Chapter 15: Problems of Adulthood

Morrison-Valfre: Foundations of Mental Health Care, 7th Edition

Multiple Choice

1. The nurse is caring for an adult male client who lacks a strong sense of personal identity. With which area of development will this client most likely struggle the most?

a. Social b. Intellectual c. Emotional d. Vocational

ANS: A

If an individual has little or no sense of identity, it is difficult to establish relationships with others. Lack of personal identity will not affect the other areas of development as strongly as it does social development. Vocation is not one of the areas of development; choosing a vocation or career is a core task of young adulthood.

DIF: Cognitive Level: Comprehension REF: p. 171 OBJ: 2

TOP: Adult Growth and Development KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Adulthood b. Adolescence c. Childhood d. Parenting

2. is a major challenge for adults because energies are not concentrated on the self, and the demands can create feelings of anxiety, isolation, inadequacy, and helplessness.

ANS: D

Most of a parent’s energy is focused on the child or children every minute of every day. The responsibility is immense and can cause various emotions, especially if the parent works outside the home. Adulthood, adolescence, and childhood do not have a primary focus on others as parenting does.

DIF: Cognitive Level: Comprehension REF: p. 171 OBJ: 3

TOP: Adult Growth and Development KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Improve his strength in the ability to adapt to new situations. b. Develop the ability to establish and maintain an intimate relationship. c. Discern his feelings about relationship choices and level of commitment. d. Outline his life’s dream.

3. An adult male client is admitted to a mental health facility with the diagnosis of depression following the breakup of a long-term engagement. He states that he couldn’t “commit to marriage.” In conducting his admission assessment, the nurse learns that during his childhood he did not feel guided, nurtured, or accepted by his parents. One of the goals for this client is to help him develop a positive personal identity. Which intervention should the nurse implement to meet this goal?

ANS: C

Discerning his feelings about relationship choices and commitment best meets the needs of this client at this time in his life. Improving his ability to adapt and developing his ability to establish and maintain an intimate relationship are not indicated in the scenario as an issue. Outlining his life’s dream assists in building a positive personal identity but is too broad a task for this client at this time.

DIF: Cognitive Level: Analysis REF: p. 173

TOP: Personal Identity

OBJ: 4

KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity

4. The term “sandwich generation” best describes adults: a. caught between adulthood and late adulthood. b. caring for their children and aging parents. c. caring for their children and grandchildren. d. caught between young adulthood and adulthood.

ANS: B

This generation can be a problem for many adults in that they face multiple responsibilities, resulting in increased levels of stress.

DIF: Cognitive Level: Knowledge REF: p. 173

TOP: Internal (Developmental) Problems

KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

OBJ: 5 a. married couples b. single women c. single men d. relatives

5. An increasing number of are the head of the household of families in the United States.

ANS: B

In single family households, the single parent must function as father, mother, and provider. The joys of children can be overshadowed by the work and stress of providing for them. Without support and intervention, adults in these families have a high potential for developing several mental health problems.

DIF: Cognitive Level: Knowledge REF: p. 174

OBJ: 5

TOP: Guiding the Next Generation KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Assist the client in seeking educational and/or vocational programs for single parents. b. Encourage the client to explore her feelings related to the reasons for her divorce. c. Persuade the client to contact her ex-husband for financial and parental support. d. Share information with the client regarding support groups for single mothers.

6. The nurse is caring for a client who is a single mother of two young children, has no financial or parental support from her ex-husband, is troubled by her financial circumstances and future, and works at a local fast-food restaurant. She is seeking help for depression. What is the nurse’s best action?

ANS: A

Assisting the client in finding programs for single parents helps the client by giving her support as she tries to better her financial situation in a way that will improve her self-esteem, independence, and personal identity and will help her to secure her financial future. Exploring feelings related to the divorce and having the client contact her ex-husband are not going to help her depression at this time. Sharing information about support groups will be helpful in the future but does not meet her immediate need.

DIF: Cognitive Level: Application REF: p. 174 OBJ: 6

TOP: Education KEY: Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity a. “Would you like me to call your family to assist you in deciding what is best for you to do?” b. “I am sure you will make friends once you find a steady job that you like.” c. “Can you tell me what you mean by your statement that you don’t think you can stand being lonely anymore?” d. “Let me give you a list of some social groups that might be of interest to you.”

7. An adult female calls a crisis hotline stating that she moved a few months ago to seek a new job “in a big city.” She is crying and says that she doesn’t think she can stand being so lonely anymore but doesn’t want to move back to her small hometown and face her family and friends as a “failure.” What is the nurse’s first response?

ANS: C

The nurse must first clarify what the client’s statement is referring to so as to eliminate the possibility that the client is thinking of harming herself. Once this is clarified, and if it is not what the client is indicating, a list of social groups might be supplied later in the conversation. Offering to call the client’s family and assuring her that she will make friends are disregarding what the client is telling the nurse she feels. Social isolation is not a healthy state for an individual.

DIF: Cognitive Level: Analysis REF: p. 175 OBJ: 7

TOP: Health Care Interventions KEY: Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity

8. AIDS is a condition that most likely would be seen in: a. the homosexual population. b. sexually promiscuous heterosexuals. c. individuals in a heterosexual monogamous relationship. d. persons who have a chemical dependency on illegal intravenous drugs.

ANS: C

This term stands for acute fear regarding acquired immunodeficiency syndrome (AIDS). It is seen in individuals whose behaviors based on their lifestyle put them at very little risk of contracting HIV/AIDS. Individuals in a heterosexual monogamous relationship most likely would demonstrate AIDS. The other populations are at higher risk for contracting the disease based on the behaviors associated with their lifestyle.

DIF: Cognitive Level: Comprehension REF: p. 175 OBJ: 8

TOP: Acquired Immunodeficiency Syndrome

KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity a. 15 million b. 20 million c. 43 million d. 60 million

9. How many people in the United States have a severe mental illness?

ANS: C

As of 2018, 43.8 million people meet the criteria for severe mental illness.

DIF: Cognitive Level: Knowledge REF: p. 176 OBJ: N/A

TOP: Mental Health Problems of Adults KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. The client sees his goals as less important. b. The client’s family is not supportive. c. The client’s disorder is difficult to treat. d. The client’s medications are being adjusted.

10. When the nursing care plan for a client with a mental health disorder is developed, what is the most likely reason that interventions are ineffective and goals are not met?

ANS: A

Unrealistic goals set the client up for failure. Even the best interventions will not be successful in this circumstance. The nurse must be sure to accurately assess the client’s life situation when working with the client to set realistic goals. The other options must be considered when a care plan is being developed, but if taken into consideration, they do not hinder the outcome as much as the client not seeing importance in his goals. Therapeutic actions will have greater results if goals are as important to the client.

DIF: Cognitive Level: Application REF: p. 176 OBJ: 9

TOP: Health Care Interventions KEY: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity a. Acceptance of self b. Finding a balance between giving and taking c. Making sound decisions d. Learning from past decisions

11. A 42-year-old male client continues to enter into business deals that cause him to lose large amounts of money. He subsequently seeks mental health care for stress-related disorders. Which characteristic of a successful adult is this client lacking?

ANS: D

Making sound decisions and learning from past decisions describe this client’s situation, but learning from past decisions applies the most in that he has made the wrong decision numerous other times in the past. Acceptance of self is not addressed in this scenario, and finding a balance between giving and taking refers to maintaining a balance between caring for others and taking care of oneself.

DIF: Cognitive Level: Synthesis REF: p. 170

OBJ: 3

TOP: Adult Growth and Development KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

12. A 68-year-old woman tells the nurse that since she retired a few months ago, she has been “taking it easy” by sleeping later and staying around the house to rest. She has recently noticed that she is having a little trouble with remembering things. The nurse is aware that intellectual development is continuous and suggests to the client: a. “You might think about volunteering somewhere to keep your mind sharp.” b. “You are probably just tired from all those years at work.” c. “After you have gotten used to being at home, I am sure your memory will improve.” d. “Sometimes we must accept the fact that as we get older, we sometimes become more forgetful.”

ANS: A

To maintain intellectual development, individuals must engage in productive activities at all ages.

DIF: Cognitive Level: Application REF: p. 171

OBJ: 3

TOP: Adult Growth and Development KEY: Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity

13. A 49-year-old woman who has been the owner of a successful large business for several years decides to sell her business and move to a remote island to open a small dress shop. She most likely has made this decision based on her need to: a. avoid becoming stagnant in her life. b. earn more money. c. prevent another company from taking over her business. d. improve her social development.

ANS: A

Making a dramatic change in one’s adult life prevents an individual from becoming dormant in his or her daily life. People who are unhappy tend to develop mental health disorders.

DIF: Cognitive Level: Application REF: p. 172

OBJ: 3

TOP: Adult Growth and Development KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Health-seeking behaviors b. Family processes, readiness for enhanced c. Coping, ineffective d. Hopelessness

14. A 37-year-old client who has been divorced for several years recently lost joint custody of a 10-year-old daughter because of drug and alcohol use, along with nonpayment of child support. The client is referred to the clinic as the result of a court order. When arriving at the clinic, the client has been on a drinking binge for 2 days. What is the most appropriate nursing diagnosis for this client?

ANS: C

This client is using drugs and alcohol as coping mechanisms. It is unlikely that the client is choosing these actions as a health-seeking mechanism. The client is not ready to work on family processes, and there is not enough evidence to suggest hopelessness.

DIF: Cognitive Level: Analysis REF: p. 172 OBJ: 4

TOP: Internal (Developmental) Problems

KEY: Nursing Process Step: Diagnosis MSC: Client Needs: Psychosocial Integrity a. 10 b. 15 c. 18 d. 25

15. % of the adult population in the United States has a mental health disorder.

ANS: C

This percentage refers to diagnosable mental health disorders.

DIF: Cognitive Level: Knowledge REF: p. 176 OBJ: N/A

TOP: Mental Health Problems of Adults KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

16. A newly married couple residing in a large city is expecting the birth of their first child in 3 months. The wife wishes to maintain her career and remain in their apartment. The husband has expressed the desire to relocate to a more suburban setting to raise their child. Their ability to successfully face this challenge depends upon their ability to: a. negotiate a mutually satisfying solution. b. employ appropriate coping mechanisms. c. avoid conflict by dealing with the issue at a later time. d. maintain a firm sense of individuality.

ANS: A

Compromise involves a willingness to negotiate and enter into interactions in which neither person wins or loses. Conflicts are resolved by defining and solving the problem. The focus is kept on the issue. Couples who compromise, communicate openly, listen carefully, and try to understand their partner’s point of view find that their relationship is respected and cherished.

DIF: Cognitive Level: Knowledge REF: p. 172 OBJ: 3

TOP: Adult Growth and Development KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Instruct the client on proper nutrition and educate her regarding the dangers of hypertension. b. Make a referral for the client to a weight loss center. c. Assist the client to plan better coping strategies. d. Assess the family’s daily living needs and consult social work for community resources.

17. An obese woman is seen in the emergency department complaining of headaches. Her blood pressure is 150/92. Also present are her 4-year-old son and 2-year-old daughter. When the nurse offers to call a family member to pick up the children, the woman states that they are living alone in a women’s shelter. What is the most appropriate action for the nurse to take?

ANS: D

It is crucial to learn about the client’s living conditions and work within the reality of their situation. Instruction on nutrition and health practices and development of coping strategies cannot be addressed until basic needs for food, clothing, and shelter are met.

DIF: Cognitive Level: Knowledge REF: p. 174 OBJ: 6

TOP: Health Care Interventions KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

18. The parents of a 21 year old who attended church services on a consistent basis are concerned when their child returns home from college and announces she is converting to another religion. This individual is most likely experiencing: a. a personality disorder. b. the need to challenge a value and belief system. c. instability due to dysfunctional parenting. d. regression to an unresolved developmental task.

ANS: B

Development within the spiritual dimension focuses on defining one’s value system and belief system. Young adults often challenge their current religious practices by changing churches or refusing to attend services. This is not seen as a personality disorder or a result of dysfunctional parenting. This task is expected during this phase of development.

DIF: Cognitive Level: Knowledge REF: p. 172 OBJ: 6

TOP: Adult Growth and Development KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. Which statements describe the adult who has achieved the successful emotional development of adulthood? (Select all that apply.)

a. The adult is able to function effectively in a stressful environment.

b. The adult possesses effective intellectual and abstract problem-solving skills.

c. The adult is able to adapt to growing older.

d. The adult sets realistic personal and professional goals.

ANS: A, C, D

These are characteristics of an individual who has achieved the expected emotional development of adulthood. Possessing effective intellectual and abstract problem-solving skills refers to intellectual development of adulthood.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 3

TOP: Adult Growth and Development KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. His or her significant other b. His or her physician c. His or her children d. His or her coworkers

2. One of the ways in which the social development of adults can be assessed is by observing the individual’s ability to effectively communicate with whom? (Select all that apply.)

ANS: A, C, D

These are people with whom the adult interacts on a daily basis, so effective communication will confirm that one aspect of the social task of adulthood is achieved. It would be unfair to base this on how effectively the client communicates with his or her physician because this interaction does not occur on a daily basis and often occurs during stressful times.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 1

TOP: Adult Growth and Development KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Continue to define identity in terms of role in nuclear family. b. Develop career path and goals. c. Recognize how emotions influence achievement of goals and relationships. d. Maintain personal distance in relationships.

3. Therapeutic interventions are effective in the prevention of mental and emotional disorders and assisting the client to cope. Which of the following interventions assists in providing for a positive personal identity? (Select all that apply.)

ANS: B, C

The individual is assisted to develop a positive personal identity by differentiating self from the nuclear family, developing occupational goals, assessing how emotions influence achievement and relationships, and deciding on relationship choices and level of commitment.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 2

TOP: Therapeutic Interventions for a Positive Personal Identity

KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

Chapter 16: Problems of Late Adulthood

Morrison-Valfre: Foundations of Mental Health Care, 7th Edition

Multiple Choice

1. % of older adults are living at poverty level.

a. 12 b. 18 c. 26 d. 23

ANS: A

This is similar to the economic status of other ages.

DIF: Cognitive Level: Knowledge

TOP: Facts and Myths of Aging

REF: p. 180

OBJ: 1

KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

2. A 55-year-old man is extremely fearful of the effects of growing old. He is experiencing: a. ageism. b. gerontophobia. c. an age phobia. d. elder phobia.

ANS: B

This term also includes refusal to accept the elderly into the mainstream of society. Ageism is stereotyping the elderly as weak, dependent, and nonproductive. Age phobia and elder phobia are not used terms.

DIF: Cognitive Level: Knowledge

REF: p. 180

OBJ: 1

TOP: Facts and Myths of Aging KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

3. Physical signs of aging usually begin in the late 30s. Physical signs of aging begin to slow after one reaches the age of approximately: a. 35. b. 45. c. 65. d. 85.

ANS: D

Signs of aging continue to show themselves until around 85 years. Physical aging is affected by genetics, health care, lifestyle, and attitude.

DIF: Cognitive Level: Knowledge

REF: p. 180

OBJ: N/A

TOP: Physical Health Changes KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Confusion, chronic b. Coping, ineffective c. Self-esteem, risk for situational low d. Grieving, dysfunctional

4. An elderly man has serious vision problems and is no longer allowed to obtain a driver’s license. He has been very independent until this time. Which nursing diagnosis is most appropriate for this situation?

ANS: C

“Self-esteem, risk for situational low” is most appropriate because of his previous independence. The other options are also nursing diagnoses, but the situation does not lend itself to these diagnoses.

DIF: Cognitive Level: Application REF: p. 183

OBJ: 2

TOP: Physical Adaptations KEY: Nursing Process Step: Diagnosis

MSC: Client Needs: Health Promotion and Maintenance a. “Have you been taking your medication as often as you are supposed to?” b. “I don’t understand why your BP is up.” c. “Maybe I should check your BP at another time.” d. “I hope you are taking your medication. Otherwise, I am wasting my time.”

5. The home health nurse is caring for a 79-year-old man with the diagnosis of hypertension who is on a fixed income. He was discharged from the hospital a few weeks ago with his newly prescribed medication to keep his BP under control. His BP measurements have been gradually increasing over the last few visits, with no other changes in status assessed. Which nurse statement would be most appropriate?

ANS: A

Clients on fixed incomes often take less of their medications so they will last longer. None of the other options meets the need of the situation, and saying that the client is wasting the nurse’s time is an inappropriate statement.

DIF: Cognitive Level: Application REF: p. 185

OBJ: 3

TOP: Psychosocial Adaptations KEY: Nursing Process Step: Intervention

MSC: Client Needs: Physiological Integrity a. 2,150,000 b. 3,250,000 c. 1,850,000 d. 1,500,000

6. A 2015 survey estimates the average number of elderly who are abused is .

ANS: A

Today, it is estimated that the average number of elderly who are abused is 2,150,000 (NCEA, 2015).

DIF: Cognitive Level: Knowledge REF: p. 187

TOP: Elder Abuse KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

OBJ: 5 a. Pointing out the colors of the medications for easier identification b. Referring to medications by name and providing written instructions c. Quizzing the client on each medication’s purpose, side effects, and drug interactions d. Encouraging the client to hold all questions until the end of the discussion so the nurse will not have to repeat information

7. Which intervention will be most effective when one is teaching a client about his or her medications and their administration?

ANS: B

Referring to the medications by name and providing written instructions will lead to less confusion. Pointing out colors can be a problem if there is visual impairment; quizzing the client is not necessary; and encouraging the client to hold questions may cause questions to be forgotten.

DIF: Cognitive Level: Application REF: p. 185

OBJ: 8

TOP: Age-Related Interventions KEY: Nursing Process Step: Intervention

MSC: Client Needs: Physiological Integrity

8. The nurse is caring for a 79-year-old client with dementia. The client worked as an obstetrics nurse before retiring. Despite her dementia, she still remembers terms and procedures and basic nursing care interventions from her past career. This is an example of: a. working memory. b. reasoning. c. information processing. d. crystallized intelligence.

ANS: D

Crystallized intelligence is specialized accumulated knowledge, and it is common for individuals to remember this specialized information, even if they experience dementia. Working memory is the random access memory to which one refers. Reasoning is the ability to solve problems and make choices, and information processing is the ability to relate to, store, and retrieve information.

DIF: Cognitive Level: Comprehension REF: p. 181

OBJ: 2

TOP: Mental Health Changes KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

9. An elderly client states that she paid $10,000 to a “nice repairman” for fixing her broken window and fence. This is an example of elder abuse known as: a. violation of rights. b. exploitation. c. psychological abuse. d. neglect.

ANS: B

It is estimated that approximately 10% of the elderly population are victims of this type of abuse.

DIF: Cognitive Level: Comprehension REF: p. 187

OBJ: 5

TOP: Elder Abuse KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

10. The nurse must be aware of physical signs and symptoms of depression because these are often the first, sometimes overlooked, signs of the disorder. Physical signs and symptoms of depression include: a. decreased or slowed memory. b. fatigue. c. changes in appetite. d. abdominal pain.

ANS: D

Abdominal pain, muscle aches, and dry mouth are common physical symptoms of depression in the older adult. Other physical causes of these symptoms must be ruled out, and further assessment of other signs of depression must be noted. Decreased or slowed memory is cognitive; fatigue is emotional; and change in appetite is behavioral

DIF: Cognitive Level: Comprehension REF: p. 188 | Box 16.3

OBJ: 6 TOP: Depression KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Sympathy b. Empathy c. Helping the client write a paragraph about his life d. Contacting old acquaintances for their interpretation of the client’s life

11. The nurse is implementing validation therapy with an elderly male client to assist him in resolving old conflicts and making peace with himself. Which is one of the techniques used?

ANS: B

Empathy and several other interventions constitute validation therapy. The other options are not used in validation therapy.

DIF: Cognitive Level: Knowledge REF: p. 188 | Box 16.4

OBJ: 9 TOP: Depression KEY: Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity

12. It is important for the nurse to be aware that a. 35 b. 55 c. 75 d. 95

% of individuals over 45 years old take prescription medications, over-the-counter medications, or a combination of these medications.

ANS: C

Seventy-five percent of individuals over 45 years old take prescription medications, over-the-counter medications, or a combination of medications. This is important to know when one is planning interventions.

DIF: Cognitive Level: Knowledge REF: p. 185 | Box 16.2

OBJ: 4 TOP: Substance Abuse

KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

13. One of the ways that nursing care of the elderly is ensured is by the enactment and monitoring of: a. DSM-IV-TR standards. b. State boards of health. c. Standards of geriatric nursing practice. d. State nurse practice acts.

ANS: C

Standards of geriatric nursing practice were developed to specifically address the needs of the elderly population.

DIF: Cognitive Level: Knowledge REF: p. 188 OBJ: 7

TOP: Standards of Geriatric Care KEY: Nursing Process Step: Assessment

MSC: Client Needs: Safe and Effective Care Environment a. 83.7 b. 61.3 c. 43.8 d. 56.5

14. It is projected that by 2050, the population of those aged 65 and over will be million.

ANS: A

By “2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012” (U.S. Census Bureau, 2018).

DIF: Cognitive Level: Knowledge REF: p. 179 OBJ: 1

TOP: Overview of Aging KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

15. The visiting nurse is at the home of an 88-year-old woman whose physician is concerned that she is losing weight. While performing an assessment, the nurse discovers that the client’s dentures are ill-fitting and this makes eating painful. The client claimed she informed her daughter of this, but the daughter is too busy to take her to the dentist. The nurse is concerned that this is a possible sign of: a. abuse. b. neglect. c. domestic violence. d. depression.

ANS: B

Neglect is defined as failing to meet basic physical needs. Abuse and domestic violence are evidence of actual physical harm. This situation does not describe depression.

DIF: Cognitive Level: Knowledge REF: p. 187 | Box 16.2

OBJ: 5 TOP: Elder Abuse KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Complete the admission interview with the client’s son. b. Shout at the client so he or she can hear. c. Provide pen and paper and let the client write his answers. d. Allow the client time to respond to the questions regarding health history.

16. The nurse is completing an admission interview with an older adult on a busy medical unit. What action is most appropriate for the nurse to take?

ANS: D

Information processing speed decreases with age, and it may take longer for the client to retrieve the information and respond.

DIF: Cognitive Level: Application REF: p. 181 | Box 16.1

OBJ: 2 TOP: Mental Changes of Aging

KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. “Why would you want to stress yourself at your age?” b. “That may not be possible. As you age, your ability to learn decreases.” c. “Going back to school will keep you engaged and active.” d. “Let’s do a cognitive function test to see if you are eligible.”

17. A 70-year-old woman who was recently widowed expresses a desire to go back to school and finish the degree she started before her children were born. What response is most appropriate?

ANS: C

It is important for older adults to stay active and engaged. Encouraging the woman in her pursuit is an appropriate response. The other options may all discourage the client from remaining engaged in society.

DIF: Cognitive Level: Comprehension REF: p. 182 | Box 16.1

OBJ: 2 TOP: Mental Changes of Aging

KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

18. A 78-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She appears to be confused and combative at times. Her daughter is concerned because her mother was alert and oriented prior to being diagnosed with pneumonia. Her altered mental status is related to: a. the onset of Alzheimer’s disease. b. alteration in oxygenation. c. family neglect. d. dysfunctional coping.

ANS: B

Physical problems can lead to changes in mental status. Early assessment and intervention are key for keeping an older adult’s minor problems from becoming major ones. An alteration in oxygenation can affect a client’s behavior.

DIF: Cognitive Level: Comprehension REF: p. 183 OBJ: 2

TOP: Physical Adaptations KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. Which conditions most commonly place older adults at risk for overdose from medications and severe reactions? (Select all that apply.)

a. Depression b. Higher rate of metabolism c. Interaction with other medications d. Problems with sight and memory

ANS: C, D

Older adults often are taking numerous medications prescribed by several specialists, and sight and memory can cause errors in taking medications. Depression is not a common cause of overdose, and metabolism is usually slower in this age-group.

DIF: Cognitive Level: Comprehension REF: p. 185 OBJ: 4

TOP: Substance Abuse KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Increased anxiety or dependence b. Fatigue c. Feels he or she has no purpose d. Withdraws from people

2. Which emotional signs and symptoms of depression in the elderly must the nurse be aware of and monitor for? (Select all that apply.)

ANS: A, B, C

Increased anxiety or dependence, fatigue, and feelings of purposelessness are emotional signs and symptoms of depression. Withdrawal from people is a behavioral sign of depression.

DIF: Cognitive Level: Application REF: p. 187 OBJ: 6

TOP: Depression KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Speak very loudly and in high-pitched tones. b. Ask clients to repeat your message. c. Break complex tasks into small, pertinent steps. d. Refer to medications by color.

3. To respectfully and effectively provide health teaching to the older adult, which of the following actions should be employed? (Select all that apply.)

ANS: B, C

When teaching older adults, it is important to have them repeat your message back to you to ensure that they understand. It is also helpful to break complex tasks into smaller manageable steps to help the client remember. Speaking loudly and in high-pitched tones will not assist the client in learning. A nurse should refer to medications by name rather than color.

DIF: Cognitive Level: Application

TOP: Age-Related Interventions

MSC: Client Needs: Psychosocial Integrity

REF: p. 189

OBJ: 8

KEY: Nursing Process Step: Assessment

Chapter 17: Cognitive Impairment, Alzheimer’s Disease, and Dementia

Morrison-Valfre: Foundations of Mental Health Care, 7th Edition

Multiple Choice

1. A 75-year-old male client is brought to the clinic by his son. The son states, “Ever since Mom died, Dad hasn’t been the same. At first he just seemed sad, but now he seems to get mixed up about everything.” The nurse is aware that based on the client’s history, the source of confusion is most likely: a. dementia. b. depression from the loss of his wife. c. hypoxia of the brain. d. delirium from medications.

ANS: B

Depression in the elderly population is often a cause of confusion. The son’s description of the behaviors of his father since his wife’s death indicate that he became depressed, which has been followed by confusion. Dementia is a gradual onset of confusion, hypoxia is the result of brain injury, and delirium is sudden. Even though it appears that the confusion is caused by the depression, a thorough examination is warranted to confirm the cause.

DIF: Cognitive Level: Application REF: p. 193 OBJ: 2

TOP: The Five “Ds” of Confusion KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

2. Vascular dementia is more common in individuals living in: a. the United States. b. Japan. c. France. d. Australia.

ANS: B

The incidence of vascular dementia is more common in Japan for unknown reasons. Japanese citizens who move to the United States have been found to have a decreased rate of vascular dementia.

DIF: Cognitive Level: Knowledge REF: p. 195 | Cultural Considerations

OBJ: 5 TOP: Causes of Dementia

KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

3. A newly admitted elderly client seems to become confused and agitated every evening after dinner. This client most likely is suffering from: a. Alzheimer’s disease. b. acute dementia. c. sundown syndrome. d. delirium.

ANS: C

Sundown syndrome typically occurs during the late afternoon, evening, or night when an elderly person is in unfamiliar surroundings. The other three options occur at any time of day, evening, or night. The symptoms often disappear when the client is back in familiar surroundings.

DIF: Cognitive Level: Comprehension REF: p. 195 OBJ: 5

TOP: Symptoms of Dementia KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

4. The elderly spouse of a 74-year-old male client states that she has noticed that her husband “doesn’t remember as well as he used to.” She explains that he has been putting on his coat before his shirt, and that he can never get their checkbook to balance as it did in the past. The client is exhibiting signs and symptoms typical of: a. vascular dementia. b. Alzheimer’s disease. c. acute delirium. d. aging.

ANS: B

The person with Alzheimer’s disease commonly shows deficits in familiar tasks. Vascular dementia and acute delirium relate more to confused states, and dementia symptoms should not be assumed to be part of normal aging.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 6

TOP: Alzheimer’s Disease KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

5. The affective losses of Alzheimer’s disease refer to losses noticed in the individual’s: a. personality. b. thought processes. c. ability to make and carry out plans. d. self-care.

ANS: A

Affective losses result in personality changes in the individual with Alzheimer’s disease. Thought processes and self-care do not relate to the individual’s personality, and the ability to make and carry out plans is referred to as conative loss.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 6

TOP: Symptoms and Course of Alzheimer’s Disease

KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity

6. The average time that a person with Alzheimer’s disease lives after diagnosis is: a. 2 years. b. 8 years. c. 10 years. d. 20 years.

ANS: B

Eight years is the average, with the life span ranging from 2 to 20 years after diagnosis of the disease.

DIF: Cognitive Level: Knowledge REF: p. 197 OBJ: 6

TOP: After the Diagnosis KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Helping the loved one with memory and communication problems b. Providing a stable, routine environment c. Providing complete assistance with physical care d. Adapting to the changing personality and behavior of the loved one

7. For those family members who desire to care at home for loved ones who have been given a diagnosis of Alzheimer’s disease, it is important for the nurse to ensure that the family is aware of which caregiver skills and responsibilities will be necessary. What is one of the responsibilities of the caregiver during the middle stage of the disease?

ANS: D

The middle stage is when personality changes begin to occur. It is difficult for the family to see the loss of their loved one’s personality. Helping with memory and communication problems and providing a stable, routine environment occur in the early stage, and complete assistance with physical care is typically a responsibility of the caregiver during the severe stage.

DIF: Cognitive Level: Comprehension REF: p. 197 OBJ: 6

TOP: Stages of Alzheimer’s Disease KEY: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity a. “There is no cure or treatment for Alzheimer’s disease.” b. “Medications have shown little improvement in symptoms.” c. “Medications for the disease have been found to improve thinking abilities, behavior, and daily functioning in some clients.” d. “Alternative therapies, such as co-enzyme Q-10 and Ginkgo biloba, are more effective than any of the prescription medications used to treat the symptoms.”

8. The nurse is answering questions from a client and his family regarding a recent diagnosis of Alzheimer’s disease. The client asks how effective medication is in treating the disease. What is the nurse’s best response?

ANS: C

The most accurate statement is to say that medications have been found to improve thinking abilities, behavior, and daily functioning in some clients. Although no cure for the disease is known, it is inaccurate to say that there is no treatment. To say that medications have produced little improvement in symptoms is misleading because it sounds as though medications are not effective. Stating that alternative therapies are more effective is inaccurate because these therapies are still under investigation for determination of their effectiveness in treating symptoms of the disease.

DIF: Cognitive Level: Comprehension REF: p. 198

TOP: Interventions With Alzheimer’s Disease

OBJ: 6

KEY: Nursing Process Step: Planning MSC: Client Needs: Physiological Integrity a. Use simple, familiar words, along with short and simple sentences. b. If the client tends to pace a lot, be sure to encourage her to sit during interactions. c. If she doesn’t understand the communication, change key words. d. Use hand gestures when speaking to try to explain what is being said.

9. Which of the following is an effective communication technique that should be included in the teaching plan for the family members of a woman in whom Alzheimer’s disease has been diagnosed recently?

ANS: A

Alzheimer’s affects cognitive ability, so it is best to use words and phrases that do not require a great deal of thought to be understood. Having the client sit when she likes to pace may increase her anxiety and block communication. Repeat key words to assist in understanding; changing the key words may further confuse the client. Hand gestures may further confuse the troubled thought processes.

DIF: Cognitive Level: Application REF: p. 200 | Box 17.6

OBJ: 7 TOP: Interventions With Alzheimer’s Disease

KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity a. “Keep rooms well lit.” b. “Keep the home environment simple and user-friendly for her.” c. “Have clocks and calendars with large letters in several rooms of the house.” d. “Place large signs on doors or entryways that identify the room.”

10. The elderly spouse of a female Alzheimer’s client states that his wife seems to wander aimlessly from room to room looking for things in incorrect places, such as kitchen utensils in the bedroom and laundry detergent in the kitchen. He asks the nurse for suggestions of what he can do to help her. What is the nurse’s best response?

ANS: D

All of these options will assist her in keeping her orientation to the environment, but because she is wandering to the wrong rooms to look for items, signs on the doors and entryways would be most helpful to her as she finds the appropriate room.

DIF: Cognitive Level: Application REF: p. 200 | Box 17.7

OBJ: 7 TOP: Interventions With Alzheimer’s Disease

KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

11. The nurse performs a functional assessment of a client upon admission to a home health service. The purpose of this assessment is to determine the client’s: a. level of consciousness. b. ability to perform activities of daily living. c. degree of reasoning, judgment, and thought processes. d. level of functioning memory.

ANS: B

This is an important point of assessment if the nurse is trying to determine the level of care necessary for this client. The other options also may be assessed at some point in the admission, but they do not make up the functional assessment.

DIF: Cognitive Level: Comprehension REF: p. 199

OBJ: N/A

TOP: Assessment KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Life review b. Doll therapy c. Comfort touch d. Audio presence therapy

12. A 72-year-old client with dementia, who resides in a long-term care facility, frequently goes to her room and cries because she misses her children. This client could benefit most from which intervention?

ANS: D

Because missing her children brings sadness to this client, she may benefit from hearing their voices on tape and recalling pleasant family memories. The other interventions are effective therapies for clients with dementia, but they do not address this client’s immediate need.

DIF: Cognitive Level: Application REF: p. 198 OBJ: 7

TOP: Interventions With Alzheimer’s Disease

KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

13. The medication donepezil (Aricept) frequently is used to treat the early-stage symptoms of Alzheimer’s disease. When administering this particular medication, the nurse should be especially alert to assess the client for: a. weight changes. b. tremors. c. increased sweating. d. alterations in blood pressure.

ANS: D

This medication may cause high or low blood pressure. The other options typically are not seen with donepezil (Aricept) but sometimes are seen with other Alzheimer’s medications.

DIF: Cognitive Level: Application REF: p. 199 | Drug Alert

OBJ: 7 TOP: Interventions With Alzheimer’s Disease

KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity a. Forgetting in what order to put clothes on b. Forgetting simple words c. Forgetting where one lives d. Becoming suspicious of others

14. Which symptom of Alzheimer’s disease is associated with disorientation to time and place?

ANS: C

Additional examples of disorientation to time and place include a person’s getting lost on the street where he or she lives and forgetting how he or she got to places. Forgetting in what order to put on clothing relates to difficulty with performing familiar tasks; forgetting simple words relates to problems with language; and becoming suspicious of others relates to changes in personality.

DIF: Cognitive Level: Comprehension REF: p. 197 | Table 17.1

OBJ: 6 TOP: Stages of Alzheimer’s Disease

KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

15. An elderly woman is brought to the clinic by her daughter. The client states that she has had a cold for several days. Her daughter states that her mother has been confused about when her routine medications are to be taken and that her mother has never experienced confusion about her medications before. Based on this information, it is important that the nurse ask the client whether: a. there is a history of mental illness in the family. b. she has been given a diagnosis of a mental health disorder in the past. c. she can recall her last visit to a physician. d. she has taken any over-the-counter medications for her cold.

ANS: D

Over-the-counter cold medications can cause confusion in the elderly population. Because this client has had a cold recently, it would be important to determine whether she has been taking any of these types of medications. There is no indication that the other options have any significance in relation to the acute confusion.

DIF: Cognitive Level: Application REF: p. 193

TOP: Medications and the Elderly Population

OBJ: 3

KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity a. Early stage b. Intermediate stage c. Severe stage d. End stage

16. The daughter of an elderly nursing home resident is crying outside her father’s room. When the nurse comforts her, she states, “It is so hard to come here to visit when my father doesn’t even know who I am.” The nurse knows the client is in which stage of Alzheimer’s disease?

ANS: B

Visual agnosia, the loss of recognition of previously known or familiar people, is a manifestation of the intermediate stage of Alzheimer’s disease.

DIF: Cognitive Level: Application REF: p. 197 OBJ: 6

TOP: Stages of Alzheimer’s Disease

MSC: Client Needs: Physiological Integrity

KEY: Nursing Process Step: Assessment a. These symptoms are a normal part of aging and he should accept it. b. He has Alzheimer’s disease and nothing can be done to help him. c. Further assessment is needed to determine the cause of these symptoms. d. Admission to a nursing home for more intensive care is needed.

17. A 75-year-old man finds that he continually misplaces items he uses every day. In addition, his wife becomes annoyed when he asks the same question several times because he does not remember the answer. What advice is the most appropriate for his health care provider to give him?

ANS: C

Multiple factors influence how one ages mentally. Culture, education, general health, genetics, and living conditions all have an influence on one’s cognitive (intellectual) abilities. We all age individually, but one thing is certain: confusion is not normal. Although it most often occurs in older adults, individuals of any age can become confused. No matter what the age, confusion demands investigation.

DIF: Cognitive Level: Application REF: p. 192

OBJ: 1

TOP: Normal Changes in Cognition KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity a. 30% b. 50% c. 70% d. 90%

18. The most common severe cognitive impairment in the United States is Alzheimer’s dementia. What percentage of the population over the age of 85 is at risk for getting the disease?

ANS: B

The incidence of dementia increases with age. Alzheimer’s dementia is the most common severe cognitive impairment in the United States. “For people age 85 years or older, the risk of getting Alzheimer’s Dementia approaches 50%” (Small, 2010).

DIF: Cognitive Level: Application REF: p. 196

OBJ: 4

TOP: Symptoms of Dementia KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity a. The onset is sudden and acute. b. The cognitive changes are hidden by the client. c. The client demonstrates apathetic demeanor or flat affect. d. The client’s ability to perform ADLs is intact.

19. Which client exhibits signs and symptoms of delirium and not dementia or depression?

ANS: A

Cognitive changes that occur with delirium are sudden in nature. Clients with dementia may attempt to hide cognitive changes in the early stages, and they are able to perform ADLs in the early stage as well. Clients suffering from depression often display apathy or a flat affect.

DIF: Cognitive Level: Application REF: p. 193

OBJ: 4

TOP: Clients With Delirium KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity

Multiple Response

1. The nurse anticipates that the normal aging process of losing neurons and shrinkage of brain size will result in which assessment findings in older adults? (Select all that apply.)

a. Confusion b. Slower response times c. Depression d. Deficiencies in short-term memory

ANS: B, D

These are normal occurrences in aging. Confusion and depression are not considered normal responses to aging and should be investigated further.

DIF: Cognitive Level: Knowledge REF: p. 192 OBJ: 1

TOP: Normal Changes in Cognition KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity a. Gradual onset b. Poor short-term memory c. Problems with judgment d. Fast onset e. Poor remote memory f. Difficulty with abstract thinking g. Personality changes

2. Which characteristics are commonly seen in clients with dementia? (Select all that apply.)

ANS: A, B, C, E, F, G

These are all signs and symptoms of dementia, regardless of whether it is classified as Alzheimer’s or non–Alzheimer-type dementia.

DIF: Cognitive Level: Knowledge REF: p. 194 OBJ: 5

TOP: Symptoms of Dementia KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Provide activity which stimulates the client’s interest. b. Assist in toileting to prevent incontinence. c. Turn on lights before the room gets dark. d. Provide companionship. e. Prepare client for sleep by turning off lights. f. Reduce environmental stimulation at dinner. g. Maintain client’s familiar routine.

3. Which interventions will help to lessen the effects of sundown syndrome? (Select all that apply.)

ANS: B, C, D, F, G

Sundown syndrome is associated with physical and social stressors including the decrease of visual and social cues. Interventions include meeting the client’s basic needs and maintaining a consistent routine without abrupt changes such as decreasing lighting, withdrawing companionship, and changing or increasing stimulation.

DIF: Cognitive Level: Knowledge REF: p. 195

OBJ: 2

TOP: Symptoms of Dementia KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity