterioration. Which nursing intervention is appropriate to improve communication?
- Discourage attempts at verbal communication owing to increased client frustration.
- Increase the volume of the nurse’s communication responses.
- Verbalize the nurse’s perception of the implied communication.
- Encourage the client to communicate by writing.
Rationale: The most appropriate nursing intervention is to verbalize the nurse’s perception of the implied communication. The nurse should also keep explanations simple, use face-to-face interaction, and speak slowly without shouting.
An older client is exhibiting symptoms of major depressive disorder. A physician is considering prescribing an antidepressant. Which physiological problem should make a nurse question this medication regime?
- Altered cortical and intellectual functioning
- Altered respiratory and gastrointestinal functioning
- Altered liver and kidney functioning
- Altered endocrine and immune system functioning
Rationale: The nurse should question the use of antidepressant medication in a client with altered liver and kidney function. Antidepressant medication should be administered with consideration for age-related physiological changes in absorption, distribution, elimination, and brain receptor sensitivity. Because of these changes, medications can reach high levels despite moderate oral dosage.
An older client has met the criteria for a diagnosis of major depressive disorder. The client does not respond to antidepressant medications. Which therapeutic intervention should a nurse anticipate will be ordered for this client?
- Electroconvulsive therapy (ECT)
- Neuroleptic therapy
- An antiparkinsonian agent
- An anxiolytic agent
Rationale: The nurse should anticipate that ECT will be ordered to treat this client’s symptoms of depression. ECT remains one of the safest and most effective treatments for major depression in older adults. The response to ECT may be slower in older clients, and the effects may be of limited duration.
A nurse is charting assessment information about a 70-year-old client. According to the U.S. Census Bureau, what term would the nurse use to describe this client?
- The nurse should document using the term older.
- The nurse should document using the term elderly.
- The nurse should document using the term aged.
- The nurse should document using the term very old.
Rationale: The U.S. Census Bureau classifies a 70-year-old individual as elderly. The U.S. Census Bureau has developed a system for classification of older Americans: older: 55–64; elderly: 65–74; aged: 75–84; very old: 85 years and older.
Which individual is most likely to be below the poverty level in the United States?
- A 70-year-old Hispanic woman living alone
- A 72-year-old African American man living alone
- A 68-year-old Asian American woman living with family
- A 75-year-old Latino American man living with family
Rationale: Approximately 3.5 million persons age 65 or older were below the poverty level in 2010. Older women had a higher poverty rate than older men, and older Hispanic women living alone had the highest poverty rate.
According to Reichard, Livson, and Peterson, which classification of the personalities of older men describe passive-dependent individuals who are content to lean on others for support, to disengage, and to let most of life’s activities pass them by?
- “Mature men” personalities
- “Armored men” personalities
- “Self-haters” personalities
- “Rocking chair” personalities
Rationale: In a classic study by Reichard, Livson, and Peterson, the personalities of older men were classified into five major categories according to their patterns of adjustment to aging. “Rocking chair” personalities are found in passive-dependent individuals who are content to lean on others for support, to disengage, and to let most of life’s activities pass them by.
According to Reichard, Livson, and Peterson, a client is classified as an “armored man.” Which personality description led to this classification?
- Rigid and stable, presenting a strong silent front
- Passive-dependent individuals who lean on others for support
- Aggressiveness is common, as is suspicion of others
- Animosity is turned inward on themselves
Rationale: In a classic study by Reichard, Livson, and Peterson, the personalities of older men were classified into five major categories according to their patterns of adjustment to aging. Armored men have well-integrated defense mechanisms, which serve as adequate protection. Rigid and stable, they present a strong silent front and often rely on activity as an expression of their continuing independence.
According to genetic theory, aging is an involuntarily inherited process that operates over time to alter cellular or tissue structures. Which of the following findings support this theory? (Select all that apply.)
- Decreased amounts of adrenocorticotropic hormone, resulting in less-efficient stress response
- The development of collagen
- The development of lipofuscin
- The increased frequency in the occurrence of cancer
- The increased frequency in the occurrence of autoimmune disorders
ANS: 2, 3, 4, 5
Rationale: According to genetic theory, aging is an involuntarily inherited process that operates over time to alter cellular or tissue structures. This theory suggests that life span and longevity changes are predetermined. The development of free radicals, collagen, and lipofuscin in the aging body, and an increased frequency in the occurrence of cancer and autoimmune disorders, provide some evidence for this theory and the proposition that error or mutation occurs at the molecular and cellular level. Decreased amounts of adrenocorticotropic hormone, resulting in less-efficient stress response is part of the normal aging process of the endocrine system.