What is the greatest threat to the mental well-being of the elderly?     Anxiety

   Alcoholism   Depression   Pain

The primary goal of treatment of depression in the elderly is:

    Prompt prescription of appropriate antidepressants.   Improving their quality of life.   Improving their affect.  Helping them cope with life stressors.

    Provide one-to-one contact with the resident.  Allow residents to wander the halls to get acquainted.  Share a daily listing of activities and invite the resident to participate.  Provide group learning activities.

Which of the following might cause the nurse to suspect elder abuse when making a home visit?

    There is a bruise on the client’s right leg that she says she got from bumping into a table.  There are only peanut butter and jelly in the refrigerator.  The client is wrapped in a large wool shawl.  The temperature in the house is 78°F.

    Consult with the physician about a possible change in medication.  Discuss the reasons for the depression with the client.  Suggest that the client taper the dose or frequency of the medication to see if symptoms subside.  Ask the client for suggestions about activities that would lift the depression.

One of the most common reasons that depression is misunderstood in the elderly is the belief that:

    The elderly have come to terms with the inevitability of their death.  The elderly have relatively stable mental health due to their maturity.  Depression is to be expected as part of aging and declining health.  The elderly have less need for companionship as they age.

    Alcoholism often arises as a coping mechanism to deal with loss, depression, or anxiety.  Physicians are more likely to detect this problem than is any other group of healthcare providers.  Elderly females are the group least likely to respond to treatment.  Treatment programs are relatively successful with the elderly.

The elderly spouse who provides home care for a loved one with accelerating Alzheimer’s disease has begun to say that the stress is getting overwhelming and it might be hard to “keep going.” What intervention might the nurse suggest to deal with this problem?

    A low dose of an anti-depressant medication might help lift mood.  Begin to visit care centers that specialize in the care of residents with Alzheimer’s disease.  A support group might help with coping strategies and to relieve some tension.  Keep a journal to record thoughts and feelings to help sort them out later.

     Tricyclic antidepressants.  Selective serotonin reuptake inhibitors (SSRIs).   Thiazides.  Monoamine oxidase inhibitors (MAOIs).

When an elderly resident of a nursing home is flat of affect, the nurse is likely to observe:

     Erratic behavior.   Dull eyes and no smile.   Slurred speech and many gestures.   4Decreased appetite.

1. A nurse is caring for a terminally ill client. In which order is she likely to observe the following five stages of death and dying, as described by Elisabeth Kubler-Ross?

1. bargaining2. denial and isolation3. acceptance4. anger5. depression

What is the greatest threat to

the mental well-being of the elderly?

Your Answer:

Anxiety

Correct Answer:

Depression

  Rationale: Depressive symptoms among the elderly are widespread, with estimates ranging from 8 to 27% of the elderly population. It is the mental health problem with the greatest frequency and magnitude. Anxiety, alcoholism, and pain occur in the elderly, but not as frequently as depression does.Nursing Process: EvaluationCognitive Level:

ComprehensionNCLEX-RN Test Plan: Psychosocial Integrity

2. The primary goal of treatment of depression in the elderly is:

Your Answer:

Prompt prescription of appropriate antidepressants.

Correct Answer:

Improving their quality of life.

  Rationale: The elderly are less likely to seek and get treatment for depression than are other age groups, but their quality of life can be significantly

improved with appropriate diagnosis and treatment. They need to be encouraged to understand that depression is common and not associated with the social stigma it once was. Treatment will improve affect and their ability to cope with stress. Prescription of antidepressants is not a goal.Nursing Process: ImplementationCognitive Level: AnalysisNCLEX-RN Test Plan: Psychosocial Integrity

3. Which of the following interventions might the nurse use to prevent loneliness in a

newly admitted resident of a nursing home?

Your Answer:

(blank)

4. Which of the following might cause the nurse to suspect elder abuse when making a home visit?

Your Answer:

There is a bruise on the client’s right leg that she says she got from bumping into a table.

Correct Answer:

There are only peanut butter

and jelly in the refrigerator.

  Rationale: A single bruise usually is not cause for concern, but a client who clearly has inadequate food might be suffering from abuse by family or caregivers. Sensitivity to hot or cold might dictate the methods the elderly use to feel comfortable.Nursing Process: EvaluationCognitive Level: AnalysisNCLEX-RN Test Plan: Psychosocial Integrity

5. When the nurse suspects that a medication an elderly

client is taking is causing signs of depression, the nurse should:

Your Answer:

Consult with the physician about a possible change in medication.

  Rationale: For the nurse to suspect a medication is contributing to depression in the elderly client, it would have been important to have eliminated other causes first, so in this case, the nurse would consult with the physician to determine a course of action with respect to medication. Psychosocial changes

should be assessed routinely by the nurse. It is not appropriate for the nurse to suggest the client change the medication dosage or frequency.Nursing Process: ImplementationCognitive Level: ApplicationNCLEX-RN Test Plan: Psychosocial Integrity

6. One of the most common reasons that depression is misunderstood in the elderly is the belief that:

Your Answer:

The elderly have come to terms with the inevitab

ility of their death.

Correct Answer:

The elderly have relatively stable mental health due to their maturity.

  Rationale: Aging requires many adjustments to life circumstances (living arrangements, health, finances, and social circle), and the elderly might experience depression due to the rapidity of the changes and adjustment required. The elderly are no less likely to need companionship than

are other age groups. Depression is not part of normal aging, and many elderly are very content with their lives.Nursing Process: EvaluationCognitive Level: AnalysisNCLEX-RN Test Plan: Psychosocial Integrity 

7. When providing care for an elderly alcoholic client, the nurse recognizes that:

Your Answer:

Alcoholism often arises as a coping mechanism to deal with loss, depression, or anxiety.

  Rationale: The elderly will turn to alcohol to deal with losses and use it as an escape mechanism more often than other age groups will. They also are more likely to drink alone, so the problem often goes undetected. Treatment is no more likely to be successful with the elderly than with other age groups.Nursing Process: PlanningCognitive Level: AnalysisNCLEX-RN Test Plan: Psychosocial Integrity

8. The elderly spouse who provides home care for a loved one with accelerating Alzheimer’s disease has begun to say that

the stress is getting overwhelming and it might be hard to “keep going.” What intervention might the nurse suggest to deal with this problem?

Your Answer:

A low dose of an anti-depressant medication might help lift mood.

Correct Answer:

A support group might help with coping strategies and to relieve some

tension.  Rationale: Coping with

the stress of care giving can be overwhelming. Many elderly people benefit from group interaction and support, and are willing to use that kind of resource when it is presented in a positive manner by the nurse. The caregiver, with support, might come to realize that care outside of the home can be beneficial. Medications are considered only after discussion with the healthcare provider. Journaling might help relieve stress, but it is not the most helpful intervention the nurse could suggest.Nursing Process: Implementation

Cognitive Level: ApplicationNCLEX-RN Test Plan: Psychosocial Integrity

9. The most commonly used classification of medications used to treat depression in the elderly is:

Your Answer:

Tricyclic antidepressants.

Correct Answer:

Selective serotonin reuptake inhibitors (SSRIs).

  Rationale: This classification of medications usually is well tolerated by the elderly because of the few side effects and adverse effects. Tizzies are diuretics.

Nursing Process: ImplementationCognitive Level: ComprehensionNCLEX-RN Test Plan: Psychosocial Integrity

10. When an elderly resident of a nursing home is flat of affect, the nurse is likely to observe:

Your Answer:

Erratic behavior.

Correct Answer:

Dull eyes and no smile.

  Rationale: An individual who exhibits a flat affect has a face devoid of emotion, and tends to be quiet and withdrawn. The other observations

listed are not associated with a flat affect.Nursing Process: AssessmentCognitive Level: AnalysisNCLEX-RN Test Plan: Psychosocial Integrity

2. 2,4,1,5,3 Rationale: According to Kubler-Ross, the five stages of death and dying are denial and isolation, anger, bargaining, depression, and acceptance.