Nokea
Discharge planning begins for an elderly patient hospitalized for 2 weeks diagnosed with major depression. The patient needs ongoing assessment and socialization opportunities as well as education about medication and relapse prevention. The patient lives with a daughter, who works during the week. Select the best referral for this patient.
- A. Behavioral health home care
- B. Partial hospitalization
- C. A skilled nursing facility
- D. A halfway house
Correct Answer: A
Rationale: The correct answer is A: Behavioral health home care. This option provides ongoing assessment, socialization opportunities, and education about medication and relapse prevention, which are all essential for the elderly patient with major depression. Additionally, it allows the patient to stay in their own home environment, promoting comfort and familiarity.
Option B: Partial hospitalization may not provide the ongoing support and socialization opportunities needed for the patient.
Option C: A skilled nursing facility may offer medical care but may not focus on mental health needs or socialization.
Option D: A halfway house is typically for individuals transitioning from addiction treatment and may not address the specific needs of an elderly patient with major depression.
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Which nursing intervention supports the principles on which the cross-links theory of aging is based?
- A. Applying an elastin-sustaining moisturizer to an adult patient’s skin
- B. Assessing a patient’s family history for genetic diseases and disorders
- C. Questioning a patient about long-term exposure to environmental toxins
- D. Assisting an adult patient in selecting foods high in vitamins A, C, and E
Correct Answer: D
Rationale: The correct answer is D because selecting foods high in vitamins A, C, and E supports the principles of the cross-links theory of aging, which focuses on the accumulation of damage from oxidative stress. Vitamins A, C, and E are antioxidants that help combat oxidative stress and reduce the formation of cross-links in tissues. This intervention can potentially slow down the aging process by reducing cellular damage.
Choice A is incorrect because applying an elastin-sustaining moisturizer does not directly address the oxidative stress aspect of the cross-links theory of aging.
Choice B is incorrect as assessing family history for genetic diseases does not specifically target the mechanisms involved in the cross-links theory of aging.
Choice C is incorrect because questioning about exposure to environmental toxins may be important for overall health but is not directly related to the principles of the cross-links theory of aging.
When making a distinction as to whether an elderly patient has confusion related to delirium or another problem, what information would be of particular value?
- A. Evidence of spasticity or flaccidity
- B. The patient’s level of motor activity
- C. Medications the patient has recently taken
- D. Level of preoccupation with somatic symptoms
Correct Answer: C
Rationale: The correct answer is C: Medications the patient has recently taken. This information is crucial because certain medications can cause symptoms of delirium or exacerbate confusion in elderly patients. By reviewing the patient's recent medications, healthcare providers can identify potential drug-induced causes of confusion and adjust the treatment accordingly.
Choice A (Evidence of spasticity or flaccidity) is incorrect because these symptoms are more related to neurological conditions such as stroke or spinal cord injury, not specifically delirium.
Choice B (The patient’s level of motor activity) is not as relevant in distinguishing delirium from other problems as medication history, as motor activity can be influenced by various factors.
Choice D (Level of preoccupation with somatic symptoms) is also less relevant compared to medication history in differentiating delirium, as somatic symptoms may not always directly indicate the underlying cause of confusion in elderly patients.
A novice nurse who will be assessing a patient after electroconvulsive therapy (ECT) asks her mentor, “What sort of memory impairment is present after several ECT treatments?” The best response for the mentor would be:
- A. “It’s hard to say. Treatment affects everyone differently.”
- B. “Usually the patient has severe difficulty remembering remote events.”
- C. “Patients have mild difficulty remembering recent events, like what waseaten for breakfast.”
- D. “Both recent and remote memory is affected, producing profound confused, cognitive
Correct Answer: D
Rationale: The correct answer is D because it accurately reflects the typical memory impairment after ECT treatments. ECT affects both recent and remote memory, leading to profound confusion and cognitive difficulties. This is due to the disruption of neural pathways involved in memory consolidation and retrieval.
Choice A is incorrect as ECT does have predictable effects on memory. Choice B is incorrect because patients typically have more difficulty with recent memory than remote memory. Choice C is also incorrect as patients usually experience more than just mild difficulty remembering recent events; the memory impairment is more severe than just forgetting what was eaten for breakfast.
A woman whose abusive husband was killed in an automobile accident 3 years earlier continues to idealize him and repeatedly talks about their “wonderful relationship.” Which outcome is most appropriate for the patient? Patient will:
- A. Enlist the emotional support of both family and friends.
- B. Keep a daily journal recording memories of time spent with her husband.
- C. Express both positive and negative feelings about her husband and their life together.
- D. Read information on the affects of physical abuse and the support groups available to her.
Correct Answer: C
Rationale: Rationale:
Choice C is correct because it encourages the patient to express both positive and negative feelings about her husband and their relationship. This approach helps the patient process complex emotions and move towards a more realistic view of the past. It promotes emotional healing and growth by allowing the patient to acknowledge and work through conflicting feelings.
Summary of Incorrect Choices:
A: While emotional support is important, simply enlisting the support of family and friends may not address the underlying issues of idealization and unresolved emotions.
B: Keeping a daily journal may reinforce the idealization of the husband and could potentially hinder the patient's progress in coming to terms with the reality of the relationship.
D: Reading about abuse and support groups may provide information, but it does not directly address the patient's need to explore and express her own feelings about her husband and their relationship.
A patient states, "I’m not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up." Which nursing intervention should have the highest priority?
- A. Self-esteem-building activities.
- B. Anxiety self-control measures.
- C. Sleep enhancement activities.
- D. Suicide precautions.
Correct Answer: D
Rationale: The correct answer is D: Suicide precautions. The patient's statement indicates they are experiencing severe depression and suicidal ideation. Suicide precautions should be the highest priority to ensure the patient's safety. This includes removing any potential means of self-harm, constant monitoring, and close supervision. Self-esteem-building activities (A) may be helpful in the long term but are not the immediate priority. Anxiety self-control measures (B) are important but addressing suicidal ideation takes precedence. Sleep enhancement activities (C) are also important but not the highest priority when dealing with suicidal thoughts.