Help with a question?

[Middleburg08]

I was quite confused with this question and didn't quite kno how to eliminate the answers. But the question was:

An confused elderly patient is brought in by her daughter. The daughter states she is depressed and not eating correctly. On assessment you see the patient is slightly dehydrated. You want to do a furthur assessment to confirm:

Dementia

Incontinence

Elder Abuse

Medication overuse

I picked medication overuse thinking that possibly there was overuse of laxatives because of the dehydration.

We weren't taught about Elder Abuse, so I don't know the signs of it.

Dementia didn't seem to fit the depression sign.

Incontinence didn't fit the question.

[shibaowner, MSN, RN, NP]

It is very common for elderly people to be slightly dehydrated. This can be due to suboptimal eating and drinking habits. A lot of elderly people just don't want to eat or drink very much. A caregiver must be vigilant and remind/encourage good fluid intake.

There is no indication of medication overuse. It would be appropriate to ask if the patient is taking any medications, including laxatives, and if so, what they are. Then it could be determined if there is medication overuse.

Incontinence - I agree that this would not be my first choice, although the question should be asked.

That leaves dementia or elder abuse.

Dementia - I would definitely assess for this.

Elder abuse - Depression symptoms can include decreased appetite. And depression can occur from abuse.

Personally, I would also check for a UTI.

I hated these NCLEX-type questions. In real life, you can quickly screen for all of these and that is what you should do. Good luck!