Care of the Older Adult and Chronic Illness

Which of the following psychiatric disorders is found most frequently among older adults? a. depression b. dementia c. anxiety d. social phobia

a. depression

Which statement regarding the use of restraints is true? a. Restraint free care appreciably diminishes the overall safety of any older adult patient compared with the use of physical or chemical restraints. b. The nurse is responsible for patient safety during the time the patient is restrained c. Chemical restraint presents less potential for patient harm that physical restraint d. Restraint may be used to prevent extubation if a nursing protocol exists.

b. The nurse is responsible for patient safety during the time the patient is restrained

Self Actualization needs involves

becoming everything someone is capable of

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 toard the elderly based on physical disability.

c. negative attitudes toward the eldery based on age. Agesim is a negative attidude based on age

In Maslow's hierarchy of needs, which of the following are included in love and belonging

Affiliations, affectionate relationships and love

A patient comes to the ER during the morning and is experiencing rapid onset of impaired memory, reduced attention span, aggitation and disorientation, this patient will be experiencing a. sundowners b. Acute Delirium c. Alzhiemers d. Dementia

B. acute delirium s/s of delirium include rapid onset of symptoms that are reversible, sundowners" is a manifestation of symptoms that occur at night, intermittent with periods of clarity with periods of disoriention, imparied memory and impared atention span.

In what phase of the communication process is verbal and nonverbal techniques be used

Message

4 phases of the Nurse-Patient relationship include

Pre-interaction phase Orientation phase Working phase Termination phase

The acronym SPICES is used when assessing patients for ADL abilities, social-enviroment patterns and mental status. The acronym statnds for:

Sleep disorder Problems with eating or feeding Incontinence Confusion Evidence of Falls Skin Breakdown

The Communication process consists of these 4 parts

Stimulus-->Sender-->Message-->Receiver-->Feedback >Sender

An 80 yo female patient is receiving palliative care for heart failure. Primary purpose(s) of her receiving palliative care is (are) select all that apply: a. improve her quality of life. b. assess her coping ability with disease c. have time to teach patient and family about disease. d. docus on reducing the severity of disease symptoms. e. provide care that the family is unwilling or unable to give.

a and d The focus of palliatvie care is reduction of the severity of disease symptoms. the goals of palliative care are to (1) prevent and relieve suffering and (2) to improve quality of life for patients with serious, life limiting illnesses.

The nurse would be concerned the patient is displaying spiritual distress when he is exhibiting the following; select all that apply a. anger toward God or a higher being b. Change in behavior or mood c. Expressed desire for spiritual assistance d. dynamic and adapted lifestyles e. express quality rest and sleep

a, b and c

Example of normal changes in aging include. Select all that apply a. Decreased chest wall compliance, and cough function b. Increased systolic pressure c. Less orthostatic hypotension d. Altered drug excretion e. More erections

a, b, d Normal changes in aging include decreased chest wall compliance, muscle strength, alveoli function, cough and macrophage function. Increased systolic pressure, more orthostatic hypotension, and arrhythmias. Many older men experience erectile dysfuntion and alteration in drug metabolism.

The children caregivers of an elderly patient whose death is imminent have not left the bedside for the past 36 hours. In the nurse's assessment of the family, what findings indicate the potential for an abnormal grief reaction to occur. Select all that apply. a. Family cannot express their feelings to one another. b. Dying patient is becoming more restless and agitated c. A family member is going through a difficult divorce d. Family talks with and reassures the patient at frequent intervals.

a, c the nurse must be able to recognize signs and behaviors among family members who may be at risk for abnormal grief reactions. They may include dependency and negative feelings about the dying person, inability to express feelings, sleep disturbances, a history of depression, difficult reactions to previous losses, perceived lack of social or family support, low self-esteem, multiple previous bereavements, alcoholism, and substance abuse. Caregivers with concurrent life crises are especially at risk.

In carrying out patients' wishes and directives as a nurse, which of the following is an unethical action for the nurse? a. Ignoring a " do not resuscitate" order for an older adult patient in the ICU b. Implementing a hysician's order to withhold artificial hydration from an older adult patient in irreversible coma c. Adhering to the choices made for an older adult patient by the individual with durable power of attorney for health care

a. Ignoring a " do not resuscitate" order for an older adult patient in the ICU

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

a. adult day care Adult day care (ADC) programs provide daily surpervision, social activites, and assistance with activities of daily living (ADL's) for persons who are cognitively impaired and persons who have problems with (ADL's). ADC centers provide physical and emotional relief for the caergiver and allow the caregive to pursue continued employment.

Based on Maslow's Hierarchy of Needs a patient with SOB and depression would be treated for which level first a. physiological needs b. Safety needs c. Love and belong needs d. Esteem needs e. Self-actualization needs

a. physiological needs

To provide trans-cultural nursing, the nurse must understand the meaning is

analysis of culture to reveal facts that can guide the nursed in providing culturally appropriate care

When a Jewish patient is receiving EOL care, the nurse understands the most appropriate way to care for this patient would be a. Offer theraputic touch and low voice b. A dying person should not be left alone ( a rabbi's presence is desired c. The Jewish faith usually cremates the person after death.

b. A dying person should not be left alone ( a rabbi's presence is desired

The home health nurse visits a 40 yo patient with metastatic breast cancer who is receiving palliative care. The patient is experincing pain 7-10. In prioritizing activities for the visit, the nurse would do which first? a. Auscultate for breath sounds b. Administer PRN pain medication c. Check pressure points for skin breakdown d. Ask family about patient's food and fluid intake.

b. Administer PRN pain medication Meeting the patient's physiological safety needs is the priority. Physical care focuses on the needs for oxygen, nutrition, pain relief, mobilty, elimination, and skin care. The paatient is not experiencing oxygenation problem. the priority is to treat the severe pain with pain medication.

A 67 yo woman was recently diagnosed with inoperable pancreatic cancer. Before the diagnosis she was very active in her neighoborhood association. Her husband is concerned because his wife is staying home and missing her usual community activities. Which common EOL psychologic manifestation is she most likely demonstrating? a. Peacefullness b. Decreased socialization c. Decreased decision making d. Anxiety about unfinished business

b. Decreased socialization Decreased socialization is a common psychosocial manifestation of approaching death.

While caring for his dying wife, the husband states that his wife is a devout Roman Catholic, but he is a Baptist. Who is considered the most reliable source for spiritual preferences concerning EOL are for the dying wife? a. A priest b. Dying wife c. Hospice staff d. Husband of dying wife

b. Dying wife Assessment of spiritual needs for palliative care is a key consideration, and individual choices should be respected. the prefereences of the patient and family with regard to spiritual guidance or pastoral cre services should be assessed and appropriate referreal s made. The patient is the most reliable source for the spiritual assessment.

An elderly patient asks the nurse what contributes most to healty aging. The best response would be. (select all that apply) a. regular exercise at least 90 min per day b. a nutritious diet with plenty of fruits and vegetables c. a strong support system d. involvement in community activites

b. a nutritious diet with plenty of fruits and vegetables c. a strong support system d. involvement in community activites

A 68 yo man who recently retired states he is not his usual self, has poor appetite and low energy. Physical findings were within normal limits. The priority nursing intervention is to a. encourage the patient to seek diversional activities b. assess the patient for depression c. ask the patient if he has access to firearms d. refer the patient to a dietitin for counseling

b. assess the patient for depression

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

b. avoidence of tobacco produts. Primary prevention refers to measures such as poper diet, suitable exercise and timely immunizations that prevent the occurence of a specific disease.

A characteristic of a chronic illness is that is (select all that apply) a. has reversible pathologic changes b. has a consistant predictable clinical course. c. results in permanent deviation from normal d. always starts with an acute illness and then progresses slowly.

c and d 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.

The family attorney informed a patient's adult children and wife tht the patient did not have advance directive after he suffered a serious stroke. Who is responsible for making the decision about EOL measures when the patient cannot communicate his or her wishes? a. Notary and attorney b. Physician and family c. Wife and and adult children d. Physician and nursing staff

c. Wife and and adult children In the event that the patient is not capable of communicating his or her wishes, the surrogate decision make, who is usually the next of kin (spouse or other family member), determines what measures will or will not be taken. the surrogate decision maker is responsible for making the final decision. The physician and nurse should discuss with surrogate decision makers what the options are.

A nurse has been working full time with terminally ill patients for 3 years. He has bee experiencing irritability and mixed emotions when expressing sadness since four of his patients died on the same day. To optimize the quality of his nursing care, he should examine his own a. full-time work schedule b. past feelings toward death c. patterns for dealing with grief d. demands for involvement in patient care

c. patterns for dealing with grief Caring for a dying patient is intense and emotionally charge, and nurses must be aware of how grief affects them. The nurse may have feelings of loss, helplessness and powerlessness when dealing with death. Feelings of sorrow, guilt, and frustration need to be expressed. recognizing personal feelings allows openness in exchanging feelings with the patient and family.

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

c. teaching positive health behaviors A high value should be placed on health promotion and positive health behaviors.

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. tret the patient as a competent manager of the disease. d. encourage the patient to "fight" the disease as long as possible.

c. treat the patient as a competent manager of the disease. 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 psychological consequences, and lifestyle changes in response to living with long-term disorder.

Signs of elder abuse can include all of the following except a. Bruising b. lacerations c. fractures in various stages of healing d. Elder expressing contentment with life

d. Elder expressing contentment with life and death A patient who expresses acceptance of worth and uniqueness of one's own life and accepts death, is showing integrity within Erikson's stage of development.

For the past 5 years Tom has repeatedly asked his mother to donate his deceasd father's belongings to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband. What type of grief is Tom's mother experiencing? a. Adaptive grief b. Disruptive grief c. Anticipatory grief d. Prolonged grief disorder

d. Prolonged grief disorder Prolonged grief disorder is prolonge, intense mourning and includes symptoms such as recurrent distressing emotions and intrusive thoughts related to the loss of a loved one, severe pangs of emotion, self-neglect, and denial of the loss for longer than 6 months.

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.

d. alter their daily living activities to accommodate new symptoms. Older adults may underreport symptoms and treat symptoms by altering their functional status.

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 teachings. d. emphasizes that a therapeutic diet does not allow for ethnic foods.

d. emphasizes that a therapeutic diet does not allow for ethnic foods. An older adult with strong ethnic and cultural beliefs may experience loss of self if nurses ignore ethnic and cultural practices and behaviors.

The primary purpose of hospice is to a. allow patients to die at home b. provide better quality of care than the family can c. coordinate care for dying patients and their families d. provide comfort and support for dying patients and their families

d. provide comfort and support for dying patients and their families Hosipice provides support and care at the end of life to help patients live as fully and as comfortable as possible. The emphasis is on symptom management, advance care planning, spiritual care, and family support, including bereavement.