1. A nurse monitors older adults in a long-term care facility. Which of the following symptoms would require follow-up by the nurse to assess for depression in the older adult?
A) Anorexia
B) Weakness
C) Labile a
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1. A nurse monitors older adults in a long-term care facility. Which of the following symptoms would require follow-up by the nurse to assess for depression in the older adult?
A) Anorexia
B) Weakness
C) Labile affect
D) Impaired perceptions - ANSWER Ans: A
Appetite disturbances, particularly anorexia, are among the most common physical complaints of depressed older adults. Individuals with dementia have the following symptoms: vague fatigue, labile affect, and physical complaints that are easily forgotten
2. A nurse is reviewing the side effects of antidepressants with a group of older adults. Which of the following statements by a member of the group indicates that the nurse's teaching has been effective?
A) "I will start on the dose that I will take for life."
B) "Fluoxetine should be given in the evening because it may help me sleep."
C) "I need to maintain my fluid intake while on antidepressant medication."
D) "The length of antidepressant treatment is usually 3 months for a first-time depression." - ANSWER Ans: C
An increase in fluid intake helps prevent the risk of postural hypotension. Dosages can be increased gradually until maximal therapeutic levels are reached, while observing for adverse effects. Fluoxetine should be given in the afternoon because of agitation. The length of treatment is usually 6 months for a first-time depression
3. A nurse monitors for depression in the older adult population. Which of the following are a risk factor and a functional consequence of depression in the older adult? (Select all that apply.)
A) Chronic pain
B) Functional impairment
C) Hypernatremia
D) Nutritional deficiencies
E) Renal impairment - ANSWER Ans: A, B, D
Chronic pain, functional impairment, and nutritional deficiencies are both contributing factors and consequences of depression in the older adult. Renal impairment and hypernatremia are not specifically related to depression.
4. A nurse educator teaches about theories of late-life depression. Which of the following statements by a student shows that the material is understood?
A) "Adverse events impair your ability to evaluate yourself."
B) "Depression is caused by decreased activity in the hypothalamic-pituitary-adrenal axis."
C)"Older adults with depression and chronic illness have more serious negative functional consequences."
D) "Researchers have identified a cause-and-effect relationship between depression and dementia." - ANSWER Ans: C
Studies consistently find that the co-occurrence of depression with chronic conditions in older adults is associated with more serious negative functional consequences. Cognitive theory says that distorted perceptions, not adverse (unfavorable) events, impair one's ability to appraise oneself and the event constructively. Increased plasma cortisol levels and increased activity of the hypothalamic-pituitary-adrenal axis can lead to depression. Researchers have identified neuropathologic changes but have not identified a specific cause-and-effect relationship between dementia and depression.
5. When risk factors to potential suicide have been identified, a nurse must further assess the actual risk for a suicide attempt. Which of the following questions would be appropriate for initial assessment to determine the presence or absence of suicidal thoughts in an older adult with risk factors?
A) "Under what circumstances would you take your life? Have you ever started to act on a plan to harm yourself?"
B) "Do you have a plan for taking your life? What action would you take if you were to harm yourself?"
C) "Does your life feel worthless? Do you ever think about escaping from your problems?"
D) "Do you think about harming yourself? Do you ever think about committing suicide?" - ANSWER Ans: C
Suicide assessment is multilevel, and each level of questions depends on the response the client gives to the previous level's questions. Level 1 questions determine the presence or absence of suicidal thoughts. Level 1 questions are indirect; at level 2, they become more direct. Level 2 determines the presence or absence of thoughts about self-harm. Level 3 questions determine whether the client has a realistic suicide plan.
6. A gerontological nurse conducts an assessment of an older adult who has a history of depression. Assessment reveals that the client has been drinking up to two bottles of wine each day for the last several months. What should the nurse teach the client about alcohol use and depression?
A) "If you choose to use alcohol to address your depression, it's best to limit it to four to five drinks each day."
B) "We recommend that everyone over the age of 70 abstain from drinking alcohol."
C) "Alcohol has been shown to contribute to depression and vice versa."
D) "If you quit drinking, your depression will likely improve." - ANSWER Ans: C
Alcohol and depression have a synergistic relationship: alcohol causes depression, depression leads to alcohol abuse, which, in turn, exacerbates the depression. Four or five drinks daily is excessive, but abstinence is not necessary for all older adults. Abstinence is not guaranteed to improve symptoms of depression
7. An older adult has been accompanied by an adult child to visit a primary care provider. The child has expressed concern about the client's increasing apathy, isolation, and apparent sadness over the past several months; and the client acknowledges many of the symptoms of depression. Which of the following assessments should the nurse prioritize?
A) Functional assessment
B) Medication assessment
C) Musculoskeletal assessment
D) Cardiovascular assessment - ANSWER Ans: B
Medications may be risk factors for depression in numerous ways. A functional assessment is necessary, but this is more likely to ascertain the effects, rather than causes, of her depression. Musculoskeletal and cardiovascular assessments are secondary
8. Which of the following statements by residents of a nursing home should prompt a nurse to assess for depression?
A) "Lately I wake up for the day at 4:00 or 5:00 in the morning and can't fall asleep again."
B) "I've got these cravings for sugary and salty snacks more than I used to."
C) "I've never been too prone to headaches, but these days I always seem to have one."
D) "I don't know why this sore on my ankle just won't heal this time." - ANSWER Ans: A
Early morning waking is a sleep disturbance that is characteristic of depression. Headaches and impaired healing may also be linked with depression, but sleep disturbances are more highly associated with the problem. Food cravings are not typical of depression in older adults.
9. A nurse on an acute care for elders (ACE) unit monitors clients for functional consequences of depression. Which of the following statements by a client is of highest priority for follow-up?
A) "I can't shake this feeling that I've got a cloud hanging over me these days."
B) "I feel like I've got no appetite these days and it takes everything in me just to eat a little meal."
C) "I used to be a powerhouse of energy when I was younger, and now all I can do is sit in a chair."
D) "I think it would be better for everyone if I wasn't here anymore." - ANSWER Ans: D
All of these statements may be indicative of depression, but an allusion to suicide always constitutes the priority for further follow-up
10. An older adult was diagnosed with depression shortly after relocating to the nursing home 6 weeks ago. What intervention should the nurse implement to address the depression?
A) Teach the client about the problem of suicide in older adults.
B) Provide opportunities for the client to engage with other residents.
C)
Direct the client to list all the positive aspects of her present circumstances.
D) Appoint another resident as a "buddy" to accompany the client during the day. - ANSWER Ans: B
Social engagement and contact of all types has the potential to aid in the treatment of depression. Appointing a "buddy," however, is likely to be construed as intrusive and is unfair to the other resident. Asking an individual to focus on positives may be seen as simplistic. Teaching about suicide is unlikely to alleviate the signs and symptoms of depression
11. Which of the following clients is at highest risk for suicide?
A) An 18-year-old who has made an appointment with his primary health care provider
B) A 60-year-old with kidney stones
C) A 75-year-old woman living with her child and grandchildren
D) An 85-year-old man whose spouse died 1 year ago - ANSWER Ans: D
White men aged 85 years and older have the highest suicide rate. One of the commonly identified risks for suicide in older adults is recent bereavement. Presence of chronic or severe pain is a risk factor, as is loneliness
12. A nurse recognizes that depression has functional consequences. Which of the following are functional consequences of late-life depression? (Select all that apply.)
A) Decreased functioning
B) Dementia
C) Higher incidence of a stroke
D) Higher level of pain
E) Increased risk for suicide - ANSWER Ans: A, D, E
Increased risk for suicide, decreased functioning, and higher level of pain are functional consequences of late-life depression. Strokes are a risk factor. Dementia is strongly related to depression but not a consequence
13. An older adult is admitted to the hospital with weight loss and cognitive impairment. To assist in the diagnosis of major depressive disorder, for which of the following should the nurse assess? (Select all that apply.)
A) Decreased deep tendon reflexes
B) Loss of interest or pleasure
C) Psychomotor agitation
D) Respiratory difficulty
E) Sleep disturbances - ANSWER Ans: B, C, E
Diagnostic criterion for major depression includes depressed mood and/or loss of interest or pleasure along with at least five of the following signs and symptoms: weight loss, appetite change, sleep disturbances, observable, psychomotor agitation or retardation (i.e., slowness), fatigue or loss of energy, feeling worthless or excessively guilty, cognitive impairment, and recurrent thoughts of death or suicide. It does not include deep tendon reflexes or respiratory difficulty
14. An older adult started an antidepressant 1 week ago. The client states, "I don't want to take that pill, it's not doing anything." Which of the following responses by the nurse is most appropriate?
A) "That is fine, it is your right to refuse medications."
B) "It is too soon to see effects; positive effects may begin around 3 weeks."
C) "Let's notify the primary health care provider to try another type of medication."
D) "What side effects are you having?" - ANSWER Ans: B
Immediate improvement will not be evident, but a fair trial must be given to the medication as long as serious adverse effects are not noticed. The fair trial may take as long as 12 weeks, but some positive effects should be noticed within 2 to 4 weeks. If one type of antidepressant is not effective, another type may be effective. The right to refusal is the seventh medication right; however, it is the nurses' responsibility to ensure that the client is informed before accepting the refusal
15. A nurse teaches an older adult about the antidepressant medication recently prescribed. Which of the following should the nurse include in the teaching? (Select all that apply.)
A) Antidepressants can interact with alcohol and over-the-counter medications.
B) Depression is uncommon in the older adult population.
C) Expect adverse effects of the medicine; stop medication if they occur.
D) Don't expect immediate improvement; a fair trial may take up to 12 weeks.
E) The medication is to be taken only as needed. - ANSWER Ans: A, D
Immediate improvement will not be evident, but a fair trial must be given to the medication as long as serious adverse effects are not noticed. The fair trial may take as long as 12 weeks, but some positive effects should be noticed within 2 to 4 weeks. Antidepressants can interact with alcohol, nicotine, and other medications, including over-the-counter medications, possibly altering the effects of the medication or increasing the potential for adverse effects. Depression is common in older adults, it's treatable, if the client sticks to the treatment plan and takes medication daily (not PRN). Medication should not be stopped without consulting the primary hea
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