Age Specific Patient Care

Age Specific Patient Care Related

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The caregiver for a client with moderate to severe dementia tells the nurse, 'I'm exhausted. He wanders at night instead of sleeping, so I get no rest. I'm afraid to leave him during the day, so I have to take him to the grocery store and to the laundromat. When I'm busy there, he often wanders off. Still, I have to do it all.' The nurse recognizes the need to provide teaching for this caregiver. An appropriate outcome is that the caregiver will:

  • A. Feel justified in putting the client in a nursing home
  • B. Verbalize realistic self-expectations
  • C. Cease abusive interactions with the client
  • D. Feel comfortable leaving the client alone one morning a week
Correct Answer: B

Rationale: The correct answer is B: Verbalize realistic self-expectations. This is the most appropriate outcome to address the caregiver's situation. By verbalizing realistic self-expectations, the caregiver can understand the importance of self-care and setting boundaries. This outcome promotes the caregiver's well-being while still providing care for the client.

Choice A is incorrect because putting the client in a nursing home may not be the best solution without exploring other options first. Choice C is incorrect as there is no mention of abusive interactions in the scenario. Choice D is incorrect because feeling comfortable leaving the client alone without addressing the caregiver's exhaustion and concerns may not be the most appropriate approach.

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A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior?

  • A. Idea of reference
  • B. Delusion of infidelity
  • C. Auditory hallucination
  • D. Echolalia
Correct Answer: A

Rationale: The correct identification for the behavior described is "A: Idea of reference." This term refers to the belief that neutral events are directed at oneself. In this case, the patient's belief that the doctors were plotting to kill him is an example of a false idea of reference. Delusion of infidelity (choice B) involves false beliefs about a partner's unfaithfulness, not relevant here. Auditory hallucination (choice C) pertains to false perceptions of hearing sounds, not applicable. Echolalia (choice D) is the repetition of words spoken by others, not seen in this scenario. Identifying the behavior as an idea of reference helps the nurse understand the patient's distorted perception of reality.

An adolescent patient is diagnosed with dementia. The patient's age would cause a nurse to suspect which underlying condition sometimes associated with this diagnosis?

  • A. Head trauma
  • B. Neurosyphilis
  • C. Pick disease
  • D. Hypothyroidism
Correct Answer: A

Rationale: The correct answer is A: Head trauma. Adolescents are less likely to develop dementia due to age-related neurodegenerative diseases. Head trauma can lead to cognitive impairment and memory loss, mimicking symptoms of dementia. Neurosyphilis is a sexually transmitted infection affecting the brain, not common in adolescents. Pick disease is a rare neurodegenerative disorder more commonly seen in older adults. Hypothyroidism can cause cognitive symptoms but is not typically associated with dementia in adolescents.

Your pregnant patient has a history of major depression. Which of the following is she most likely to be at risk for?

  • A. She is at risk for development of manic episodes.
  • B. She is at risk for recurrence of depression after the birth of the baby.
  • C. She is more likely to have an autistic child.
  • D. She has no higher risk for emotional problems than other patients.
Correct Answer: B

Rationale: History of major depression (B) is the biggest risk factor for postpartum depression, increasing the likelihood of recurrence post-delivery.

A patient with schizophrenia refuses to take his medication because he believes he is not ill. What phenomenon most likely underlies this presentation?

  • A. The patient is unable to face having an illness and is in denial.
  • B. Stigma causes the patient to refuse to admit his mental illness.
  • C. The illness itself is preventing the patient from realizing he is ill.
  • D. Command hallucinations are instructing him to deny the illness.
Correct Answer: C

Rationale: The correct answer is C because anosognosia, a symptom of schizophrenia, can prevent patients from recognizing they are ill due to the illness itself affecting their insight and awareness. Anosognosia is a neurocognitive deficit common in schizophrenia, where the brain's ability to recognize one's own illness is impaired. This leads the patient to genuinely believe they are not ill, even when presented with evidence to the contrary.

Choice A: Denial is a psychological defense mechanism, not a symptom of schizophrenia.
Choice B: Stigma might influence perceptions of mental illness, but it does not directly cause anosognosia in schizophrenia.
Choice D: Command hallucinations can influence behavior, but they typically involve auditory commands unrelated to recognizing one's illness.

A patient admitted to the eating disorders unit has yellow skin, the extremities are cold, and the heart rate is 42 bpm. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient is quiet during the assessment saying only, "I will not eat until I lose enough weight to look thin." Select the best initial nursing diagnosis.

  • A. Anxiety related to fear of weight gain
  • B. Disturbed body image related to weight loss
  • C. Ineffective coping related to lack of conflict resolution skills
  • D. Imbalanced nutrition: less than body requirements related to self-starvation
Correct Answer: D

Rationale: The correct initial nursing diagnosis is D: Imbalanced nutrition: less than body requirements related to self-starvation. The patient's symptoms indicate severe malnutrition from self-starvation, leading to the yellow skin, cold extremities, low heart rate, and underweight status. The patient's statement reflects their distorted perception of body image and the extreme measures taken to achieve thinness. Choice A (Anxiety related to fear of weight gain) is not the best initial diagnosis as it focuses on anxiety rather than the critical issue of malnutrition. Choice B (Disturbed body image related to weight loss) is not the best initial diagnosis as it does not address the immediate risk of severe malnutrition. Choice C (Ineffective coping related to lack of conflict resolution skills) is not the best initial diagnosis as it does not prioritize the life-threatening malnutrition present in this case.

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