ch. 5 chronic illness and older adults

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 B D 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.

When teaching a 69-year-old patient about self-care, what will promote health (select all that apply)? a. Proper diet b. Immunizations c. Teaching chair yoga d. Demonstrating balancing techniques e. Participation in health promotion activities

a, b, c, d, e. Any of these actions will promote health.

Which nursing actions would demonstrate the nurse's understanding of the concept of providing safe care without using restraints (select all that apply)? a. Placing patients with fall risk in low beds. b. Asking simple yes-or-no questions to clarify patient needs. c. Making hourly rounds on patients to assess for pain and toileting needs. d. Placing a disruptive patient near the nurses' station in a chair with a seat belt. e. Applying a jacket vest loosely so the patient can turn but cannot climb out of bed.

a, b, c. These actions are alternatives to restraints that may help to reduce falls and keep the patient safe. A jacket vest and a seat belt are forms of restraint and require an order and frequent reassessment and order renewal.

Which statement(s) about older people are only myths and illustrate the concept of ageism (select all that apply)? a. Can't teach an old dog new tricks. b. Old people are not sexually active. c. Most old people live independently. d. Most older adults can no longer synthesize new information. e. Most older people lose interest in life and wish they would die.

a, b, d, e. Ageism is a negative attitude based on age.

According to the Corbin and Strauss chronic illness trajectory, which statement describes a patient with an unstable condition? a. Life-threatening situation b. Increasing disability and symptoms c. Gradual return to acceptable way of life d. Loss of control over symptoms and disease course

d. The trajectory defines a life-threatening situation as a crisis. Increasing disability is described as downward. A gradual return to an acceptable way of life is a comeback.

In view of the fact that most older adults take at least six prescription drugs, what are four nursing interventions that can specifically help prevent problems caused by multiple drug use in older patients?

Any of the following eight nursing interventions listed in Table 5-13: (1) Evaluate cognitive function and ensure ability to self-administer medication, (2) Attempt to reduce medication use that is not essential, (3) Screen all medication use, (4) Assess alcohol use, (5) Encourage the use of written or medication-reminder systems, (6) Encourage the use of one pharmacy, (7) Work with health care providers and pharmacists to establish routine drug profiles on all older adult patients, (8) Advocate with drug companies for low-income prescription support services.

The old-old population (85 years and older) has an increased risk for frailty. However, old age is just one element of frailty. Identify at least three other assessment findings that contribute to frailty. (UPS)

Any three of the following are appropriate: unplanned weight loss (≥10 lb in the last year), weakness, poor endurance and energy, slowness and low activity.

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 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.

Aging primarily affects the _________of drugs. A. excretion B. absorption C. metabolism D. distribution

C 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.

An appropriate care choice for an older adult who lives with an employed daughter but requires help with activities of daily living is a. adult day care. b. long-term care. c. a retirement center. d. an assisted living facility.

Correct answer: a Rationale: Adult day care (ADC) programs provide daily supervision, social activities, and assistance with activities of daily living (ADLs) for persons who are cognitively impaired and persons who have problems with ADLs. ADC centers provide physical and emotional relief for the caregiver and allow the caregiver to pursue continued employment.

Examples of primary prevention strategies include a. colonoscopy at age 50. b. avoidance of tobacco products. c. intake of a diet low in saturated fat in a patient with high cholesterol. d. teaching the importance of exercise to a patient with hypertension.

Correct answer: b Rationale: Primary prevention refers to measures such as proper diet, suitable exercise, and timely immunizations that prevent the occurrence of a specific disease.

Nursing interventions directed at health promotion in the older adult are primarily focused on a. disease management. b. controlling symptoms of illness. c. teaching positive health behaviors. d. teaching regarding nutrition to enhance longevity.

Correct answer: c Rationale: A high value should be placed on health promotion and positive health behaviors.

Indicate what the acronym SCALES stands for in assessment of nutrition indicators in frail older adults.

S Sadness (mood) C Cholesterol (high) A Albumin (low) L Loss (or gain of weight) E Eating problems S Shopping (and food preparation problems)

What are three common factors known to precipitate placement in a long-term care facility? (CAR)

a. Rapid patient deterioration b. Caregiver exhaustion c. Alteration in or loss of family support system

1. 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 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.

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 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 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 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 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 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 C 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.

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 C D E 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 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 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 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.

An important nursing action to help a chronically ill older adult is to a. avoid discussing future lifestyle changes. b. assure the patient that the condition is stable. c. treat the patient as a competent manager of the disease. d. encourage the patient to "fight" the disease as long as possible.

Correct answer: c Rationale: Chronically ill older adults should understand and manage their own health. Self-management is the individual's ability to manage his or her symptoms, treatment, physical and psychosocial consequences, and lifestyle changes in response to living with a long-term disorder.

Ageism is characterized by a. denial of negative stereotypes regarding aging. b. positive attitudes toward the elderly based on age. c. negative attitudes toward the elderly based on age. d. negative attitudes toward the elderly based on physical disability.

Correct answer: c Rationale: Ageism is a negative attitude based on age.

An ethnic older adult may feel a loss of self-worth when the nurse a. informs the patient about ethnic support services. b. allows a patient to rely on ethnic health beliefs and practices. c. has to use an interpreter to provide explanations and teaching. d. emphasizes that a therapeutic diet does not allow ethnic foods.

Correct answer: d Rationale: An older adult with strong ethnic and cultural beliefs may experience loss of self if nurses deny or ignore ethnic and cultural practices and behaviors.

Older adults who become ill are more likely than younger adults to a. complain about the symptoms of their problems. b. refuse to carry out lifestyle changes to promote recovery. c. seek medical attention because of limitations on their lifestyle. d. alter their daily living activities to accommodate new symptoms.

Correct answer: d Rationale: Older adults may underreport symptoms and treat these symptoms by altering their functional status.

A characteristic of a chronic illness is that it (select all that apply) a. has reversible pathologic changes. b. has a consistent, predictable clinical course. c. results in permanent deviation from normal. d. is associated with many stable and unstable phases. e. always starts with an acute illness and then progresses slowly.

Correct answers: c, d Rationale: The following are characteristics of chronic illness: permanent impairments or deviations from normal, irreversible pathologic changes, residual disability, requirements for special rehabilitation, and need for long-term medical or nursing management (or both). Chronic illness may have stable and unstable periods.

What is a mental status assessment of the older adult especially important in determining? a. Potential for independent living b. Eligibility for federal health programs c. Service and placement needs of the individual d. Whether the person should be classified as frail

a. The results of mental status evaluation often determine whether the patient is able to manage independent living, a major issue in older adulthood. Other elements of comprehensive assessment could determine eligibility for special problems, determination of frailty, and total service and placement needs.

An 80-year-old woman is brought to the emergency department by her daughter, who says her mother has refused to eat for 6 days. The mother says she stays in her room all of the time because the family is mean to her when she eats or watches TV with them. She says her daughter brings her only one meal a day and that meal is cold leftovers from the family's meals days before. a. What types of elder mistreatment may be present in this situation? b. How would the nurse assess the situation to determine whether abuse is present? The daughter says her mother is too demanding and she just cannot cope with caring for her 24 hours a day. c. What might be an appropriate nursing diagnosis for the daughter? d. What resources can the nurse suggest to the daughter?

a. Psychologic abuse, psychologic neglect, physical neglect, and perhaps violation of personal rights b. Perform a very careful medical history and screening for mistreatment; interview the mother alone; use an assessment tool designed specifically for elder mistreatment; specifically assess for dehydration, malnutrition, pressure ulcers, and poor personal hygiene; evaluate explanations about physical findings that are not consistent with what is seen or contradictory statements made by the daughter and the mother c. Caregiver role strain d. Community caregiver support group, formal support system for respite care, adult day care

Consider the differences between primary and secondary prevention. Fill in the blanks. a. Actions aimed at early detection of disease and interventions to prevent progression of disease are considered _ prevention. b. Following a proper diet, getting appropriate exercise, and receiving immunizations against specific diseases is considered _ prevention.

a. secondary b. primary

A 78-year-old female patient is admitted with nausea, vomiting, anorexia, diarrhea, and dehydration. She has a history of diabetes mellitus and 2 years ago had a stroke with residual right-sided weakness. Identify which characteristics of chronic illness the nurse will probably find in this patient (select all that apply). a. Self-limiting b. Residual disability c. Permanent impairments d. Infrequent complications e. Need for long-term management f. Nonreversible pathologic changes

b, c, e, f. The diabetes mellitus and residual right-sided weakness from the cerebrovascular accident (CVA) contribute to the residual disability and permanent impairments. The diabetes requires long-term management and both problems contribute to nonreversible pathologic changes.

The 58-year-old male patient will be transferred from the acute care clinical unit of the hospital to another care area. The patient requires complicated dressing changes for several weeks. To which practice setting should the patient be transitioned? a. Acute rehabilitation b. Long-term acute care c. Intermediate care facility d. Transitional subacute care

b. Long-term acute care provides acute care for an average length of greater than 25 days. Acute rehabilitation is a postacute level of care with therapies for returning the patient to the best level of functioning as possible. Intermediate care facilities provide convalescent care. Transitional subacute care facilities are used for 5 to 21 days.

What is an important nursing measure in the rehabilitation of an older adult to prevent loss of function from inactivity and immobility? a. Using assistive devices such as walkers and canes b. Teaching good nutrition to prevent loss of muscle mass c. Performance of active and passive range-of-motion (ROM) exercises d. Performance of risk appraisals and assessments related to immobility

c. Exercise for all older adults is important to prevent deconditioning and subsequent functional decline from many different causes. Walkers and canes may improve mobility but can also decrease mobility if they are too difficult for the patient to use. Nutrition is important for muscles but muscle strength is primarily dependent on use. Risk appraisals are usually performed for specific health problems.

What is the leading cause of death in the United States? a. Cancer b. Diabetes mellitus c. Coronary artery disease d. Cerebrovascular accident e. Chronic obstructive pulmonary disease

c. Coronary artery disease is the leading cause of death in the United States.

An 88-year-old woman is brought to the health clinic for the first time by her 64-year-old daughter. During the initial comprehensive nursing assessment of the patient, what should the nurse do? a. Ask the daughter whether the patient has any urgent needs or problems. b. Interview the patient and daughter together so that pertinent information can be confirmed. c. Obtain a health history using a functional health pattern and assess activities of daily living (ADLs) and mental status. d. Refer the patient for an interdisciplinary comprehensive geriatric assessment because at her age she will have multiple needs.

c. During an initial contact with an older adult, the nurse should perform a comprehensive nursing assessment that includes a history using a functional health pattern format, physical assessment, assessment of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), mental status evaluation, and a social-environmental assessment. If available, a comprehensive interdisciplinary geriatric assessment may then be done to maintain and enhance the functional abilities of the older adult. The older adult and the caregiver should be interviewed separately and the older adult should identify his or her own needs.

An 83-year-old woman is being discharged from the hospital following stabilization of her international normalized ratio (INR) levels (used to assess effectiveness of warfarin therapy). She has chronic atrial fibrillation and has been on warfarin (Coumadin) for several years. Discharge instructions include returning to the clinic weekly for INR testing. Which statement by the patient indicates that she may be unable to have the testing done? a. "When I have the energy, I have taken the bus to get this test done." b. "I will need to ask my son to bring me into town every week for the test." c. "Should I just keep taking the same pill every day until I can get a ride to town?" d. "It is very important to have this test every week. I have several church friends who can bring me."

c. This statement indicates that this patient does not understand the importance of having the test every week and that the test results will determine ongoing dosing. The other three statements indicate that the patient is thinking about ways to get into town weekly.

The nurse identifies the presence of age-associated memory impairment in the older adult who states a. "I just can't seem to remember the name of my granddaughter." b. "I make out lists to help me remember what I need to do but I can't seem to use them." c. "I forgot that I went to the grocery store this morning and didn't realize it until I went again this afternoon." d. "I forget movie stars' names more often now but I can remember them later after the conversation is over."

d. Age-associated memory impairment is characterized by a memory lapse or benign forgetfulness that is not the same as a decline in cognitive functioning. Forgetting a name, date, or recent event is not serious but the other examples indicate abnormal functioning.

When working with older patients who identify with a specific ethnic group, the nurse recognizes that health care problems may occur in these patients because they a. live with extended families who isolate the patient. b. live in rural areas where services are not readily available. c. eat ethnic foods that do not provide all essential nutrients. d. have less income to spend for medications and health care services.

d. Older adults with an ethnic identity often have disproportionately low incomes and might not be able to afford Medicare deductibles or medications to treat health problems. Although they often live in older urban neighborhoods with extended families, they are not isolated. Ethnic diets have adequate nutrition but health could be impaired if money is not available for food.