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Ch. 22 - Psychotherapy for Older Adults

Terms in this set (27)

A young nurse charted that a 70-year-old client was unable to perform ADLs due to old age. What should the nursing supervisor do in response to this attitude?

1. Reassign the nurse to another unit with younger clients
2. Explain how aging does not prevent one from performing ADLs
3. Reprimand the nurse for charting opinions rather than facts
4. Suggest the young nurse encourage the client to be more independent
2. Explain how aging does not prevent one from performing ADLs
Which of the following statements should the nurse include in a presentation to the community regarding mental health care resources for elders?

1. Better pharmacological treatments have increased the normal life span of individuals afflicted with mental illness.
2. Medicare coverage will pay for most mental health services provided to elders.
3. Most elders require frequent hospitalization due to chronic illness and mental disability.
4. More long-term care facilities are admitting geropsychiatric clients.
1. Better pharmacological treatments have increased the normal life span of individuals afflicted with mental illness.
Which of the following biopsychosocial theories of aging is the nurse using when taking a small gvroup of older adults out in the community to a local restaurant for dinner and dancing?

1. Wear-and-tear theory
2. Activity theory
3. Nutritional theory
4. Environmental theory
2. Activity theory
The nurse is teaching a seminar for health professionals on the differences between the normal aging process and Alzheimers disease. Which of the following biopsychosocial theories of
normal aging should be discussed regarding cellular changes?
Select all that apply.

1. Genetic theory
2. Immunology theory
3. Wear-and-tear theory
4. Environmental theory
5. Disengagement theory
Correct Answer: 1,2,3

Rationale 1: Genetic theory: According to this theory, harmful genes activate in late life to stop
cell growth and division; aging is programmed by genetic makeup.

Rationale 2: Immunology theory: Higher susceptibility to disease occurs as the bodys
defensive ability declines with age, causing old irregular cells to be misidentified as foreign
bodies and attacked by the body.

Rationale 3: Wear-and-tear theory: In this theory, cells eventually wear out with age; however, individual rates of cellular decline can be hastened by abuse and lack of care.

Rationale 4: Environmental theory: Various environmental substances such as pesticides,
smog, and smoking can seriously harm health and cause cellular damage affecting ones ability to
fight disease.

Rationale 5: Disengagement theory: Aging is an inevitable process in which older adults withdraw from social contacts and responsibilities. Psychosocial rather than cellular changes are
responsible.
The nurse is teaching staff at a long-term health care facility about depression in older adults. Which comment by staff indicates to the nurse the need for further teaching?

1. Inability to organize and abstract information may indicate depression in older adults.
2. Depressed older adults may exhibit an excessive preoccupation with chronic constipation or pain.
3. Sadness or feeling blue are normal aspects of the aging process and are not a cause for concern.
4. Lack of interest or apathy may be a sign of depression in older adults.
3. Sadness or feeling blue are normal aspects of the aging process and are not a cause for concern.
The nurse suspects a 75-year-old male client with a recent diagnosis of cancer is contemplating suicide. Which one of the following cues indicates the highest suicide potential?

1. Yearly updating his will
2. Complaining of chronic pain
3. Vague statements about future funeral plans
4. Buying a hand revolver
4. Buying a hand revolver
During the nursing assessment of the older adult female client, the nurse finds the client believes others are poisoning her food. Which of the following psychiatric disorders would not be
indicated?

1. Delirium
2. Adjustment disorder
3. Anxiety disorder
4. Dementia
2. Adjustment disorder
The wife of an older client is concerned that her husband has recently experienced memory lapses, is unusually aggressive and was involved in three traffic accidents in the past month. In
planning a response, the nurse is guided by the knowledge that:

1. Further intervention is needed to prevent elder abuse of the wife.
2. Further assessment is needed to determine if alcohol abuse is possible.
3. These are normal responses to aging.
4. These are signs of depression or dementia.
2. Further assessment is needed to determine if alcohol abuse is possible.
The nurse is teaching a group of older adults about changes in sleep patterns due to the aging process. Which statement by older adults indicates understanding of the nurses teaching
regarding the use of nonpharmacologic therapies for sleep?

1. We should avoid coffee, tea, or other fluids in the evening hours.
2. An herbal remedy such as melatonin can help us sleep better.
3. Taking long naps during the day will help us sleep better at night.
4. Taking a sleeping pill every night will improve our total sleep time.
1. We should avoid coffee, tea, or other fluids in the evening hours.
When interviewing elders the psychiatric nurse is guided by the knowledge that:

1. Shame may inhibit the expression of feelings in elders.
2. Touch is inappropriate during the interview.
3. Family and staff members may provide inaccurate information.
4. Less time may be needed with elders than with other age groups.
1. Shame may inhibit the expression of feelings in elders.
A thorough biopsychosocial assessment of elders includes:
Select all that apply.

1. Spirituality
2. Social supports
3. Coping strategies
4. Sexuality
5. Early childhood interactions
Correct Answer: 1,3,4

Rationale 1: Spirituality. Spiritual integrity is a basic human power that becomes especially
important in later stages of life.

Rationale 2: Early childhood interactions. Early childhood interactions are more consistent
with earlier psychological theories of mental disorder and are not needed.

Rationale 3: Coping strategies. Coping strategies are important data to collect from elders to
obtain information regarding their reactions to stress.

Rationale 4: Sexuality. Sexuality is an important often overlooked area in elders and should be
approached in a tactful, caring and nonjudgmental manner.

Rationale 5: Social supports. Interpersonal relationships and social networks of elders are
important for optimal functioning especially with psychiatric disorders or confusion.
The nurse is assessing the social and financial status of an older adult. Which of the following questions would be appropriate to ask?

1. Do you have transportation to get to doctors appointments?
2. Do you have problems with your family taking advantage of you?
3. How often do you forget to pay your bills?
4. How much money do you get from social security?
1. Do you have transportation to get to doctors appointments?
Which of the following signs would lead the nurse to suspect elder abuse is occurring?

1. Leaving a competent elder at the doctors office to wait for an appointment
2. Leaving a confused elder at home alone
3. Complaints of a person poisoning their food or robbing them
4. Skin tears on the arms and hands
2. Leaving a confused elder at home alone
An elderly client has presented to the clinic with multiple physical complaints. Biologic assessment information must be obtained before any physical illnesses can be ruled out. Which
of the following objective measurements would be most helpful?

1. Electroencephalogram (EEG)
2. Standard diagnostic laboratory analyses
3. Lumbar puncture
4. Drug toxicology screening
2. Standard diagnostic laboratory analyses
Which of the following nursing diagnoses would be most appropriate for an older adult who recently lost his wife of 50 years after a long history of breast cancer?

1. Activity Intolerance
2. Ineffective Role Performance
3. Feeding Self-Care Deficit
4. Risk for Other-Directed Violence
2. Ineffective Role Performance
Which of the following outcomes would be the most important for an older adult who recently lost his wife of 50 years after a long history of breast cancer?

1. Ability to recognize behaviors that reduce feelings of hopelessness
2. Ability to focus on specific stimuli
3. Ability to acquire, organize, and use information
4. Ability to dress self and maintain own hygiene
1. Ability to recognize behaviors that reduce feelings of hopelessness
The nurse plans to implement health promotion activities at the local senior citizen center. Which one of the following strategies should the nurse include to meet the goal of promoting relaxation and restoring balance?

1. Pet therapy
2. Tai Chi exercises
3. Social support groups
4. Reality orientation
2. Tai Chi exercises
The nurse is planning teaching for a staff seminar regarding psychiatric medication administration. The nurses teaching should be guided by the knowledge that:

1. Sedation is a desirable side effect for older adults.
2. Falls and choking risk are increased by psychiatric medications.
3. Older adults are less prone to side effects than other age groups.
4. Standard adult dosages are well tolerated by older adults.
2. Falls and choking risk are increased by psychiatric medications.
The nurses evaluation of the outcomes of care for an older adult mentally ill client should be guided by the knowledge that:

1. Cultural preferences that conflict with treatment goals take precedence.
2. Complete absence of psychiatric symptoms is the gold standard.
3. Clients values and preferences should be honored whenever possible.
4. Families and significant others are not routinely involved in this process.
3. Clients values and preferences should be honored whenever possible.
The nurse plans to increase self-esteem and reduce social isolation for residents living at the long-term care facility. Which one of the following strategies should the nurse include to meet
these goals?

1. Reality orientation
2. Reminiscence therapy
3. Respite services
4. Restorative care
2. Reminiscence therapy
Which of the following behaviors would indicate that the nurses remotivation therapy group for long-term care residents was effective?

1. Orientation to time, place, and person
2. Active discussion of dating practices in teenage years
3. Active discussion of presidential candidates in the next election
4. Orientation to the long-term care surroundings
3. Active discussion of presidential candidates in the next election
Which of the following outcomes would indicate successful reality orientation of an older adult client?

1. Ability to identify personal strengths
2. Ability to perform basic tasks and personal care activities
3. Ability to identify place and person
4. Ability to express faith and meaning in life
3. Ability to identify place and person
The nurse case manager has become concerned that an older adult confused client is no longer safe at home due to wandering outside when the caregiver is not watching. Which of the following community-based programs would be most appropriate for referral?

1. Long-term care facilities
2. Assisted living communities
3. Senior citizen centers
4. Residential care facilities
1. Long-term care facilities
The wife of a man with early stage Parkinsons disease expresses frustration and despair while caring for him at home because she is unable to leave him while she plays bridge with her friends
twice a week. Which of the following community-based resources would be most appropriate in this situation?

1. Hospice care
2. Long-term care
3. Respite care
4. Restorative care
3. Respite care
A nurse is discussing the demanding and dependent behavior of an older, depressed female client with the treatment team. Which of the following comments indicates ageism?

1. She is demanding and dependent because she is lonely and not receiving enough attention from staff members.
2. She is feeling depressed and could benefit from counseling or an antidepressant.
3. She should be encouraged to attend more activities and do as much as possible by herself.
4. She should be encouraged to spend more time with people her own age instead of trying to look or act younger.
4. She should be encouraged to spend more time with people her own age instead of trying to look or act younger.
Which of the following statements represents a myth about aging?

1. Advancing age does not condemn one to dependence and isolation.
2. Older adults do not benefit from supportive psychosocial services.
3. Senility and sadness are not inevitable outcomes with advancing age.
4. Aging itself is not a problem.
2. Older adults do not benefit from supportive psychosocial services.
Which of the following statements is true regarding financial roadblocks to mental health care services for people over the age of 65?

1. Medicare covers inpatient but not community mental health services.
2. Medicare Part D provides simple options for prescription coverage.
3. Medicare provides little coverage for long-term care services.
4. Medicare offers low copayments for most psychotropic medications.
3. Medicare provides little coverage for long-term care services.
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