Chapter 8 : Caring For Patients With Chronic Illness EAQ

Clinical Information Systems

Maintain and share patient health information among providers and patients to ensure effective communication and quality patient care. EX: Share patient health information among providers. EX: Documenting patient information for the health care provider to review before prescribing a treatment

Which patient statement is an example of a nonmodifiable risk factor for heart disease?

"My family has a history of heart disease."

When caring for patients with more than one chronic disease, the nurse recalls that they are likely to experience which event? Select all that apply. One, some, or all responses may be correct.

- Frequent health care visits - Increased health care expenses - Multiple medications - Greater changes in the ability to perform daily activities

Which factor is associated with the development of chronic disease? Select all that apply. One, some, or all responses may be correct.

- Genetics - Environment - Lifestyle Factors

Autosomal Dominant Disorders

- Huntington's chorea - Familial hypercholesterolemia - Neurofibromatosis

Which statement will the nurse use to respond to the patient who states, "I know I need to lower my weight, but I do not like dieting"?

"Can you tell me what dieting means to you?"

The nurse reviews a patient's medical record. Using the Chronic Care Model, which initial question does the nurse ask the patient when implementing the self-management support component of the model?

"Do you feel like you are ready to make some changes?" Before implementing the self-management support, the nurse will need to assess the patient's readiness for change. The self-management support component places the patient at the center of disease management.

The nurse provides education about tobacco use for a group of community members. Which statement made by a member of the group indicates the need for further teaching?

"Electronic cigarettes are safer than regular cigarettes because they do not contain nicotine."

Which condition is directly associated with smoking behavior? Select all that apply. One, some, or all responses may be correct.

- Cancer - Cardiovascular Disease - Pulmonary Disease

Which chronic disease is associated with the costliest health care?

Dementia

The nurse reviews a 30-year-old female patient's history and notes that her mother died from breast cancer at the age of 55. Which action does the nurse take?

Refer the patient for genetic testing for a BRCA1 or BRCA2 mutation.

Which element of the Chronic Care Model is most likely to improve outcomes for a patient with chronic obstructive pulmonary disease (COPD)?

Self-management support

Which patient benefit is gained through the use of the patient-centered medical home (PCMH) delivery model? Select all that apply. One, some, or all responses may be correct.

- It facilitates coordination of care. - To provide culturally appropriate care when and where patients need it, comprehensive care can be provided.

Which emotional response would the nurse expect in a patient living with advanced colon cancer? Select all that apply. One, some, or all responses may be correct.

- Loneliness - Frustration - Depression - Social isolation - Fear about the future

Predictive and presymptomatic genetic testing serves which purpose?

Find genetic variations that increase a person's chance of developing a specific disease

Predictive and presymptomatic genetic testing

Finds genetic variations that increase a person's chance of developing a certain disease.

The nurse performs an assessment of a female patient's alcohol intake. The nurse suspects alcohol misuse based on which patient statement?

"I drink a total of eight drinks per week." The nurse should suspect alcohol misuse when a patient reports excess total alcohol consumption, which is more than SEVEN drinks a week for WOMAN ; FOURTEEN drinks a week for MEN

The nurse is using the Five As model for a patient diagnosed with chronic liver disease. Which statement made by the patient reflects the "agreement" component of the model?

"It's realistic for me to follow the dietary plan that we worked on together."

An adult child of a patient with chronic obstructive pulmonary disease asks the nurse how a Chronic Resource Disease Self-Management Resource Program (CDSMRP) can be helpful. Which response does the nurse provide?

"The program will help you manage your parent's disease."

A patient asks the nurse for assistance with smoking cessation. The nurse provides education about the American Lung Association's "Freedom from Smoking Plus" program and includes which information?

"The website provides encouragement and ideas about how to stop smoking, as well as information about why and how to stop."

The nurse refers a patient with hypertension to the American Heart Association website to assist with blood pressure monitoring. The nurse lists which additional benefit of using this resource?

"You will be given a digital tracking mechanism with reminders on when to monitor your blood pressure."

Which question does the nurse ask during the assessment of a patient with a chronic illness? Select all that apply. One, some, or all responses may be correct.

- "Do you feel rested in the morning?" - "Have you been maintaining your appetite?" - "Are you able to follow the prescribed treatment plan?" - "Are there any changes in how you are coping with your disease?" - "What kind of pain are you experiencing?"

Which information will the nurse include in the teaching of a patient who will be participating in a Chronic Disease Self-Management Resource Program (CDSMRP)? Select all that apply. One, some, or all responses may be correct.

- "The leaders of the workshops are not health care professionals." - "The workshops will focus on improving your self-management skills." - "The workshops you attend will be limited to a small group of participants." - "The workshops last 2.5 hours and will occur 1 day a week for the next 6 weeks."

Which factor places a caregiver of a patient with chronic illness at an increased risk of poor health? Select all that apply. One, some, or all responses may be correct.

- Age of the caregiver - Living with the patient - Type of chronic illness - Direct relation to the patient

Which intervention will the nurse provide in chronic disease PREVENTION? Select all that apply. One, some, or all responses may be correct.

- Assessing family history - Screening for early disease - Increasing healthy behavior through education - Supporting public policy to improve health at the local, state, and national levels

The nurse educator provides teaching for a group of nurses who work in a pediatric office. The educator emphasizes the importance of early detection of disease and encourages which simple screening measure? Select all that apply. One, some, or all responses may be correct.

- Blood pressure - Height - Weight

To improve the outcome of a patient diagnosed with type 2 diabetes, the nurse implements the Chronic Care Model and includes which component? Select all that apply. One, some, or all responses may be correct.

- Connect the patient to community resources. - Educate the patient about a low-carbohydrate diet. - Encourage the patient to participate in the care being provided. - Share patient health information among providers.

Autosomal Recessive Disorders

- Cystic fibrosis - Sickle Cell Anemia

Which condition is an autosomal recessive disorder that occurs most commonly when both parents are carriers of the recessive genetic disorder? Select all that apply. One, some, or all responses may be correct.

- Cystic fibrosis - Sickle cell anemia

The Chronic Care Model includes which essential element? Select all that apply. One, some, or all responses may be correct.

- Decision support - Delivery system design - Self-management support - Clinical information systems

Which intervention will the nurse include in the education for a patient at risk for oral cancer? Select all that apply. One, some, or all responses may be correct.

- Decreasing alcohol intake - Maintaining a healthy weight - Avoiding drinks high in sugar - Adequate intake of fruit and vegetables

The nurse refers a patient with heart failure to the American Heart Association website, which provides patients with which tool? Select all that apply. One, some, or all responses may be correct.

- Diet information - Digital tracking with reminders for patients on when to monitor their blood pressure - Self-assessment of heart failure symptoms

The nurse provides care for a patient with a chronic illness who is diagnosed with depression. The nurse identifies that the patient is at risk for which other condition? Select all that apply. One, some, or all responses may be correct.

- Fatigue - Social isolation - Increased levels of pain - Detachment from daily activity - Nonadherence to the treatment

A patient tells the nurse, "I seldom take the blood pressure medications that have been prescribed for me." Which patient-focused approach does the nurse use to promote adherence to the treatment plan? Select all that apply. One, some, or all responses may be correct.

- Implement the use of motivational interviewing. - Educate the patient about the importance of following the treatment plan. - Provide the patient with verbal guidance and a written copy of the individualized plan for treatment. - Provide education using a teach-back approach to assess the patient's understanding of adherence to treatment.

The nurse provides care for a patient with a chronic illness who does not adhere to the prescribed treatment plan. The nurse identifies that the patient is at risk for which occurrence? Select all that apply. One, some, or all responses may be correct.

- Increased mortality - Increased morbidity - Increased hospital admissions - Increased health care expenses

The nurse provides education to a patient about making dietary choices to promote health and prevent obesity. The nurse includes which recommendation? Select all that apply. One, some, or all responses may be correct.

- Intake of a variety of fruits and vegetables - Intake of low-fat dairy - Controlling sodium intake - Intake of grains - Controlling alcohol intake

When assessing a patient's risk for chronic disease, which aspect of the family history would be a consideration? Select all that apply. One, some, or all responses may be correct.

- Multigenerational disease patterns - Generational frequency of the disorder - Age of family member at onset of disease

Which action is included in the nurse's role in preventing chronic disease? Select all that apply. One, some, or all responses may be correct.

- Obtain a thorough family history. - Support public policy to improve health. - Provide information on genetic screening. - Provide education about healthy behavior. - Screen patients for early detection of disease.

Which symptom will the nurse monitor for in a patient diagnosed with both depression and type 2 diabetes mellitus? Select all that apply. One, some, or all responses may be correct.

- Pain - Fatigue - Social isolation - Adherence with treatment - Withdrawal from activities

Which factor will the nurse include when providing education on environmental risks for developing breast cancer in female patients? Select all that apply. One, some, or all responses may be correct.

- Poor Diet - Inactivity - Exposure to secondhand smoke

Which lifestyle choice is an example of a risk behavior? Select all that apply. One, some, or all responses may be correct.

- Poor nutrition - Smoking cigarettes - Lack of physical activity - Excessive alcohol consumption - Exposure to secondhand smoke

The nurse provides care for a patient with a chronic illness. The nurse identifies which factor that may affect the patient's adherence to a prescribed treatment plan? Select all that apply. One, some, or all responses may be correct.

- Severity of the illness - Socioeconomic status - Mental health - Relationship with health care providers

Place in the correct order implementation of the Five As to aid a patient in self-management of chronic disease.

1. ASSESS: Determine a patient's beliefs, behaviors, and knowledge. 2. ADVISE: Provide specific information regarding health risks and the benefits of changing behaviors. 3. AGREE: Collaborate with the patient to set realistic goals. 4. ASSIST: Help the patient identify barriers, strategies, problem-solving skills, and available support. 5. ARRANGE: Determine a follow-up plan such as return visits, phone calls, and text messages.

Components Of The CHRONIC CARE MODEL

1. Health System 2. Delivery System Design 3. Decision Support 4. Clinical Information Systems 5. Self-Management Support 6. Community

The nurse discusses the World Health Organization's recommendations to prevent chronic noncommunicable illnesses with a group of adult community members. Which exercise routine does the nurse suggest?

150 minutes of moderate-intensity activity per week "WHO" recommendations to prevent chronic noncommunicable illnesses include: (A) ADULTS: 150 minutes of moderate intensity activity per week or 75 minutes of vigorous aerobic activity per week; (B) OLDER ADULTS WITH LIMITED MOBILITY: activity to enhance balance 3 or more days per week; and (C) ALL AGES: strengthening exercises 2 or more days per week.

Which family caregiver would the nurse expect to be at the greatest risk for poor psychological and physical health?

67-year-old spouse providing tracheostomy care for 2 years

Which element of the Chronic Care Model is the nurse utilizing when documenting patient information for the health care provider to review before prescribing a treatment?

Clinical information systems

Which lifestyle factor directly correlates with an increased risk of type 2 diabetes?

Decreased physical activity

Which component of the Chronic Care Model does the nurse use when providing evidence-based care that is patient-centered?

Delivery System Design

Care for which chronic illness creates the largest financial burden on the health care system?

Dementia

The information obtained from a health risk assessment on a patient is used for which purpose?

Detection of health issues

A patient who is 6 weeks pregnant has a family history of cystic fibrosis (CF). The patient asks the nurse if the baby will have the disease. Which information will the nurse include in the teaching of the patient?

Discuss carrier testing.

After reviewing the patient's record, which action will the nurse anticipate including in the plan of care for the patient?

Evaluate the blood level of valproic acid.

Community

Help develop partnerships to enhance the effectiveness of chronic disease management programs. Community partnerships between health systems and local, state, and national agencies help fill in the gaps that exist in different services and improve patient care. EX: Providing the patient with information about available community resources

Which intervention does the nurse implement to promote patient adherence to a treatment plan?

Help the patient identify barriers and strategies

Prenatal testing

Helps identify fetuses during a pregnancy that have certain diseases.

The nurse suggests the Chronic Disease Self-Management Resource Program (CDSMRP) for a patient with rheumatoid arthritis. Which benefit of the program does the nurse include when educating the patient?

Increased socialization

Health System

Needs to constantly attempt to improve the management of chronic illnesses and focus on safety and quality of care.

Which nursing action related to assessment yields the most information when interviewing a patient diagnosed with lung cancer?

Obtaining a full medical history

Autosomal Recessive:

Occurs most commonly when both parents are carriers of the recessive genetic disorder. Although these parents are carriers of the genetic disease, they do not have the disease. Each child born from two parents who carry a recessive disorder has a 25% risk of having the disease.

Autosomal Dominant:

Occurs when a person has one parent with the dominant genetic disorder or a new mutation in a gene occurs. Each child born from parents in whom one has the dominant disorder has a 50% risk of having the disorder.

Self-Management Support

Places the patient in the center of disease management. Self-management support requires providers to collaborate with patients, which ultimately empowers patients to take responsibility for and manage their chronic diseases. EX: Encourage the patient to participate in the care being provided. (His or her own care) Best For: IMPROVING PATIENT OUTCOMES

Carrier testing

Provides information about a person carrying a gene that can cause disease.

Which type of patient support will the nurse anticipate for a patient with hypertension and type 2 diabetes who is participating in the Chronic Disease Self-Management Resource Program (CDSMRP)? Select all that apply. One, some, or all responses may be correct.

Small community meetings

The nurse is using the Chronic Care Model to care for a patient diagnosed with type 2 diabetes. Which nursing intervention correlates with the promotion of self-management?

Teaches the patient how to read the labels on food items

Diagnostic testing

The ability to identify a genetic condition or illness that is making or will make a patient ill in the future.

Decision Support

Used by health care providers to implement evidence-based guidelines, guide patient education, and encourage patients to participate in their care. EX: Educate the patient about a low-carbohydrate diet

Delivery System Design

Uses evidence-based care that is patient-centered, preventive in nature, and occurs in a variety of acute, outpatient, and community settings.