Chapter 9

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin and exenatide and reports adhering to a diet. The glycohemoglobin is 5.9%. According to the stable phase of the Trajectory Model of Chronic Illness, how should the nurse respond?

Acknowledges that the client is performing satisfactorily

An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse

Acknowledges the client's achievement when she walks to the bedside commode with her walker

Spinal cord injury is an example of which type of disability?

Acquired

A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have?

Acquired disability

The client who has the chronic condition of diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. What phase of the Trajectory Model of Chronic Illness does the nurse assess this client is in?

Acute

The nurse recognizes which disorder as a developmental disability in a patient?

Cerebral palsy

The nurse is caring for a client with diabetes. Which of the following is a characteristic of chronic illness?

Chronic illness affects the entire family.

Which statement is a misconception about chronic disease?

Chronic illnesses cannot be prevented.

The nurse is working with a client who has difficulty controlling her blood sugar. The overweight client does not adhere to a low-calorie diet and forgets to take medications and check her blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, the nurse first

Collaborates with the client to establish an agreed-upon goal

Which phase of the Trajectory Model does the nurse recognize is present when the patient is in remission, after an exacerbation of illness?

Comeback

This type of disability represents one that occurs any time from birth to 22 years and results in impairment of physical or mental health, cognition, speech, language, or self-care.

Developmental

A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as

Downward

The client with blindness is hospitalized following a myocardial infarction. Which care measures would the nurse take with this client? Select all that apply.

Identify self when walking into the client's room. State when the nurse is leaving the room. Orient the client to the room using a clock reference.

Which is a cause related to the increasing number of people with chronic conditions?

Improved screening and diagnostic procedures

A nurse prepares a diabetes prevention health seminar for community residents. Her teaching points should emphasize the most important factor influencing metabolic syndrome (pre-diabetes). What is that factor?

Obesity

A client who is blind is hospitalized for hip surgery. The nurse notices that the containers on the client's lunch tray are unopened, the client is fumbling with items, and food is on the front of the client's gown. The nurse assists the client by

Opening containers and orienting the client to placement of items on the tray

A client has lost mobility following a stroke. The nurse has established interventions that include providing direct care to the client, teaching, making referrals, and managing the case, to meet the goal. The next step is to

Plan with the client how to incorporate the regimen into the client's activities of daily living.

The client had a cerebrovascular accident with drooping of the face. Speech is slurred. The nurse is obtaining the admission assessment data. It would be best for the nurse to

Repeat back what the client states.

A community nurse is working to decrease the incidence of cardiac disease in Nicaragua. The nurse should plan educational health promotion activities around which element?

Smoking cessation

During which phase of the Trajectory Model of chronic illness is the focus of nursing care on reinforcing positive behaviors and offering ongoing monitoring?

Stable

The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate?

Stable

A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness:

The client stops taking some medications due to side effects that are disturbing to the client.

A client with impaired hearing communicates through sign language and has been admitted to the unit before scheduled surgery. The interpreter that the hospital employs is at the bedside. The nurse needs to take what actions into consideration prior to doing preoperative teaching with this client?

The interpreter may lag a few words behind--especially if names or technical terms are to be finger spelled.

The number of people with disabilities is expected to increase over time. What is a major contributor to this prediction?

The survival of people with severe trauma, chronic disorders, and early-onset disabilities

A nurse cares for a client with a chronic illness who has a diagnostic workup for the illness and announces the diagnosis to friends and family. According to the Trajectory Model of Chronic Illness, what phase is the client displaying?

Trajectory onset

A client is hospitalized with a traumatic brain injury following an automobile accident. The client has difficulty processing information and needs information to be repeated. A consulting physician enters the room. The nurse

Turns off the television

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need for which accomplishments? Select all that apply.

Validate individual self-worth Alleviate and manage symptoms Validate family functioning

An elderly client with chronic osteoarthritis has difficulty ambulating and is seeking a prescription for a walker. How should the nurse categorize the client's disability?

acquired

A student nurse approaches a nursing instructor and states that a client was just told that she had a "chronic condition." The student asks the instructor what "chronic condition" means. What would be the instructor's best response?

"Chronic conditions are illnesses or diseases that have a prolonged course."

According to the U.S. Census (2010), what percentage of people are diagnosed with a disability?

20

A nurse practitioner would be applying the pre-trajectory model of chronic illness when she:

Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing.

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause?

Early detection and treatment of diseases

A nursing instructor is discussing characteristics of chronic illness with a class. The instructor asks the students to name one characteristic. Which of the following answers is correct?

Managing chronic conditions must be a collaborative process.

A cause related to the increasing number of people with chronic conditions is

improved screening and diagnostic procedures.

A nurse is preparing to provide discharge teaching for a hospitalized 19-year-old client who is hearing impaired with functioning hearing aides. The television is on, and several of the client's fraternity brothers are present. What are potential teaching barriers for the nurse? Select all that apply.

television in use fraternity brothers

When caring for clients with disabilities, nurses need to understand not only pathophysiological issues but also the concept of disability. Which of the following statements to the client demonstrates that the nurse understands the concept of disability?

"I have collaborated with a social worker to assess your needs for after discharge."

A nurse is caring for a client with multiple chronic conditions and some physical disabilities. The nurse is using "people-first" language with the following statement during end-of-shift report:

"Last evening, Mr. Rudd, a 44-year-old patient with diabetes was admitted to the unit."

A client who is obese and the nurse have established a goal for the client to achieve a weight loss of 1 pound each week. One month later, the nurse evaluates that the client has lost 2 pounds. The nurse first states

"You have succeeded in making positive progress."

The nurse is planning community education on the prevalence and incidence of disabilities in the United States. The nurse includes that, according to the U.S. Census (2010), what percentage of people are diagnosed with a disability?

20

The nurse is caring for a patient who had a stroke and has right-sided hemiparesis. The patient is receiving physical therapy that will continue when discharged through home health care services. After what minimum period of time could this patient's medical condition be termed chronic?

3 months

Chronic conditions occur in people of every age group, socioeconomic level, race, and culture. Globally, annual deaths due to chronic disease are expected to increase from 38 million in 2012 to 52 million by 2030. It is predicted that by 2030, what percent of the world's population will have at least one chronic illness?

50

An elderly male client was in an automobile accident 2 weeks ago and incurred a spinal cord injury with resulting paralysis. The nurse assesses this disability as

Acquired

A nurse is assigned to work with a client who has a disability. The nurse believes that all people with disabilities have a poor quality of life and are dependent and nonproductive. What type of barrier will this client experience?

Attitudinal barrier

The instructor provides corrective information to the nursing student when the student refers to the client as the

COPDer in 216

A client who is blind is admitted for treatment of a small bowel obstruction and has been vomiting for days. Which nursing diagnosis takes highest priority for this client?

Deficient fluid volume

Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability?

Developmental

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.

End-stage renal disease

Which aspect of a healthy lifestyle can the nurse encourage a client to improve that can significantly enhance quality of life with a chronic condition?

Exercise

A client who is legally blind had orthopedic surgery 3 days ago and wants to urinate. She is using a walker for ambulation. It would be best for the nurse to

Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode.

Empowering the client with a disability will better serve him or her than will promoting dependency. This type of approach is seen in which type of model of disability?

Interface model

Clients must contend with chronic illness daily. Nurses relate more effectively to clients when they understand the following as characteristics of chronic illness. Choose all that apply.

Managing chronic conditions must be a collaborative process. Chronic illness affects the entire family. The management of chronic conditions is a process of discovery.

Which model of disability views disability as a problem of the person?

Medical

A nurse is talking on the phone with a doctor and states, "I am calling you about Mrs. Nye, my client with cancer in room 213." This is an example of what type of language that is important to all people?

People-first

A nursing student shares that he read that chronic conditions are costly to people, families, and society, and that one of the major goals of nursing today should be the prevention of chronic conditions and the care of people with them. The student asks the instructor what can nurses do to help. Which of the following is a correct answer given by the instructor?

Promote wearing seat belts.

Which of the following describes the crisis phase of the trajectory model of chronic illness?

The client is experiencing a critical or life-threatening situation requiring emergency treatment.

A client experiencing a manic phase of bipolar disorder sustained cuts on the body from falling through a store window. The nurse is preparing to start an intravenous needle insertion. How should the nurse explain the procedure to the client?

Using clear and simple terms