George Palo VSIM Questions and Answers Graded A

George Palo VSIM Questions and Answers Graded A Which nursing interventions implemented during Mr. Palo's assessment will assist him to communicate as effectively as his cognitive deterioration allows? (Select all that apply.) Providing simple explanations about why questions are being asked Phrasing questions so as to require simple answers Arranging for frequent breaks in the assessment process Allowing ample time for the patient to respond to questions. Rationale: The nurse provides simple explanations as often as patients need them, such as "I'm asking these questions so the staff can see how your health is." It helps to ask simple questions (those that require simple answers) rather than compound questions, and to allow patients ample time to answer. Patients may become confused or tire easily, so frequent breaks in the interview may be needed, Although it might become necessary to rely on family for answers to assessment questions, Mr. Palo appears capable of being the primary information provider. Relying on his daughter at this point would be nontherapeutic because it would minimize his role in the assessment process. Which statement made by Mr. Palo identifies an intervention that his family has implemented to help deal with his decline in executive functioning? "I put my bills in a special box, and Maggie pays them twice a month." Rationale: Having difficulty paying one's bills on time and correctly would be an example of a disturbance in executive functioning, which is the ability to think abstractly and to plan, initiate, sequence, monitor and stop complex behavior. The other options address Mr. Palo's poor nutrition, social isolation, and ineffective self-hygiene issues. Which assessment findings would indicate that Mr. Palo is experiencing both insufficient nutritional and fluid intake? (Select all that apply.) General weakness Altered mental status Weight loss Poor skin turgor Rationale: Indications of poor nutritional and fluid intake would include all the options with the exception of bradycardia. Such deficiencies would result in tachycardia and hypotension. When assessing Mr. Palo's risk for acute depression, the nurse is using the Geriatric Depression Scale: Short Form. What question(s) should the nurse be prepared to ask Mr. Palo? (Select all that apply.) "Are you basically satisfied with your life?" "Do you often get bored?" "Do you feel pretty worthless the way you are now?" Rationale: This depression screening tool focuses on older patients' feelings and the possible presence of boredom, worthlessness, and satisfaction with their current life. The origin or specific circumstances associated with their feelings are not addressed by the screening's short form. When Mr. Palo is unable to button his shirt appropriately after numerous attempts, the nurse matter-of-factly resumes the task for hm. What is the primary rationale for the nurse's actions? Minimizes his frustration with his failure to complete the task. Rationale: The nurse is correct in using a matter-of-fact approach when assuming tasks the patient can no longer perform. Preventing patients from working unsuccessfully at a task for an extended time helps in preserving their dignity and minimizing their frustration with their progressive memory loss. Although the nurse's action does help achieve the other options, none of them is the primary reason for the intervention. Mr Palo is demonstrating a rather pessimistic attitude when he and the nurse discuss ways to minimize his tendency to socially isolate. Which technique should the nurse implement to help him take a positive role in this discussion? Encouraging Mr. Palo to identify ways he could volunteer his time caring for animals. Rationale: The nurse should use therapeutic techniques to encourage patients to generate their own solutions. Studies have shown that patients tend to act on plans or solutions they generate rather than those that others offer. Finding and acting on their own solutions gives patients a renewed sense of competence and self-worth. All the other options provide possible solutions for his issue with socializtion. Considering Mr. Palo's history and assessment findings, which factor is most likely the primary contributor to the recent weight loss? Depression Rationale: A commonly observed physical response to depression is poor appetite and the resulting weight loss. Although nausea and vomiting are possible side effects of galantamine, there are no assessment data to suggest the patient is experiencing either. Both living alone and dementia (including Alzheimner disease), especially in its later stages can affect the patient's interest in preparing and eating food, but neigher has the high degree of influence presented by depression. Which statement made by Mr. Palo would demonstrate that his religious belief system is influential in the decision not to consider suicide? "No! He gives it and only He can take it away." Rationale: Suicidal thoughts are common in people with mood disorders, especially depression. An individual's belief systems and values can influence his or her decision concerning the act of suicide. Mr. Palo's reference to his belief in the time of death being determined only by God supports the religious influence of his decision. The other statements express various ethical objections to suicide but do not indicate that they are based on his religious belief system. Mr. Palo has been diagnosed with both mild dementia and depression. Which of his signs and symptoms are most likely associated with the dementia he is currently experiencing? (Select all that apply.) Easily frustrated Unkempt appearances Forgetfulness Rationale: Dementia is commonly associated with poor hygiene and dressing habits, as well as a low frustration point and forgetfulness. All of these behaviors are generally related to the loss of ability to perform familiar tasks and the anxiety this creates. Depression is more likely responsible for the tearfulness. Hypertension is not generally associated with either of these disorders, Mr. Palo states, "I'm old; when you get old, you naturally get depressed thinking of all the people you've lost and the things that have changed." To best address his safety, which initial response should the nurse make? "Depression isn't a normal part of getting older. Are you thinking about ending your life?" Rationale: Depression is not an expected, normal part of aging. To diagnose and treat the estimated 14% of older adults with depression, a standard, routine screening for depression should be part of a regular visit to the primary provider. Too often, both provider and older adult patient may view changes in mood as part of physical illness, or "just to be expected." Any patient suspected of being depressed should be assessed immediately for suicidal ideations. The other options encourage the patient to discuss his feelings and to explore possible treatment modalities.