Nokea
An older adult with a history of major depressive disorder has taken an antidepressant daily for 3 years. The patient tells the nurse, 'I want to stop taking this medication. I don't think I need it anymore.' What is the nurse's best response to assure the patient's safety?
- A. Why do you think you don't need this medication anymore?'
- B. Have you talked with your family members about this decision?'
- C. If you stop the medication, your depression will return worse than ever.'
- D. This medication should be gradually stopped. Let's talk to your health care provider about a plan.'
Correct Answer: D
Rationale: A gradual discontinuation is needed to avoid discontinuation symptoms, ensuring patient safety.
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A 78-year-old nursing home resident diagnosed with hypertension and cardiac disease is usually alert and oriented. This morning, however, the resident says, 'My family visited during the night. They stood by the bed and talked to me.' In reality, the patient's family lives 200 miles away. The nurse should first suspect what as the trigger for the resident's experience?
- A. A side effect associated with medications.
- B. Early Alzheimer's disease associated with advanced age.
- C. A transient ischemic attack and developed sensory perceptual alterations.
- D. Previously unidentified alcohol abuse and is beginning alcohol withdrawal delirium.
Correct Answer: A
Rationale: A resident taking medications is at high risk for becoming confused because of medication side effects, drug interactions, and delayed excretion.
A community mental health nurse plans an educational program for staff members at a home health agency that specializes in the care of older adults. What topic is of high priority?
- A. Identifying depression in older adults
- B. Providing cost-effective foot care for older adults
- C. Identifying nutritional deficiencies in older adults
- D. Psychosocial stimulation for those who live alone
Correct Answer: A
Rationale: Depression is the most common, most debilitating, and also most treatable psychiatric disorder in the older adult. Home health staff are often better versed in the physical aspects of care and less knowledgeable about mental health topics. Statistics show that older adult patients with mental health problems are less likely than young adults to be diagnosed accurately.
Recognizing the risk for acquired immunodeficiency syndrome (AIDS) among older adults, nurses should provide health teaching focused on what?
- A. Discouraging sexual expression
- B. Using birth control measures
- C. Avoiding blood transfusions
- D. Encouraging condom use
Correct Answer: D
Rationale: Safe sex continues to be important and should be taught to the older adult population. Condom use is diminished in postmenopausal women, which places older adults at risk for AIDS and other sexually transmitted diseases.
A tricyclic antidepressant is prescribed for an older adult patient diagnosed with major depressive disorder. Nursing assessment should include careful collection of information regarding what focus?
- A. Use of other prescribed medications and over-the-counter products
- B. Evidence of pseudoparkinsonism or tardive dyskinesia
- C. A history of psoriasis and any other skin disorders
- D. A current immunization status
Correct Answer: A
Rationale: Drug interactions, with both prescription and over-the-counter products, can be problematic for the geriatric patient taking tricyclic antidepressant medications.
A health care provider writes these new prescriptions for a resident in a skilled care facility: '2 g sodium diet; restraint as needed; limit fluids to 2000 mL daily; 1 dose milk of magnesia 30 mL orally if no bowel movement occurs for 3 days.' Which prescription should the nurse question?
- A. Restraint
- B. Fluid restriction
- C. Milk of magnesia
- D. Sodium restriction
Correct Answer: A
Rationale: Restraints may be applied only on the written order of the health care provider that specifies the duration during which the restraints can be used. The Joint Commission guidelines and Omnibus Budget Reconciliation Act regulations also mandate a number of other conditions that must be considered and documented before restraints are used.