Chronic Illness quiz (chapters 9, 10, & 11)

A nursing instructor is preparing a class on pressure ulcers. Which of the following would the instructor most likely include as a possible risk factor? Select all that apply.

Increased moisture Immobility Anemia Risk factors associated with pressure ulcer development include immobility, decreased sensory perception, anemia, decreased tissue perfusion, and increased moisture. (no reference provided)

The client with blindness is hospitalized following a myocardial infarction. Which of the following care measures would the nurse take with this client? Select all answers that apply.

Leave the bathroom door either completely open or closed. State when the nurse is leaving the room. Identify self when walking into the client's room. Suggestions when providing care to a client with low vision or blindness include identifying oneself to the client, stating when leaving the room, and leaving the doors either completely open or closed according to the client's preference. The nurse uses a normal tone of voice, not even slightly louder. The nurse does not pat service animals without the owner's prior permission. (ch 9, p. 145)

A nurse is reviewing the medications of a client who lives alone and reports having difficulty remembering when to take them. To aid in medication compliance, which of the following measures would the nurse employ? Select all answers that apply.

Suggest that the client uses a multiple-dose medication dispenser. Write down the medication schedule for the client. Recommend to the client to use one pharmacy for all prescriptions. Strategies to help clients improve medication compliance include providing a written copy of the medication schedule; encouraging the use of a multiple-day, multiple-schedule medication dispenser; and recommending the use of one pharmacy for prescriptions. If no children are in the household, then the nurse may encourage the use of standard medication containers without safety lids for ease of opening. Keeping empty medication containers will only add to the confusion, so the nurse should encourage the client to dispose of them when they are finished. (ch 11, p. 196)

An older adult in the hospital with a fractured hip is being prepared for surgical repair. The client left his bilateral hearing aids at home and is having difficulty hearing. To promote communication, which of the following actions should the nurse perform? Select all answers that apply.

Talk directly to the client. Use a deeper tone of voice. Ask the client to repeat what was stated. Actions that a nurse can take to help a client with hearing loss include the following: talk directly to the client, use a deep tone rather than a high tone, and ask the client to repeat what was stated to ensure understanding. The nurse does not speak in a loud voice, because in doing so, the nurse would use a higher tone, which is more difficult to hear. The nurse should minimize background noises in the room by turning off the television. (ch 9, p. 145)

A nurse is completing an assessment of a client who has just been transferred to the rehabilitation facility. During the health history, the nurse asks about the client's activities of daily living (ADLs). About which areas would the nurse gather information? Select all that apply.

Toileting Eating Bathing ADLs refer to those activities related to personal care, such as bathing, using the toilet, and eating. Cleaning and cooking are independent ADLs--activities that are important for independent living. (ch 10, p. 156)

The nurse brings the older adult patient a dinner tray and observes the patient placing excess amounts of salt on the food. What suggestions for flavoring can the nurse provide to decrease the amount of salt the patient is placing on her food? (Select all that apply.)

Use pepper instead of salt. Use lemon instead of salt to flavor food. Use low-sodium herbs and spices. To add flavor to food without adding salt, the nurse should encourage the use of lemon, spices, and herbs. Drinking water or using an alcohol-based mouthwash prior to eating would not improve the taste of the food. (ch 11, p. 186)

A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply.

Using familiar cues about the environment Providing a calm, quiet environment Supervising nutritional intake Appropriate interventions when caring for a patient with delirium include maintaining a calm, quiet environment, supervising and monitoring nutritional and fluid intake, and using familiar environmental cues. Psychoactive drugs should be minimized to reduce the possibility of delirium. Keeping the patient awake as much as possible would lead to sleep deprivation, which would increase the patient's risk for delirium. (ch 11, p. 199)

The rehabilitation nurse is working closely with a patient who has a new orthosis following a knee injury. What are the nurse's responsibilities to this patient? Select all that apply.

Teach the patient how to care for the skin that comes in contact with the orthosis. Help the patient learn to apply and remove the orthosis. Assist the patient in learning how to move the affected body part correctly. Collaborate with the physical therapist to set goals for care. In addition to learning how to apply and remove the orthosis and maneuver the affected body part correctly, patients must learn how to properly care for the skin that comes in contact with the appliance. Skin problems or pressure ulcers may develop if the device is applied too tightly or too loosely or if it is adjusted improperly. Nurses do not perform the initial fitting of orthoses. (ch 10, p. 164)

When assessing a client's risk for pressure ulcer development, which finding would alert the nurse to an increased risk? Select all that apply.

Edema Diaphoresis Anemia Risk factors for pressure ulcer development include prolonged pressure on the tissue, sensory deficit or loss, edema, urinary or fecal incontinence, malnutrition, anemia, hypoproteinemia, and excessively moist skin. (ch 10, p. 167)

The nurse is developing a bowel training program for a patient. What education can the nurse provide for the patient that will increase the chance of success of the bowel program? (Select all that apply.)

Have a fluid intake between 2 and 4 L/day. Have an adequate intake of fiber-containing foods. Set a daily defecation time that is within 15 minutes of the same time every day. Regularity, timing, nutrition (including increased fiber intake), and fluids (2 to 4 L daily), exercise, and correct positioning promote predictable defecation (National Institute for Health and Clinical Excellence, 2010). A regular time for defecation is established, and attempts at evacuation should be made within 15 minutes of the designated time daily. Enemas and laxatives are only needed if the patient is constipated and then only as needed, not daily. (ch 10, p. 177)

Falls, which are a major health problem in the elderly population, occur from multifactorial causes. When implementing a comprehensive plan to reduce the incidence of falls on a geriatric unit, what risk factors should nurses identify? Select all that apply.

Poor lighting Medication effects Sensory impairment Causes of falls are multifactorial. Both extrinsic factors, such as changes in the environment or poor lighting, and intrinsic factors, such as physical illness, neurologic changes, or sensory impairment, play a role. Mobility difficulties, medication effects, foot problems or unsafe footwear, postural hypotension, visual problems, and tripping hazards are common, treatable causes. Overdependence on assistive devices and ineffective use of coping strategies have not been shown to be factors in the rate of falls in the elderly population. (ch 11, p. 203)

A clinic nurse is meeting with a group of older adults living in a community that has been experiencing extremely hot summer days. Which of the following measures would the nurse encourage the clients to practice to protect their health during the hot summer days? Select all answers that apply.

Wear lightweight shirts and shorts. Take cool showers. Increase fluid intake. Circulate air with a fan or air conditioner. Older adults have decreased tolerance for temperature extremes. Clients should dress appropriately for the temperature. For hot weather, this means wearing clothes that are cool, such as lightweight shirts and shorts. Other measures to minimize the effects of hot temperatures are taking cool showers, increasing fluid intake, and circulating air with a fan or air conditioner. Hot tub baths would be contraindicated. (ch 11, p. 186)

A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply.

Wear nonslip shoes or socks when walking. Have routine vision and hearing screenings. Place grab bars in the shower and tub. Review medications routinely for side effects. Grab bars in the shower and tub may decrease the chance of a fall on a slippery surface. Visual and hearing issues may contribute to falls. Medication interaction and side effects may increase the risk for falls, so medications should be reviewed. The older adult should wear proper nonskid footwear or socks when walking to help prevent falls. Changing the layout of the furniture in the home may increase the risk for falls due to items being in unfamiliar locations. Scatter rugs should not be used as they increase the risk for falls. (ch 11, p. 203)