Nurse 3403 exam 2 elsevier exam with
complete solutions
An older adult client has the following symptoms: disturbances in attention and
awareness, changes in cognition, and delusional thoughts and behavior. You
have watched these symptoms develop over the last couple of days. Considering
what you know about cognitive impairment, you realize your client is
experiencing which one of the following conditions?
A. lowered stress threshold
B. delirium
C. normal pressure hydrocephalus
D. dementia
B. delirium
Delirium develops over a short period, and symptoms include disturbances in attention
and awareness and changes in cognition. Perceptual disturbances are often
accompanied by delusional thoughts and behavior. Dementia typically has a gradual
onset and a slow, steady pattern of decline without alterations in consciousness. The
lowered stress threshold model was one of the first models used to plan and evaluate
care for people with NCDs in every setting. Normal pressure hydrocephalus causes a
type of dementia that is characterized by ataxic gait, incontinence, and memory
impairment.
An older adult male client’s family has made the difficult decision to place him in
a nursing home. You discuss with the family about person-centered care. What
do you explain to the family that this care involves? (Select all that apply.)
A. offers hope
B. enhances the quality of life
C. focuses on the disease
D. supports limitations
E. fosters abilities
F. maintains the quality of life
A, B, D, E
Person-centered care fosters abilities by acknowledging that the older adult brings with
him or her expert knowledge and skill. Person-centered care enhances the quality of life
,by encouraging older individuals to achieve their full potential and participate in their
communities. Person-centered care offers hope for those who need it―hope that will be
respected―and gives the support an older adult requires. Person-centered care
supports a client's limitations, works within those limitations, and encourages the client.
Person-centered care looks beyond the disease and the tasks to be performed. Person-
centered care actually enhances not maintains an individual's quality of life.
Your client has perceptual disturbances and misinterpretations of reality. When
providing care for her, you learn that she does not like bathing. When
approached, she screams at you and strikes out. Which of the suggestions below
might make her more comfortable? (Select all that apply.)
A. washing her hair first
B. keeping the room warm and low-lit
C. using bathing terminology
D. playing background music
E. singing to her
F. bathing the least sensitive areas first
B, D, E, F
The use of music and other sound stimulation can contribute to improved health and
well-being. Singing familiar songs has been shown to enhance the expression of
positive moods and emotions, increase the mutuality of communication, and reduce
aggression and resistive care behaviors. Having the room ready, warm, and well-lit, and
providing a large towel or blanket preserves dignity and keeps them warm. Begin
bathing the least sensitive areas first—legs and feet first, followed by arms, trunk,
perineum area, and face last. Avoid using bathroom and bathing terminology to create a
more positive atmosphere. Wash the hair last or at a separate time.
The overriding goals in caring for older adults with dementia include what of the
following? (Select all that apply.)
A. maintain function
B. limit opportunities for interaction
C. create a therapeutic milieu
D. structure the environment
A, C, D
Persons with dementia may understand more than is realized. Structuring the
environment and relationships help maintain stability. Maintaining function helps prevent
excess disability. Creating a therapeutic milieu nurtures the personhood of the individual
and maintains a quality of life. Providing opportunities for interaction and caring
communication, both verbal and nonverbal, are still important.
Components to a cognitive assessment include which of the following? (Select all
that apply.)
A. differentiating delirium, dementia, and depression
B. complete blood count
, C. assessing for atypical presentation of illness
D. comprehensive assessment
A, C, D
Whenever there is a change in cognitive status, it is essential that a comprehensive
cognitive assessment be done to identify reversible conditions that may be the cause of
an individual's symptoms. An important aspect of this is differentiating delirium,
dementia, and depression. A comprehensive assessment would be performed if an
impairment is identified through screening. Older individuals often present with atypical
signs or symptoms of illnesses. This can be exaggerated when the client had dementia.
A complete blood count would provide an idea of basic cell functions; however, it would
not help with diagnosing cognitive dysfunction.
Typically, when discussing the topic of suicide, the discussion is targeted to the
younger or middle-aged adult. However, older adults actually account for 20% of
the suicide deaths in the United States. When assessing an older adult male
client, you believe that suicide might be his intent. Which of the following
questions should you ask? (Select all that apply.)
A. "how often have you had these thoughts?"
B. "why do you think you will not be around much longer?"
C. "have you ever though about killing yourself?"
D. "do you have the implement to kill yourself?"
E. "how would you kill yourself if you decided to do it?"
F. "have you thought of those who love you?"
A, C, D, E
If the suspicion exists that an older adult is suicidal, then use direct and straightforward
questions such as, "Have you ever thought about killing yourself?" Asking how often
one has had thoughts of suicide is direct and straightforward and will give you a clear
answer. Many times, those who intend to commit suicide have already decided how
they are going to kill themselves. Being direct in this line of questioning encourages the
client to discuss their suicidal intentions with you. Knowing whether the client has the
implement to kill himself will give you a good idea of his intent of suicide. Have you
thought of those who love you does not directly ask a question about suicide.
Attempting to place the client on a guilt trip is not directly addressing the issue of
suicide.
Which of the following social determinates does not play a part in influencing
levels of chronic illness?
A. language barrier
B. socially disadvantaged
C. education
D. delirium
D. delirium
