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Mr J., an 80 yr old who has had flu like symptoms with diarrhea and has vomited 4 times in the last 24 hours is seen in the ED. Mr. J seems confused and is lethargic. The nurse notes that Mr. J has dry skin, a brown tongue, sunken cheeks and concentrated urine. This array of symptoms indicates:
- A. congestive heart failure
- B. dehydration
- C. urinary tract infection
- D. bowel obstruction
Correct Answer: B
Rationale: The correct answer is B: dehydration. Mr. J's symptoms of flu-like illness, diarrhea, vomiting, confusion, lethargy, dry skin, brown tongue, sunken cheeks, and concentrated urine are indicative of severe dehydration. Dehydration can lead to electrolyte imbalances, decreased blood volume, and impaired organ function, resulting in confusion and lethargy. Skin changes, dry mucous membranes, and concentrated urine are also classic signs of dehydration. The other choices (A, C, D) do not align with the constellation of symptoms presented by Mr. J and are less likely based on the information provided.
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What is the primary role of the gerontological nurse when providing end-of-life care for a terminally ill older adult?
- A. To offer aggressive curative treatments to extend life
- B. To focus on pain management and comfort care, ensuring dignity
- C. To administer sedatives to prevent distress
- D. To encourage family members to make all decisions for the patient
Correct Answer: B
Rationale: The correct answer, B, is the primary role of the gerontological nurse when providing end-of-life care for a terminally ill older adult. This choice emphasizes the importance of pain management, comfort care, and preserving the patient's dignity. The nurse's focus should be on enhancing the quality of life and ensuring the patient's comfort rather than pursuing aggressive curative treatments (A). Administering sedatives (C) should be based on individual needs and preferences, not as a blanket approach. While family involvement is crucial, the nurse should still advocate for the patient's autonomy and preferences, rather than solely relying on family decisions (D).
Which physiological change in the brain is the reason the nurse allows more time for answering questions with older adults?
- A. Increased secretion of cholinesterase
- B. Decreased secretion of neurotransmitters
- C. Loss of spinal cord and brainstem neurons
- D. Atrophy of dendrites in the cerebral cortex
Correct Answer: D
Rationale: The correct answer is D: Atrophy of dendrites in the cerebral cortex. With aging, there is a natural decline in brain volume and synaptic connections, leading to reduced dendritic branching and synaptic density in the cerebral cortex. This affects processing speed and cognitive functions, requiring more time for older adults to respond to questions.
Rationale:
A: Increased secretion of cholinesterase is not a physiological change associated with aging that would require more time for answering questions.
B: Decreased secretion of neurotransmitters may occur with aging but is not the primary reason for slower processing speed in older adults.
C: Loss of spinal cord and brainstem neurons is not the main factor influencing older adults' response time to questions compared to atrophy of dendrites in the cerebral cortex.
In which context are members of a cohort described when using the age-stratification theory to explain the effect of similar events, conditions, and circumstances?
- A. Historical
- B. Biological
- C. Sociological
- D. Chronological
Correct Answer: A
Rationale: The correct answer is A: Historical. In age-stratification theory, cohort members are described in historical context to explain shared experiences. This theory emphasizes that individuals born around the same time experience similar events shaping their lives. Historical context is crucial as it considers the societal, cultural, and economic factors influencing a specific generation. Choice B, Biological, is incorrect as age-stratification theory focuses on social aspects rather than biological ones. Choice C, Sociological, is broad and doesn't specifically address the historical aspect of cohort description. Choice D, Chronological, is incorrect as it simply refers to the order of events without considering the historical backdrop of a cohort's experiences.
A retirement community is divided into different communities with different activities available for the residents. There is one community for individuals ages 65 to 74 years, one for individuals ages 75 to 85 years, and one for individuals older than age 85 years. This is consistent with which theory of aging?
- A. Role theory
- B. Disengagement theory
- C. Age-stratification theory
- D. Social exchange theory
Correct Answer: C
Rationale: The correct answer is C: Age-stratification theory. This theory suggests that age is a powerful determinant of social organization. In the given scenario, the retirement community is structured based on age groups, indicating stratification by age. This separation aligns with the concept of age-based social hierarchies and differing opportunities and resources based on age.
Choice A (Role theory) focuses on how individuals adapt to social roles as they age, which is not directly reflected in the scenario. Choice B (Disengagement theory) posits that aging individuals withdraw from societal roles, which is not evident in the active engagement of residents in different age-specific communities. Choice D (Social exchange theory) emphasizes the relationships individuals form based on rewards and costs, which is not the primary focus in the scenario compared to the age-based stratification.
In treating depression in older adults, which of the following is considered the most effective treatment modality?
- A. Long-term pharmacological therapy with SSRIs
- B. Cognitive-behavioral therapy (CBT) combined with antidepressant medications
- C. Antidepressant medications alone
- D. Psychodynamic therapy to address unresolved issues from early life
Correct Answer: B
Rationale: The correct answer is B, cognitive-behavioral therapy (CBT) combined with antidepressant medications, for treating depression in older adults. CBT helps address negative thought patterns and behaviors associated with depression, while antidepressant medications provide physiological support. Combining both approaches has been shown to be more effective than either treatment alone in older adults.
A: Long-term pharmacological therapy with SSRIs may have side effects and limited effectiveness in older adults.
C: Antidepressant medications alone may not address the underlying psychological factors contributing to depression.
D: Psychodynamic therapy may not be as effective in older adults as it focuses on unresolved issues from early life rather than targeting current depressive symptoms.