VNSG 1226: Unit 5 Prep U Questions

Family caregiving for the older client at home includes which type of assistance? Select all that apply.

Cooking for the client Providing meals Supervising the client Protecting the client Explanation: Cooking, providing meals, supervising, and protecting are types of assistance provided by family members. The nurse monitors the impact of caregiving.

Which older adult service qualifies for home health care paid for by Medicare?

IV antibiotic administration through Central Line Explanation: Medicare is limited to skilled home care, which means that a person must be homebound, have services ordered by a primary care provider, require skilled nursing or rehabilitative services, and need intermittent but not full-time care.

An adult son who lives out of state is planning a visit with an older client. When should the nurse recommend that the son make the next visit?

When doctor's appointments are scheduled Explanation: Nurses can recommend to long-distance caregivers that they plan their visits at times when medical appointments are scheduled so that they can receive direct information about health care status and care, and ask any questions that they may have. The role of the long-distance caregiver would be limited when the client is hospitalized or independent because the visit would be more social that caregiving. If a visit occurs when the client needs the most assistance, the visit may be focused on providing routine care needs and not planning for what the client may need in the future.

The charge nurse must provide teaching when hearing a new staff nurse make which statement?

"We should use standardized care plans to utilize our time more effectively." Explanation: The needs of older adults are complex and changing, or dynamic; therefore a standardized, "one size fits all" plan of care is not the best approach for older adults. Most older adults are independent; however many do require partial, intermittent, or continuous nursing care.

What activity demonstrates a nurse's understanding of effective care for the dying client and the family?

Asking about needs and how the nurse can help meet them. Explanation: Because the dying process is unique for every human being, individualized nursing intervention is required. Asking the family and the dying client what "they need" addresses the issues and provides individualized care. While the other options may prove helpful, they do not address the issue of individualized care.

Which intervention demonstrates the nurse's understanding of the role of family in the care of a dying member?

Asking family members if they want to bath the mom or would you prefer a staff member to do it Explanation: The separation of individuals from their loved ones and familiar surroundings during the dying process seems discomforting, stressful, and unjust. Family members may benefit from participating in care activities, or they may prefer to simply be present when care is being provided. Nurses need to continually assess needs of the family for information as well as for their desired level of involvement. None of the other options address the need to assess for involvement.

During a recent visit, an adult daughter is concerned that an aging parent is not taking care of personal hygiene needs. On what should the nurse focus when assessing the client during the next home visit? Select all that apply.

Bathing Dressing Toileting Explanation: Personal hygiene needs include bathing, dressing, and toileting. Feeding is a nutritional need. Transporting would be essential for health care appointments and socialization.

Which nursing intervention demonstrates attention to the fundamental spirtual need of a dying client?

Being fully available and focused on the client during times of care giving Explanation: Perhaps the most easily implemented—as well as the most challenging—spiritual intervention is providing genuine presence while clients are experiencing suffering or dying. Physical needs of clients during serious illness and end of life can be intense, leaving little time for nurses to simply be present with clients and families. However, at all times while providing care, nurses can communicate compassion and focus attention on being fully present as a nursing intervention that is "the first step into spiritual care." All other options are appropriate but not fundamental to spiritual care.

A staff nurse asks for a change in assignment because of the frequency of clients dying while the nurse is providing care. What response should be provided to this nurse's request?

Change the assignment Explanation: The attitude of colleagues and the environment should be such that nursing staff can retreat from a situation that is not therapeutic either for them or for the client. The assignment should be changed. There is no reason for the nurse to attend a seminar or talk with a pastor about the death of clients.

During a home visit the nurse learns that adult children rarely visit an older client. Which situation should the nurse consider as causing this current parent-child relationship?

Client has few personal friends Explanation: Relationships in old age are affected by the forms of relationships experienced throughout life. Parents who ignored or abused their children early in life may produce children who want nothing to do with them in adulthood. Siblings who have unresolved anger over favoritism displayed by their parents may refuse to assist when the favored child is in need. Couples who never shared intimacy and friendship may exist in separate worlds under the same roof.

The nurse works for a home health services agency and is scheduled to visit an older adult diabetic client for medication management. In addition to this assignment, which actions exemplify other roles that the nurse could provide the client in the home care setting? (Select all that apply.)

Coordinate a multidisciplinary team. Refer available community resources Teach about interventions to provide quality care. Provide resources to caregivers to reduce caregiver stress. Explanation: Nurses who provide skilled home care services typically assume a primary coordinating role with a multidisciplinary team. Nursing responsibilities include referrals for additional services. Nurses direct their interventions toward the caregivers, providing teaching about interventions and addressing needs of the caregiver related to information about resources and ways to reduce caregiver stress.

When explaining nursing home selection to the older client, which of the following is on the list as an important philosophy of care issue?

Custodial care rather than rehabilitative care Explanation:Custodial care is on the list as an important philosophy of care issue. Noise control, and lighting are physical facility issues. Cost is not a philosophical issue.

When explaining potential risks for older adults during hospitalization, which is the most important to include about loss of functional independence?

Development of complications Explanation: Development of complications is the most important to include about loss of functional independence. Weakness, sedation, and disruption of routine are not risks for loss of functional independence in the hospitalized acute care older adult.

The nurse identifies Powerlessness as a diagnosis for a client with a terminal illness. Which contributing factor did the nurse identify when choosing this diagnosis? Select all that apply.

Disability Dependency Explanation: Factors contributing to the diagnosis of Powerless include dependency, disability, institutional constraints, and the inability to reverse the condition. Fear, anxiety and depression are contributing factors to the diagnosis of Altered Thought Processes.

Which end-of-life nursing diagnosis is associated with the aging client and fear?

Disturbed thought process Explanation: Disturbed thought process is the nursing diagnosis associated with the aging client and fear. Disturbed body image is associated with loss of body function or part, institutionalization, and pain. Impaired skin integrity is associated with immobility, infections, edema, dehydration, and emaciation, and deficit, knowledge is associated with diagnostic tests, treatments, drugs, and pain management.

A nurse who works in a palliative setting is aware of the need to facilitate a "good death" for as many clients as possible. Which intervention should be included?

Empower the client and family to maintain as much control as possible. Explanation: A "good death" is fostered by enabling a sense of control for the client and his or her family over a challenging situation. Nursing interventions are chosen carefully but are not necessarily minimized. A discussion of the client's strengths and weaknesses is inappropriate, and spiritual needs are not mutually exclusive of comfort and appropriate biomedical interventions.

Which measure is most important to help families prior to the nursing home admission of a relative? Select all that apply.)

Encourage the family to visit the facility. Ask for information about the resident. Accompany the family to a private area. Advise the family that it is normal for them to feel some guilt Explanation: Encourage the family to visit the facility, ask for information about the resident, accompany the family to a private area, and advise the family that it is usual to experience some guilt. Asking why they cannot care for the client is not therapeutic because it is likely to increase their guilt.

Which activities demonstrate a hospice nurse's understanding of effective self-care? Select all that apply.

Engaging in self-reflection of personal values regularly Attending the funeral service of a client who recently died Participating in a grief support group Explanation: Strategies that promote self-care for the hospice nurse include engaging in self-reflection, acquiring closure through participation in client funerals or memorial services, and attending grief support programs as needed. Other interventions would include accepting the lack of power over the process of death and acknowledging the very important role hospice nurses play in the life and death of a client.

An older client tells the nurse to send family home because an adult daughter keeps complaining about wasting time sitting in a hospital room. On which family dynamic is the client having an issue?

Feeling about family members Explanation: The dynamics among family members can have positive or negative effects on older individuals. The daughter's complaint about wasting time sitting in a hospital room demonstrates an issue with how the family members feel about each other. There is no evidence that the client is expressing an issue with community ties, communication, or attitudes, values, and beliefs.

Which of the following is the most complete information for a nurse to include during a presentation on elder care?

Greater numbers of families are providing more complex care for older adults for longer periods of time. Explanation: Greater numbers of families are providing more, not less, complex care for older adults for longer, not shorter, periods of time. Government is still involved in various ways.

An older female who is capable of self-care but is unable to function independently in the community would best benefit from which program?

Group Home Explanation: Group home programs offer services to individuals who are capable of self-care but who require supervision to protect them from harm. Day hospitals focus primarily on health services. Telephone reassurance may be helpful but does not provide supervised care to protect this client from harm. The client's lack of independence rules out assisted living.

Long-term care laws passed to protect older clients in a nursing home include which important standards?

Higher standards added to federal regulations Explanation: Higher standards added to federal, not local or regional, regulations are the important mandates to protect older clients in a nursing home. State standards add to but don't replace basic federal regulations.

A nurse cares for a 100-year-old client in hospice. The client contemplates perspectives regarding end-of-life care. Which historical perspectives most likely represent how this client's life experiences have had a formative influence on the client's views on death and dying? (Select all that apply.)

I lost an infant to small pox." "I outlived my children and my two spouses." "I never thought that I would be this old." "My brother died in a work-related accident." Explanation: Concepts related to death, dying, and end of life have changed since the early 1900s. At that time, death was a common occurrence in infants, children, youth, and young adults. Communicable diseases were common. Families provided care. Accidental deaths were common, and death was accepted as an inevitable and normal part of life.

When explaining potential risks for older adults during hospitalization, which is the most important to include about loss of functional independence?

Insufficient time for self-care Explanation: Insufficient time for self-care is the most important to include about loss of functional independence. Excess stimuli, apathy, and lack of resistance are not described as risks for loss of functional independence in the hospitalized acute care older adult.

A client receiving end-of-life care is experiencing severe constipation. What should the nurse request from the health care provider to help this client?

Laxative Explanation: Knowing that the risk of constipation is high, nursing staff should take measures to promote regular bowel elimination in terminally ill clients. Laxatives usually are administered on a regular schedule. An enema would be uncomfortable for this client. There is no evidence that the client needs an antiemetic. A stool softener may be appropriate one the bowel pattern has been reestablished with the use of laxatives.

When an older client becomes aware of impending death, which variables determine when more therapeutic responses will occur after the denial stage. Select all that apply.

Life philosophy Unique coping mechanisms Knowledge of condition Explanation: Life philosophy, unique coping mechanisms, and knowledge of condition are defense mechanisms that determine when less radical responses will occur during the Denial Stage. Anger and sadness do not suggest resolution of the denial stage.

The nurse reviews pain medication prescribed for a client with a terminal illness. Which medication should the nurse question before administering to this client?

Meperidine Explanation: Meperidine is contraindicated for pain control in older adults because of a high incidence of adverse effects, particularly psychosis, at relatively low dosages. Codeine, haloperidol, and hydrocodone are not contraindicated for pain control in older clients.

A nurse is teaching an older adult about possible involvement in Programs of All-Inclusive Care for the Elderly (PACE). Which statement by the older adult shows understanding?

PACE programs provide several social and medical services on a managed care basis. Explanation: PACE programs provide a range of services using a capitated managed care model. They are focused on meeting the needs of adults with chronic conditions and are not an alternative to in-hospital treatment of acute illness. They are less expensive than fee-for-service models and presently are receiving funding under both Medicare and Medicaid. The 2010 Affordable Care Act provides incentives for further expansion of PACE programs.

When reducing potential fall risks for older adults during hospitalization, which consideration should the nurse prioritize?

Presence of equipment and supplies Explanation: Presence of equipment and supplies can cause a risk for falls in the hospitalized acute care older adult. Pain, knowledge deficit, and shortness of breath are less common risks for falls in the hospitalized acute care older adult.

The nurse is planning care for a client with a terminal illness. What should the nurse identify as the goal of pain control for this client?

Prevent pain from occurring Explanation: For the dying client, the goal of pain management is to prevent pain from occurring rather than to respond to it after it occurs. The type of analgesic used will depend on the intensity of the pain. Meperidine is contraindicated for pain control in older adults because of the high incidence of adverse effects, particularly psychosis, at relatively low dosages.

The nurse is beginning a new position as a community health nurse. On what should the nurse focus when caring for older community members? Select all that apply.

Preventing risks to health Maintaining independence Developing self-care strategies Establishing meaningful lifestyles Explanation: When working with community-based older adults, nurses focus on preventing risks to health and well-being, maintaining independence, developing self-care strategies, and establishing meaningful lifestyles. Controlling finances would be appropriate for a banker or accountant to manage for an older client.

An older adult with arthritis is moving into a retirement housing complex. What is the priority feature the nurse should advise the client and family to look for in the new house?

Slopes instead of stairs Explanation: The new housing complex may contain all the listed features, but the priority feature involves safety in the form of slopes versus stairs to help prevent falls. Marble flooring may actually pose a risk for injury.

An older client is considering relocating to a nursing home since all family members have either died or moved away. What should the nurse suggest the client consider when deciding on a facility? Select all that apply.

The daily rate Type of health insurance accepted Policy regarding reimbursement limits Explanation:Arrangements for transfer to a hospital are important special services that should be discussed when explaining nursing home selection to the older client. Factors to review would include information about the type of health insurance accepted by the nursing home, the nursing home's daily rate, and the policy regarding reimbursement limits. Nursing homes do not store personal furniture. Visitor policies are usually lenient and would not need to be reviewed with the client who has no family in the area.

An adult daughter is crying uncontrollably after seeing the body of her late mother in the hospital bed. What should the nurse consider when consoling the daughter?

The daughter most likely has not had much exposure to death Explanation:With fewer people dying at earlier ages than in the past and most deaths occurring in hospitals or nursing homes, most people have minimal direct involvement with dying individuals. There is no evidence to support that the daughter feels guilty or relief that the client has died. There is also no evidence to suggest that the daughter is overwhelmed with feelings about her own death.

During a home visit the adult daughter of an older client telephones to find out how the client is recovering after surgery. What should the nurse expect to occur regarding the caregiving relationship between the daughter and client?

The daughter will increase contact with the client Explanation: The provision of family assistance is a subtle, gradual process. What might start as telephone calls may increase to more frequent visits. It is unlikely that the amount of telephone contact will remain the same. The client is not likely to need less telephone contact. It is unlikely that the daughter will immediately move in with the client although this might need to occur, over time.

An older client is breathing and has a heartbeat however has no active brain waves. What is the best way to describe this client's status as a living human being?

The level of death needs to be decided first Explanation: Terms such as brain death, somatic death, and molecular death confuse the issue about death. The controversy lies in deciding at which level of death a person is considered dead. The other statements indicate confusion as to what should define live and death.

When conducting a rehabilitative care assessment of a frail older adult, which specific assessment findings are most important in determining nursing care? Select all that apply.

Unplanned weight loss Slow walking speed Low grip strength Low level of activity Explanation: Unplanned weight loss, slow walking speed, low grip strength, and low level of activity are important assessment findings in the frail older adult that are used to determine care. Emotional changes are not assigned high importance.

Active care management is often necessary in order to maintain wellness among older adults. Which of these older adults is most likely to require care management?

a 90-year-old who lives alone and has no living family members Explanation: Community-dwelling older adults who may lack family involvement in their care often require independent community-based professional geriatric care management. Individuals who are experiencing acute medical conditions and who are in institutional or acute care settings are not frequent recipients of care management.

The nurse overhears an older client say to an adult child "you can't leave town because there would be no one to take care of me." On which family dynamics issue should the nurse focus when assessing the client?

attitudes, values, and beliefs Explanation: The dynamics among family members can have positive or negative effects on older individuals. For attitudes, values, and beliefs, the nurse should assess who should take care of the older people in the family and expectations of family members. Family member feelings asks how family members feel about each other. Manner of communication focuses on the sharing of daily events and communication style. With family-community involvement, the focus is on the degree of involvement with people outside of the family unit.

An older client admits that the thought of dying is not pleasant however it is an expectation that life eventually ends. What should this client's statement suggest to the nurse?

the client has had previous experiences with death Explanation:Clients' reactions to dying are influenced by previous experiences with death, age, health status, philosophy of life, and religious, spiritual, and cultural beliefs. The client's statement does not indicate that the client is delusion, not ready to accept that death occurs, or that the client will avoid talking about death in the future.