Med Surg Chapter 7 Course Point
The nurse is providing report to the oncoming shift. In which way will the nurse describe a newly admitted client with hemiplegia?
"The client in Room 412 with left-sided hemiplegia." Explanation: It is important to all people, both those with and those without disabilities, that they not be equated with their illness or physical condition. Therefore, nurses should refer to all people using "people-first" language. That means referring to the person first by stating "the client in Room 412 with left-sided hemiplegia." The client should not be referred to by their condition, nor as paralyzed or wheelchair bound. This communicates that the client, rather than the health problem, is of greater importance to the nurse.
A client with a chronic obstructive pulmonary disease (COPD) says, "I'm glad I don't need to get annual mammograms anymore." Which statement will the nurse make in response to this client?
"It is important to keep current with all health promotion activities."
The nurse is concerned that a client with a chronic illness is becoming more debilitated due to increasing body mass index. Which health promotion education will the nurse provide to this client? Select all that apply. 'You should aim for 30 minutes of physical activity daily." "Prompt smoking cessation will reverse your symptoms." "Moving from the city to rural areas will improve your health." "Eat a diet high in fruits and vegetables." "Limit consumption of sodium and saturated fats."
'You should aim for 30 minutes of physical activity daily." "Eat a diet high in fruits and vegetables." "Limit consumption of sodium and saturated fats."
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 Explanation: In the comeback phase of the Trajectory Model of Chronic Illness, the nurse provides positive reinforcement for goals identified and accomplished by the client. This would be acknowledging the client's achievement when she ambulates to the bedside commode with her walker.
Spinal cord injury is an example of which type of disability?
Acquired Explanation: Spinal cord injury is an example of an acquired disability. An acute nontraumatic injury is a stroke or myocardial infarction. Age-related disabilities include hearing loss, osteoporosis, and osteoarthritis. Cerebral palsy and muscular dystrophy are examples of developmental disabilities.
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? Pretrajectory Acute Stable Trajectory Comeback
Acute Explanation: In the acute phase of the Trajectory Model of Chronic Illness the client has severe and unrelieved symptoms or complications that necessitate hospitalization. The client's blood glucose level is high enough that hospitalization may be required. The pretrajectory phase is one in which lifestyle behaviors place a client at risk for a chronic condition. The stable phase is characterized by symptoms of illness being under control. The comeback phase is one in which there is a gradual recovery to an acceptable way of life.
A nurse practitioner would be applying the pre-trajectory model of chronic illness when she: Encouraged a post-fracture patient to continue physical therapy. Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing.
Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing. Explanation: The pre-trajectory phase involves the prevention of a chronic illness. For example, the focus of nursing care would be to refer the patient for genetic testing and counseling, if indicated, and provide education about prevention of modifiable risk factors and behaviors.
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 Explanation: Attitudinal barriers are barriers in which bias, mistaken beliefs, and prejudices impose limitations for people with disabilities. This client experienced no barrier to health care, no structural barrier, and no transportation barrier as currently defined.
Which phase of the Trajectory Model does the nurse recognize is present when the patient is in remission, after an exacerbation of illness?
Comeback Explanation: The acute phase is characterized by severe and unrelieved symptoms or the development of illness complications necessitating hospitalization, bed rest, or interruption of the person's usual activities to bring the illness course under control. The crisis phase is characterized by a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed. The comeback phase is characterized by a gradual recovery after an acute period and learning to live with or overcome disabilities and return to an acceptable way of life within the limitations imposed by the chronic condition or disability. It involves physical healing, limitations stretching through rehabilitative procedures, psychosocial coming-to-terms, and biographical reengagement with adjustments in everyday life activities. The downward phase is characterized by rapid or gradual worsening of a condition, including physical decline accompanied by increasing disability or difficulty in controlling symptoms. It requires biographical adjustment and alterations in everyday life activities with each major downward step.
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 Explanation: The downward phase of the Trajectory Model of Chronic Illness is characterized by a worsening of the client's condition with alterations in everyday activities. The stable phase is one in which the client's symptoms are under control. The acute phase is characterized as severe and unrelieved symptoms necessitating hospitalization, bedrest, or interruption of the client's usual activities to bring the disease under control. The crisis phase is one in which the situation is critical or life-threatening and requires emergency care.
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. Explanation: The nurse should work with the client and family to identify ways to implement the treatment regimen. The nurse does not tell the client what the client must do. The other options may be appropriate interventions for this client, but these would not be the next step.
The nurse is caring for a client with COPD who was recently admitted to the hospital with an acute exacerbation of the illness. What indicates to the nurse that the client is in the comeback phase of the Trajectory Model of Chronic Illness?
The client gradually returns back to an acceptable way of life within the limits imposed by the illness. Explanation: In the comeback phase of the Trajectory Model of Chronic Illness, the client gradually returns back to an acceptable way of life within the limits imposed by the illness. The acute phase has unrelieved symptoms that result in the interruption of the client's everyday life activities. In the stable phase, the illness course and symptoms are under control and the client's everyday life activities are managed. In the trajectory onset phase, the client begins to cope with implications of the illness.
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. Explanation: Clients who experience a chronic illness may stop taking medications or alter dosages of medications due to side effects that they consider more disturbing or disruptive than the chronic illness. Many clients and their families have the chronic illness become the focal point of their life. For many clients, the effects of the chronic illness threaten identity and body image. Clients have difficulty adhering to a therapeutic regimen due to the realities of daily life and culture, values, and socioeconomic factors.
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 fingerspelled.
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. The management of chronic conditions is a process of discovery. Chronic conditions only involve one phase of a person's life. Managing chronic conditions must be a collaborative process. Chronic illness affects the entire family. Chronic illness involves treating only the medical problems.
The management of chronic conditions is a process of discovery. Managing chronic conditions must be a collaborative process. Chronic illness affects the entire family.
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 Explanation: When communicating with clients who have psychiatric or mental health disabilities, the nurses uses clear and simple communication. The nurse needs to listen to the client and wait for the client to finish speaking. The client makes independent decisions, and the nurse does not ignore the client's refusal.
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 Explanation: Developmental disabilities occur any time from birth to 22 years and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.
A client with end-stage lung cancer has been admitted to hospice care. The hospice team is meeting with the client and her family to establish goals for care. What is likely to be a first priority in goal setting for the client?
pain control Explanation: Once the phase of illness has been identified for a specific client, along with the specific medical problems and related social and psychological problems, the nurse helps prioritize problems and establish the goals of care. Pain control is essential for clients who have a terminal illness. If pain control is not achieved, all activities of daily living are unattainable. This is thus a priority in planning care over the other listed goals.
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
During which phase of the Trajectory Model of chronic illness is the focus of nursing care on reinforcing positive behaviors and offering ongoing monitoring? Pretrajectory Stable Trajectory
stable Explanation: In the Stable phase, the focus of nursing care is on reinforcing positive behaviors and offering ongoing monitoring. During the Pretrajectory phase, the focus is on referring the person for genetic testing and counseling, if indicated, and providing education about prevention of modifiable risk factors and behaviors. The trajectory onset phase provides explanation of diagnostic tests and procedures and reinforces information and explanation given by the primary health care provider. During the Unstable phase of the Trajectory Model, the focus of nursing care is on providing guidance and support and reinforcing previous teaching.
