Age Specific Nursing Care

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A man, aged 84 years, was stopped for going through a red light in a small town where he lives. He told the officer, 'It wasn't there yesterday.' He was unable to tell the officer his address and demonstrated labile mood, seeming pleasant one minute and angry the next. The officer took the man home to discuss his condition with the family and found that he has been wandering around the neighborhood, sometimes taking tools from people's garages, saying they belong to him. The family reluctantly agreed that he should go to the emergency department. What cardinal sign of Alzheimer's disease does this patient demonstrate?

  • A. Agnosia.
  • B. Apraxia.
  • C. Aphasia.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Agnosia. Agnosia is the inability to recognize or interpret sensory information, such as objects, people, sounds, or shapes. In this case, the patient's inability to recognize the red light, his own address, and the ownership of tools indicates a problem with perception and recognition. This aligns with the symptoms of agnosia commonly seen in Alzheimer's disease.

Choices B and C are incorrect. Apraxia is the inability to perform purposeful movements, and aphasia is the loss of ability to understand or express speech. These symptoms are not the primary cardinal sign demonstrated by the patient in the scenario. Choice D, "None of the above," is also incorrect as the patient's symptoms align with the characteristics of agnosia.

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Which nursing intervention will assist a client being treated in the Emergency Department for extensive soft tissue injuries to disclose an experience of domestic violence?

  • A. Interviewing her in the presence of another professional
  • B. Speaking with the client in the absence of her husband
  • C. Providing a safe, nonintimidating environment
  • D. Allowing the client to initiate the topic of violence
Correct Answer: C

Rationale: Rationale for Correct Answer (C): Providing a safe, nonintimidating environment is crucial to encourage the client to disclose domestic violence. This approach helps establish trust and confidentiality, making the client feel secure to share sensitive information. It creates a conducive setting for open communication without fear of repercussions.

Summary of Incorrect Choices:
A: Interviewing her in the presence of another professional may not ensure privacy and could potentially increase the client's discomfort or fear of being overheard.
B: Speaking with the client in the absence of her husband might not guarantee safety and confidentiality, as the client may still feel threatened or hesitant to reveal the abuse.
D: Allowing the client to initiate the topic of violence puts the burden on the client, who may already be feeling overwhelmed or unable to bring up the sensitive issue without support and encouragement.

It is a primary dementia that is incurable, irreversible, and fatal. It is caused by the accumulation of amyloid protein in the neurons, resulting in senile plaques.

  • A. Alzheimer's disease.
  • B. Frontotemporal dementia.
  • C. Parkinson's disease dementia.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Alzheimer's disease. Alzheimer's disease is a primary dementia that is characterized by the accumulation of amyloid protein in neurons, leading to senile plaques. It is incurable, irreversible, and fatal. Frontotemporal dementia (B) is caused by the degeneration of frontal and temporal lobes, not amyloid protein accumulation. Parkinson's disease dementia (C) is a secondary dementia that occurs as a complication of Parkinson's disease, not due to amyloid protein accumulation. Choice D is incorrect as Alzheimer's disease fits all the criteria mentioned in the question.

Which of the following is a characteristic behavior in patients with anorexia nervosa?

  • A. Binge eating followed by purging.
  • B. Extreme weight loss due to excessive food restriction.
  • C. Frequent overeating with a lack of control.
  • D. Excessive weight gain through overeating and exercise.
Correct Answer: B

Rationale: The correct answer is B: Extreme weight loss due to excessive food restriction. Patients with anorexia nervosa typically exhibit severe food restriction leading to significant weight loss. This behavior is driven by a distorted body image and fear of gaining weight. Binge eating followed by purging (choice A) is characteristic of bulimia nervosa, not anorexia nervosa. Frequent overeating with a lack of control (choice C) is a feature of binge eating disorder, not anorexia nervosa. Excessive weight gain through overeating and exercise (choice D) does not align with the weight loss seen in anorexia nervosa.

A depressed patient who is taking a tricyclic antidepressant tells the nurse, "I don't think I can keep taking these pills. They make me very dizzy, especially when I stand up." The best nursing response is:

  • A. That is annoying, but it is something most patients are able to learn to live with as time goes on. You'll get used to the medicine's side effects.
  • B. The medicine can slow the body's adjustment of blood pressure when changing position; drinking more fluids and changing position slowly can help.
  • C. Compared to the problems caused by the depression, it seems like a relatively small annoyance to have to put up with.
  • D. All medicines have side effects, and this one is relatively mild. It could be that your depression is causing you to think negatively about the medicine.
Correct Answer: B

Rationale: The correct answer is B because tricyclic antidepressants can cause orthostatic hypotension leading to dizziness upon standing. Advising the patient to drink more fluids and change positions slowly can help alleviate this symptom. Choice A minimizes the patient's concern, which is not therapeutic. Choice C diminishes the patient's experience and feelings. Choice D dismisses the patient's symptoms and attributes them solely to the patient's negative thinking, which is not appropriate.

A client displays disorganized thinking, difficult-to-follow speech, and silly, inappropriate affect. The client isolates himself from other clients and staff, ignores unit activities, and often seems to be listening and responding to unseen stimuli. This client's behavior most closely conforms to the characteristic behavior of:

  • A. Residual schizophrenia
  • B. Schizoaffective disorder
  • C. Paranoid schizophrenia
  • D. Disorganized schizophrenia
Correct Answer: D

Rationale: The correct answer is D: Disorganized schizophrenia. The client's symptoms of disorganized thinking, difficult-to-follow speech, inappropriate affect, social withdrawal, and hallucinations (responding to unseen stimuli) align with the diagnostic criteria for Disorganized Schizophrenia. This subtype is characterized by disorganized behavior, speech, and affect, as well as social withdrawal and hallucinations.

A: Residual schizophrenia does not involve active psychotic symptoms like hallucinations or delusions, which are present in the client's behavior described.
B: Schizoaffective disorder combines symptoms of schizophrenia and mood disorders, and the client's symptoms do not strongly suggest a mood disorder component.
C: Paranoid schizophrenia typically involves prominent delusions and auditory hallucinations, which are not emphasized in the client's behavior described.

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