Chapter 9: Chronic Illness and Disability

38. A case manager is responsible for ensuring that patients meet the criteria for diagnoses of chronic conditions in order to ensure their eligibility for federal programs. Which of these definitions may not apply for legal purposes? A) A person who is temporarily disabled but later return to full functioning. B) A person who is disabled and cannot expect a return to full functioning. C) A person whose disability is the result of a developmental disorder. D) A person whose disability is the result of a traumatic injury.

A) A person who is temporarily disabled but later return to full functioning.

11. A man with a physical disability uses a wheelchair. The individual wants to attend a support group for the parents of autistic children, which is being held in the basement of a church. When the individual arrives at the church, he realizes there are no ramps or elevators to the basement so he will not be able to attend the support group. What type of barrier did this patient encounter? A) A structural barrier B) A barrier to health care C) An institutional barrier D) A transportation barrier

A) A structural barrier

12. A patient who is legally blind is being admitted to the hospital. The patient informs the nurse that she needs to have her guide dog present during her hospitalization. What is the nurses best response to the patient? A) Arrangements can be made for your guide dog to be at the hospital with you during your stay. B) I will need to check with the care team before that decision can be made. C) Because of infection control, your guide dog will likely not be allowed to stay in your room during your hospitalization. D) Your guide dog can stay with you during your hospitalization, but he will need to stay in a cage or crate that you will need to provide.

A) Arrangements can be made for your guide dog to be at the hospital with you during your stay.

28. The community nurse is caring for a patient who has paraplegia following a farm accident when he was an adolescent. This patient is now 64 years old and has just been diagnosed with congestive heart failure. The patient states, Im so afraid about what is going to happen to me. What would be the best nursing intervention for this patient? A) Assist the patient in making suitable plans for his care. B) Take him to visit appropriate long-term care facilities. C) Give him pamphlets about available community resources. D) Have him visit with other patients who have congestive heart failure.

A) Assist the patient in making suitable plans for his care.

2. A patient tells the nurse that her doctor just told her that her new diagnosis of rheumatoid arthritis is considered to be a chronic condition. She asks the nurse what chronic condition means. What would be the nurses best response? A) Chronic conditions are defined as health problems that require management of several months or longer. B) Chronic conditions are diseases that come and go in a relatively predictable cycle. C) Chronic conditions are medical conditions that culminate in disabilities that require hospitalization. D) Chronic conditions are those that require short-term management in extended-care facilities.

A) Chronic conditions are defined as health problems that require management of several months or longer.

36. In your role as a school nurse, you are presenting at a high school health fair and are promoting the benefits of maintaining a healthy body weight. You should refer to reductions in the risks of what diseases? Select all that apply. A) Heart disease B) Stroke C) Cancer D) Diabetes E) Hypertension

A) Heart disease B) Stroke D) Diabetes E) Hypertension

6. An international nurse has noted that a trend in developing countries is a decrease in mortality from some acute conditions. This has corresponded with an increase in the incidence and prevalence of chronic diseases. What has contributed to this decrease in mortality from some acute conditions? A) Improved nutrition B) Integration of alternative health practices C) Stronger international security measures D) Decrease in obesity

A) Improved nutrition

9. A home care nurse is making an initial visit to a 68-year-old man. The nurse finds the man tearful and emotionally withdrawn. Even though the man lives alone and has no family, he has been managing well at home until now. What would be the most appropriate action for the nurse to take? A) Reassess the patients psychosocial status and make the necessary referrals B) Have the patient volunteer in the community for social contact C) Arrange for the patient to be reassessed by his social worker D) Encourage the patient to focus on the positive aspects of his life

A) Reassess the patients psychosocial status and make the necessary referrals

10. You are caring for a patient with a history of chronic angina. The patient tells you that after breakfast he usually takes a shower and shaves. It is at this time, the patient says, that he tends to experience chest pain. What might you counsel the patient to do to decrease the likelihood of angina in the morning? A) Shower in the evening and shave before breakfast. B) Skip breakfast and eat an early lunch. C) Take a nitro tab prior to breakfast. D) Shower once a week and shave prior to breakfast.

A) Shower in the evening and shave before breakfast.

22. A patient with a spinal cord injury is being assessed by the nurse prior to his discharge home from the rehabilitation facility. The nurse is planning care through the lens of the interface model of disability. Within this model, the nurse will plan care based on what belief? A) The patient has the potential to function effectively despite his disability. B) The patients disabling condition does not have to affect his lifestyle. C) The patient will not require care from professional caregivers in the home setting. D) The patients disability is the most salient aspect of his personal identity.

A) The patient has the potential to function effectively despite his disability.

1. An elderly patient has presented to the clinic with a new diagnosis of osteoarthritis. The patients daughter is accompanying him and you have explained why the incidence of chronic diseases tends to increase with age. What rationale for this phenomenon should you describe? A) With age, biologic changes reduce the efficiency of body systems. B) Older adults often have less support and care from their family, resulting in illness. C) There is an increased morbidity of peers in this age group, and this leads to the older adults desire to also assume the sick role. D) Chronic illnesses are diagnosed more often in older adults because they have more contact with the health care system.

A) With age, biologic changes reduce the efficiency of body systems.

Research has corroborated an experienced nurses observation that the incidence and prevalence of chronic conditions is increasing in the United States. What health promotion initiative most directly addresses the factor that has been shown to contribute to this increase? A) A program to link residents with primary care providers B) A community-based weight-loss program C) A stress management workshop D) A cancer screening campaign

B) A community-based weight-loss program

A 19-year-old patient with a diagnosis of Down syndrome is being admitted to your unit for the treatment of community-acquired pneumonia. When planning this patients care, the nurse recognizes that this patients disability is categorized as what? A) A sensory disability B) A developmental disability C) An acquired disability D) An age-associated disability

B) A developmental disability

A nurse knows that patients with invisible disabilities like chronic pain often feel that their chronic conditions are more challenging to deal with than more visible disabilities. Why would they feel this way? A) Invisible disabilities create negative attitudes in the health care community. B) Despite appearances, invisible disabilities can be as disabling as visible disabilities. C) Disabilities, such as chronic pain, are apparent to the general population. D) Disabilities. Such as chronic pain, may not be curable, unlike visible disabilities.

B) Despite appearances, invisible disabilities can be as disabling as visible disabilities.

A nurse is planning the care of a patient who has been diagnosed with renal failure, which the nurse recognizes as being a chronic condition. Which of the following descriptors apply to chronic conditions? Select all that apply. A) Diseases that resolve slowly B) Diseases where complete cures are rare C) Diseases that have a short, unpredictable course D) Diseases that do not resolve spontaneously E) Diseases that have a prolonged course

B) Diseases where complete cures are rare D) Diseases that do not resolve spontaneously E) Diseases that have a prolonged course

5. A patient with end-stage lung cancer has been admitted to hospice care. The hospice team is meeting with the patient and her family to establish goals for care. What is likely to be a first priority in goal setting for the patient? A) Maintenance of activities of daily living B) Pain control C) Social interaction D) Promotion of spirituality

B) Pain control

3. A medical-surgical nurse is teaching a patient about the health implications of her recently diagnosed type 2 diabetes. The nurse should teach the patient to be proactive with her glycemic control in order to reduce her risk of what health problem? A) Arthritis B) Renal failure C) Pancreatic cancer D) Asthma

B) Renal failure

39. A 39-year-old patient with paraplegia has been admitted to the hospital for the treatment of a sacral ulcer. The nurse is aware that the patient normally lives alone in an apartment and manages his ADLs independently. Before creating the patients plan of care, how should the nurse best identify the level of assistance that the patient will require in the hospital? A) Make referrals for assessment to occupational therapy and physical therapy. B) Talk with the patient about the type and level of assistance that he desires. C) Obtain the patients previous medical record and note what was done during his most recent admission. D) Apply a standardized care plan that addresses the needs of a patient with paraplegia.

B) Talk with the patient about the type and level of assistance that he desires.

13. The staff development nurse is presenting a class on the importance of incorporating people-first language into daily practice as well as documentation. What is an example of the use of people-first language when giving a verbal report? A) The schizophrenic B) The patient with schizophrenia C) The schizophrenic patient D) The schizophrenic client

B) The patient with schizophrenia

29. An initiative has been launched in a large hospital to promote the use of people-first language in formal and informal communication. What is the significance to the patient when the nurse uses people-first language? A) The nurse knows more clearly who the patient is. B) The person is of more importance to the nurse than the disability. C) The patients disability is the defining characteristic of the patients life. D) The nurse knows that the patients disability is a curable condition.

B) The person is of more importance to the nurse than the disability.

23. During the care conference for a patient who has multiple chronic conditions, the case manager has alluded to the principles of the interface model of disability. What statement is most characteristic of this model? A) This patient should be free to plan his care without our interference. B) This patient can be empowered and doesn't have to be dependent. C) This patient was a very different person before the emergence of these health problems. D) This patients physiological problems are the priority over his psychosocial status.

B) This patient can be empowered and doesn't have to be dependent.

20. A patient who has recently been diagnosed with chronic heart failure is being taught by the nurse how to live successfully with her chronic condition. Her ability to meet this goal will primarily depend on her ability to do which of the following? A) Lower her expectations for quality of life and level of function. B) Access community services to eventually cure her disease. C) Adapt her lifestyle to accommodate her symptoms. D) Establish good rapport with her primary care provider.

C) Adapt her lifestyle to accommodate her symptoms.

The nurse is reviewing the importance of preventative health care with a patient who has a disability. The patient states that she will not have the money to pay for her annual gynecologic exams or mammograms due to the cost of this hospitalization. What information would be appropriate for the nurse to share with the patient? A) Limited finances are a common problem for patients with a disability. Since you were hospitalized this year, you can likely forego the gynecologic exam and mammogram. B) These are very important health preventative measures, so you will need to borrow the money to pay for the exam and mammogram. C) Ill look into federal assistance programs that provide financial assistance for health-related expenses for people with disabling conditions. D) These preventative measures should likely be tax deductible, so you should consult with your accountant and then make your appointments.

C) Ill look into federal assistance programs that provide financial assistance for health-related expenses for people with disabling conditions.

16. You are the case manager who oversees the multidisciplinary care of several patients living with chronic conditions. Two of your patients are living with spina bifida. You recognize that the center of care for these two patients typically exists where? A) In the hospital B) In the physicians office C) In the home D) In the rehabilitation facility

C) In the home

24. The nurse is caring for a young adult male with a traumatic brain injury and severe disabilities caused by a motor vehicle accident when he was an adolescent. Where does the nurse often provide care for patients like this young adult? A) Adult day-care facilities B) Step-down units C) Medical-surgical units D) Pediatric units

C) Medical-surgical units

17. The nurse is caring for a patient diagnosed with cancer of the liver who has chosen to remain in his home as long as he is able. The nurse reviews the care plan for the patient and notes that it focuses on palliative measures. The nurse also notes that over the last 3 weeks, the patients condition has continued to deteriorate. What is the nurses best response to this clinical information? A) Recognize that death will most likely occur in the next week. B) Recognize that the patient is in the trajectory phase of chronic illness and should be kept pain-free. C) Recognize that the patient is in the downward phase of chronic illness and should be reassessed. D) Recognize that the patient should immediately be admitted into the hospital.

C) Recognize that the patient is in the downward phase of chronic illness and should be reassessed.

30. A patient who is recovering from a stroke expresses frustration about his care to the nurse, stating, It seems like everyone sees me as just a problem that needs fixing. This patients statement is suggestive of what model of disability? A) Biopsychosocial model B) Social model C) Rehabilitation model D) Interface model

C) Rehabilitation model

26. You are the nurse caring for a young mother who has a longstanding diagnosis of multiple sclerosis (MS). She was admitted to your unit with a postpartum infection 3 days ago. You are planning to discharge her home when she has finished 5 days of IV antibiotic therapy. With what information would it be most important for you to provide this patient? A) A succinct overview of postpartum infections B) How the response to infection differs in patients with multiple sclerosis C) The same information you would provide to a patient without a chronic condition D) Information on effective management of multiple sclerosis in the home setting

C) The same information you would provide to a patient without a chronic condition

35. You are presenting patient teaching to a 48-year-old man who was just diagnosed with type 2 diabetes. The patient has a BMI of 35 and leads a sedentary lifestyle. You give the patient information on the risk factors for his diagnosis and begin talking with him about changing behaviors around diet and exercise. You know that further patient teaching is necessary when your patient tells you what? A) I need to start slow on an exercise program approved by my doctor. B) I know theres a chance I could have avoided this if Id always eaten better and exercised more. C) There is nothing that can be done anyway, because chronic diseases like diabetes cannot be prevented. D) I want to have a plan in place before I start making a lot of changes to my lifestyle.

C) There is nothing that can be done anyway, because chronic diseases like diabetes cannot be prevented.

A man and woman are in their early eighties and have provided constant care for their 44-year-old son who has Down syndrome. When planning this family's care, the nurse should be aware that the parents most likely have what concerns around what question? A) What could we have done better for our son? B) Why was our son born with Down syndrome while our other children are healthy? C) Who will care for our son once were unable? D) Will we experience the effects of developmental disabilities late in life?

C) Who will care for our son once were unable?

21. A major cause of health-related problems is the increase in the incidence of chronic conditions. This is the case not only in developed countries like the United States but also in developing countries. What factor has contributed to the increased incidence of chronic diseases in developing countries? A) Developing countries are experiencing an increase in average life span. B) Increasing amounts of health research are taking place in developing countries. C) Developing countries lack the health infrastructure to manage illness. D) Developing countries are simultaneously coping with emerging infectious diseases.

D) Developing countries are simultaneously coping with emerging infectious diseases.

7. A 37-year-old woman with multiple sclerosis is married and has three children. The nurse has worked extensively with the woman and her family to plan appropriate care. What is the nurses most important role with this patient? A) Ensure the patient adheres to all treatments B) Provide the patient with advice on alternative treatment options C) Provide a detailed plan of activities of daily living (ADLs) for the patient D) Help the patient develop strategies to implement treatment regimens

D) Help the patient develop strategies to implement treatment regimens

25. You are caring for a young woman who has Down syndrome and who has just been diagnosed with type 2 diabetes. What consideration should you prioritize when planning this patients nursing care? A) How her new diagnosis affects her health attitudes B) How her diabetes affects the course of her Down syndrome C) How her chromosomal disorder affects her glucose metabolism D) How her developmental disability influences her health management

D) How her developmental disability influences her health management

8. A patient has recently been diagnosed with type 2 diabetes. The patient is clinically obese and has a sedentary lifestyle. How can the nurse best begin to help the patient increase his activity level? A) Set up appointment times at a local fitness center for the patient to attend. B) Have a family member ensure the patient follows a suggested exercise plan. C) Construct an exercise program and have the patient follow it. D) Identify barriers with the patient that inhibit his lifestyle change.

D) Identify barriers with the patient that inhibit his lifestyle change.

37. A nurse is aware that the number of people in the United States who are living with disabilities is expected to continue increasing. What is considered to be one of the factors contributing to this increase? A) The decrease in the number of people with early-onset disabilities B) The increased inability to cure chronic disorders C) Changes in infection patterns resulting from antibiotic resistance D) Increased survival rates among people who experience trauma

D) Increased survival rates among people who experience trauma

The interface model of disability is being used to plan the care of a patient who is living with the effects of a stroke. Why should the nurse prioritize this model? A) It fosters dependency and rapport between the caregiver and the patient. B) It encourages the provision of care that is based specifically on the disability. C) It promotes interactions with patients focused on the root cause of the disability. D) It promotes the idea that patients are capable and responsible.

D) It promotes the idea that patients are capable and responsible.

34. During their prime employable years between ages 21 and 64, 77% of those with a non-severe disability are employed. What has research shown about this employed population? A) Their salaries are commensurate with their experience. B) They enjoy their jobs more than people who do not have disabilities. C) Employment rates are higher among people with a disability than those without. D) People with disabilities earn less money than people without disabilities.

D) People with disabilities earn less money than people without disabilities.

4. A patient who undergoes hemodialysis three times weekly is on a fluid restriction of 1000 mL/day. The nurse sees the patient drinking a 355-mL (12 ounce) soft drink after the patient has already reached the maximum intake of fluid for the day. What action should the nurse take? A) Take the soft drink away from the patient and inform the dialysis nurse to remove extra fluid from the patient during the next dialysis treatment B) Document the patients behavior as noncompliant and notify the physician C) Further restrict the patients fluid for the following day and communicate this information to the charge nurse D) Reinforce the importance of the fluid restriction and document the teaching and the intake of extra fluid

D) Reinforce the importance of the fluid restriction and document the teaching and the intake of extra fluid

40. A community health nurse has drafted a program that will address the health promotion needs of members of the community who live with one or more disabilities. Which of the following areas of health promotion education is known to be neglected among adults with disabilities? A) Blood pressure screening B) Diabetes testing C) Nutrition D) Sexual health

D) Sexual health

27. You have admitted a new patient to your unit with a diagnosis of stage IV breast cancer. This woman has a comorbidity of myasthenia gravis. While you are doing the initial assessment, the patient tells you that she felt the lump in her breast about 9 months ago. You ask the patient why she did not see her health care provider when she first found the lump in her breast. What would be a factor that is known to influence the patient in seeking health care services? A) Lack of insight due to the success of self-managing a chronic condition B) Lack of knowledge about treatment options C) Overly sensitive patient reactions to health care services D) Unfavorable interactions with health care providers

D) Unfavorable interactions with health care providers