ATI LPN
Psychiatric Nursing: Contemporary Practice 6th Edition
Chapter 37 : Mental Health Assessment of Older Adults Questions
Question 1 of 5
Assessment of an older adult client reveals that the client is receiving psychiatric medications. The client states, 'I get dizzy periodically and have trouble walking.' Which of the following should the nurse do first?
Correct Answer: A
Rationale: Dizziness and walking difficulties in an older adult on psychiatric medications may indicate orthostatic hypotension, a common side effect. Comparing baseline and current blood pressure (option
A) is the first step to assess this. Stopping medications (option
B) is premature without evidence. Interviewing family (option
C) is secondary to physical assessment. Mouthwash (option
D) is irrelevant to the symptoms.
Question 2 of 5
The nurse is planning to assess a client?s anxiety level using the Rating Anxiety in Dementia Scale because the client also has dementia. When using this scale which of the following areas would the nurse assess? Select all that apply.
Correct Answer: A,B,E,F
Rationale: The Rating Anxiety in Dementia Scale assesses anxiety symptoms in dementia patients, including apprehension (
A), motor tension (
B), autonomic hyperactivity (E), and worry (F). Life satisfaction (
C) and boredom (
D) are not specific components of this scale, which focuses on anxiety-related behaviors and physiological signs.
Question 3 of 5
A nurse is preparing a presentation for a group of colleagues about suicide and the older adult population. Which of the following would the nurse include in this presentation? Select all that apply.
Correct Answer: C,E
Rationale: Depression (
C) is the greatest risk factor for suicide in older adults, as it significantly increases vulnerability. Recent behavior changes and loss of support (E) are critical to assess, as they signal increased risk. Option A is incorrect, as older adults have higher suicide rates than middle-aged adults. Option B is false, as White men, not African American men, are at higher risk. Option D is incorrect, as White men, not women, have the highest suicide rates in this group.
Question 4 of 5
A group of nursing students is reviewing information about age-related changes occurring in cognition and intellectual performance. The students demonstrate understanding of the information when they identify which of the following as a normal cognitive change?
Correct Answer: B
Rationale: Slowed information processing (option
B) is a normal age-related cognitive change, as processing speed declines with aging but does not impair overall function significantly. Disorientation to time (
A), diminished executive functioning (
C), and restricted judgment (
D) are more indicative of pathological conditions like dementia, not normal aging.
Question 5 of 5
A nurse is assessing an older adult client. Which of the following would the nurse interpret as most indicative of mental health and wellness?
Correct Answer: B
Rationale: Interacting with others in the environment (option
B) is most indicative of mental health and wellness, as it reflects social engagement, a key component of psychological well-being. Keeping social contacts to a minimum (
A) or relying solely on family (
C) suggests isolation or dependence, which are less healthy. Bereavement (
D) is a normal response but not an indicator of wellness.