Ch. 5 Chronic Illness and Older Adults

Which criteria must a 65-year-old person meet to qualify for Medicare funding? 1 Being entitled to Social Security benefits 2 A documented absence of family caregivers 3 A validated need for long-term residential care 4 A history of failed responses to standard medical treatments

1 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. Text Reference - p. 68

A nurse reviews a list of drugs prescribed for an older adult to determine if the drug doses are safe for the patient. What is the primary reason for increased drug toxicity and adverse drug events in older adults? 1 Decline in enzyme activity 2 Increase in metabolism 3 Decrease in drug half-life 4 Increase in hepatic blood flow

1 Age-related changes alter the pharmacodynamics and pharmacokinetics of drugs in older adults. Drastic changes occur in metabolism due to aging. Aging leads to a decline in the renal clearance of drugs. Hepatic blood flow also decreases. The enzymes largely responsible for drug metabolism are decreased. As a result, drug half-life is increased in older adults as compared to younger adults. This leads to drug toxicity and adverse drug events. In older adults metabolism is usually slow. The half-life of the drug is increased, leading to an accumulation of drug toxicity. The hepatic blood flow is decreased, which affects the metabolism of the drug. Text Reference - p. 74

An older adult is admitted to a hospital for acute exacerbation of chronic obstructive pulmonary disease (COPD). Before beginning the admission assessment, what nursing interventions should be performed? Select all that apply. 1 Ask if the patient needs to urinate. 2 Place the patient's glasses within reach. 3 Properly place any hearing aids so that the patient can hear. 4 Ask the patient to answer promptly during the history-taking. 5 Ask the patient to take off the oxygen mask to speak more clearly.

1, 2, 3 Before beginning the assessment, the nurse should ensure patient comfort. A patient would be more comfortable if the bladder is empty. Assistive devices should be made accessible for the patient. Hearing aids should be fitted so that the patient can hear the nurse and answer the questions appropriately. The older patient should be given adequate time for responses and promptness should not be emphasized. Removing the oxygen mask would make the patient uncomfortable. Text Reference - p. 72

A nurse pays a home visit to a chronically ill patient. Which nursing observations would suggest the patient's inability to carry out instrumental activities of daily living (IADLs)? Select all that apply. 1 Inability to shop for groceries 2 Inability to wash clothes 3 Inability to use a telephone 4 Inability to dress oneself 5 Inability to feed self

1, 2, 3 Patients with chronic illness often are unable to carry out activities of daily living (ADLs) and instrumental ADLs (IADLs). These are indicative of a patient's functional status. Shopping for groceries, washing clothes, and using a telephone are considered instrumental ADLs (or IADLs), and are not strictly vital to a patient's ability to care for him or herself. Dressing and feeding oneself, on the other hand, are ADLs; inability to carry out these basic activities indicates a very low functional status, and that the patient needs support. Text Reference - p. 64

The nurse is comparing characteristics of chronic and acute illnesses. Which of these is a characteristic of an acute illness? Select all that apply. 1 It has a rapid onset and short duration. 2 Special rehabilitation may be required. 3 The illness responds readily to treatment. 4 It is prolonged and does not resolve spontaneously. 5 The illness results in permanent deviations from normal.

1, 3 Characteristics of acute illness include having a rapid onset and short duration, usually being self-limiting, responding well to treatment, and having infrequent complications. Characteristics of chronic illness include being prolonged, not resolving spontaneously and rarely cured completely, resulting in permanent impairments or deviations from normal, having irreversible pathologic changes and residual disability, and requiring special rehabilitation. Text Reference - p. 61

A patient suffers from a chronic illness. The nurse recognizes which characteristics of a chronic illness? Select all that apply. 1 The patient has a permanent disability. 2 The patient returns to a fully functional state after illness. 3 The patient's condition declines in terms of everyday life. 4 The patient responds to treatment well. 5 The patient needs a strong support system.

1, 3, 5 The characteristic of a chronic illness is that it leaves a patient with a permanent disability which can be physical or mental. This disability affects the day-to-day life activities of the patient, preventing the patient from performing activities of daily life. The patient may need family support for performing daily activities. In an acute illness, the patient returns to a fully functional life after treatment; in chronic illness the patient may not be able to resume a normal life. The treatment is more effective in acute illness; patients with chronic illnesses are less likely to respond to treatments in later stages. Text Reference - p. 63

An elderly patient sustains a fall while attempting to get up from a bed. The nurse recalls that what factors lead to a higher risk of accidents in older adults? Select all that apply. 1 Decreased sensory perception 2 Decreased weight 3 Memory loss 4 Slower reflexes 5 Changes in gait and balance

1, 4, 5 Decreased sensory perception to heat and pain may prevent the patient from reacting appropriately to stimuli. It can lead to accidents, injuries, and burns. An elderly patient may not be able to judge a potentially dangerous situation because of the slower reflexes to react to sudden changes in the environment. The age-related changes in gait and balance may increase the risk of fall. Decreased weight and memory loss do not put patients at a risk of accidents. Text Reference - p. 74

A nurse is providing care to an elderly patient who is recovering from a hip replacement surgery. The patient has difficulty walking and is prescribed a quad cane to assist with ambulation. Which devices can be categorized as assisted devices to enhance functional mobility? Select all that apply. 1 Wheelchair 2 Coronary stent 3 Inhaler 4 Dentures 5 Walker

1, 5 Wheelchairs and walkers are assisted devices that help the patient to be ambulatory and move around. A coronary stent is not an assistive device; it is a medical equipment to aid in improving coronary flow. Inhalers are not assistive devices, but help in treating respiratory conditions. Dentures are not assistive devices, but are aids for eating and chewing. Text Reference - p. 74

A patient went to visit a friend who has a cat. The exposure to cat fur triggered an asthmatic attack in the patient. The patient was admitted to a hospital for the management of shortness of breath. Which phase of the trajectory model of chronic illness did the patient go through? 1 Onset 2 Acute 3 Stable 4 Crisis

2 In the acute phase, the patient presents with severe symptoms of the disease which may require hospitalization. In the onset phase, diagnosis of the chronic disease happens. In the stable phase, the disease is under control with the help of treatment modalities. The crisis phase involves a critical condition which may be life-threatening. Text Reference - p. 63

A nurse is assessing a newly admitted resident in a nursing home. What kind of communication techniques should the nurse use during assessment to ensure that the patient is relaxed and comfortable for optimum assessment? Select all that apply. 1 Ask strict questions. 2 Avoid eye contact. 3 Use light humor. 4 Ask direct and simple questions. 5 Hold the patient's hand.

3, 4, 5 Relocation to a nursing home can be stressful and depressing for a patient. For a thorough assessment, the nurse should try to make the patient relax by using gentle humor. Asking direct and simple questions would help the patient provide adequate information and prevent unnecessary stress. Using direct gentle touch like holding the patient's hand indicates concern and warmth. The nurse should not behave strictly with the patient. Appropriate eye contact should be made during assessment to make the patient trust the nurse. Text Reference - p. 72

What should be included when planning care for an older adult? 1 Patient priorities should be the only focus of care 2 Additional time related to declining energy reserves 3 Reduction of disease and problems should be the focus 4 Tobacco cessation will help the patient cope with other illnesses

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. Text Reference - p. 72

A nurse is assessing an older adult patient during a routine checkup. The patient is able to care for herself but demonstrates signs of social isolation. The patient's primary caregiver has a busy job and isn't sure how to help. Which of the following is the best caregiving option the nurse could suggest? 1 A personal care aide 2 An adult day care center 3 A long-term care facility 4 An online support group

An adult day care center is the best option for this patient, who is still healthy enough to be active but needs more social interaction. A personal aide—e.g., someone who does shopping, dog walking, and helps with laundry—will not necessarily provide the social interactions needed and may be an unnecessary expense, since the patient can do many activities herself. The patient does not need a long-term care facility, which is for adults with serious conditions who cannot care for themselves. The Internet may be useful for keeping in touch with family and friends but may encourage isolation. TEST-TAKING TIP: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer. Text Reference - p. 70

The nurse is caring for a 76-year-old patient who is recovering from a minor heart attack. What behavior by the nurse is inappropriate and an example of ageism? 1 The nurse directs all questions and instructions to the patient's caregiver because the patient probably won't understand. 2 The nurse prints out instructions for a new medication rather than emailing the instructions to the patient. 3 The nurse suggests a pill box and timer to help the patient adhere to a medication schedule. 4 The nurse suggests a generic equivalent medication that is more affordable than a brand-name medication.

Assuming that older patients will not understand the details and instructions for their own care is a form of prejudice called ageism. While it is important to speak to caregivers, there is no reason to exclude older patients from discussions regarding their own care. Printing out instructions is not necessarily an example of ageism because the printout may facilitate the nurse's face-to-face discussion with the patient. The nurse may suggest pill boxes and timers to any patient to increase adherence to a medication schedule, so this is not necessarily ageism. Suggesting a generic medication is appropriate for patients of all ages and is not an example of ageism. TEST-TAKING TIP: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment. Text Reference - p. 65

Before a patient is discharged from the hospital following an acute myocardial infarction (MI), the nurse will assess the patient's ability to perform activities of daily living (ADLs). Which activity is considered an ADL and might affect the patient's capacity for self-management at home? 1 Speaking 2 Reading 3 Eating 4 Driving

Eating is considered an ADL and is vital to survival outside of the hospital setting. If a patient cannot eat independently, he or she can be given a nasogastric tube and instruction on how to manage this at home. Other activities such as speaking, reading, and driving affect the quality of a patient's life and may be considered instrumental activities of daily living (IADL). They do not, however, require the same level of planning, nor are they as vital to a patient's survival outside the hospital setting. Text Reference - p. 63

A nurse educates a patient about the potential risks of a heart attack, explaining that the patient might experience acute chest pain radiating down the left arm just before a heart attack. The nurse then discusses the use of sublingual nitroglycerin and the need for the patient to report to the emergency room immediately. The nurse is educating the patient for what task? 1 Prevention and management of a crisis 2 Control of symptoms 3 Adjustment to changes in the course of a disease 4 Reorder time

For preventing and managing a crisis, the patient should be educated on early detection of symptoms preceding a crisis and how to manage the situation if a crisis occurs. Controlling symptoms, adjustment to change, and reordering time are other tasks of people with chronic illness, but these do not prevent a crisis or help in managing one. Text Reference - p. 63

A nurse finds that an 88-year-old patient has lost significant weight, is weak, and has low energy levels and lower activity level. What is the geriatric condition of the patient called? 1 Homelessness 2 Memory impairment 3 Ageism 4 Frailty

Frailty is the geriatric condition when the patient has poor nutrition, unplanned weight loss, low energy and activity levels, weakness, slowness, and advanced age. Homelessness is not a geriatric-specific condition; it can happen with anyone. Memory impairment involves loss of short- and long-term memory. Ageism does not involve the symptoms of significant weight loss, weakness, and low energy. Text Reference - p. 68

Which action by the nurse is most helpful to a chronically ill older adult? 1 Avoid discussing future lifestyle changes. 2 Assure the patient that the condition is stable. 3 Plan care with the patient and caregiver. 4 Encourage the patient to research the illness on his or her own.

The nurse's management of individuals with chronic illness begins with planning care, teaching the patient and caregiver regarding the treatment plan, implementing strategies for symptom management, and assessing patient outcomes. Part of this might be discussion of future lifestyle changes. It would not be appropriate to provide assurances of a stable condition or to expect the patient to research the illness on his or her own. Text Reference - p. 63