Chapter 5 chronic illness Medsurg
When teaching a patient about primary prevention of a chronic illness, the nurse focuses on which topic? 1 Diet 2 Rehabilitation 3 Pain medication 4 Screening procedures
1 A proper diet is an example of a primary prevention method that can reduce the risk of chronic illness. Pain medication and rehabilitation are tertiary prevention measures, which limit the progression of the chronic disease. Screening procedures are an example of secondary preventions, which focuses on the early detection of chronic diseases.
Which patient is referred to as an old-old adult? 1 An 85-year-old patient who lives alone 2 A 66-year-old patient with heart failure 3 A 73-year-old patient with a hip prosthesis 4 A 75-year-old patient with mental dysfunction
1 An individual who is 85 years old or older is referred to as an old-old adult. A 66-year-old patient and 73-year-old patient are called young-old adults. A 75-year-old patient with mental dysfunction is termed a frail older adult.
An elderly patient is admitted from home with an infected pressure sore. What will the nurse include during the assessment of this patient? 1 Screening for mistreatment 2 Development of a safety plan 3 Notifying the health care provider 4 Asking the caregiver what happened
1 Assessment should include screening the patient for elder mistreatment (EM). Developing a safety plan should be initiated if the patient appears to be in immediate danger. The health care provider should be notified of the assessment findings so the proper treatment can be initiated. The caregiver may be interviewed after a thorough screening and head-to-toe assessment is completed.
An older patient has bruises on the breast and anal bleeding. Laboratory data indicate a genital infection. What should the nurse suspect the patient has been experiencing based upon these findings? 1 Sexual abuse 2 Physical abuse 3 Financial abuse 4 Psychologic abuse
1 Bruises on the breast, anal bleeding, and genital infection could indicate that the patient is a victim of sexual abuse. Bruises, bilateral injuries, and oversedation are signs of physical abuse. Sudden changes in personal finance and sudden transfers of assets indicate financial abuse. Depression, withdrawn behavior, and agitation are the signs of psychologic abuse.
While working at a home care agency, the nurse visits a 79-year-old male patient for a non-healing leg ulcer. The patient has a history of diabetes; is alert; and is oriented to person, place, and time. He resides with his son, who is unemployed. The nurse notes the patient is unbathed and emaciated. The leg ulcer dressing is saturated with fluid. Skin turgor is decreased and a urinal on the table contains dark, concentrated urine. When questioned about his fluid intake, the patient states how lucky he is to have a son to care for him at home. What is the most likely reason for the patient's lack of acknowledgment of his fluid intake? 1 Fear of being abused by his son 2 Unable to ambulate to obtain water 3 Suffering from dementia and delirium 4 Unaware of his surroundings and care
1 Fear of being abused by his son is a likely a concern of the patient. He has multiple healthcare needs that are not being met, but he may not want to cause any issues that may lead to verbal or physical abuse or abandonment to a nursing home. The patient may not be able to ambulate to get water, but further assessment needs to be done to determine this. The patient is aware of his surroundings and care as he is alert and oriented to person, place, and time. He does not appear to suffer from dementia or delirium.
A 67-year-old patient is admitted to a hospital with acute chest pain and is diagnosed with coronary artery disease. The patient needs to be hospitalized for 6 days. Which part of Medicare would cover the patient's hospitalization? 1 Part A 2 Part B 3 Part C 4 Part D
1 Medicare Part A covers inpatient health services and a part of skilled nursing facilities. Part B covers outpatient and home health care. Part C, also called Medicare Advantage Plans, is offered by Medicare-approved private insurance companies. Part D covers prescription drugs.
An elderly patient arrives at the emergency department with infected pressure ulcers on the sacral area and heels. Laboratory tests reveal an elevated hematocrit (HCT) and serum sodium. What type of elder mistreatment correlates with these assessment findings? 1 Neglect 2 Abandonment 3 Physical abuse 4 Psychologic abuse
1 Neglect is a failure to provide basic life needs and physical aids to ensure the safety of the patient. Abandonment occurs when the patient has been deserted. Physical abuse occurs when the patient is slapped, struck, restrained, incorrectly positioned, or overly sedated with medication. Psychologic abuse occurs when the patient is berated, intimidated, harassed, deprived, or threatened.
A nurse who is providing care for an 81-year-old patient recognizes the need to maximize the patient's mobility during recovery from surgery. What accurately describes the best rationale for the nurse's actions? 1 Continued activity prevents deconditioning. 2 Pharmacokinetics are improved by patient mobility. 3 Lack of stimulation contributes to the development of cognitive deficits in older adults. 4 Regularly scheduled physical rehabilitation provides an important sense of purpose for older patients.
1 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 patient that has been cared for at home has rapidly deteriorated and is no longer able to be cared for in that environment. What facility should the nurse recommend that would offer a safer environment for this patient? 1 Long-term care 2 Home health care 3 Adult day health care 4 Adult day care centers
1 Patients generally are in placed long-term care facility so that care is available to the patient when rapid deterioration occurs. Home health care is provided to an older patient who is homebound, has acute health needs, and has supportive caregiver involvement. Adult day health care and care facilities support the patient's family and provide a social environment to the patient.
A patient tells the nurse, "I am worthless because I can no longer provide income for my family." The patient's statement reflects which concept? 1 Self-concept 2 Self-awareness 3 Self-preservation 4 Positive self-esteem
1 Self-concept refers to the patient's perception of his or her own strengths, weaknesses, and capabilities. The patient's statement of feeling "worthless" and "no longer" being able to provide financial family support reflects the patient's self-concept. Self-preservation is the protection of oneself from harm or death. Self-awareness is the acknowledging of one's character, personality, feelings, motives, and desires. Self-esteem reflects one's own worth or abilities. Positive self-esteem reflects an optimism, not worthlessness.
Which assessment findings would alert the nurse to possible elder mistreatment? Select all that apply. 1 Agitation 2 Depression 3 Weight gain 4 Weight loss 5 Hypernatremia 00:00:05 Question Answer Confidence Buttons
1,2,4,5, Agitation and depression may be manifestations of psychologic abuse or neglect. A loss of body weight, rather than weight gain, is another clinical manifestation of physical neglect. Hypernatremia may signify dehydration caused by physical neglect.
Which barriers contribute to health care disparities in older adults living in rural areas? Select all that apply. 1 Lack of quality care 2 Financial limitations 3 Lack of family assistance 4 Limited number of health care workers 5 Limited number of health care facilities
1,2,4,5, Barriers that contribute to health care disparities in older adults living in rural areas include lack of quality care, financial limitations, limited health care workers, and a limited number of health care facilities. Lack of family assistance is not a barrier specific to health care disparities in older adults in rural areas.
When assessing older adults who have illnesses, the nurse knows that which statement is correct? Select all that apply. 1 Older adults may underreport symptoms. 2 Disease symptoms are often atypical in older adults. 3 Older adults complain about the symptoms of their problems. 4 Older adults refuse to carry out lifestyle changes to promote recovery. 5 Older adults respond to new symptoms by altering their functional status.
1,2,5 Older adults may underreport symptoms and manage these symptoms by altering their functional status. In addition, disease symptoms are often atypical in older adults. Older adults may or may not complain about symptoms of their problems. Not all older adults refuse to implement lifestyle changes to promote recovery.
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 being cured completely, resulting in permanent impairments or deviations from normal, having irreversible pathologic changes and residual disability, and requiring special rehabilitation.
The nurse is performing an admission assessment for an 87-year-old patient cared for by the patient's daughter, who works fulltime and has three young children. The daughter shows the nurse the patient's prescription medication bottles. The nurse notes most of the pills are still remaining in the prescription bottles with expired dates. Which situations might the nurse suspect? Select all that apply. 1 Possibility of elder mistreatment (EM) 2 Lack of insurance to refill the medications 3 Patient refusal to take medication as ordered 4 Sharing of medication with other family members 5 Concern for safety of young children around medications
1,3, The possibility of elder mistreatment (EM) exists, as the daughter may be too busy with work and family obligations to adequately care for the parent. The nurse needs to do further assessment to determine if the patient is refusing to take medications as ordered. Lack of insurance is not noted in this case scenario. Safety of young children is a concern, but nothing in this case scenario leads the nurse to believe it is an issue. Young children would be likely to try eating medications, resulting in lower, rather than higher, pill counts. Sharing of medication with other family members would also result in lower pill counts.
An older adult is brought into the emergency department by a family member who has been providing care for the patient at home. Upon physical assessment, the nurse notes that the patient has bilateral bruising on the arms in various stages of healing. Significant laboratory results include an increased hematocrit, increased serum sodium, and decreased serum protein. Furthermore, the patient states, "They take all of my money and threaten to send me to a nursing home." What type of elderly mistreatment (EM) will the nurse document? Select all that apply. 1 Neglect 2 Abandonment 3 Physical abuse 4 Financial abuse 5 Psychologic abuse 6 Violation of personal rights
1,3,4,5, The patient is experiencing financial abuse and exhibits signs of psychologic abuse, neglect, and physical abuse, all of which are characteristics of EM. A violation of personal rights occurs when the older adult is denied a right to privacy or a right to make a decision regarding health care and living arrangements or experiences a forcible eviction. Abandonment is characterized by desertion.
An employed daughter is now responsible for caring for her parent, who requires assistance with activities of daily living. Which of these would be an appropriate care choice for this situation? Select all that apply. 1 Adult day care 2 Long-term care 3 Private duty care 4 Home health services 5 Personal care services
1,4,5 Adult day care programs provide social, recreational, and health-related services to individuals in a safe, community-based environment. This includes daily supervision, social activities, opportunities for social interaction, and activities of daily living (ADLs) assistance for two major groups of adults: those who are cognitively impaired and those who have problems independently performing ADLs. In addition to adult day care centers, home health and personal care services may provide respite to allow continued employment for the caregiver and delay institutionalization of older adults. Long-term care is appropriate when the caregiver is no longer able to care for the patient. Private duty care is appropriate for those who require 24-hour ADL assistance or continuous monitoring for safety.
What are the common causes of medication errors among older adults? Select all that apply. 1 Decreased vision 2 Decreased physical activity 3 Decreased olfactory function 4 Decreased cognitive function 5 Refusal to take the medications 6 Purchasing medications from one pharmacy
1,4,5 Poor vision often leads to medication errors, because the older adult may mistake one drug for another. Decreased cognitive function may cause an older adult to forget to take medication when scheduled. The older adult may refuse to take medications, because they are more prone to suffer from undesirable side effects. Missing doses leads to medication errors. Reduced olfactory activity does not cause medication errors. Decreased physical activity is not a common cause of medication errors. Purchasing medications from a single pharmacy helps prevent medication errors.
In which phase of the chronic illness trajectory is a patient who can maintain everyday activities? 1 Onset 2 Stable 3 Downward 4 Comeback
2 A patient who maintains everyday activities is in the stable phase of the chronic illness trajectory. A patient experiencing deterioration is in the downward phase. The comeback phase is experienced when there is a gradual return to an acceptable way of life. When signs and symptoms are present, the patient is in the onset phase.
A nurse is assessing an older adult patient during a routine checkup. The patient is able to care for him- or 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
2 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, because the patient can do many activities him- or 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.
A home care nurse working with a group of elderly adults in a predominantly Jewish area of the community wants to provide culturally competent care. Which intervention would be a priority for the nurse to initially complete? 1 Ensuring that all interventions align with the Jewish faith 2 Assessing each older adult's ethnic and cultural orientation 3 Observing the practices and activities of daily living of the population 4 Speaking with local faith leaders to obtain background on the elderly population
2 Before developing plans of care, the nurse should assess each individual's ethnic and cultural orientation. Once the nurse has established the ethnic and cultural orientation, the nurse can attempt to align interventions as well as possible. The nurse should never assume the ethnic and cultural orientation of patients. Speaking with local faith providers may help to provide information to the nurse, but this information would only address those who participate in faith-based activities and may provide an incomplete picture. Observing the practices and activities of daily living will not necessarily provide the information needed to provide culturally competent care.
What factor(s) place older adults at greater risk for elder mistreatment (EM)? 1 Increased social support 2 Dementia and depression 3 Pneumonia and heart failure 4 Ability to perform activities of daily life (ADLs)
2 Dementia and depression place older adults at risk of elder mistreatment (EM), as the behaviors associated with these diagnoses increase the difficulty of caring for the patient. Ability to perform ADLs decreases the level of care needed and the incidence of EM. Increased social support helps to relieve some of the burden of care needed; this generally decreases the incidence of EM. Pneumonia and heart failure are not noted as risk factors increasing the incidence of EM.
What are the signs of physical abuse? 1 Desertion of an older adult at a hospital 2 Multiple injuries at various stages of healing 3 Depression, agitation, and withdrawn behavior 4 Bruised breasts and unexplained vaginal or anal bleeding
2 Physical abuse is associated with slapping, striking and restraining. Therefore it can be identified by the presence of bruises, bilateral injuries on the wrists and ankles, and injuries at various stages of healing. Depression, agitation, and withdrawn behavior are signs of psychologic abuse. Leaving an older adult at a hospital is abandonment. Bruised breasts or unexplained vaginal or anal bleeding are manifestations of sexual abuse.
An older adult patient is admitted for injuries caused by abuse from the person with whom he or she resides. What type of mistreatment or abuse does the nurse document? 1 Family 2 Domestic 3 Community 4 Institutional
2 The older adult who is being mistreated or abused by a person who resides with him or her is experiencing domestic abuse. Institutional mistreatment or abuse occurs in settings such as a hospital, long-term care facility, or nursing home. Mistreatment in the community may occur at a church or a recreation facility. The perpetrator who lives with the patient is not always necessarily a family member.
A nurse is helping a cognitively impaired older adult to cope with daily activities. The nurse finds that the patient is very forgetful. What devices can be used as memory aids to help the patient perform daily activities? Select all that apply. 1 Cane 2 Clock 3 Sticky notes 4 Hearing aids 5 Wheelchair
2,3 A clock and sticky notes can be used as memory aids to remind the patient of various activities. An activity can be associated with a specific time, and the patient recalls the activity to be done when the clock strikes at that specific time. Sticky notes posted on the patient's activity area may help the patient to recall the activities that need to be performed. Canes and wheelchairs are used as assistive devices for ambulation, and hearing aids are used in hearing impairment.
A nurse is caring for an older adult who was recently admitted to a long-term care facility. The patient appears fearful and anxious. What communication techniques will help the patient feel relaxed? Select all that apply. 1 Loud voice 2 Direct touch 3 Gentle humor 4 Simple statements 5 Indirect statements
2,3,4 An older adult patient may be fearful and anxious in a new place. The nurse can make patients feel more relaxed by using proper communication and care techniques. The nurse should make the patient comfortable by using direct touch and gentle humor. Using simple statements promotes effective communication and reduces the chance of the patient misunderstanding the nurse. Talking in a loud voice may be offensive and embarrassing to the patient and should be avoided except as needed with hearing-impaired patients. Loud voices can be interpreted as anger, and it may be more stressful for the older adult patient. The nurse should avoid indirect statements because these may be difficult for the patient to understand and may cause confusion.
A nurse is teaching a group of patients about prevention of chronic illness. Which statements made by the patients indicate effective learning? Select all that apply. 1 "Rehabilitation prevents disease progression." 2 "Proper exercise prevents disease occurrence." 3 "A proper diet helps prevent the occurrence of disease." 4 "Immunizations are a form of primary prevention of disease." 5 "Secondary prevention refers to activities that decrease the risk of diseases."
2,3,4 Chronic illness is preventable. Proper exercise prevents disease occurrence. Immunizations are a form of primary disease prevention and help to reduce susceptibility to diseases. Eating a healthy diet can help prevent occurrence of disease. A balanced diet plays a vital role and provides all essential nutrients to the body. Tertiary prevention refers to activities that limit disease progression, such as rehabilitation. Activities that decrease the risk of diseases are primary prevention, not secondary prevention.
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 Memory loss 2 Slower reflexes 3 Decreased weight 4 Changes in gait and balance 5 Decreased sensory perception
2,4,5 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.
Which legal document is a written statement of a chronic illness patient's wishes regarding medical care? 1 Will 2 Healthcare proxy 3 Advance directive 4 Power of attorney
3 An advance directive contains specific written statements of a person's wishes regarding medical care. A will is a legal document that sets forth the patient's wishes regarding the distribution of property and care of any minors. A healthcare proxy allows the patient to appoint a specific individual to make medical decisions in the event that the patient is unable to make his or her own medical decisions. A power of attorney allows an appointed individual to handle specified or all legal and financial responsibilities.
A nurse suspects a chronic illness patient is the victim of elder mistreatment. What is the priority action of the nurse? 1 Notify the nurse manager at the end of the shift. 2 Obtain a consult for a psychologic evaluation. 3 Report the findings to the appropriate state agency. 4 Ask the family members what is occurring in the home.
3 Any elder abuse should be reported to the appropriate state agency. Notifying the nurse manager at the end of the shift is not safe for the patient and is not the standard of care. Because the family members may be the perpetrators of the abuse, they should not be asked about what is occurring at home. A psychologic evaluation is not necessary to prove elder abuse
What is the leading cause of death in older adults with chronic illnesses? 1 Arthritis 2 Diabetes 3 Coronary artery disease (CAD) 4 Chronic obstructive pulmonary disease (COPD)
3 CAD is the leading cause of death in older adults with chronic illnesses. COPD is the third leading cause of death. Arthritis is one of the most common chronic illnesses but not a cause of death. Diabetes is the seventh leading cause of death.
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
3 Eating is considered an activity of daily living (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.
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 Reorder time 2 Control of symptoms 3 Prevention and management of a crisis 4 Adjustment to changes in the course of a disease
3 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.
The nurse is caring for a patient brought from home by his or her spouse. The patient's clothing is torn and dirty. The patient does not appear to have been recently bathed. The nurse suspects elder mistreatment (EM). Which nursing action is a priority? 1 Ordering a high-protein dietary tray for the patient 2 Asking the nurse assistant to help bathe the patient 3 Preserving physical evidence of dirty, torn clothing 4 Obtaining current contact information for the spouse
3 Preserving physical evidence of dirty, torn clothing may help to prove EM. Dietary preferences and restrictions must be assessed before ordering a dietary tray. The patient should be bathed only after necessary physical evidence and tests are completed. Obtaining the spouse's contact information is not a priority.
What does the "I" represent in the acronym "SPICES," an evidence-based geriatric assessment tool? 1 Illness 2 Insomnia 3 Incontinence 4 Implementation
3 The letter "I" stands for "incontinence." Illness is a disease or sickness affecting the mind and/or body. Implementation is part of the nursing process. Illness and implementation are not part of SPICES. The letter "S" in SPICES stands for "sleep disorders," such as insomnia.
What approach may help decrease the disparity of health care for older adults living in rural areas? 1 Extension of clinic hours 2 Increased nursing staff for the clinic 3 Use of community centers for health screenings 4 Increase the use of unlicensed assistive personnel (UAPs) in the clinic
3 Use of community centers to promote health practice and conduct health screenings is one approach that may help decrease the disparities of health care for adults in rural areas. These centers are much easier to access than a clinic or hospital located farther away from the community. Extending clinic hours may not be helpful if the clinic is in a distant location, because transportation is the number one barrier to health care in rural areas. If the issue is health care provider availability, increasing nursing staff in the clinic will not help. Increasing nursing staff will also increase the cost of running the clinic. Increasing the use of UAPs in the clinic will not affect the disparity of health care in this situation.
A nurse is performing an assessment of a 73-year-old patient with limited mobility. The nurse suspects that the patient is a victim of elder mistreatment and abuse. What observations would lead the nurse to suspect elder mistreatment? Select all that apply. 1 The patient is talkative and jolly. 2 The drug regimen is strictly followed. 3 The patient has not been bathed for one week. 4 An unhealed bed sore on the coccyx is present. 5 There has been no routine blood work in the past month.
3,4,5 Elderly mistreatment involves deliberate acts of omission or commission by a caregiver or a family member that result in harm or serious risk of harm to a vulnerable older adult. An elder facing mistreatment and negligence by family and friends is likely to have unhealed sacral ulcers, poor hygiene, and nonadherence to a medical treatment plan. Talkativeness and a jolly mood are observed in someone who is emotionally well and is taken care of properly. Following a drug regimen and maintaining social interactions also indicate a good caring environment for the older patient.
A newly admitted resident in a nursing home is not able to find the way back to the correct room and is confused. What measures should the nursing staff take to prevent such confusion and increase the safety and comfort of the residents? Select all that apply. 1 Bright lights 2 Complex wall designs 3 Simple nurse call control 4 Thorough orientation of the facility 5 Clear designations of doors, exits, and room numbers
3,4,5 Thorough orientation of the nursing facility to a new resident is important to ensure safety and avoid confusion. Doors, exits, and rooms should be clearly marked with large prints for easy accessibility. The nurse call control should be simple and easy to operate. Visually confusing wall designs and bright lights should be avoided because these may lead to more confusion and discomfort to the resident.
Which criteria are used to diagnose frailty syndrome? Select all that apply. 1 Low income 2 Chronic illness 3 Reported weakness 4 Slow walking speed 5 Cognitive impairment 6 Unintentional weight loss
3,4,6 (1) unintentional weight loss (greater than or equal to 10 pounds in a year); (2) self-reported exhaustion; (3) weakness (measured by grip strength); (4) slow walking speed; (5) low level of physical activity. Frailty is a clinical syndrome that is diagnosed with three or more criteria: unintentional weight loss, slow walking speed, and reported weakness. Cognitive impairment, low income, and chronic illness are not associated with frailty syndrome.
An older adult who has insomnia treats the condition with sleeping medication and consequently becomes confused and fractures a hip after falling. What does this scenario demonstrate? 1 Polypharmacy 2 Self-management 3 Elder mistreatment 4 Cascade disease pattern
4 A cascade disease pattern occurs when an issue escalates into more serious complications. Self-management refers to the individual's ability to manage his or her own health, especially regarding a chronic illness. Elder mistreatment describes intentional acts of omission or commission of a caregiver or "trusted other" that cause harm or serious risk of harm to a vulnerable older adult. Polypharmacy is the use of multiple medications by a patient who has one or more health problems.
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 suggests a pill box and timer to help the patient adhere to a medication schedule. 2 The nurse prints out instructions for a new medication rather than e-mailing the instructions to the patient. 3 The nurse suggests a generic equivalent medication that is more affordable than a brand-name medication. 4 The nurse directs all questions and instructions to the patient's caregiver because the patient probably won't understand. 00:00:02 Question Answer Confidence Buttons
4 Assuming that older patients will not understand the details and instructions for their own care is a form of prejudice called ageism. Although 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.
Which characteristic best describes a chronic illness? 1 An illness with rapid onset 2 A usually self-limiting illness 3 An illness with a short duration 4 An illness that does not resolve spontaneously
4 Chronic illnesses do not resolve spontaneously. Acute illnesses are usually self-limiting, have a short duration, and have rapid onset
When caring for a chronically ill patient in a long-term care facility, which symptom does the nurse recognize as indicative of a downward trajectory in the patient's status? 1 Uncontrolled hypertension 2 Well-controlled hypertension 3 Angina-like chest pain with new onset radiating arm pain 4 Uncontrolled severe hypertension with difficulty getting out of bed
4 Downward trajectory of a chronic illness happens when the patient has severe symptoms with increased disability and progressive deterioration. Well-controlled hypertension is the stable phase, whereas angina would be the onset phase of chronic illness. Uncontrolled hypertension is the unstable phase.
Medicare regulations affect how a hospital utilizes its resources to deliver care to older adults. In the event that an elderly patient needs to be discharged, Medicare regulations require a care transition plan for patient discharge. Which scenario is the best way to develop safe and effective care transitions? 1 A registered nurse collaborating with the patient to coordinate care 2 A social worker collaborating with the patient and family to coordinate care 3 A registered nurse collaborating with the patient and family to coordinate care 4 A social worker and registered nurse collaborating with the patient and family to coordinate care
4 Medicare regulations require a registered nurse, social worker, or qualified person to develop a care transition plan for patient discharge. Safe and effective care transitions are most likely to occur when interprofessional team members work together with the patient and family to coordinate care. Such team members can include a registered nurse and a social worker. A registered nurse collaborating with the patient is acceptable, but interprofessional collaboration is the best method. A social worker collaborating with the patient and family is acceptable, but it is not the most effective method. A registered nurse collaborating with both the patient and family is acceptable, but interprofessional collaboration is the best method.
The primary health care provider has recommended a long-term care facility for an older patient. The nurse observes that the patient is anxious and depressed. What is the best nursing action in this situation? 1 Avoid informing the patient about location. 2 Avoid sharing pictures of new location with the patient. 3 Instruct the patient in a firm tone about need of long-term treatment. 4 Ask the personnel from the institute to send a welcome message to the patient.
4 Physical relocation of the patient may cause the patient to develop anxiety and depression. This condition is called relocation stress syndrome. The nurse should ensure that the institute sends a welcome message to the patient to reduce anxiety. The nurse should inform the patient about the location to relieve the patient's anxiety. Sharing pictures of the new location with the patient will help reduce the risk of relocation stress syndrome. The nurse should not instruct the patient in a firm tone, because it can make the patient feel uncomfortable.
The student nurse is assessing an older adult. Which student nurse's action would make the patient uncomfortable? 1 Asking the patient to urinate before the assessment 2 Involving family members while assessing the patient 3 Maintaining eye contact with the patient during the interview 4 Continuing the interview when the patient experiences fatigue 00:00:03 Question Answer Confidence Buttons
4 The nurse should stop the assessment if the older adult patient experiences fatigue. The patient might not provide accurate information if he or she is tired or uncomfortable. Asking the patient to urinate before the assessment will help the patient relax. Involving the patient's family members will help obtain detailed information about the patient. Maintaining eye contact with the patient during the interview will help develop trust and ensures comfort in the patient.
What are the effects of aging on drug metabolism? Select all that apply. 1 Plasma protein levels rise. 2 Renal elimination increases. 3 Hepatic enzyme activity increases. 4 Levels of the drug in the circulatory system rise. 5 Gastrointestinal absorption of drugs increases. 6 A small quantity of central nervous system (CNS) drugs produce a large effect.
4,6 The amount of free drug available in the blood is higher in older adults due to a reduced number of plasma proteins. Brain receptor sensitivity increases with age. Hence, drugs acting on the central nervous system are very potent in geriatric patients. Plasma protein levels in the elderly fall rather than rise. Older adults have decreased renal perfusion. Therefore elimination of drugs through the kidneys decreases. The size of the liver and hepatic blood flow decreases with aging. Therefore in older adults, hepatic enzyme activity is low. Gastrointestinal absorption does not increase in the older adults, because the gastrointestinal motility and gastric emptying rate are slow. Therefore absorption decreases.
A patient is currently being cared for by a grandchild. The patient has multiple health problems, is currently nonambulatory, and requires assistance in all activities of daily living (ADLs). There is also evidence of kidney deterioration. The grandchild tells the nurse, "I can no longer take care of my grandparent. I must return to work. What is an appropriate health care alternative?" What should the nurse suggest to the grandchild? 1 Home health care 2 Adult day care center 3 Long-term care facilities 4 Adult day health care cent
Long-term care facilities are recommended for older patients who are physiologically deteriorating, dependent on others for all activities of daily living (ADLs), and for whom the caregiver can no longer provide care single-handedly. Adult day care and adult day health care centers provide care to those who cannot maintain independence or cognitively impaired older adults. Home health care is an alternative care option for older patients who are homebound and require intermittent health care, but are fairly independent in performing daily activities.
The nurse is caring for a newly admitted client from the nursing home. The client has a history of dementia, hypertension, and urinary incontinence. The client has a Foley catheter draining clear yellow urine. What recommendation should the nurse make to the physician? a. Discontinue the Foley catheter as soon as possible (UTI, remove, straight cath, address urinary retention, constipation) b. Prescribe intermittent catheterization every 2-3 hours c. Discuss surgical options for bladder repair with family d. Leave catheter in place until incontinence resolves
a. Discontinue the Foley catheter as soon as possible (UTI, remove, straight cath, address urinary retention, constipation)
5. Which statement made by the nurse is an example of ageism? a. "I really enjoy caring for the older adults. They share so many stories" b. "That old man uses his call bell too much. He must be demented " c. "Mr. Jones is confused so he needs to be on fall precautions" d. "Make sure that Mrs. Weber wears her hearing aids when you speak to her"
b. "That old man uses his call bell too much. He must be demented "
Which may be assessment findings of sexual abuse in an older adult? 1 Sexually transmitted infection 2 Anal bleeding from hemorrhoids 3 Use of lubricant during intercourse 4 Vaginal bleeding after a Papanicolaou smear
1 Sexually transmitted infections may be a sign of sexual abuse due to the abuser's sexual habits. Anal bleeding would be an expected finding from hemorrhoids. Use of lubricant may be normal in older adults due to vaginal dryness after menopause. Vaginal bleeding may be related to a Papanicolaou smear.
The nurse has developed a plan of care for an older patient with cognitive impairment. What action by the nurse will result in a positive outcome for the patient? 1 Offer careful explanation of the treatment plan. 2 Avoid eye contact with the patient during interaction. 3 Talking with a loud voice while explaining the treatment plan. 4 Educate the family members about the patient's condition in the presence of patient.
1 The nurse should offer a careful explanation of the treatment plan to the patient with cognitive impairment to relieve the patient's anxiety and increase the patient's cooperation with the plan. The nurse should talk in a low voice to avoid anxiety in the patient. The nurse should maintain eye contact with the patient during interaction to help develop trust. The family members should be informed about the patient's condition in the absence of the patient to avoid anxiety and curiosity in the patient.
An older adult reports loss of sleep, weight loss, decreased memory, nervousness, lack of energy, and an inability to concentrate. The nurse recognizes that the patient is likely experiencing what condition? 1 Depression 2 Deconditioning 3 Relocation stress syndrome 4 Age-associated memory impairment
1 The patient is likely suffering from depression. Depression in older adults arises due to loss of self-esteem and changing life situations, such as the ability to care for oneself. It manifests as loss of sleep, weight loss, decreased memory, nervousness, lack of energy, and inability to concentrate. Deconditioning occurs as a result of unstable acute medical conditions, environmental barriers that limit mobility, and a lack of motivation to stay in condition. In relocation stress syndrome, the patient feels disruption, confusion, and challenges in facing a new environment. Age-associated memory impairment shows symptoms like memory lapse or benign forgetfulness.
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.
n which of the following situations is the nurse legally obligated to report elder mistreatment (EM)? Select all that apply. 1 Actual EM 2 Abandonment 3 Suspected EM 4 Patient request 5 Inability to purchase prescriptions 6 Family unable to care for the older adult
1,2,3,4 Actual EM, a patient request, patient abandonment, and suspected EM are all subject to mandated reporting to Adult Protective Services. Social services and/or a caseworker can assist an older adult with the purchase of prescriptive medications and assist with placement of the patient when a family is unable to care for the patient.
A nurse is educating a group of older adults about a healthy lifestyle. Which actions suggested by the nurse should be included in primary prevention? Select all that apply. 1 Healthy diet 2 Getting a vaccination 3 An annual blood screen 4 A regular exercise program 5 Annual ultrasound screening
1,2,4 Following a routine exercise program and eating a healthy diet helps to prevent chronic diseases, and are included in primary prevention. Getting appropriate vaccinations also helps to prevent diseases. Annual blood screens and ultrasounds are secondary levels of prevention for early detection.
The nurse is caring for an older patient who is suffering from a chronic illness. Which nursing interventions would provide effective care for the patient? Select all that apply. 1 Reduce social isolation 2 Reorder the patient's schedule 3 Avoid changes in treatment regimen 4 Prevent and manage possible crises 5 Give medication as per the patient's wish
1,2,4,5 The patient with chronic illness may have problems with treatment plans. Therefore the nurse should eliminate activities or reorder the patient's schedule to make the patient comfortable. Some chronic illnesses such as aphasia increase the risk of social isolation; the nurse should reduce social isolation in the patient. The nurse should prevent and manage the patient's crises to avoid any acute exacerbations of symptoms. The nurse should adjust changes in course according to the patient's disease condition. Adhering to the same course without evaluating the outcome can place the patient at risk. The nurse should give medications to the patient according to the treatment regimen to obtain the desired outcome.
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 Use light humor. 2 Avoid eye contact. 3 Ask strict questions. 4 Hold the patient's hand. 5 Ask direct and simple questions.
1,4,5 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.
A patient is preparing to be discharged from the hospital in a couple of days and will require wound care at home. The patient asks what home health services are. What is the best response by the nurse? 1 "It is the service that provides good opportunities for social interaction." 2 "It is the service, which can get reimbursement from Medicaid coverage facility." 3 "It is an alternative for adults who need 24-hour assistance for activities of daily living." 4 "It is an alternative for patients who have acute health needs and have supportive caregiver involvement."
4 Home health care is provided to homebound patients. The caregiver cares for the patients who are in need of acute health care. Adult day care centers provide good opportunities for social interaction. Long-term care facilities receive reimbursement from Medicaid coverage facilities. Long-term care is provided for a patient who needs 24-hour assistance for activities of daily living.
A client with dementia is discharged to a nursing home. How should the nurse ensure that this client's needs are best met? a. Send a written copy of care plan to the nursing home b. Assist client to met all his goals prior to discharge c. Teaching family to be actively involved in client's care d. Providing a verbal report to the nursing home (use SBAR)
a. Send a written copy of care plan to the nursing home
The nurse at a senior center notes an increased incidence of constipation among some of clients. The nurse provides a program on the topic. What information should be included? a. Use laxatives to maintain normal peristalsis b. Drink fruit juices instead of water (sugar) c. Get daily exercise, like a short walk d. Decrease fiber intake, which adds bulk
c. Get daily exercise, like a short walk
1. While performing an assessment on a 75 year old adult, the nurse notes a variety bruises in different stages of healing. After documenting the findings, what should the nurse do next? a. Notify the MD about the findings b. Call the nurse supervisor to review findings c. Obtain more information from the client d. Follow the agency's policy for reporting abuse
c. Obtain more information from the client
