Greene is an 85-year-old male placed on a 5150 by the crisis team after his nurse called them. He has taken a fall in his driveway after his dialysis. He has end-stage kidney disease, diabetes, and a history of myocardial infarction 4 years ago. He was living alone until his home health nurse found him crying out in pain, clutching onto his leg in the kitchen. “I’m so tired,” he says.
Nortriptyline and some tricyclic antidepressants may be helpful with neuropathic pain but are often contraindicated in elderly clients such as Mr. Greene because (select the best answer)
Are outdated medications
Can increase cardiac side effects and urinary retention
Are only taken at night
Are expensive
Are expensive
The Correct Answer is B
Choice A reason:
While some may consider tricyclic antidepressants outdated, they are still used for certain conditions, including neuropathic pain. The primary concern with their use in elderly clients is not their age but their side effect profile.
Choice B reason:
Tricyclic antidepressants, including nortriptyline, can increase cardiac side effects and urinary retention, which are significant concerns in elderly clients. These medications can cause orthostatic hypotension, arrhythmias, and exacerbate urinary retention, making them less suitable for older adults with pre-existing health conditions.
Choice C reason:
The timing of medication administration (e.g., only taken at night) is not the primary issue with tricyclic antidepressants. The concern lies in their side effects, which can be particularly problematic for elderly clients.
Choice D reason:
While the cost of medication can be a factor in treatment decisions, it is not the primary reason tricyclic antidepressants are contraindicated in elderly clients. The main concern is their potential to cause serious side effects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Thought content refers to the actual ideas and themes that a person expresses. It includes what the person is thinking about, such as delusions, obsessions, or preoccupations. Assessing thought content involves understanding the specific topics and beliefs the patient discusses.
Choice B reason:
Thought process refers to the way in which thoughts are organized and connected. Describing a patient’s speech as hesitant, slow, and with thought blocking indicates issues with the thought process. Thought blocking, where a person’s speech is interrupted by sudden silences, suggests difficulty in maintaining a coherent flow of ideas.
Choice C reason:
Affect refers to the observable expression of emotion. It includes the patient’s facial expressions, tone of voice, and body language. While affect can provide clues about a person’s emotional state, it does not directly relate to the organization of their thoughts.
Choice D reason:
Mood refers to the patient’s sustained emotional state, such as feeling depressed, anxious, or euphoric. While mood can influence speech patterns, the description of hesitant, slow speech with thought blocking specifically pertains to thought process rather than mood.
Correct Answer is A
Explanation
Choice A reason:
Anger is one of the stages of grief according to Kubler-Ross. Edward’s statement about wanting to punch his aunt reflects feelings of frustration and anger, which are common during this stage. Anger can be directed at various targets, including loved ones, healthcare providers, or even the deceased.
Choice B reason:
Denial is the initial stage of grief where individuals may refuse to accept the reality of the loss. Edward’s statement does not indicate denial but rather an active expression of anger and frustration.
Choice C reason:
Acceptance is the final stage of grief where individuals come to terms with the loss. Edward’s statement indicates unresolved anger, suggesting that he has not yet reached the stage of acceptance.
Choice D reason:
Bargaining involves making deals or promises in an attempt to reverse or lessen the loss. Edward’s statement does not reflect bargaining but rather anger towards his aunt for not informing him sooner.
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