Anxiety problems in older adults can manifest as a fear of falling, greatly influencing an older adult's personal freedom. A home health nurse checking on a patient with mild dementia and anxiety related to falling should question which new order?

Correct Answer: D

Rationale: The correct answer is D: Electric wheelchair. This is because anxiety related to falling can impact an older adult's mobility and independence. Providing an electric wheelchair can help the patient move around safely and independently, reducing the fear of falling and promoting personal freedom. Choice A: Yoga and tai-chi may help with relaxation and balance, but they may not address the immediate mobility concerns of the patient with mild dementia and anxiety related to falling. Choice B: Xanax is a medication commonly used to treat anxiety, but it may not address the underlying mobility issues and could potentially cause side effects in older adults. Choice C: Relaxation techniques can be beneficial for managing anxiety, but in this case, addressing the patient's mobility concerns with an electric wheelchair would be more appropriate and effective.

Correct Answer: D

Rationale: The correct answer is D: Exhaustion. In the general adaptation syndrome model, developed by Hans Selye, the final stage is exhaustion. This stage occurs when the body can no longer cope with the stressors and resources are depleted. This leads to a breakdown in physical and emotional functioning. The other choices are incorrect because: A: Perception of a threat is the first stage (alarm reaction); B: Use of coping mechanisms occurs in the second stage (resistance); C: Physiologic response is a general term encompassing all stages, not specific to the final stage.

Correct Answer: D

Rationale: The correct answer is D: Electric wheelchair. This is because anxiety related to falling can impact an older adult's mobility and independence. Providing an electric wheelchair can help the patient move around safely and independently, reducing the fear of falling and promoting personal freedom. Choice A: Yoga and tai-chi may help with relaxation and balance, but they may not address the immediate mobility concerns of the patient with mild dementia and anxiety related to falling. Choice B: Xanax is a medication commonly used to treat anxiety, but it may not address the underlying mobility issues and could potentially cause side effects in older adults. Choice C: Relaxation techniques can be beneficial for managing anxiety, but in this case, addressing the patient's mobility concerns with an electric wheelchair would be more appropriate and effective.

Correct Answer: B

Rationale: The correct answer is B: Catharsis. Catharsis refers to the process of emotional release and purification through expressing feelings and emotions. In this scenario, the patient is engaging in bibliotherapy and expressing his feelings, indicating a release of pent-up emotions. This is a therapeutic process that allows the patient to process and cope with their emotions in a healthy way. Choice A: Insight is incorrect as it refers to gaining a deeper understanding or awareness, which is not explicitly mentioned in the scenario. Choice C: Anxiety reduction is incorrect as the scenario does not specify that the patient's goal is to reduce anxiety, but rather to express feelings associated with the reading material. Choice D: Problem solving is incorrect as the scenario does not involve the patient actively working through a specific problem, but rather expressing emotions related to the reading material.

Correct Answer: C

Rationale: The correct answer is C: Quetiapine (Seroquel) is a second-generation antipsychotic agent. This is because second-generation antipsychotics, also known as atypical antipsychotics, have a lower risk of extrapyramidal side effects compared to first-generation antipsychotics. Quetiapine is known for its efficacy in treating both positive and negative symptoms of schizophrenia. Fluphenazine, Thiothixene, and Chlorpromazine are all first-generation antipsychotic agents and are associated with a higher risk of extrapyramidal side effects and other adverse effects. Therefore, the correct choice for a second-generation antipsychotic agent is Quetiapine.

Correct Answer: A

Rationale: The correct answer is A: glomerular filtration rate of 14 mL/minute. A GFR of 14 mL/minute indicates severe kidney dysfunction, warranting hemodialysis to filter waste products and excess fluids from the blood. B: BUN 16 mg/dL, C: serum magnesium 1.8 mg/dL, and D: serum phosphorus 4.0 mg/dL are within normal ranges and do not specifically indicate the need for hemodialysis in chronic kidney disease.

Correct Answer: B

Rationale: The correct answer is B because it prioritizes de-escalation and patient cooperation by using a calm and empathetic approach. Accompanied by staff members ensures safety and support. It communicates the purpose of the medication positively. Choice A lacks support and may not address the patient's aggression. Choice C uses a physical hold, which can escalate the situation. Choice D introduces a security guard, potentially increasing hostility and fear. Overall, choice B aligns with best practices for managing aggressive behavior in a therapeutic and respectful manner.

Correct Answer: B

Rationale: Step 1: Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for anxiety disorders due to their efficacy and tolerability. Step 2: SSRIs are also effective in treating somatic symptom disorders by addressing the underlying anxiety symptoms. Step 3: MAOIs are not commonly used for anxiety due to their dietary restrictions and potential for drug interactions. Step 4: Tricyclic antidepressants (TCAs) are less preferred due to their side effect profile and risk of toxicity. Step 5: Atypical antipsychotics are not typically prescribed for anxiety unless there is a specific indication for their use. Summary: B, SSRI is the correct choice for treating both anxiety and somatic symptom disorder, while the other options have limitations or are not commonly used for these conditions.

Correct Answer: B

Rationale: The correct answer is B: Rinse the mouth with a mouthwash. Anticholinergic medications can cause dry mouth due to decreased saliva production. Rinsing with a mouthwash can help moisturize the oral mucosa and provide temporary relief. Chewing hard candies (choice A) may provide temporary relief but can also increase the risk of dental caries. Using more seasonings on food (choice C) and drinking decaffeinated beverages often (choice D) do not directly address the dry mouth concern.