Ch. 5: Chronic Illness & Older Adults

A male patient has a history of hypertension and type 1 diabetes mellitus. Because of these chronic illnesses, the patient exercises and eats the healthy diet that his wife prepares for him. Which factors will most likely have a positive impact on his biologic aging (select all that apply)? A) Exercise B) Diabetes C) Social support D) Good nutrition E) Coping resources

A, C, D, E [Exercise, Social support, Good nutrition, Coping resources] RATIONALE: Biologic aging is the progressive loss of function. Obesity, diabetes, hypertension, and cancer are all associated with the effects of aging. Exercise, good nutrition, social support, stress management, and coping resources are all positive factors related to the aging process.

A 70-year-old man has just been diagnosed with chronic obstructive pulmonary disease (COPD). At what point should the nurse begin to include the patient's wife in the teaching around the management of the disease? A) As soon as possible B) When the patient requests assistance from his spouse and family C) When the patient becomes unable to manage his symptoms independently D) After the patient has had the opportunity to adjust to his treatment regimen

A) As soon as possible RATIONALE: In the management of chronic illness, it is desirable to include family caregivers in patient education and symptom-management efforts as early in the diagnosis as possible.

Which criterion must a 65-year-old person meet in order to qualify for Medicare funding? A) Being entitled to Social Security benefits Correct B) A documented absence of family caregivers C) A validated need for long-term residential care D) A history of failed responses to standard medical treatments

A) Being entitled to Social Security benefits RATIONALE: In order to qualify for Medicare, an individual must be entitled to receive Social Security benefits. Absence of caregivers and inadequate responses to treatment are not qualification criteria for Medicare, and the program does not cover residential care services.

A nurse who is providing care for an 81-year-old female patient recognizes the need to maximize the patient's mobility during her recovery from surgery. What accurately describes the best rationale for the nurse's actions? A) Continued activity prevents deconditioning. B) Pharmacokinetics are improved by patient mobility. C) Lack of stimulation contributes to the development of cognitive deficits in older adults. D) Regularly scheduled physical rehabilitation provides an important sense of purpose for older patients.

A) Continued activity prevents deconditioning. RATIONALE: Older adults are highly susceptible to deconditioning, a process that can be slowed or prevented by regular physical activity. This consideration supersedes any possible effect on pharmacokinetics, prevention of cognitive deficits, or the patient's sense of purpose.

What is most appropriate for the nurse to do when interviewing an older patient? A) Ensure all assistive devices are in place. B) Interview the patient and caregiver together. C) Perform the interview before administering analgesics. D) Move on to the next question if the patient does not respond quickly.

A) Ensure all assistive devices are in place. RATIONALE: All assistive devices, such as glasses and hearing aids, should be in place when interviewing an older patient. It is best to interview the patient and caregiver separately to ensure a reliable assessment related to any possible mistreatment. The patient should be free from pain during the assessment and may need extra time to respond to questions.

An 82-year-old woman with chronic heart failure is cared for in the home by her only child. What problem is indicated by the caregiver's failure to provide companionship or social stimulation? A) Neglect B) Sexual abuse C) Abandonment D) Violation of personal rights

A) Neglect RATIONALE: Neglect characteristics: leaving alone for long periods, failing to provide social stimulation and/or companionship; Sexual abuse: nonconsensual sexual contact includes touching inappropriately, forcing sexual contact; Abandonment: desertion by person who's assumed responsibility for providing care or person w/ physical custody; Violation of personal rights: denying right to privacy or make decisions regarding health care or living environment, forcible eviction.

An appropriate care choice for an older adult who lives with an employed daughter but requires help with activities of daily living (ADLs) is: A) adult day care. B) long-term care. C) a retirement center. D) an assisted living facility.

A) adult day care. RATIONALE: Adult day care (ADC) programs provide daily supervision, social activities, and assistance with ADLs for persons who are cognitively impaired and persons who have problems with ADLs. ADC centers provide physical and emotional relief for the caregiver and allow the caregiver to pursue continued employment.

Which assessment findings would alert the nurse to possible elder mistreatment (select all that apply)? A) Agitation B) Depression C) Weight gain D) Weight loss E) Hypernatremia

A, B, D, E [agitation, depression, weight loss, hypernatremia] RATIONALE: Agitation and depression may be manifestations of psychologic abuse or neglect. Hypernatremia may signify dehydration caused by physical neglect. Weight loss, rather than weight gain, is another manifestation of physical neglect.

A 67-year-old woman who has a long-standing diagnosis of incontinence is in the habit of arriving 20 minutes early for church in order to ensure that she gets a seat near the end of a row and close to the exit so that she has ready access to the restroom. Which tasks of the chronically ill is the woman demonstrating (select all that apply)? A) Controlling symptoms B) Preventing social isolation C) Preventing and managing a crisis D) Denying the reality of the problem E) Adjusting to changes in the course of the disease

A, C [Controlling symptoms & Preventing and managing a crisis] RATIONALE: The woman's efforts to ensure that she can continue in her lifestyle of church attendance while accommodating the frequent elimination caused by her health problem are an example of controlling her symptoms and preventing a personal crisis.

A nurse is caring for an adult who sustained a severe traumatic brain injury following a motor vehicle accident. Once the patient recovers from the acute aspects of this injury and is no longer ventilator-dependent, discharge planning would include that this patient will be transferred to what type of practice setting? A) Assisted living B) Acute rehabilitation C) Long-term acute care D) Skilled nursing facility

B) Acute rehabilitation RATIONALE: Acute rehabilitation practice settings provide a post-acute level of care specializing in therapies for patients with neurologic or physical injuries, such as those with head trauma, spinal cord injury, or stroke.

What should be included when planning care for an older adult? A) Patient priorities should be the only focus of care. B) Additional time related to declining energy reserves. C) Reduction of disease and problems should be the focus. D) Tobacco cessation will help the patient cope with other illnesses.

B) Additional time related to declining energy reserves. RATIONALE: Additional time required w/ older patients w/ declining energy reserves. Pt. priorities considered to best meet pt. needs but will not be only focus of care. Focusing on strengths and abilities as well as physical and mental status will facilitate goal setting to reduce disease or problems. As with all patients, safety is a primary concern, and decreasing tobacco use will improve all of the patient's body functioning.

A 60-year-old female patient has had increased evidence of dementia and physical deterioration. What would be the best assistance to recommend to her caregiver husband who is exhausted? A) Long-term care B) Adult day care Correct C) Home health care D) Homemaker services

B) Adult day care RATIONALE: Adult day care provides social, recreational, and health-related services in safe, community-based environment that would keep pt. safe & decrease stress on husband. Long-term care used when pt. has rapid deterioration, caregiver's unable to continue care, and there's alteration in or loss of family support system. Home health care when there's supportive caregiver involvement for pt. w/ health needs. Homemaker services provide services, not pt. care.

Example of primary prevention strategies include: A) colonoscopy at age 50. B) avoidance of tobacco products. C) intake of a diet low in saturated fat in a patient with high cholesterol. D) teaching the importance of exercise to a patient with hypertension.

B) avoidance of tobacco products. RATIONALE: Primary prevention refers to measures such as proper diet, suitable exercise, and timely immunizations that prevent the occurrence of a specific disease. Colonoscopy is a diagnostic test and therefore secondary prevention. In C and D, patients already have condition (high cholesterol and HTN) so it cannot be primary prevention.

Ageism is characterized by: A) Denial of negative stereotypes regarding aging. B) Positive attitudes toward the elderly based on age. C) Negative attitudes toward the elderly based on age. D) Negative attitudes toward the elderly based on physical disability.

C) Negative attitudes towards the elderly based on age. RATIONALE: Ageism is a negative attitude based on age.

Aging primarily affects the _________of drugs. A) excretion B) absorption C) metabolism D) distribution

C) metabolism RATIONALE: Because the liver mass shrinks and hepatic blood flow and enzyme activity decrease in older adults, metabolism of drugs drops 1/2 to 2/3 of the rate of young adults. This increases the chance of drug toxicity and adverse drug events.

Nursing interventions directed at health promotion in the older adult are primarily focused on: A) disease management. B) controlling symptoms of illness. C) teaching positive health behaviors. D) teaching regarding nutrition to enhance longevity.

C) teaching positive health behaviors. RATIONALE: A high value should be placed on health promotion and positive health behaviors.

An important nursing action to help a chronically ill older adult is to: A) avoid discussing future lifestyle changes. B) assure the patient that the condition is stable. C) treat the patient as a competent manager of the disease. D) encourage the patient to "fight" the disease as long as possible.

C) treat the patient as a competent manage of the disease. RATIONALE: Chronically ill older adults should understand and manage their own health. Self-management is the individual's ability to manage his or her symptoms, treatment, physical and psychosocial consequences, and lifestyle changes in response to living with a long-term disorder.

A characteristic of a chronic illness is that it (select all that apply): A) has reversible pathologic changes. B) has a consistent, predictable clinical course. C) results in permanent deviation from normal. D) is associated with many stable and unstable phases. E) always starts with an acute illness and then progresses slowly.

C, D [has a consistent, predictable clinical course; results in permanent deviation from normal] RATIONALE: Characteristics of chronic illness include: permanent impairments or deviations from normal, irreversible pathologic changes, residual disability, requirements for special rehabilitation, and need for long-term medical and/or nursing management. Chronic illness may have stable and unstable periods.

A 74-year-old patient admitted with an irregular cardiac rhythm has a much lower blood level of his home medication than expected. Which common cause of medication errors made by older adults should be suspected? A) Shorter drug half-life leading to medication overdose B) Decreased use of nonprescription over-the-counter drugs C) Improved tolerance of adverse effects of prescribed drugs D) Lack of financial resources to obtain prescribed medications

D) Lack of financial resources to obtain prescribed medications RATIONALE: Common causes of medication errors by older adults include poor eyesight, forgetting to take drugs, use of nonprescription over-the-counter drugs, use of medications prescribed for someone else, lack of financial resources to obtain prescribed medication, failure to understand instructions or importance of drug treatment, and refusal to take medication because of undesirable side effects. Drug half-life is increased in older adults.

Older adults who become ill are more likely than younger adults to: A) complain about the symptoms of their problems. B) refuse to carry out lifestyle changes to promote recovery. C) seek medical attention because of limitations on their lifestyles. D) alter their daily living activities to accommodate new symptoms.

D) alter their daily living activities to accommodate new symptoms. RATIONALE: Older adults may underreport symptoms and treat these symptoms by altering their functional status.

An ethnic older adult may feel a loss of self-worth when the nurse: A) informs the patient about ethnic support services. B) allows a patient to rely on ethnic health beliefs and practices. C) has to use an interpreter to provide explanations and teaching. D) emphasizes that a therapeutic diet does not allow ethnic foods.

D) emphasizes that a therapeutic diet does not allow ethnic foods. RATIONALE: An older adult with strong ethnic and cultural beliefs may experience loss of self if nurses deny or ignore ethnic and cultural practices and behaviors.