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Are outdated medications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While some may consider tricyclic antidepressants outdated, they are still used for certain conditions, including neuropathic pain.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.
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Correct Answer is D
Explanation
Choice A reason:
The statement “The stress of nursing school will cause depression” is not accurate according to the Diathesis-Stress Model. While stress can contribute to the development of depression, the model emphasizes the interaction between genetic vulnerabilities and environmental stressors, not a direct cause-and-effect relationship.
Choice B reason:
“Depression is a result of cultural and religious perspectives” is not a statement supported by the Diathesis-Stress Model. This model focuses on the interplay between genetic predispositions and environmental stressors, rather than cultural or religious factors alone.
Choice C reason:
“The stress of parenting often causes depression” is an oversimplification. While parenting can be stressful and may contribute to depression in some individuals, the Diathesis-Stress Model highlights the importance of genetic vulnerabilities interacting with life stressors to trigger depression.
Choice D reason:
“People with genetic vulnerabilities can develop depression with added stress of life events” accurately reflects the Diathesis-Stress Model. This model posits that individuals with a genetic predisposition to depression are more likely to develop the condition when exposed to significant stressors, such as life events or environmental challenges.
Correct Answer is B
Explanation
Choice A reason:
Saying “If you don’t stop this, you are going to get an infection and I will have to call the doctor” is not an effective way to address Tiffany’s behavior. This statement is likely to increase her anxiety and does not help her understand or manage her triggers.
Choice B reason:
Asking “Can you tell me about what increases your anxiety?” is the best approach. This question is open-ended and non-judgmental, encouraging Tiffany to share her thoughts and feelings. Understanding her triggers is essential for developing effective coping strategies and interventions.
Choice C reason:
Ignoring the behavior and asking other questions is not appropriate. It is important to address Tiffany’s anxiety and compulsive behaviors directly to provide appropriate support and interventions.
Choice D reason:
Asking “Why do you keep washing your hands? They are starting to bleed!” is likely to be perceived as critical and may increase Tiffany’s anxiety. It is important to approach the topic with empathy and understanding, focusing on identifying triggers and developing coping strategies.