Med/Surg Unit 1

Assessing elderly patients...

*When assessing a patient, assess individually. Do NOT assume anything based on age. *Older adults are more susceptible to HAIs. *Older adults may need more services upon discharge-help with ADLs, medication management, etc. ASSESS for this. * Do not immediately label older adults "not compliant" with treatment. Think about what the obstacle is behind their refusal (financial, education, physically incapable,etc.) Whats causing the problem?

Examples of Chronic Illnesses

-Congestive Heart Failure (CHF) -Diabetes Mellitus (DM) -Chronic Obstructive Pulmonary Disease (COPD) -Arthritis -Lupus -Chronic illnesses are the leading cause of health problems in the world

Characteristics of a Chronic Illness

-It is a permanent change -It causes, or is caused by irreversible alterations in normal anatomy and physiology. -It requires special patient education for rehabilitation. -It usually requires a long period of care or support. -Increases health care costs; prolongs hospitalization. -Increases assistance; taxes family's coping.

Characteristics of Acute Illness

-Often appear abruptly and subside quickly depending on the cause. -May or may not require intervention by a healthcare provider. -Most people return to their normal level of wellness.

Examples of Acute Illness

-Pneumonia -Appendicitis -Diarrhea -Common cold -Some are life threatening -Many do not require health care provider

A nurse has been assigned the following clients on the day shift. In updating their plans of care, which client would have both Risk for Ineffective Breathing Pattern and Risk for Impaired Gas Exchange as a priority diagnoses? 1. A newly admitted 32-year-old female with exacerbation of myasthenia gravis. 2. A second day post-op 66 year old client who underwent femoropopliteal bypass grafting. 3. A 56 year old client admitted for an appendectomy. 4. An 82 year old client with non-metastic prostate cancer.

1. A newly admitted 32-year-old female with exacerbation of myasthenia gravis. Rationale: A client with myasthenia gravis may have risk for ineffective breathing pattern because of neuromuscular effects of a disease, and may also have risk for impaired gas exchange because of the possible respiratory impairments from the physiological process of this disease. A postoperative client who had surgery more than 24 hours ago may have pain at the surgical site but should not have hypoventilation from anesthesia, as these effects should wear off within 24 hours. A preoperative client in pain may or may not have respiration affected. It is highly unlikely that a client with prostate cancer will experience respiratory difficulty unless there is dysuria or localized pain, which may result in change in breathing pattern.

The nurse would assess for hyperkalemia in a client with which of the following problems? 1. Renal failure. 2. Nausea and vomiting. 3. Excessive laxative use. 4. Loop diuretic use.

1. Renal Failure Rationale: Renal failure results in the inability of the kidneys to excrete potassium, which leads to hyperkalemia. Nausea, vomiting, excessive laxative use, and loop diuretic all cause excess fluid loss from the body. With this fluid will also be loss of electrolytes which would lead to hypokalemia rather than hypokalemia.

What are the 3 components of evidenced based practice?

1. Research. 2. Clinical Expertise. 3. Patient Preference.

A nurse is revising the client goals and interventions in the nursing care plan. What information enables the nurse to make relevant revisions? 1. Knowledge of the hospital's standards of care. 2. Medical assessment and written prescriptions. 3. Health care team conferences. 4. Validation of the effectiveness of nursing interventions.

4. Validation of the effectiveness of nursing interventions. Rationale: It is necessary to know how well the interventions worked in order to revise them appropriately. Medical assessment and written prescriptions are components of the client care but not the focus of the nursing plan of care. The focus of the care plan is to direct the nurse to where the client is in his or her recovery, where he needs to go next, and what the nurse and client need to do to achieve that goal.

The nurse is preparing the client for an ultrasound of the gallbladder. Which statement would be the most important to prepare the client for the test? 1. You will have food and fluids restricted for 4 to 8 hours prior to the test. 2. Stool in the bowel may cause a reporting of inaccurate findings. 3. There is no special preparation for this procedure. You may eat and drink as usual. 4. You will be asked to drink a solution of radionuclide 2 hours prior to the procedure.

1. You will have food and fluids restricted for 4 to 8 hours prior to the test. Rationale: The client will be required to have an empty stomach for the procedure to allow visualization of the gallbladder and adjacent structures to accurately rule out tumors, structural abnormalities, or the presence of stones. Since the lower GI tract is not visualized during this procedure, there is no need for the bowel to be empty. Also, ultrasound does not require the use of radioactive isotopes.

The nurse is assisting with prioritization of admission, discharge, and triage of acutely ill clients. Which client would require continued monitoring in the the ICU? Select all that apply. 1. Client with terminal cancer in the process of dying. 2. Client with congestive heart failure and chronic renal failure who develops an exacerbation of the heart failure. 3. Hemodynamically unstable client who requires vasoactive drugs to maintain blood pressure. 4. Client with metastatic lung disease who develops a pneumonia. 5. Client with a tracheostomy who may require mechanical ventilation.

2. Client with congestive heart failure and chronic renal failure who develops an exacerbation of the heart failure. 3. Hemodynamically unstable client who requires vasoactive drugs to maintain blood pressure. 4. Client with metastatic lung disease who develops a pneumonia. Rationale: Priority is given to acutely ill, unstable clients who require invasive procedures or monitoring that cannot occur outside the intensive care area, and who for all purposes have a good chance of surviving their acute illness.

The nurse is caring for a client on digoxin. Which electrolyte abnormality should the nurse be concerned about regarding the risk of digoxin toxicity? 1. Sodium 132 mEq/L 2. Potassium 3.0 mEq/L 3. Magnesium 1.0 mEq/L 4. Calcium 9.2 mEq/L

2. Potassium 3.0 mEq/L Rationale: A low serum potassium level (nml 3.5-5.1) enhances the level of digoxin and predisposes the client receiving the medication to develop toxicity. Hyponatremia, hypomagnesemia, and a normal calcium level do not contribute to digoxin toxicity.

HCO3

22-26

Which statements made by the nurse while taking a nursing history would elicit the greatest amount of client data? 1. Did your pain begin recently? 2. You said the pain started yesterday? 3. Can you tell me more about how the pain began? 4. The pain isn't bad right now is it?

3. Can you tell me more about how the pain began? Rationale: Open-ended questions encourage the client to speak freely and to elaborate and clarify answers as needed. Restrictive questions that only require a "yes" or a "no" answer do not encourage free exchange of information nor does frequent rephrasing of the client's answer. Leading questions tend to elicit

A client has recently returned to the nursing unit following a bronchoscopy and is requesting a glass of water. What should the nurse's initial assessment before meeting this request? 1. Determine if the client is able to ambulate without assistance. 2. Ensure that the side rails are up on the client's bed. 3. Determine if the client is received a local anesthetic during the procedure. 4. Ensure that the call light is within the client's reach.

3. Determine if the client is received a local anesthetic during the procedure. Rationale: The administration of a local anesthetic is possible during the procedure to decrease the gag reflex and increase comfort. The nurse should check for the return of the gag reflex to prevent the potential for aspiration. The position of the side rails, the availability of the call light, and the ability to ambulate without assistance are safety concerns but are not related to specific client request.

PaCo2 (dissolved 02 in blood)

35-45

The nurse is caring for a man who was admitted after being found unresponsive at home by his wife. If all of the following assessments and interventions must be completed on this client, place them in order of priority from high priority to lowest. Place the options in the correct order. 1. Performa neurological exam. 2. Obtain blood samples. 3. Prepare a client for a CT scan. 4. Assess and establish the airway.

4. Assess and establish the airway. 1. Performa neurological exam. 2. Obtain blood samples. 3. Prepare a client for a CT scan. Rationale: Airway and respiratory status take priority over all other interventions. After this is established, performing a neurological exam is indicated as the first step in determining if the cause of the unresponsiveness is related to a neurological or metabolic cause. Blood would then be drawn in a general physiologic screening as well as in a toxicology screen to determine the presence of drugs as a cause for the unresponsiveness. If the cause of the unresponsiveness is determined to be neurological in origin, a CT scan would be done.

The nurse is caring for a client who has an oxygen dose decreased to 2L/min by nasal cannula. Shortly after this change, the client reports feeling short of breath (SOB). The nurse determines that the current pulse oximetry reading reveals an oxygen saturation of 71%. What would be the nurse's initial intervention? 1. Closely monitor the client's condition and increase the oxygen concentration to 15/L min. 2. Place the client in a semi-Fowler's position and continue to monitor. 3. Do nothing; the drop in oxygen concentration is expected with the change in oxygen being delivered. 4. Sit the client up, assess the client's respiratory status and notify the health care provider immediately.

4. Sit the client up, assess the client's respiratory status and notify the health care provider immediately. Rationale: An oxygen saturation of less than 80% with observable signs of shortness of breath indicates respiratory distress, which requires immediate intervention. A rapid respiratory assessment should be performed and the health care provider advised of the findings immediately. Symptomatic respiratory distress should never be ignored. The repositioning of the client and the receiving of a health care provider's order to increase the rate of oxygen delivery would help increase the oxygen saturation.

pH

7.35-7.45

Nml pH

7.40

PaO2

80-100

SaO2% (Pulse Ox.)

95-100%

Chronic Illness Definition

A broad term that encompasses many different physical and mental alterations and usually last six or more months.

Telehealth includes using devices to provide which types of care for the patient (select all that apply)? A. Administering medications B. Evaluation of weight loss C. Video assessment of wounds D. Monitoring peak flow meter results E. Real-time blood pressure assessment

A. Administering medications B. Evaluation of weight loss C. Video assessment of wounds D. Monitoring peak flow meter results E. Real-time blood pressure assessment Telehealth enables the nurse to provide distance assessment, planning, intervention, and evaluation of outcomes of nursing care using technologies such as the Internet, digital assessment tools, and telemonitoring equipment.

What factor has been most clearly identified as an influence on the future of nursing practice? A. Aging of the American population and increases in chronic illnesses B. Increasing birth rates coupled with decreased average life expectancy C. Increased awareness of determinants of health and improved self-care D. Apathy around health behaviors and the relationship of lifestyle to health

A. Aging of the American population and increases in chronic illnesses The American population is aging at the same time that the incidence of chronic health conditions is increasing. There is no noted increase in the overall awareness of the determinants of health, but at the same time, observers have not identified apathy as a predominant attitude. Life expectancy is increasing, not decreasing.

When planning care for a patient, the nurse may use a visual diagram of patient problems and interventions to illustrate the relationships among pertinent clinical data. What is this format called? A. Concept map B. Critical pathway C. Clinical pathway D. Nursing care plan

A. Concept map A concept map is another method of recording a nursing care plan. In a concept map, the nursing process is recorded in a visual diagram of patient problems and interventions. A clinical (critical) pathway is a prewritten plan that directs the entire health care team in the daily care goals for select health care problems.

A 40-year-old female patient is being prepared for discharge home after a laparoscopic cholecystectomy. Which team member can be assigned to complete a discharge assessment and provide patient teaching for post-discharge care? A. Registered nurse (RN) B. Nursing technician (NT) C. Unlicensed assistive personnel (UAP) D. Licensed practical/vocational nurse (LPN/LVN)

A. Registered nurse (RN) Nursing interventions that require independent nursing knowledge, skill, or judgment such as assessment, patient teaching, and evaluation of care cannot be delegated. These interventions are the responsibility of the RN. The scope of practice for LPN/LVNs is determined by each state board of nursing. The RN must know the legal scope of practical/vocational nursing practice and delegates and assigns nursing functions appropriately. In most states LPN/LVNs may administer medications, perform sterile procedures, and provide a wide variety of interventions planned by the RN. UAP are unlicensed individuals who serve in an assistive role to the RN and may include nursing assistants or technicians. The RN may delegate specific activities such as obtaining routine vital signs on stable patients, feeding/assisting patients at mealtimes, ambulating stable patients, and helping patients with bathing and hygiene.

When nurses disagree about the effectiveness of a commonly used nursing intervention, the best evidence for solving the question related to an intervention is: A. a systematic review of randomized controlled trials. B. a qualitative research study with a large sample size. C. a methodological Internet search using key medical terms. D. Anecdotal evidence retrieved from two or more case studies.

A. systematic review of randomized controlled trials. Rationale: Systematic reviews of randomized controlled trials (RCTs) are considered the strongest level of evidence to answer questions about interventions (i.e., cause and effect).

What is the difference between chronic and acute illness?

Acute: Sudden, less than 6 months, reversible. Chronic: Greater than 6 months irreversible.

A nurse is providing care for a patient who had transurethral resection of his prostate this morning. The patient is receiving continuous bladder irrigation, but his urinary catheter is now occluded. The nurse is now planning to phone the patient's health care provider and communicate using the SBAR (Situation-Background-Assessment-Recommendation) format. Which statement is a component of communication using SBAR? A. "What do you think could be causing this occlusion?" B. "I think that we should manually irrigate his catheter." C. "What do you know about this patient and his history?" D. "Could you please provide some direction for his care?"

B. "I think that we should manually irrigate his catheter." Proposing a recommendation is a component of the "R" component of SBAR communication. Asking the health care provider for possible contributing factors to the problem or for general direction may be appropriate in some circumstances, but these are not explicit components of SBAR. The nurse should briefly identify the patient and his circumstances, not ask an open-ended question regarding the physician's familiarity.

Nurses deliver patient-centered care in collaboration with the interdisciplinary health care team within the framework of a care delivery model. In which care delivery model does the nurse plan and coordinate the aspects of patient care with other disciplines with a focus on continuity of care and interdisciplinary collaboration even when the nurse is absent? A. Team nursing model B. Primary nursing model C. Total patient care model D.Case management nursing model

B. Primary nursing model Primary nursing model includes planning the patient's care, coordinating and communicating all aspects of care with other disciplines and those providing care in the nurse's absence. The focus is on continuity of care and interdisciplinary collaboration. Team nursing uses the RN as the team leader to organize and manage the care for a group of patients with other ancillary workers. The RN has authority and accountability for the quality of care delivered by the team only during the work period. In a total patient care model, the nurse is accountable for the complete care of the patient during the assigned shift. Case management is not a model of care delivery, but a collaborative process that involves assessing, planning, facilitating, and advocating for health services with a variety of resources to promote cost-effective outcomes.

The nurse establishes priorities and determines outcomes for an individual patient during the A. analysis phase of the nursing process. B. planning phase of the nursing process. C. evaluation phase of the nursing process. D. assessment phase of the nursing process.

B. planning phase of the nursing process. During the planning phase of the nursing process, patient outcomes or goals are developed and nursing interventions are identified to accomplish the outcomes. The assessment phase of the nursing process includes the collection of subjective and objective patient information on which to base the plan of care. The evaluation phase of the nursing process determines if the patient outcomes have been met as a result of nursing interventions. Nursing diagnosis is the act of analyzing the assessment data and making a judgment about the nature of the data.

A registered nurse (RN) has delegated the administration of IV medications to a licensed practical/vocational nurse (LPN/LVN). Which statement accurately describes delegation? A. The RN should first teach the LPN how to administer IV medications. B. Ultimate responsibility for the execution of the task now lies with the LPN. C. The RN is still accountable for the quality of care and procedures that the patient receives. The RN is responsible for observing and evaluating the administration of IV medications by the LPN.

C. The RN is still accountable for the quality of care and procedures that the patient receives. Delegation entails a redistribution of nursing work, but the RN remains ultimately responsible and accountable for the execution of the task. It would be inappropriate to delegate if the LPN was unfamiliar with the task. The RN is not obliged to observe the LPN's execution of the task.

A nurse is monitoring all of the patients in an outpatient procedure area for complications of IV fluid administration. What type of function is the nurse demonstrating? A. Dependent nursing function B. Independent nursing function C. Autonomous nursing function D. Collaborative nursing function

D. Collaborative nursing function A collaborative nursing function is demonstrated when the nurse monitors patients for complications of acute illness, administers IV fluids and medications per physician or nurse practitioner orders, and implements nursing interventions such as providing emotional support or teaching about specific procedures. Nursing functions may be dependent, collaborative, or independent. The nurse functions dependently when carrying out medical orders. Physician-initiated nursing functions may include administering medications, performing or assisting with certain medical treatments, and assisting with diagnostic tests and procedures. Independent nursing functions include interventions such as promotion and optimization of health, prevention of illness, and patient advocacy.

When the nurse encourages a patient with heart failure to alternate rest and activity periods to reduce cardiac workload, what phase of the nursing process is being used? A. Planning B. Diagnosis C. Evaluation D. Implementation

D. Implementation Carrying out a specific, individualized plan constitutes the implementation phase of the nursing process. The nurse's action of encouragement and instruction to the patient is part of carrying out a plan of action.

Acute Illness definition

Generally has a rapid onset of signs and symptoms and lasts only a relatively short time.

Electrolyte lab values

Mg-1.5-2.5 Ca-8.6-10 Cl-97-107 Na-135-145

What is the tool SPICES used for? What does it stand for?

S: Sleeping disorders P: Problems with nutrition and eating I: Incontinence C: Confusion E: Evidence of falls S: Skin breakdown *Elderly assessment tool. 65 years and older population.

Which assessment findings would alert the nurse to possible elder mistreatment (select all that apply)? a. Agitation b. Depression c. Weight gain d. Weight loss e. Hypernatremia

a. Agitation b. Depression d. Weight loss e. Hypernatremia Agitation and depression may be manifestations of psychologic abuse or neglect. Hypernatremia may signify dehydration caused by physical neglect. A loss of body weight, rather than weight gain, is another clinical manifestation of physical neglect.

How do nurses use EBP?

Use during interventions in nursing practice.

What factor has been most clearly identified as an influence on the future of nursing practice? a. Aging population and chronic illness b. Increasing birth rates coupled with decreased average life expectancy c. Increased awareness of detriments of health and improved self care d. Apathy around health behaviors and the relationship of lifestyle to health.

a. Aging population and chronic illness The American population is aging at the same time that the incidence of chronic health conditions is increasing. There is no noted increase in the overall awareness of the determinants of health, but at the same time, observers have not identified apathy as a predominant attitude. Life expectancy is increasing, not decreasing.

A 70-year-old man has just been diagnosed with chronic obstructive pulmonary disease (COPD). At what point should the nurse begin to include the patient's wife in the teaching around the management of the disease? a. As soon as possible b. When the patient requests assistance from his spouse and family c. When the patient becomes unable to manage his symptoms independently d. After the patient has had the opportunity to adjust to his treatment regimen

a. As soon as possible In the management of chronic illness, it is desirable to include family caregivers in patient education and symptom-management efforts as early in the diagnosis as possible.

A 70-year-old man has just been diagnosed with chronic obstructive pulmonary disease (COPD). At what point should the nurse begin to include the patient's wife in the teaching around the management of the disease? a. As soon as possible b. When the patient requests assistance from his spouse and family c. When the patient becomes unable to manage his symptoms independently d. After the patient has had the opportunity to adjust to his treatment regimen

a. As soon as possible. In the management of chronic illness, it is desirable to include family caregivers in patient education and symptom-management efforts as early in the diagnosis as possible.

Which criterion must a 65-year-old person meet in order to qualify for Medicare funding? a. Being entitled to Social Security benefits b. Documented absence of family care givers c. A validated need for long-term residential care d. A history of failed responses to standard medical treatments

a. Being entitled to Social Security benefits In order to qualify for Medicare, an individual must be entitled to receive Social Security benefits. Absence of caregivers and inadequate responses to treatment are not qualification criteria for Medicare, and the program does not cover residential care services.

Which criterion must a 65-year-old person meet in order to qualify for Medicare funding? a. Being entitled to Social Security benefits b. A documented absence of family caregivers c. A validated need for long-term residential care d. A history of failed responses to standard medical treatments

a. Being entitled to Social Security benefits In order to qualify for Medicare, an individual must be entitled to receive Social Security benefits. Absence of caregivers and inadequate responses to treatment are not qualification criteria for Medicare, and the program does not cover residential care services.

A group of nurses have a plan to implement evidence-based practice (EBP) for care of patients with pressure ulcers. What will this change in practice encompass (select all that apply)? a. Consulting with the wound care and ostomy nurse b. The preferences of patients and their particular circumstances c. Nurses' expertise and their bodies of experience and knowledge d. The traditions that surround pressure ulcer practices on the unit e. Journal articles that address the care of patients with pressure ulcers

a. Consulting with the wound care and ostomy nurse b. The preferences of patients and their particular circumstances c. Nurses' expertise and their bodies of experience and knowledge d. The traditions that surround pressure ulcer practices on the unit e. Journal articles that address the care of patients with pressure ulcers EBP draws on research, data from local quality improvement, professional organization standards, patient preferences, and clinical expertise. The particular traditions on the nursing unit are not part of EBP.

A group of nurses have a plan to implement evidence-based practice (EBP) for care of patients with pressure ulcers. What will this change in practice encompass (select all that apply)? Select one or more: a. Consulting with the wound care and ostomy nurse b. The preferences of patients and their particular circumstances c. Nurses' expertise and their bodies of experience and knowledge d. The traditions that surround pressure ulcer practices on the unit e. Journal articles that address the care of patients with pressure ulcers .

a. Consulting with the wound care and ostomy nurse e. Journal articles that address the care of patients with pressure ulcers. a:EBP draws on research, data from local quality improvement, professional organization standards, patient preferences, and clinical expertise. The particular traditions on the nursing unit are not part of EBP. e: EBP draws on research, data from local quality improvement, professional organization standards, patient preferences, and clinical expertise. The particular traditions on the nursing unit are not part of EBP.

A nurse who is providing care for an 81-year-old female patient recognizes the need to maximize the patient's mobility during her recovery from surgery. What accurately describes the best rationale for the nurse's actions? a. Continued activity prevents deconditioning. b. Pharmacokinetics are improved by patient mobility. c. Lack of stimulation contributes to the development of cognitive deficits in older adults. d. Regularly scheduled physical rehabilitation provides an important sense of purpose for older patients.

a. Continued activity prevents deconditioning. Older adults are highly susceptible to deconditioning, a process that can be slowed or prevented by regular physical activity. This consideration supersedes any possible effect on pharmacokinetics, prevention of cognitive deficits, or the patient's sense of purpose.

A 67-year-old woman who has a long-standing diagnosis of incontinence is in the habit of arriving 20 minutes early for church in order to ensure that she gets a seat near the end of a row and close to the exit so that she has ready access to the restroom. Which tasks of the chronically ill is the woman demonstrating (select all that apply)? a. Controlling symptoms b. Preventing social isolation c. Preventing and managing a crisis d. Denying the reality of the problem e. Adjusting to changes in the course of the disease

a. Controlling symptoms c. Preventing and managing a crisis The woman's efforts to ensure that she can continue in her lifestyle of church attendance while accommodating the frequent elimination caused by her health problem are an example of controlling her symptoms and preventing a personal crisis.

What is most appropriate for the nurse to do when interviewing an older patient? a. Ensure all assistive devices are in place b. Interview the patient and caregiver together. c. Perform interview before administering analgesics d. Move onto to next question if the patient does not respond quickly.

a. Ensure all assistive devices are in place. All assistive devices, such as glasses and hearing aids, should be in place when interviewing an older patient. It is best to interview the patient and caregiver separately to ensure a reliable assessment related to any possible mistreatment. The patient should be free from pain during the assessment and may need extra time to respond to questions.

What is most appropriate for the nurse to do when interviewing an older patient? a. Ensure all assistive devices are in place. b. Interview the patient and caregiver together. c. Perform the interview before administering analgesics. d. Move on to the next question if the patient does not respond quickly.

a. Ensure all assistive devices are in place. Rationale: All assistive devices, such as glasses and hearing aids, should be in place when interviewing an older patient. It is best to interview the patient and caregiver separately to ensure a reliable assessment related to any possible mistreatment. The patient should be free from pain during the assessment and may need extra time to respond to questions.

A male patient has a history of hypertension and type 1 diabetes mellitus. Because of these chronic illnesses, the patient exercises and eats the healthy diet that his wife prepares for him. Which factors will most likely have a positive impact on his biologic aging (select all that apply)? a. Exercise b. Diabetes c. Social support d. Good nutrition e. Coping resources

a. Exercise c. Social support d. Good nutrition e. Coping resources Biologic aging is the progressive loss of function. Obesity, diabetes, hypertension, and cancer are all associated with the effects of aging. Exercise, good nutrition, social support, stress management, and coping resources are all positive factors related to the aging process.

A male patient has a history of hypertension and type 1 diabetes mellitus. Because of these chronic illnesses, the patient exercises and eats the healthy diet that his wife prepares for him. Which factors will most likely have a positive impact on his biologic aging (select all that apply)? a. Exercise b. Diabetes c. Social support d. Good nutrition e. Coping resources

a. Exercise c. Social support d. Good nutrition a: Biologic aging is the progressive loss of function. Obesity, diabetes, hypertension, and cancer are all associated with the effects of aging. Exercise, good nutrition, social support, stress management, and coping resources are all positive factors related to the aging process. c: Biologic aging is the progressive loss of function. Obesity, diabetes, hypertension, and cancer are all associated with the effects of aging. Exercise, good nutrition, social support, stress management, and coping resources are all positive factors related to the aging process. d: Biologic aging is the progressive loss of function. Obesity, diabetes, hypertension, and cancer are all associated with the effects of aging. Exercise, good nutrition, social support, stress management, and coping resources are all positive factors related to the aging process.

What are the 3 components of the Chronic Care Model? (Who is involved?)

a. Patient. b. Healthcare team/system. c. Community resources. *Best outcomes are achieved when 3 work together to care for the chronically ill.

A nurse is caring for an adult who sustained a severe traumatic brain injury following a motor vehicle accident. Once the patient recovers from the acute aspects of this injury and is no longer ventilator-dependent, discharge planning would include that this patient will be transferred to what type of practice setting? a. Assisted living b. Acute rehabilitation c. Long-term acute care d. Skilled nursing facility

b. Acute rehabilitation Acute rehabilitation practice settings provide a post-acute level of care specializing in therapies for patients with neurologic or physical injuries, such as those with head trauma, spinal cord injury, or stroke.

A nurse is caring for an adult who sustained a severe traumatic brain injury following a motor vehicle accident. Once the patient recovers from the acute aspects of this injury and is no longer ventilator-dependent, discharge planning would include that this patient will be transferred to what type of practice setting? a. Assisted living b. Acute rehabilitation c. Long term acute care d. Skilled nursing facility

b. Acute rehabilitation Acute rehabilitation practice settings provide a post-acute level of care specializing in therapies for patients with neurologic or physical injuries, such as those with head trauma, spinal cord injury, or stroke.

What should be included when planning care for an older adult? a. Patient priorities should be the only focus of care. b. Additional time related to declining energy reserves c. Reduction of disease and problems should be the focus. d. Tobacco cessation will help the patient cope with other illnesses.

b. Additional time related to declining energy reserves Additional time is required with older patients with declining energy reserves. Patient priorities are considered to best meet the patient needs but will not be the only focus of care. Focusing on strengths and abilities as well as physical and mental status will facilitate goal setting to reduce disease or problems. As with all patients, safety is a primary concern, and decreasing tobacco use will improve all of the patient's body functioning.

What should be included when planning care for an older adult? a. patient priorities should be the focus of care. b. Additional time related to declining energy reserves. c. Reduction of disease and problems should be the focus. d. Tobacco cessation will help the patient cope with other illnesses.

b. Additional time related to declining energy reserves. Additional time is required with older patients with declining energy reserves. Patient priorities are considered to best meet the patient needs but will not be the only focus of care. Focusing on strengths and abilities as well as physical and mental status will facilitate goal setting to reduce disease or problems. As with all patients, safety is a primary concern, and decreasing tobacco use will improve all of the patient's body functioning.

A 60-year-old female patient has had increased evidence of dementia and physical deterioration. What would be the best assistance to recommend to her caregiver husband who is exhausted? a. Long-term care b. Adult day care c. Home health care d.Homemaker services

b. Adult day care Adult day care provides social, recreational, and health-related services in a safe, community-based environment that would keep this patient safe and decrease the stress on the husband. Long-term care is used when the patient has rapid deterioration, the caregiver is unable to continue to provide care, and there is an alteration in or loss of the family support system. Home health care is used when there is supportive caregiver involvement for patients with health needs. Homemaker services provide services, but do not care for the patient.

A 60-year-old female patient has had increased evidence of dementia and physical deterioration. What would be the best assistance to recommend to her caregiver husband who is exhausted? a. Long term care b. Adult day care c. Home health care d. Homemaker services

b. Adult day care Adult day care provides social, recreational, and health-related services in a safe, community-based environment that would keep this patient safe and decrease the stress on the husband. Long-term care is used when the patient has rapid deterioration, the caregiver is unable to continue to provide care, and there is an alteration in or loss of the family support system. Home health care is used when there is supportive caregiver involvement for patients with health needs. Homemaker services provide services, but do not care for the patient.

Which assessment findings would alert the nurse to possible elder mistreatment (select all that apply)? a. Agitation b. Depression c. Weight gain d. Weight loss e. Hypernatremia

b. Depression d. Weight loss e. Hypernatremia b: Agitation and depression may be manifestations of psychologic abuse or neglect. Hypernatremia may signify dehydration caused by physical neglect. A loss of body weight, rather than weight gain, is another clinical manifestation of physical neglect. d: Agitation and depression may be manifestations of psychologic abuse or neglect. Hypernatremia may signify dehydration caused by physical neglect. A loss of body weight, rather than weight gain, is another clinical manifestation of physical neglect. e: Agitation and depression may be manifestations of psychologic abuse or neglect. Hypernatremia may signify dehydration caused by physical neglect. A loss of body weight, rather than weight gain, is another clinical manifestation of physical neglect.

Telehealth includes using devices to provide which types of care for the patient (select all that apply)? a. Administering medications b. Evaluation of weight loss c. Video assessment of wounds d. Monitoring peak flow meter results e.Real time blood pressure assessment

b. Evaluation of weight loss c. Video assessment of wounds e. Real time blood pressure assessment b: Telehealth enables the nurse to provide distance assessment, planning, intervention, and evaluation of outcomes of nursing care using technologies such as the Internet, digital assessment tools, and telemonitoring equipment. c: Telehealth enables the nurse to provide distance assessment, planning, intervention, and evaluation of outcomes of nursing care using technologies such as the Internet, digital assessment tools, and telemonitoring equipment. e:Telehealth enables the nurse to provide distance assessment, planning, intervention, and evaluation of outcomes of nursing care using technologies such as the Internet, digital assessment tools, and telemonitoring equipment.

Nurses deliver patient-centered care in collaboration with the interdisciplinary health care team within the framework of a care delivery model. In which care delivery model does the nurse plan and coordinate the aspects of patient care with other disciplines with a focus on continuity of care and interdisciplinary collaboration even when the nurse is absent? a. Team nursing model b. Primary nursing model c. Total patient care model d. Case management nursing model

b. Primary nursing model Primary nursing model includes planning the patient's care, coordinating and communicating all aspects of care with other disciplines and those providing care in the nurse's absence. The focus is on continuity of care and interdisciplinary collaboration. Team nursing uses the RN as the team leader to organize and manage the care for a group of patients with other ancillary workers. The RN has authority and accountability for the quality of care delivered by the team only during the work period. In a total patient care model, the nurse is accountable for the complete care of the patient during the assigned shift. Case management is not a model of care delivery, but a collaborative process that involves assessing, planning, facilitating, and advocating for health services with a variety of resources to promote cost-effective outcomes.

A registered nurse (RN) has delegated the administration of IV medications to a licensed practical/vocational nurse (LPN/LVN). Which statement accurately describes delegation? Select one: a. The RN should first teach the LPN how to administer IV medications. b. Ultimate responsibility for the execution of the task now lies with the LPN. c. The RN is still accountable for the quality of care and procedures that the patient receives.

c. The RN is still accountable for the quality of care and procedures that the patient receives. Rationale:The RN is still accountable for the quality of care and procedures that the patient receives. Correct Delegation entails a redistribution of nursing work, but the RN remains ultimately responsible and accountable for the execution of the task. It would be inappropriate to delegate if the LPN was unfamiliar with the task. The RN is not obliged to observe the LPN's execution of the task.

A nurse with an associate or baccalaureate degree who meets licensing requirements is qualified to practice as: a. a nurse practitioner. b. a certified specialist. c. an entry-level generalist. d. an advanced practice nurse.

c. an entry-level generalist Rationale: Entry-level nurses with an associate or baccalaureate degree are prepared to function as generalists. With experience and continued study, nurses may specialize in an area of practice and may obtain certification in nursing specialties. Certification usually requires clinical experience and successful completion of an examination. A nurse practitioner is an example of an advanced practice nurse. An advanced practice nurse has a minimum of a master's degree with advanced education in pharmacology and physical assessment as well as expertise in a specialized area of practice.

Aging primarily affects the _________of drugs. a. excretion b. absorption c. metabolism d. distribution

c. metabolism Because the liver mass shrinks and hepatic blood flow and enzyme activity decrease in older adults, metabolism of drugs drops 1/2 to 2/3 of the rate of young adults. This increases the chance of drug toxicity and adverse drug events.

Aging primarily affects the _________of drugs. a. excretion b. absorption c. metabolism d. distribution

c. metabolism Because the liver mass shrinks and hepatic blood flow and enzyme activity decrease in older adults, metabolism of drugs drops 1/2 to 2/3 of the rate of young adults. This increases the chance of drug toxicity and adverse drug events.

A 67-year-old woman who has a long-standing diagnosis of incontinence is in the habit of arriving 20 minutes early for church in order to ensure that she gets a seat near the end of a row and close to the exit so that she has ready access to the restroom. Which tasks of the chronically is the chronically ill woman demonstrating a. Controlling symptoms b. Preventing social isolation c. Preventing and managing a crisis d. Denying reality of the problem e. Adjusting to changes in the course of disease.

e. Adjusting to changes in the course of disease. The woman's efforts to ensure that she can continue in her lifestyle of church attendance while accommodating the frequent elimination caused by her health problem are an example of controlling her symptoms and preventing a personal crisis