The nurse finds that an older adult patient has reduced consciousness and fatigue, and imagines something that does not exist. Which condition does the nurse suspect in the patient?
a. Delirium
b. Dementia
c. Depression
d. Alzheimer's disease
a. Delirium
Delirium is an acute confusion state in which the patient has reduced or disturbed consciousness, is lethargic, and has distorted perceptions accompanied by delusions, hallucinations, and misperceptions. Dementia is a generalized impairment of intellectual functioning that interferes with social and occupational functioning. Older adults sometimes experience late-life depression; this is the most common undetected and untreated impairment. Alzheimer's disease is a progressive cerebral deterioration that can occur in middle or older age.
Which therapy does the nurse suggest to help older adults recall their past to resolve current conflicts?
a. Reminiscence
b. Validation therapy
c. Reality orientation
d. Therapeutic communication
a. Reminiscence
Reminiscence as a therapy uses the recollection of the past to understand and resolve current conflicts. It is a way to express personal identity and be optimistic. Validation therapy is an alternative approach to treat older adults who are confused about the present situation. Reality orientation is a communication technique that helps older adults restore a sense of reality and improve the level of awareness. Therapeutic communication skills enable the nurse to perceive and respect the older adult's uniqueness and health care expectations.
When an older adult suffers a major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis, for what should the nurse be alert?
a. Dementia
b. Delirium
c. Depression
d. Stroke
c. Depression
The onset of depression could be abrupt or gradual, but the usual cause is a major life-altering event in the life of the person experiencing the depression. Delirium is rapid onset and usually has a physiological cause; dementia's onset is slow; and a stroke presents with neurological changes.
The nurse is caring for an 80-year-old man who recently lost his wife. He states that he has been drinking more than he ever did in the past and feels hopeless without his wife. He reports that he rarely sees his children and feels isolated and alone. Which is the greatest risk for this patient?
a. Dementia
b. Liver failure
c. Dehydration
d. Suicide
d. Suicide
The patient is sharing that he is depressed. Key concepts include recent loss of his wife, excessive drinking, hopelessness, and isolation, making him at risk for suicide. Dementia presents with memory problems; liver failure would occur after significant liver damage; dehydration would occur from poor fluid intake.
A nurse is teaching an older patient about proper medication use. Which statement made by the patient indicates the need for further teaching?
a. "I will seek out low-cost generic drugs."
b. "I will consult a pharmacist before taking multiple medications."
c. "I will continue my treatment by consulting a single physician."
d. "I will use over-the-counter medicines along with prescribed drugs."
d. "I will use over-the-counter medicines along with prescribed drugs."
Using over-the-counter medicines along with prescription drugs may result in drug-drug interactions, which may cause the patient to experience severe adverse effects. Low-cost generic drugs can be used as these have similar potency and would not cause adverse effects because composition is not altered. Consulting a pharmacist before taking multiple medications will reduce the risk of polypharmacy. Consulting a single physician will reduce the risk of polypharmacy because the physician would check for drug interactions and prescribe the drug accordingly.
Test-Taking Tip: Safe medication use is a challenge for older adults. Look for the option which indicates harm to an older adult.
The nurse is explaining the instrumental activities of daily living (IADL) to an older patient who is preparing to be discharged from the medical-surgical unit following minor surgery. Which activities may be included in the list? Select all that apply.
a. Taking a bath
b. Dressing
c. Cooking meals
d. Shopping
e. Writing checks
f. Making phone calls
c. Cooking
meals
d. Shopping
e. Writing checks
f. Making phone calls
The functional status in older patients refers to the capacity and safe performance of daily activities that are categorized as activities for daily living (ADL) and instrumental activities of daily living (IADLs). IADLs include activities such as cooking meals, shopping, writing checks, and making phone calls. Basic activities such as taking a bath and dressing are considered ADLs.
Which are considered risk factors for falls in older adults? Select all that apply.
a. Osteoporosis
b. Airway blockages
c. Impaired hearing
d. Alterations in bladder function
e. Cognitive impairment
f. Peripheral neuropathy
a. Osteoporosis
d. Alterations in bladder function
e. Cognitive impairment
f. Peripheral neuropathy
Older adults who are inactive have low bone and muscle mass or muscle tone and are at higher risk for osteoporosis, which can cause falls. Older adults with altered bladder function, such as urinary incontinence and nocturia, are at increased risk for falls. Conditions affecting mobility, such as arthritis and peripheral neuropathy, may lead to falls. Conditions like cognitive impairment and confusion may cause falls in older adults. Lung injury due to smoking leads to the development of chronic obstructive pulmonary disease (COPD), causing airflow blockage and breathing difficulty; airway blockages are not a significant risk factor for falls. Impaired hearing is commonly experienced by older adults; it is not a significant risk factors for falls.
The nurse is teaching an elderly patient about care management for safe and effective care. Which teaching strategies will likely lead to effective learning in an older adult? Select all that apply.
a. Scheduling the teaching session in the evening
b. Pausing frequently before providing any new information
c. Using the teaching session to provide detailed information
d. Ensuring the presence of a family member during the teaching session
e. Using lay terms while providing medical information to the patient
b. Pausing frequently before providing any new information
d. Ensuring the presence of a family member during the teaching session
e. Using lay terms while providing medical information to the
patient
It is important to pause frequently after presenting new concepts or information because older adults need time to process the new information. The nurse should encourage the older adult to invite a family member or friend to ensure active participation of the older adult in the teaching session. Medical terminology is hard to understand and should be avoided when teaching older patients. It is important to use lay terms because it helps ensure proper understanding of the information by the older adult. The teaching session for an older patient should be scheduled in midmorning because energy levels are more likely to be high. By evening, older adults are often tired and unable to concentrate on the teaching provided to them. It is important to limit the message to a few essential key points and to avoid extraneous information in order to minimize distractions and help the older adult focus during the interaction.
A family member is considering having the mother placed in a nursing center. The nurse has talked with the family before and knows that this is a difficult decision. Which criteria should the nurse recommend in choosing a nursing center? Select all that apply.
a. The center should be clean, and rooms should look like hospital rooms.
b. There should be adequate staffing on all shifts.
c. Social activities should be available for all residents.
d. Three meals should be served daily with a set menu and serving schedule.
e. Family involvement in care planning and assisting with physical care is necessary.
b. There should be adequate staffing on all shifts.
c. Social activities should be available for all residents.
e. Family involvement in care planning and assisting with physical care is necessary.
Adequate staffing, provision of social activities, and active family involvement are essential. Meals should be high quality with options as to what to eat and when meals are served. A nursing center should be clean, but it should look like a person's home.
The nurse is assessing an anxious older adult who has recently started to make mistakes regarding date and time. What is the best approach by the nurse in this situation?
a. Let the patient continue to think in his or her own way.
b. Insist that the patient recognize the correct date and time.
c. Use touch intervention to reduce anxiety in the patient.
d. Inform the patient that this is an outcome of reminiscence.
a. Let the patient continue to think in his or her own way.
The anxious nature of the patient and mistaking the date and time are possible signs of dementia. Therefore, the patient may benefit from validation therapy, which involves letting the older adult continue to think in his or her own way. Older adults with dementia are more likely to become agitated if the nurse insists on correcting them. Use of touch therapy is usually done to provide emotional comfort; it does not address the patient's confusion. Reminiscence is a therapeutic approach that involves recalling the past to resolve present conflicts. Therefore, mistaking the present date and time is not an outcome of reminiscence.