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An older patient reports drinking a six-pack of beer daily. The patient tells the community health nurse, 'I've been having trouble with my arthritis lately, so I take acetaminophen four times a day for pain.' What are the nurse's priority interventions?
- A. Inquiring about sleep disturbances caused by mixing alcohol and analgesic medications
- B. Determining the safety of the daily acetaminophen dose the patient is ingesting
- C. Advising the patient of harmful effects of alcohol and acetaminophen on the liver
- D. Suggesting an increase in the acetaminophen dose because alcohol produces faster excretion
- E. Assessing the patient for declining functional status associated with medication-induced dementia
Correct Answer: B,C
Rationale: The toxicity of acetaminophen is enhanced by alcohol and age-related decrease in clearance, requiring assessment of the dose and education on the dangers of combined use.
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A nurse asks the following questions while assessing an older adult. The nurse will add the Geriatric Depression Scale as part of the assessment if the patient answers 'yes' to which question?
- A. Would you say your mood is often sad?'
- B. Are you having any trouble with your memory?'
- C. Have you noticed an increase in your alcohol use?'
- D. Do you often experience moderate-to-severe pain?'
Correct Answer: A
Rationale: Sadness may be a symptom of depression. Sad moods occurring with regularity should signal the need to assess further for other symptoms of depression.
An older adult patient brings a bag of medication to the clinic. The nurse found one bottle labeled 'Ativan' and one labeled 'lorazepam,' and both are labeled 'Take two times daily.' Bottles of hydrochlorothiazide, Inderal, and rofecoxib, each labeled 'Take one daily,' are also included. Which conclusion is accurate?
- A. Rofecoxib should not be taken with Ativan.
- B. The patient's blood pressure is likely to be very high.
- C. This patient should not self-administer any medication.
- D. Lorazepam and Ativan are the same drug; consequently, the dose is excessive.
Correct Answer: D
Rationale: Lorazepam and Ativan are generic and trade names for the same drug, creating an accidental overdose situation.
When making a distinction as to whether a patient is experiencing confusion related to depression or dementia, what information would be most important for the nurse to consider?
- A. The patient with dementia is persistently angry and hostile.
- B. Early morning agitation and hyperactivity occur in dementia.
- C. Confusion seems to worsen at night when dementia is present.
- D. A patient who is depressed is preoccupied with somatic symptoms.
Correct Answer: C
Rationale: Noting whether the confusion seems to increase at night, which occurs more often with dementia than with depression, will help distinguish the cause of the confused behavior.
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.
When admitting older adult patients, health care agencies receiving federal funds must provide written information about what topic?
- A. Advance health care directives
- B. The financial status of the institution
- C. How to sign out against medical advice
- D. The institution's policy on the use of restraints
Correct Answer: A
Rationale: The Patient Self-Determination Act of 1990 requires that patients have the opportunity to prepare advance directives.