An older man was oriented and responded appropriately in the hospital, but he is now disoriented and ...

Answer to #1

B
Older adults are at higher risk of hypothermia in the community because hypothermia is difficult to detect and because, as hypothermia sets in, the older adult can respond to a lower temperature. This man has clinical indicators of hypothermia; therefore the home care nurse first assesses the ambient temperature for a baseline determination because the household temperature should have the most profound impact on his body temperature. Asking about shivering can be ineffective with an older adult who is confused and disoriented; the response can be incorrect. However, to display respect, the nurse should ask the question. The type of food preparation can offer addi-tional clues about the older adult's hypothermia and mental status; if he is eating cold foods such as sandwiches and yogurt, then he can be unwittingly contributing to the problem. Presence of radon in the home may lead to lung cancer, not confusion.

Answer to #2

A

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A Correct. This individual is taking an atypical antipsychotic agent to control manic episodes of dementia. Although these agents are less likely to cause tar-dive dyskinesia (TD), the nurse monitors for the associated abnormal movements of TD including oral and facial dyskinesia, impairment in the ability to execute voluntary facial movement. The nurse reports this immediately to stop therapy and prevent an irreversible condition.
B Incorrect. Mask facies, having a masklike appearance, and shuffling gait are parkinsonian side effects of antipsychotic agents and can be improved with an-tiparkinsonian agents.
C Incorrect. Muscle spasms of the face, tongue, neck, and back are adverse effects of antipsychotic agents usually seen within the first 5 days of therapy. They are potential indicators of acute dystonia and can be improved with antiparkinsonian agents.
D Incorrect. Motor restlessness is an adverse effect of antipsychotic agents and is characteristic of akathisia.

Answer to #3

C

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A Incorrect. Only recently has gerontological nursing content begun to appear in nursing school curricula.
B Incorrect. Most nursing schools still do not have such courses.
C Correct. These issues are sorely neglected in curricula of schools of nursing.
D Incorrect. At present there are no minimum requirements for coverage of care of older adults.

Answer to #4

D
The nurse accomplished the most important aspect of fall prevention with the assessment. How-ever, in an attempt to communicate the fall risk to other staff members, the nurse failed to com-municate properly to the patient about fall prevention before leaving the room. Calling for someone to bring the sign would have been a reasonable approach to communicating the risk of falls, but it does not take the place of directly instructing the patient about prevention. The needs of an older adult can contribute to the risk of falls as an individual leans and reaches for some-thing; therefore call bell instructions are a reasonable approach for preventing falls. However, before providing the call bell instructions, the nurse needed to tell him to call for help. A urinal and drinking water are common items that an older man needs, but reaching for them can con-tribute to falls.

Answer to #5

C

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A Incorrect. Although nausea and vomiting are among the most common adverse effects of pharmacotherapy, they can indicate medication toxicity and should be reported to the health care provider.
B Incorrect. Keeping medication at the bedside is dangerous for anyone and can be especially dangerous for older adults taking antianxiety agents, hypnotic agents, and opioid analgesics because these and other medications can cause respiratory depression with and without excessive dosing. If sleepy or lethargic, an older adult can inadvertently take more than the correct dose and suffer serious consequences as a result.
C Correct. Older adults should ask the health care provider for the purpose of each drug and record the information.
D Incorrect. These are suitable instructions for many medications; however, many medications that are likely to cause nausea are taken with food. The nurse should instruct the older adults to keep a record of the recommended method of administration.

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