Final nursing fundamentals

The nurse works with elderly clients in a wellness screening clinic on a weekly basis. Which of the following statements made by the nurse is the most therapeutic regarding their mobility?

"Continue to exercise your joints regularly to your tolerance level."

A community health nurse is providing education to a group of eldery patients regarding medication administration.Which statement from the patient indicates that the nurses teaching is effective?

" I will change the site to my left leg when I take my humalog"

A nurse is providing care to a middle-aged couple. The patient has a chronic illness. Which areas will the nurse need to assess? (select all that apply)

Compliance to treatment ● Methods of coping with the illness ● Availability of community services

When developing a plan of care for an older adult who is hospitalized for an acute illness, the nurse should?

Consider the preadmission functional abilities when setting patient goals

The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin?

Crusting

You are conducting a head to toe assessment of an elderly client and evaluating the patient's skin integrity. Which finding will you record as a normal finding?

Decreased elasticity and poor tenting

The home care nurse is caring for a 78-year-old patient who is normally alert and oriented. Today, the patient is confused and running a high fever. What condition does the nurse anticipate?

Delirium

The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first?

Determine whether there is medication duplication (also known as medication reconciliation)

Identify physiologic factors and individual variables that affect medication Actions( select all that apply)

Developmental Gender age Cultural,ethnicity and genetics Diet Environment Psychological

Cultural competence based on

Developmental process that involve over time. It impacts ability to effectively function in multicultural. Recognize people's different cultural beliefs.

Psychological theories

Disengagement,Activity Continuity Developmental, gerotranscedence

Trends concerning families: Means interference in family dynamics

Domestic violence Illness Homeless Changing economic status Homesexual

Which of the following interventions should be taken to help an older client to prevent osteoporosis?

Encourage regular exercise

What suggestion should a nurse give to a family requesting help in selecting a local nursing center?

Explain that is important for the family to visit the center and inspect if personally

An older-adult patient in no acute distress reports being less able to taste and smell. What is the nurses best response to this information?

Explain to the patient that diminished senses are normal findings

disease

Is a malfunctioning of biological or psychological processes

Family resiliency

Is the ability of a family to cope with expected and unexpected stressors.

A patient prefers not to take the daily allergy pill this morning because it causes drowsiness through the day.Which response by the nurse is best.

Let's see if we can change the time you take your pill to 9:00 PM so the drowsiness occurs when you normally are sleeping.

A nurse is caring for young adult and should tell him/her to

Maintain family relationships

aging nervous system

Parkinson disease CVA, alzheimer's

An educator in a community health care setting, you are discussing sexuality with a patient in his 80's which action by the educator is best?

Provide information about the prevention of sexually transmitted infections (STI's)

An older patient suffered a hip fracture. The patient's family is concerned about the patient's ability to care for self, especially during this convalescence. Given this perspective, what is the best practice?

Provide information and answer questions as family members make choices among care options.

First step culture competence nurses:

Put your bias and prejudice at side. In order to give competence care.

What is the nurse's priority action to protect a patient from medication errors?

Reading medication labels unless 3 times before administering.

alternative family

Relationships include multi-adult households, "skip-generation" families (grandparents caring for grandchildren), communal groups with children, "nonfamilies" (adults living alone), and cohabitating partners.

In reviewing changes in the older adult, the nurse recognizes that which of the following statements related to cognitive functioning in the older client is true?

Reversible systemic disorders are often implicated as a cause of delirium.

A 82-year-old woman worked as a teller at a bank for 40 years and has been retired for the past 10 years. She never learned how to drive. She lives in a rural area that does not have public transportation. Which of the following psychosocial changes does the nurse focus on as a priority?

Social Isolation

In identifying needs for health policy and health program development and services, a community assessment focuses on which of the following elements

Structure, People, Social systems, Environments

The visiting nurse observes that the older male client is confined by his daughter to his room. When the nurse suggests that he walk into the den and join everyone, he says "I'm in everyone's way, my daughter needs me to stay here." The most important action for the nurse is to:

Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens' center. (Assisting clients and families to become aware of available community support systems is a role and responsibility of the nurse

An older-adult patient has developed acute confusion. The patient has been on tranquilizers for the past week. The patient's vital signs are normal. What should the nurse do?

Take into account age-related changes in body systems that affect pharmacokinetic activity.

You are caring for a patient with dementia as a community-based nurse; you are making a visit to the patients home. The patient's family lives in the home with the patient. What should be your major focus?

Teach/Demonstrate techniques for providing care.

Given a group of patients to care for which patient will you closely monitor for an unintended synergistic effect?

The 45 yrs old whose doctor added Metoprolol as second B/P medication.

Which of the following statements made by a family member of a client recently diagnosed with early stages of Alzheimers's disease is most reflective of an understanding of this disease process?

We have an appointment with his care provider to see about medication therapy"

There are factors that influence the musculoskeletal system associated with aging. The nurse recognizes that with age

Weight-bearing exercise reduces the loss of bone mass

Nurse discharge instructions

When teaching the patient teach also the family member who will take care of the patient at home.

The nurse is given an IM injection .Upon aspiration, the nurse notices blood return in the syringe. What should the nurse do

Withdraw the needle and prepare the injection again.

osteomalacia and osteoporosis

abnormal softening of bones due to defiance of calcium

A nurse who has recently graduated has been assigned to be a primary nurse on a geriatric unit. After completing a review of development and aging, the nurse recalls that changes for the older adult include

adjusting to decreasing health and physical strength.

You are caring for a 5 year old who is hospitalized for stabilization of asthma. To render age- specific care, an action you can take would be to:

allow the child to handle medical equipment.

Initiative vs guilt Bryan

animism,pretend new roles,fantasy and imagination,explore environment superego,teach impulses control,conflict desire let feel guilt

nurse role meds admin

assess patient ability to self administer meds correctly closely monitor effects, don't delegate this task

biological theory stochastic

based on random events that cause cellular damage that accumulates as organism ages

metabolism

change to prepare for excretion

meds errors prevention

check compatibility with chart never give meds prepared or documented by somebody else never leave meds at bedside open meds at bedside, some meds require 2 nurses to check ,check expiration date

Medication

chemical substance use to prevent disease,treat,disease and relieve pain

trust Vs mistrust (baby)

children learn to trust or mistrust their caregivers,formation of trust results in faith & optimism

meds distribution

circulation, membrane permeability, protein binding

synergistic

combined effect of two medications is greater of the effect the med given by itself

Grandparents taking care of their grandchildren as

consequence of legal intervention when parents are unfit or renounce their parenting obligations.

controlled substances

keep under lock,special inventory forms,documentation required count requieres,special procedure to discard them

Aging and the Urinary System

kidney susceptible to trauma or disease, nephrons number decrease

agin musculoskeletal system

loses bone mass increase fragile bones decrease bone straight, risk for falls. women more susceptible to get osteoporosis

aging and the digestive system

loss of teeth,decrease saliva, decrease peristalsis in esophagus, weakness in musculature of large intestine

generic-name drug

manufactures who first develops the drug

Prescription

medication to be taking outside hospital

through

minimum level in the blood serum

aging múscle skeletal system

mobility, hip fracture,back pain,knee joint pain,generalized weakness,gout

nursing implications of ageism

nurses need to recognize and address ageism by questioning prevailing negative attitudes and stereotypes. respect older adults involve them in care decisions and activities

Intimacy vs Isolation young adult Dany

open to love others,search for manful friendships & intimacy, if unable to establish a relationship isolation results

blended family

parents who bring adoptive children or fostering parents into a new join situation

Side effects of meds

predictable & often unaided secondary effects

Therapeutic effect of meds

predicted physiological response that meds causes

biological theory non-stochastic

problems with hypothalamus, endocrine glads feedback system. fault immunological function induces aging

Idiosyncratic reaction of meds

pt reacts or over react to meds dr. order labs to check patient's reaction

self-neglect

refusal or failure to provide oneself basic necessities food,water,

Psychosocial changes in older adults

retirement, social isolation,sexuality.housing,environment,death

Integrity vs. Despair (late adulthood) mom

review their lives with successful or failure, physical & social losses,regret if goals weren't met,loss of status function

meds ten rights

right patient, drug, dosage, route, time, documentation, education,refuse, assessment,evaluation

Autonomy vs. Shame Toddler

self waking,feeding,independence maturation & imitation,develop autonomy by making chooses,learn that parents and society have expectations,limited chooses become shame

Plateu

serum concentration is reached and maintained

Puberty vs Identity Liz

sexual maturation,achievement, asking who I am, acquiring sense of identity,body image,success results in devotions fidelity to others & their own ideals

aging & the nervous system

slower nerve transmission, lower voluntary movements, stooped forward flexed posture,slowed gait,dry eyes, impair ability to hear high pitched sounds, decrease ability to maintain balance and correct imbalance

Geriatrics

study of health and disease in later life

clasification of meds

the effect of medication on the body system

chemical name

the exactly description of medication composition

extended family

the family plus relatives grandparents uncles,unts

A pregnant teenager asks the clinic nurse why she should not smoke during the first trimester. The nurse's best response should be:

the organ systems are beginning to develop.

Gerontology

the study of the aging process, includes physical,mental and social changes

health promotion psychosocial

therapeutic communication,touch,reality orientation,validation therapy,reminiscence,body image interventions 58

Onset of action

time takes after a med is administered to produce a response

duration

time which medication is present it concentration great enough to produce a response

IV meds

travel faster and absorb faster because doesn't have a barrier

Adverse effects of meds

unintended desired & often unpredictable severe response to meds

caregiver neglect

unsafe and unclean soiled bedding and animal infestation

poly pharmacy

use of multiple medications

Successful nurse given care to person in diverse population

walk into an asian women room ask if she wants warm or cold water. Acknowledge patients cultures by given options to the patients.

Abandonment

withdrawing medical care or leaving the patient at shopping center

aging face

wrinkles and sagging of the skin,lips may wrinkle,yellow teeth,hyperopia increases, myopia decreases

The long-term care nurse is performing assessment on several of the residents. Which are normal age- related physiological change(s) the nurse expects to note? Select all that apply

● Decline in visual acuity ● Decreased respiratory rate ● Decline in long-term memory ● Increased susceptibility to urinary infections ● Increased incidence of awakening after sleep onset

When developing a plan of care for the elderly. Which information will you consider first?

Plan of care needs to be individualized to the patient's unique needs

trade drug name

brand name or proprietary name business

PRN order

as need

basic elements on a medication order

date & time written drug name dosage,route,time & frequency signature of provider

Industry vs inferiority quique

eager to learn new skills,learn to play and work with peers,believe adults attitudes toward work,without support or skills too hard feels inferiority

peak

meds reach highest effective concentration

legal aspects of meds administration

nurse practice act FDA,state regulations,health care institutions meds laws

meds interaction

occurs when one medication modifies the action to another

Aging

process of growing old

Allergic reaction to meds

repeated administration the patient develops an allergic response

Aging sensory system

gustatory and olfactory disturbance,hearing loss, somatosensory disturbances, macular degeneration, visual alterations.

Aging and the Special Senses

hard hearing,deafness,loss of vision,cataract surgery,glaucoma,macular degeneration,presbyopia

action

how medication acts

route

how medication enters the body

excretion

how meds exit the body

The Emergency Department nurse is assessing a patient brought in by law enforcement. The patient slurs words and smells like alcohol, yet denies drinking alcohol. When the patient is able to communicate clearly, which assessment question will the nurse ask? (Select all that apply.)

"Have you ever tried to cut down on your drinking?" , "Have you ever had a drink first thing in the morning to settle your nerves?"

Which of the following statements, made by the daughter of an older adult client concerning bringing her mother home to live with family, presents the greatest concern for the nurse?

"I don't think she will react very well to me making decisions for her"

The nurse is performing an assessment on an older client who is having difficulty sleeping at night. What statement by the client indicates education is needed on improving sleep?

"I drink hot chocolate before bed"

Which of the following responses by an older-adult client is most reflective of a need for further education by the nurse regarding the physiological changes associated with the older adult?

"I have my eyes checked regularly, I can't afford to fall."

A mother tells you that her 6-year-old child talks about friends who don't exist. What will be your best response?

"It's very normal"

The nurse is caring for a patient who is considered "frail elderly". Into which category does the nurse place the patient?

85 to 99 years of age (the old old)

Vulnerable populations of patients are those who are more likely to develop health problems as a result of:

Abusive habits

Health care disparities: differences among population in the availability accessibility and quality of care services.

Accessibility

A 70-year old client asks the nurse to explain to her about hypertension. An appropriate response by the nurse as to why older clients often have hypertension is due to:

Accumulation of plaque on arterial walls

standing/routine order

Administered until the dosage is changed or another medication is prescribed

Which of the following statements accurately reflects data that the nurse should use in planning care to meet the needs of older adults?

Adults older than 65 yrs of age are the greatest users of prescription medications.(poly- pharmacy

Which of the following might be a cause of stress for young adults

Being single, Career, Sexuality

Pharmacodynamics

is a process by which medication works in the body

The nurse is aware that the majority of older adults:

Are actively involved in their community

The nurse is preparing to discharge an 81yr old client from hospital, recognizes that the majority of older adults:

Are capable of taking care of their own lives

As an educator teaching a group of older-adult patients. Which teaching method is best to use?

Ask patients to recall past experiences that correspond with their interests.

illness

is how the individual or family react to the disease

An order written for Dilantin 500 mg IM q3-4h prn for pain. The nurse recognize that treatment of pain is not standard therapeutic indication for this drug. The nurse believes that the health care provider means to write Diludad. What should the nurse do?

Call MD to clarify

Which of the following might be a cause of stress for the middle-aged adult?

Caring for children and aging parents sandwich generation

A long term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. The nurse responds most appropriately by saying:

Feel free to ask your physician why you are receiving the medications that are prescribed to you"

Which of the following might be a cause of stress for the older adult?

Financial security, Housing, Adjusting to decreasing health and physical strength

Given a suspicion of caregiver neglect in an older-adult patient. Which assessment findings mostly triangulates that view?

Flea bites and lice

An elderly patient is dehydrated and is admitted to the hospital for intravenous fluid replacement. During the evening shift, the patient becomes acutely confused. Which possible reversible causes will the nurse consider when assessing this patient? (select all that apply

Fluid imbalance (or electrolyte imbalance) ● Sensory deprivation ● Hyperglycemia ● Drug intoxication

What will the nurse focus mostly on when caring for a middle-aged adult

Future generation relationships (ex: support children as they grow up)

You realized that you administered medications to two patients with the same last name. After gaining this understanding which action should be your priority?

Go back to the room and check the patient's current status

aging most common cause of death

Heart disease cancer COPD stroke

A nurse is teaching a health promotion class for older adults. In which order will the nurse list the most common to least common conditions that can lead to death in older adults?

Heart disease, cancer, copd, stroke

A patient is in need of immediately pain relief for abd pain. Which medication will the nurse administer to be absorbed the quickest?

IV pain Medicine

In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging?

Increased airway resistance (possible cause copd

During admission procedure and collection of data from an older adult. What will strike the nurse most?

Most older adults live with a spouse

You are a nursing supervisor in a geriatric making ward rounds, which stamentment made by another nurse under your supervision will make you intervene?

Most older people are dependent and need assistance (ex: of ageism)

nuclear family

Mother, father and children living as a unit

Which information obtained by the home health nurse when making a visit to an 88yr old with mild forgetfulness is of the most concern?

The patient has lost 10 pounds (4.5kg) during the last month.

Now order

Used when a medication is needed quickly but not as immediately as a stat.

family dynamics

care for a family member as well as the patient acknowledging family members when walking into the patient room

Aging the Endocrine System

decline hormone recreation change in glucose tolerance

agin skin

decrease in adipose tissue dry skin, decrease skin tugor,dryness and flaking of the skin,thin transparent skin,poor tenting

Aging and the respiratory system

decrease volume during inspiration and expiration, loss of elasticity in pulmonary tissue decrease cilia, decrease strength for breathing/coughing

Aging and mental health

demential, depression, delirium

health promotions physiological

dental problems,exercise,falls,sensory impairments,pain,medication use

Toxic effect of meds

develop after prolonged intake of a medication

theory of thriving

failure to thrive results from a discord between an individual and his/her environment

Generative Vs self absorption & stagnation middle age Eleazar

focus in supporting future generations,by parenthood,teaching, community involvement

nurse role before administering meds

follow 10 rights read label 3 times

distribution

from blood into cells, tissue and organs

absorption

from site to blood

Stats order

given immediately

Single (one time) order

given one time only for a specific reason

aging hair

gray less hair, male may baldness,men thicker eye brow