Age Specific Considerations in Patient Care

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An 82-year-old widow with Alzheimer's disease lives with her daughter's family, which owns a catering business. During the week, the patient attends a day care center for patients with dementia. During the evenings, members of the family care for the patient. One day, the nurse at the day care center notices the patient's appearance is disheveled and that she startles easily. She has a strong odor of urine, and her hair is uncombed. When the nurse escorts the patient to the bathroom, she notices bruises on her wrists and back. What most likely explains the nurse's observations?

  • A. The patient is being neglected and abused within the family.
  • B. The dementia is progressing, reducing self-care and increasing falls.
  • C. The patient is being inadequately cared for, resulting in accidents.
  • D. The patient has developed delirium, resulting in poor hygiene and injuries.
Correct Answer: A

Rationale: The correct answer is A: The patient is being neglected and abused within the family. The nurse's observations of the patient's disheveled appearance, strong odor of urine, uncombed hair, and bruises indicate signs of neglect and abuse. Here's the rationale:
1. Disheveled appearance and strong odor of urine suggest lack of personal care.
2. Uncombed hair signals neglect in grooming.
3. Bruises on wrists and back are indicative of physical abuse.
4. Startling easily may be due to fear or anxiety from abuse.
In summary, the other choices (B, C, D) are incorrect because they do not account for the combination of neglect, poor hygiene, and physical injuries seen in the patient, which are more indicative of abuse and neglect within the family.

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Which characteristic fits the usual profile of an individual diagnosed with pedophilic disorder?

  • A. Homosexual
  • B. Ritualistic behaviors
  • C. Seeks access to children
  • D. Self-confident professional
Correct Answer: C

Rationale: The correct answer is C because an individual diagnosed with pedophilic disorder typically seeks access to children for sexual purposes. This behavior is a key characteristic of pedophilia. Homosexuality (A) is not a defining factor in pedophilic disorder. Ritualistic behaviors (B) are not specific to pedophilia but may be present in some cases. Being a self-confident professional (D) does not correlate with pedophilic tendencies. In summary, seeking access to children (C) aligns with the diagnostic criteria for pedophilic disorder, making it the most fitting characteristic.

Which nursing strategy leads patients to respond more positivity to limit setting?

  • A. Confront the patient with the inappropriateness of the behavior.
  • B. Explore with the patient the underlying dynamics of the behavior.
  • C. Reflect back to the patient an understanding of the patient's distress.
  • D. State clear disapproval of the behavior, and support its consequences.
Correct Answer: C

Rationale: The correct answer is C because reflecting back to the patient an understanding of their distress shows empathy and validation, which can help build rapport and trust. By acknowledging the patient's feelings, it can help them feel heard and understood, leading to a more positive response to limit setting.

Choice A is incorrect because confrontation can lead to defensiveness and resistance. Choice B focuses on exploring underlying dynamics without addressing the immediate behavior. Choice D may come off as judgmental and punitive, potentially escalating the situation.

An older adult patient who lives with a daughter and attends the Alzheimer day hospital program exhibits bilateral bruising for the second time on both upper outer arms. When the nurse questions the patient about the bruising, the patient starts to cry and pleads, 'Please don't say anything. It's not my daughter's fault. I just bruise easily.' Which intervention reflects the best management of this situation?

  • A. Call the daughter to discuss both the bruising and her parent's reaction.
  • B. Report the elder abuse, and inform the patient and the daughter of your intention.
  • C. Notify the patient's social worker of the bruising after a complete assessment has been completed.
  • D. Inform the patient and the daughter of your intention to document the bruising and arrange for appropriate counseling.
Correct Answer: B

Rationale: The correct answer is B: Report the elder abuse and inform the patient and the daughter of your intention. This is the best intervention as it prioritizes the safety and well-being of the older adult. Here's the rationale:
1. The patient's repeated bruising and fear of disclosure indicate potential abuse.
2. Reporting elder abuse is mandatory to ensure protection for the patient.
3. Informing the patient and daughter shows transparency and involves them in the process.
4. It is crucial to address the situation promptly to prevent further harm.
Summary:
A: Calling the daughter may escalate the situation and compromise the patient's safety.
C: Notifying the social worker without addressing the abuse directly may delay necessary action.
D: Counseling may be beneficial, but addressing the abuse is a priority to ensure the patient's safety.

A patient with an eating disorder states, 'Now that I've gained 4 pounds, I can't wear shorts until I lose it again.' The nurse documents that the patient is exhibiting which cognitive distortion related to maladaptive eating regulation responses?

  • A. Magnification
  • B. Superstitious thinking
  • C. Personalization
  • D. Dichotomous thinking
Correct Answer: A

Rationale: The correct answer is A: Magnification. This cognitive distortion involves exaggerating the significance of a negative event, in this case, gaining 4 pounds. The patient's focus on this small weight gain as a major obstacle to wearing shorts reflects magnification. Superstitious thinking (B) involves believing in unrelated events causing outcomes, which is not evident here. Personalization (C) involves taking responsibility for events beyond one's control, which is not the case in this scenario. Dichotomous thinking (D) involves seeing things in black and white terms, which is not demonstrated in the patient's statement.

A nurse planning a group to help batterers learn more effective ways to cope would teach participants that the key component in wife battering is:

  • A. The need for the batterer to control
  • B. Alcohol abuse by the batterer
  • C. History of psychotic behavior
  • D. Failure of the woman to assert herself
Correct Answer: A

Rationale: The correct answer is A: The need for the batterer to control. This is the key component in wife battering, as it is rooted in the batterer's desire to establish power and dominance over their partner. Teaching batterers more effective ways to cope involves addressing this underlying need for control.

Explanation of other choices:
B: Alcohol abuse by the batterer - While alcohol abuse may exacerbate violent behavior, it is not the primary cause of wife battering.
C: History of psychotic behavior - Psychotic behavior may contribute to violence, but it is not the key component in wife battering.
D: Failure of the woman to assert herself - Blaming the victim is not appropriate; the responsibility lies with the batterer's need for control.

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