NR605 Final Exam
PMHNP can foster self-efficacy in older adults by: - ANSWER -advocating for participation
in care planning
-providing opportunities to make choices
-promoting physical activity
-providing health self-management education
-encouraging social interaction
-providing positive feedback
Psychosocial Considerations in Older Adults - ANSWER -Common life events experienced
by older adults:
• Retirement
• Raising grandchildren
• Caregiving for significant other
• Widowhood
Older Adults Functional Considerations - ANSWER -race, gender, ethnicity & social
determinants of health (SDOH)
• economic stability, social & community context, & healthcare access & quality
‣ contribute to wide variability in health status
-physical changes
• lead to frailty, functional decline, dependency
-higher prevalence of dementia
• raises need for neuropsychological screening
-often seek tx for depression r/t challenges caused by medical comorbidities & cognitive
changes
-may also need support navigating healthcare, housing, & finances
psychotherapy for older adults: Transference/Countertransference - ANSWER -Clients may
view therapists as they would a child or grandchild
-therapist may inadvertently project their feelings, biases, or fears about aging onto the client
-Therapists may have own experiences providing care for an older adult family member,
which could influence the therapist's perspective
older adults: Common Approaches to Treatment - ANSWER -cognitive-behavioral therapy
(CBT)
-interpersonal psychotherapy (ITP)
-problem-solving therapy for executive dysfunction (PST-ED)
-cognitive behavioral therapy for mild dementia (CBT-MD)
• for pts with cognitive impairment
-ecosystem-focused therapy (EFT)
• for pts with post-stroke depression
,older adults: Mindfulness-Based Interventions - ANSWER -Mindfulness-based stress
reduction (MBSR)
• typically provided over eight weeks
• shown some efficacy for novice and regular meditating adults
• reduce stress and mood disturbances
older adults: Reminiscence Therapy and Life Review - ANSWER -Reminiscence therapy
(RT) and life review therapy (LRT)
• approaches used to help older adults recall life events
• promote reflection
• help clients understand who they are as individuals
• help clients achieve ego integrity
-RT can help improve psychosocial outcomes, cognition, communication, and quality of life
for clients with dementia
Legal and Ethical Considerations: Elder Abuse - ANSWER -PMHNPs must be alert for
signs of elder abuse in their clients
-Worldwide
• 15% over age 60 experience abuse
• abuse rates in community & LTC settings increased during COVID pandemic
-Psychological abuse more prevalent than physical abuse
-neglect & self-neglect also occur
Types of Elder Abuse - ANSWER -Emotional abuse
-Sexual abuse
-Financial exploitation
-Neglect
-Abandonment
-Physical abuse
Which of the following are factors that contribute to elder abuse? Select all that apply.
-cognitive impairment
-aggressive behaviors
-lower household income
-psychological distress
-need for activities of daily living assistance
-shared living environment
-sharing expenses with other members living in the household
-participation in household chores - ANSWER -cognitive impairment
-aggressive behaviors
-lower household income
-psychological distress
-need for activities of daily living assistance
-shared living environment
Elder abuse: Almost ___% of abusers are caregivers, and __/__ of perpetrators are adult
children or spouses - ANSWER 60%, 2/3
,These offenders are well-intentioned. They become a caregiver expecting to provide adequate
care but are beleaguered by the amount of care and lash out verbally or physically.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
-Domineering or bullying offenders
-Impaired offenders - ANSWER Overwhelmed offenders
These offenders are well-intentioned but have personal problems that render them unqualified
to provide care. This includes caregivers who are of advanced age, have physical or mental
limitations, or have developmental disabilities.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
-Domineering or bullying offenders
-Impaired offenders - ANSWER Impaired offenders
These offenders are motivated by anticipated personal gain and not the desire to help others.
They tend to be socially sophisticated and gain a position of trust over the elder.
Maltreatment most often occurs in the form of neglect and financial exploitation.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
-Domineering or bullying offenders
-Impaired offenders - ANSWER Narcissistic offenders
These offenders are motivated by power and control and are prone to outbursts of rage. Their
abuse is chronic and includes physical, psychological, and forced coercion.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
-Domineering or bullying offenders
-Impaired offenders - ANSWER Domineering or bullying offenders
These offenders derive feelings of power and importance by humiliating and harming others.
Signs of abuse include bite, burn, and restraint marks, as well as forms of physical and sexual
assault.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
, -Domineering or bullying offenders
-Impaired offenders - ANSWER Sadistic offenders
Elder abuse screening - ANSWER -screening is critical as victims may
• fear of retaliation from their abuser
• fear of being removed from the home
-impaired cognition may be unable to report the abuse
-Assessing functional & cognitive status
• provides baseline for identifying their degree of dependence & vulnerability
-disheveled appearance or evidence of poor hygiene may raise suspicion of abuse
-Bruising & burns suggest physical abuse
EASI - ANSWER The Elder Abuse Suspicion Index
cognitive-behavioral therapy - ANSWER -focus on how well individuals can adapt
cognitively and functionally to their environments
-short-term, structured, goal-oriented form of psychotherapy
-stresses necessity of challenging maladaptive thoughts that lead to behavioral problems
-first emerged in 1955
-most widely practiced psychotherapy
-help clients recognize and address cognitive distortions
• by Albert Ellis, widely known as the grandfather of cognitive behavior therapy
-Beck
• originally trained in psychoanalysis, pioneered cognitive therapy in the 1960s, through his
research on depression
• also developed the popular Depression Inventory instrument
CBT Relationship to Nursing Theory - ANSWER -Orem's self-care deficit nursing theory
• provides a framework to view CBT as a supportive intervention
• fosters effective self-care behaviors
-Roy's Adaptation Theory
• premise that individuals use coping mechanisms to adapt to stimuli, both internal and
external
• share underpinnings with CBT.
Indications for CBT - ANSWER -treatment of a wide range of diagnoses
• depression
• anxiety disorders
• substance use disorders
• eating disorders
• severe mental illness
• PTSD
Principles of CBT include: - ANSWER -way an ind cognitively structures thoughts about
self & the world determines how the ind feels & behaves
-Dysfunctional thoughts are rooted in irrational assumptions
-Dysfunctional thinking and learned patterns of maladaptive behavior contribute to
psychological problems
PMHNP can foster self-efficacy in older adults by: - ANSWER -advocating for participation
in care planning
-providing opportunities to make choices
-promoting physical activity
-providing health self-management education
-encouraging social interaction
-providing positive feedback
Psychosocial Considerations in Older Adults - ANSWER -Common life events experienced
by older adults:
• Retirement
• Raising grandchildren
• Caregiving for significant other
• Widowhood
Older Adults Functional Considerations - ANSWER -race, gender, ethnicity & social
determinants of health (SDOH)
• economic stability, social & community context, & healthcare access & quality
‣ contribute to wide variability in health status
-physical changes
• lead to frailty, functional decline, dependency
-higher prevalence of dementia
• raises need for neuropsychological screening
-often seek tx for depression r/t challenges caused by medical comorbidities & cognitive
changes
-may also need support navigating healthcare, housing, & finances
psychotherapy for older adults: Transference/Countertransference - ANSWER -Clients may
view therapists as they would a child or grandchild
-therapist may inadvertently project their feelings, biases, or fears about aging onto the client
-Therapists may have own experiences providing care for an older adult family member,
which could influence the therapist's perspective
older adults: Common Approaches to Treatment - ANSWER -cognitive-behavioral therapy
(CBT)
-interpersonal psychotherapy (ITP)
-problem-solving therapy for executive dysfunction (PST-ED)
-cognitive behavioral therapy for mild dementia (CBT-MD)
• for pts with cognitive impairment
-ecosystem-focused therapy (EFT)
• for pts with post-stroke depression
,older adults: Mindfulness-Based Interventions - ANSWER -Mindfulness-based stress
reduction (MBSR)
• typically provided over eight weeks
• shown some efficacy for novice and regular meditating adults
• reduce stress and mood disturbances
older adults: Reminiscence Therapy and Life Review - ANSWER -Reminiscence therapy
(RT) and life review therapy (LRT)
• approaches used to help older adults recall life events
• promote reflection
• help clients understand who they are as individuals
• help clients achieve ego integrity
-RT can help improve psychosocial outcomes, cognition, communication, and quality of life
for clients with dementia
Legal and Ethical Considerations: Elder Abuse - ANSWER -PMHNPs must be alert for
signs of elder abuse in their clients
-Worldwide
• 15% over age 60 experience abuse
• abuse rates in community & LTC settings increased during COVID pandemic
-Psychological abuse more prevalent than physical abuse
-neglect & self-neglect also occur
Types of Elder Abuse - ANSWER -Emotional abuse
-Sexual abuse
-Financial exploitation
-Neglect
-Abandonment
-Physical abuse
Which of the following are factors that contribute to elder abuse? Select all that apply.
-cognitive impairment
-aggressive behaviors
-lower household income
-psychological distress
-need for activities of daily living assistance
-shared living environment
-sharing expenses with other members living in the household
-participation in household chores - ANSWER -cognitive impairment
-aggressive behaviors
-lower household income
-psychological distress
-need for activities of daily living assistance
-shared living environment
Elder abuse: Almost ___% of abusers are caregivers, and __/__ of perpetrators are adult
children or spouses - ANSWER 60%, 2/3
,These offenders are well-intentioned. They become a caregiver expecting to provide adequate
care but are beleaguered by the amount of care and lash out verbally or physically.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
-Domineering or bullying offenders
-Impaired offenders - ANSWER Overwhelmed offenders
These offenders are well-intentioned but have personal problems that render them unqualified
to provide care. This includes caregivers who are of advanced age, have physical or mental
limitations, or have developmental disabilities.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
-Domineering or bullying offenders
-Impaired offenders - ANSWER Impaired offenders
These offenders are motivated by anticipated personal gain and not the desire to help others.
They tend to be socially sophisticated and gain a position of trust over the elder.
Maltreatment most often occurs in the form of neglect and financial exploitation.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
-Domineering or bullying offenders
-Impaired offenders - ANSWER Narcissistic offenders
These offenders are motivated by power and control and are prone to outbursts of rage. Their
abuse is chronic and includes physical, psychological, and forced coercion.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
-Domineering or bullying offenders
-Impaired offenders - ANSWER Domineering or bullying offenders
These offenders derive feelings of power and importance by humiliating and harming others.
Signs of abuse include bite, burn, and restraint marks, as well as forms of physical and sexual
assault.
Match the type of offender with the description:
-Narcissistic offenders
-Sadistic offenders
-Overwhelmed offenders
, -Domineering or bullying offenders
-Impaired offenders - ANSWER Sadistic offenders
Elder abuse screening - ANSWER -screening is critical as victims may
• fear of retaliation from their abuser
• fear of being removed from the home
-impaired cognition may be unable to report the abuse
-Assessing functional & cognitive status
• provides baseline for identifying their degree of dependence & vulnerability
-disheveled appearance or evidence of poor hygiene may raise suspicion of abuse
-Bruising & burns suggest physical abuse
EASI - ANSWER The Elder Abuse Suspicion Index
cognitive-behavioral therapy - ANSWER -focus on how well individuals can adapt
cognitively and functionally to their environments
-short-term, structured, goal-oriented form of psychotherapy
-stresses necessity of challenging maladaptive thoughts that lead to behavioral problems
-first emerged in 1955
-most widely practiced psychotherapy
-help clients recognize and address cognitive distortions
• by Albert Ellis, widely known as the grandfather of cognitive behavior therapy
-Beck
• originally trained in psychoanalysis, pioneered cognitive therapy in the 1960s, through his
research on depression
• also developed the popular Depression Inventory instrument
CBT Relationship to Nursing Theory - ANSWER -Orem's self-care deficit nursing theory
• provides a framework to view CBT as a supportive intervention
• fosters effective self-care behaviors
-Roy's Adaptation Theory
• premise that individuals use coping mechanisms to adapt to stimuli, both internal and
external
• share underpinnings with CBT.
Indications for CBT - ANSWER -treatment of a wide range of diagnoses
• depression
• anxiety disorders
• substance use disorders
• eating disorders
• severe mental illness
• PTSD
Principles of CBT include: - ANSWER -way an ind cognitively structures thoughts about
self & the world determines how the ind feels & behaves
-Dysfunctional thoughts are rooted in irrational assumptions
-Dysfunctional thinking and learned patterns of maladaptive behavior contribute to
psychological problems
