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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.
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A clinic nurse interviews four patients between 70 and 80 years of age. Which patient should have further assessment regarding the risk of alcohol addiction?
- A. One with a history of intermittent problems of alcohol misuse early in life and who now consumes one glass of wine nightly with dinner.
- B. One with no history of alcohol-related problems until age 65 years, when the patient began to drink alcohol daily 'to keep my mind off my arthritis.'
- C. One who drank socially throughout adult life and continues this pattern, saying, 'I've earned the right to do as I please.'
- D. One who abused alcohol between the ages of 25 and 40 years but now abstains and occasionally attends Alcoholics Anonymous.
Correct Answer: B
Rationale: The geriatric problem drinker is defined as someone who has no history of alcohol-related problems but develops an alcohol-abuse pattern in response to the stresses of aging.
A nurse wants to perform a preliminary assessment for suicidal ideation in an older adult patient. Which question would obtain the desired data?
- A. What thoughts do you have about a person's right to take his or her own life?'
- B. If you felt suicidal, would you communicate your feelings to anyone?'
- C. Do you have any risk factors that potentially contribute to suicide?'
- D. Do you think you are vulnerable to developing a depressed mood?'
Correct Answer: A
Rationale: The correct response is clear, direct, respectful, and open-ended, producing information relative to the acceptability of suicide as an option.
A 79-year-old white man tells a visiting nurse, 'I've been feeling sad lately. My family and friends are all dead. My money is running out, and my health is failing.' How should the nurse analyze this comment?
- A. Normal negativity of older adults
- B. Evidence of suicide risk
- C. A cry for sympathy
- D. Normal grieving
Correct Answer: B
Rationale: The patient describes the loss of significant others, economic insecurity, and declining health, which are risk factors for suicide, especially in older adult white men.
A 75-year-old patient comes to the clinic reporting frequent headaches. After an introduction at the beginning of the interview, what should the nurse address?
- A. Initiate a neurological assessment.
- B. Assess if the patient can hear the spoken word clearly.
- C. Suggest that the patient lie down in a darkened room to rest.
- D. Administer medication to relieve the patient's pain prior to the assessment.
Correct Answer: B
Rationale: Before proceeding, the nurse should assess the patient's ability to hear questions. Hearing ability often declines with age. Impaired hearing could lead to inaccurate answers.
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.