Chapter 31 & 32 Test (Chronic Conditions)

Residents in an assisted-living facility attend a daily exercise class. Their blood pressures and heart rates are monitored before, during, and after exercising. While they are riding stationary bicycles, a nurse notices the signs listed below. The nurse would instruct the client with which change to stop exercising? A. Heart rate increased to 90 beats per minute. B. Facial flushing noted. C. Systolic blood pressure increased by 25 mm Hg. D. Client breathing rapidly.

C. Systolic blood pressure increased by 25 mm Hg.

An older adult and spouse live in their home of 50 years. The client has a diagnosis of osteoarthritis. The nurse is making a home visit to the client. Which factor would the nurse most likely identify as having the greatest impact on the client's ability to manage the condition? A. The openness of the client to complementary and alternative medicine (CAM) B. The financial resources available to the client and spouse C. The course and progression of the client's condition D. The availability of new treatment options for his condition

C. The course and progression of the client's condition

A homecare nursing supervisor is making a joint visit with a home care nurse who has begun providing care for an older adult in the community recently diagnosed with type 2 diabetes. The nursing supervisor is reviewing the client's plan of care developed by the homecare nurse. Which goal identified on the plan of care would the supervisor question? A. "The client will gain the knowledge and skills necessary to manage his diabetes independently and effectively within 3 months." B. "The client will maintain a high quality of life despite his diabetes." C. "The client will remain free of common complications of diabetes." D. "The client will regain blood sugar control without medications or diet limitations."

D. "The client will regain blood sugar control without medications or diet limitations."

The mobility, activity tolerance, and overall quality of life of a 79-year-old client are severely diminished by angina. The client now lives with a daughter and son-in-law, both of whom are unsure how best to foster the client's well-being. When discussing the client's care with the daughter and son-in-law, which information would be most appropriate for the nurse to provide? A. "It will be helpful for you both to occasionally remind the client about the areas of health and abilities that remain intact." B. "The most beneficial approach for your parent is to treat the client exactly as you did before this disability developed." C. "Doing as much as you and your husband can for the client will allow the client to dedicate energies to recovery." D. "Try to maximize the amount of self-care that your parent performs and still treat the client like a responsible person."

D. "Try to maximize the amount of self-care that your parent performs and still treat the client like a responsible person."

A nurse is reviewing the medical records of several older adult clients with chronic conditions. Which client would the nurse most likely identify as having the greatest care needs? A. A 77-year-old client with long-standing hypertension and exhibiting early signs of chronic renal failure. B. An 84-year-old client who lives with severe hearing loss and recurrent hemorrhoids. C. An 80-year-old client with varicose veins who has just been diagnosed with osteoarthritis. D. A 74-year-old client with severe side effects from CHF and long-standing type 1 diabetes.

D. A 74-year-old client with severe side effects from CHF and long-standing type 1 diabetes.

A nurse working in an extended-care facility is reviewing the medical records of several older adult clients. Which client would the nurse identify as being dependent in terms of the client's capacity to perform activities of daily living? A. A client who requires regular prompts for self-toileting B. A client with a long-term, indwelling urinary catheter who needs help with care. C. A client who needs to ring the call bell and then be accompanied to the toilet by a care aide. D. A client who needs the assistance of care staff to get off the bedpan after voiding.

D. A client who needs the assistance of care staff to get off the bedpan after voiding.

An older adult client has a serious chronic condition that requires visits to the health care provider several times a year (or more, if hospitalized). The client is considering four health care providers, all of whom are well qualified. Which provider is likely to be her best choice? A. The top expert in the field who is highly respected at the local hospital. B. A health care provider who communicates well with the client and is in high demand. C. A health care provider with an office in the client's neighborhood. D. A health care provider who makes the client feel comfortable.

D. A health care provider who makes the client feel comfortable.

During the homecare nurse's visit, the wife of a 74-year-old client who suffered a stroke is teary and clearly overwhelmed with the fact that she is the sole caregiver for her husband. The nurse responds to the caregiver's concerns by directing the wife to which resource to aid in her husband's functional recovery? A. A public health nurse B. The couple's family physician C. A psychologist D. A social worker

D. A social worker

A gerontological nurse is conducting an in-service program for a group of newly hired rehabilitative nurses. After conducting the program, which concept if stated by the group as a guiding principle for care indicates the need for additional teaching? A. Eliminate or minimize self-care limitations. B. Increase clients' capacity for self-care. C. Act for or do for when the person is unable to take self-action. D. Consider rehabilitation unsuccessful if client not returned to pre-illness state

D. Consider rehabilitation unsuccessful if client not returned to pre-illness state

A 70-year-old retired engineer has diabetes and is receiving dialysis. The client is a gourmet chef who takes pride in cooking delicious meals. The client's physical condition is quite good, but the client is unhappy and bored with having to lead such a restricted life. An old friend has invited the client to travel across the country and spend a week in San Francisco. Dialysis treatments can be arranged through a network of dialysis providers. Which response by the client's dialysis nurse would be most appropriate? A. Encourage the client to go, and advise the client not to worry about his condition. B. Discourage the idea, as the client is likely to eat and drink too much on vacation. C. Discourage the idea, but provide as much helpful information as possible. D. Encourage the client to go, and provide as much helpful information as possible.

D. Encourage the client to go, and provide as much helpful information as possible.

An older adult client lives with hemiplegia following an ischemic stroke 8 weeks ago, a disability that has impaired the client's ability to independently check blood sugars using a glucometer. Which action would be most effective in addressing the client's challenge? A. Reevaluate the client's goals for diabetes treatment and the need for random blood glucose monitoring. B. Enlist the help of the client's family and friends in performing the glucose monitoring. C. Substitute scheduled hemoglobin A1c testing at a facility laboratory for random blood glucose testing. D. Teach the client a method of using a glucometer that can be performed using the unaffected hand.

D. Teach the client a method of using a glucometer that can be performed using the unaffected hand.

Despite the fact that the client is now receiving palliative care because of the progression of congestive heart failure (CHF), a nurse views the care that was provided for the client as a success. The nurse arrives at this conclusion most likely based on which information? A. The client remained largely pain-free from the time of diagnosis until the present time. B. The client maintained an acceptable cardiac output for most of the time that the client lived with CHF. C. The client was able to teach other older adults about the experience of living with CHF and the way it affected life. D. The client was able to live independently and provide self-care until very late in the progression of the disease.

D. The client was able to live independently and provide self-care until very late in the progression of the disease.

A nurse is assessing the nutritional status of an older client with a disability. As part of this assessment, the nurse evaluated the client's ability to perform instrumental activities of daily living (IADLs). On which IADL would the nurse most likely focus? Select all that apply. A. Meal preparation B. Shopping for groceries C. Cleaning up after cooking d. Eating meals and snacks e. Properly chewing and swallowing

A, B, C

An older adult who lives alone has hypertension and diabetes but seems to manage both conditions quite well. The client performs daily insulin injections and manages the medications and meals. Three times a week, the client drives to a dialysis center for dialysis. Due to loneliness, the client often has lunch or dinner in restaurants where the client may eat and drink unwisely. However, the client takes the prescribed medicines along. Which suggestion could a nurse at the dialysis center suggest to best assist the client in managing his conditions? A. "Let's find some social activities you might like that do not involve eating." B. "Take a list of approved foods with you when you go to the restaurants." C. "It's important for you to eat at home most of the time." D. "Check your blood pressure and blood sugar after returning home."

A. "Let's find some social activities you might like that do not involve eating."

A nurse planning a health workshop for senior citizens wants to provide discussion topics that will interest everyone. In a typical group of seniors, which disorder would the nurse most likely identify as affecting the greatest number? A. Arthritis B. Hearing impairment C. Heart condition D. Hypertension

A. Arthritis

A nurse is completing a functional assessment of an older adult client. The nurse determines that the client would have difficulty functioning independently and living alone based on which finding? A. Client has difficulty eating B. Client has significant difficulty using a telephone C. Client is unable to read D. Client is unable to prepare meals

A. Client has difficulty eating

The director of a nursing home tries to provide stimulating activities for the residents. Every Friday evening, there are Bingo games for the residents. Most residents enjoy playing Bingo, but a few residents object that it is a "waste of time" and they refuse to play. Which action would be most appropriate for handling the situation? A. Continue the games but offer an alternative activity that provides mental stimulation. B. Continue the games but allow the residents to read or watch television instead of playing. C. Continue the games and insist that all the residents should continue participation. D. Find a new, more stimulating activity for all the residents.

A. Continue the games but offer an alternative activity that provides mental stimulation.

A nurse is providing care for an 82-year-old client on the palliative care unit of a hospital. The client has a long-standing diagnosis of diabetes that has manifested in serious cardiac problems. The client is not expected to survive the weekend. Which interpretation would be most appropriate by the nurse in light of the chronic care that the client has long received? A. Dying in comfort and dignity is the final component of high-quality chronic care. B. The period of death represents the transition from chronic care to acute care. C. Holistic, chronic care requires limiting the care to psychosocial interventions. D. Death represents the ultimate failure of the provision of care.

A. Dying in comfort and dignity is the final component of high-quality chronic care.

A nurse is developing a program for a group of older adults who are at risk for becoming frail. Which action would the nurse include as an appropriate measure to prevent or postpone frailty? A. Exercises for strengthening muscles B. Reminiscing activities C. A weight-loss diet D. Puzzles and board games

A. Exercises for strengthening muscles

A nurse is working with an older adult client who is engaging in reminiscing. Which skill would be most important for the nurse to use during this activity? A. Listening B. Guiding C. Encouraging D. Redirecting

A. Listening

A nurse is working as part of a group health care provider practice. One of the nurse's responsibilities is to provide documentation about older adult clients who may need nursing home care. Which older adult client would the nurse identify as frail? A. One who has lost 20 pounds in the past year, cannot grip utensils, and is inactive. B. One who is inactive, walks slowly, and has many colds. C. One who has many colds, tires easily, and has lost 15 pounds in the past year. D. One who has lost 10 pounds in the past year, is inactive, and has many colds.

A. One who has lost 20 pounds in the past year, cannot grip utensils, and is inactive.

A nurse is providing care to a client who is in a coma. As part of the client's care, the nurse is providing range-of-motion exercises. The nurse would most likely be performing which action? A. Passive B. Active assistive C. Active D. Resistance

A. Passive

A nurse is assessing an older adult client with a disability. When evaluating the client's activities of daily living, about which component would the nurse gather data? Select all that apply. A. Grocery shopping B. Eating C. Toileting D. Dressing e. Cooking

B, C, D

A gerontological nurse is discussing the importance of reminiscence with a group of nurses working on the rehabilitative unit. The unit provides care to many older adults. The nurse determines that the discussion was successful when the staff identifies reminiscence as having which effect? Select all that apply. A. Entertainment B. Validation of existence C. Means of finding meaning in remaining life D. Means for resolving past conflicts E. Memory improvement

B, C, D, E

The daughter of an 80-year-old client with a diagnosis of severe ischemic heart disease has been the sole care provider for over a year. The daughter is tearfully telling the homecare nurse about the onerous burden that she bears by struggling to meet the client's ever-increasing needs. Which response by the nurse would be most appropriate? A. "There are promising new treatments for heart disease that hold a great potential for your parent." B. "It's very normal for you to feel this way, given how much you do; perhaps we can explore other living options together." C. "This must be difficult for you; others in similar circumstances find it useful to remind themselves of how much their parents did for them when they were young." D. "It sounds like it is probably time to think about placing your parent into long-term care."

B. "It's very normal for you to feel this way, given how much you do; perhaps we can explore other living options together."

A 76-year-old client's quality of life has been significantly affected by chronic obstructive pulmonary disease (COPD). The client has experienced a steady decline in activity tolerance, mobility, and ultimately independence. Considering the apparent ineffectiveness of conventional treatment, the client is eager to forego conventional treatments and explore alternative and complementary treatment options. Which response by the nurse would be most appropriate? A. "Your care team is probably ignorant of alternative therapies, so you'll have to go elsewhere for any information you need." B. "Try not to think of your options as choosing either conventional treatment or alternative therapies, but rather choosing the best of both." C. "These are good options to explore, but you will need to set aside your health care provider's advice in the short term to get accurate information." D. "This is a wise decision, since conventional treatments are motivated by profit and the interests of pharmaceutical companies, not clients."

B. "Try not to think of your options as choosing either conventional treatment or alternative therapies, but rather choosing the best of both."

An older adult client says, "I don't need my medicine for hypertension. It makes me feel weak and I do not like the side effects." When the client's spouse tries to remind the client to take the drug, the client becomes enraged. Which immediate action would be most appropriate for the nurse to do? A. Insist that the client force himself to take the medicine. B. Allow the client to vent these frustrations. C. Advise the client's spouse to supervise the client. D. Pressure the client repeatedly about the need for the medicine to treat hypertension.

B. Allow the client to vent these frustrations.

An older adult client has lived with a son and his family for about 10 years. Before coming to live with them, the client was independent and healthy, but has developed rheumatoid arthritis and is nearly blind. The client's daughter-in-law has taken early retirement to care for the client. Although the daughter-in-law did so voluntarily, she now feels resentful about staying home and the family's income has lessened. Recently, the family hired a part-time home care worker to help, which gives the daughter-in-law more freedom but adds to the financial burden. The marriage is beginning to suffer. The couple meets with a nurse practitioner to obtain some guidance and direction. Which action would the nurse practitioner most likely suggest? A. Make their own decisions without outside input B. Consider finding an assisted living facility C. Discontinue the additional in-home care D. Set firmer boundaries with the client

B. Consider finding an assisted living facility

A gerontological nurse observes a staff nurse infantilizing an older adult client receiving rehabilitative services. The gerontological nurse implements actions to correct the staff nurse's action based on the understanding that the staff nurse was violating which guideline for rehabilitative nursing? A. Recognizing and praising accomplishments B. Equating physical disability with mental disability C. Preventing complications D. Providing time and flexibility

B. Equating physical disability with mental disability

After a fall in the supermarket near home, an older adult client has experienced a slow recovery in the hospital from hip replacement surgery 9 weeks ago, enduring a postoperative infection and a slow resumption of mobility. Consequently, the care team has recommended that the client be moved to a facility better able to meet the client's rehabilitative needs. Which goal would be the priority during the client's rehabilitation? A. Freedom from infection B. Improvement in functional capacity C. A return to pre-fall levels of mobility D. Attempt to manage pain

B. Improvement in functional capacity

A nurse is helping a client with range-of-motion exercises. When assisting the client, which action by the nurse would be most appropriate? A. Move each joint back and forth only once. B. Offer support above and below the joint being exercised. C. Move each joint slowly and smoothly past the point of resistance. D. Document any minor change in heart rate or respirations.

B. Offer support above and below the joint being exercised.

A nurse in a cardiac rehabilitation unit is helping an older adult client set health goals for the coming year. The client has had one heart attack and two coronary artery bypass surgeries, and can now walk only one city block (1/8 mile) before tiring. Together with the client, the nurse would most likely identify which goal to being reasonable for the client to achieve by the end of the year? A. Jogging 4 blocks every day B. Walking 10 blocks every day C. Running 10 blocks every day D. Continuing to walk 1 block every day

B. Walking 10 blocks every day

Gerontological nurses are aware of the importance of recognizing the symptoms of frailty in their patients. Which of the following is not considered to be a symptom of frailty: A. fatigue B. memory loss C. low grip strength D. progressive weight loss

B. memory loss

A nurse is developing a plan of care for an older adult client with several chronic conditions. Which information would be most important for the nurse to integrate into the plan when identifying goals for the client? Select all that apply. A. Chronic illnesses can be cured with proper and persistent treatment. B. The success of interventions should be judged on how quickly and totally the clients can recover. C. Appropriate care measures focus on helping clients live in harmony with chronic disease. D. Controlling symptoms, promoting a sense of well-being, and enhancing the quality of life are appropriate goals for persons with chronic illnesses. E. Healing requires the mobilization of the body, mind, and spirit.

C, D, E

An older adult client has recently been diagnosed with rheumatoid arthritis that is having a significant impact on the client's daily routines and quality of life. Which response by the nurse best demonstrates understanding about the importance of healing rather than curing the client's condition? A. "A combination of physical therapy and corticosteroid treatment have a strong chance of mitigating the effects of your arthritis." "The best way for us to foster your overall well-being is to eliminate the symptoms that are most affecting your daily routines." C. "There are changes that I can help you make that can help you live a full life despite this health problem." D. "There are lifestyle changes, coupled with promising new therapies, that hold out hope for being free from this problem."

C. "There are changes that I can help you make that can help you live a full life despite this health problem."

A home health care nurse is making a home visit to an older adult client with a chronic condition. The client has a chronic care coach. During the visit, the nurse observes the coach praise the client for the positive results on the current blood test. The nurse interprets this as which step? A. Help B. Observe C. Affirm D. Contact

C. Affirm

A nurse is providing care to numerous older adult clients on a rehabilitative medicine unit of a hospital. When integrating range-of-motion exercises into the clients' plans of care, which information would the nurse most likely need to consider? A. Range-of-motion exercises are contraindicated in clients with existing cardiac conditions. B. Performing range-of-motion exercises as slowly as possible maximizes the benefit. C. Clients should be encouraged to put all their joints through a range of motion at least once daily. D. Passive range-of-motion exercises should be delegated to physiotherapists to reduce the chance of injury

C. Clients should be encouraged to put all their joints through a range of motion at least once daily.

An older adult has had a series of lab tests that indicate the client is healthy. However, the client has had several colds lately and often feels fatigued. Further evaluation indicates that the client is not depressed. The client eats lightly but has a healthful diet. Which recommendation would be most appropriate for the nurse to offer to improve the client's health? A. Engage in psychotherapy. B. Increase total food intake. C. Exercise regularly D. Take mega-doses of vitamins.

C. Exercise regularly

A nurse is teaching the caregiver of an older adult client with a disability about the need to maintain correct body alignment. The nurse determines that additional teaching is needed when the caregiver identifies which reason as the basis for aligning the body correctly. A. Promotes comfort for the client B. Prevents complications such as contractures and pressure ulcers C. Makes caring for the client more manageable D. Facilitates optimal body system functioning

C. Makes caring for the client more manageable