MED SURG. Chapter 9

The nurse is caring for an adult paraplegic with an ostomy. Which of the following would be an appropriate statement for the nurse to make?

"Do you need assistance managing your ostomy?"

The nurse is planning community education on the prevalence and incidence of disabilities in the United States. The nurse includes that according to the U.S. Census (2010), what percentage of people are diagnosed with a disability?

20

The nurse is caring for a patient who had a stroke and has right-sided hemiparesis. The patient is receiving physical therapy that will continue when discharged through home health care services. After what minimum period of time could this patient's medical condition be termed chronic?

3 months

Down syndrome is categorized as which of the following?

A developmental disability

Spinal cord injury is an example of which type of disability?

Acquired

A nurse practitioner would be applying the pre-trajectory model of chronic illness when she:

Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing.

Which act mandates that people with disabilities have access to job opportunities and to the community?

Americans with Disabilities Act of 1990

A client has lung cancer and underwent chemotherapy and radiation treatment. The tumors continue to grow and have metastasized. The nurse assesses the client is in the dying phase of the Trajectory Model of Chronic Illness. The nurse

Assists with arranging hospice care for the client

A nurse is assigned to work with a client who has a disability. The nurse believes that all people with disabilities have a poor quality of life and are dependent and nonproductive. What type of barrier will this client experience?

Attitudinal barrier

The nurse recognizes which disorder as a developmental disability in a patient?

Cerebral palsy

The nurse is caring for a client with diabetes. Which of the following is a characteristic of chronic illness?

Chronic illness affects the entire family.

Which of the following statements is a misconception about chronic disease?

Chronic illnesses cannot be prevented.

The nurse is working with a client who has difficulty controlling her blood sugar. The overweight client does not adhere to a low-calorie diet and forgets to take medications and check her blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, the nurse first

Collaborates with the client to establish an agreed-upon goal

Which phase of the Trajectory Model does the nurse recognize is present when the patient is in remission, after an exacerbation of illness?

Comeback

A client who is blind is admitted for treatment of a small bowel obstruction and has been vomitting for days. Which nursing diagnosis takes highest priority for this client?

Deficient fluid volume

A graduate nurse is assigned to care for a client with an acute exacerbation of chronic obstructive pulmonary disease. The client also has Down syndrome. During the shift, the nurse discovers that the clent lives alone and holds a full-time job. Which type of disability would the nurse state the client has?

Developmental

Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability?

Developmental Examples of developmental disabilities are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.

After multiple treatment plans, a client with cancer has been told that the tumors continue to grow and have metastasized. The nurse is assisting with arranging hospice care for the client. The nurse assesses the client is in which phase of the Trajectory Model of Chronic Illness?

Dying

Which phase of the trajectory model of chronic illness is characterized by the gradual or rapid decline in the trajectory despite efforts to halt the disorder?

Dying

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause?

Early detection and treatment of diseases

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.

End-stage renal disease

Which aspect of a healthy lifestyle can the nurse encourage a patient to improve that can significantly enhance quality of life with a chronic condition?

Exercise

A cause related to the increasing number of people with chronic conditions includes which of the following?

Improved screening and diagnostic procedures

A nurse is performing a functional ability assessment for a rehab patient prior to discharge. What tool would the nurse most likely use?

Katz Index of Independence in ADLs

Which of the following is a true statement regarding characteristics of chronic conditions?

Managing chronic conditions must be a collaborative process.

Which of the following statements describes accurate information related to chronic illness?

Most people with chronic conditions do not consider themselves sick or ill.

A nurse prepares a diabetes prevention health seminar for community residents. Her teaching points should emphasize the most important factor influencing metabolic syndrome (pre-diabetes). What is that factor?

Obesity

A nurse is talking on the phone with a doctor and states, "I am calling you about Mrs. Nye, my client with cancer in room 213." This is an example of what type of language that is important to all people?

People-first

The most important health-promoting behavior that can prevent chronic illness or significantly improve the quality of life for those with a chronic condition is:

Physical exercise.

A client has lost mobility following a stroke. The nurse has established interventions that include providing direct care to the client, teaching, making referrals, and managing the case, to meet the goal. The next step is to

Plan with the client how to incorporate the regimen into the client's activities of daily living.

A patient who is at risk for developing a chronic condition because of genetic factors is said to be in which phase of the Trajectory Model?

Pretrajectory

The client had a cerebrovascular accident with drooping of the face. Speech is slurred. The nurse is obtaining the admission assessment data. It would be best for the nurse to

Repeat back what the client states.

During which phase of the Trajectory Model of chronic illness is the focus of nursing care on reinforcing positive behaviors and offering ongoing monitoring?

Stable

The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate?

Stable

A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness:

The client stops taking some medications due to side effects that are disturbing to the client.

A client with impaired hearing communicates through sign language and has been admitted to the unit before scheduled surgery. The interpreter that the hospital employs is at the bedside. The nurse needs to take what actions into consideration prior to doing preoperative teaching with this client?

The interpreter may lag a few words behind--especially if names or technical terms are to be fingerspelled.

The nurse forms a nursing diagnosis during which phase of the trajectory model of chronic illness?

Trajectory onset

A client is hospitalized with a traumatic brain injury following an automobile accident. The client has difficulty processing information and needs information to be repeated. A consulting physician enters the room. The nurse

Turns off the television

Which phase in the trajectory model of chronic illness is characterized by the reactivation of an illness in remission?

Unstable

An elderly female cient who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse

Acknowledges the client's achievement when she walks to the bedside commode with her walker

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin (Glucophage) and exenatide (Byetta) and reports adhering to her diet. The glycohemoglobin is 5.9%. In the stable phase of the Trajectory Model of Chronic Illness, the nurse

Acknowledges to the client she is performing satisfactorily

An elderly male client was in an automobile accident 2 weeks ago and incurred a spinal cord injury with resulting paralysis. The nurse assesses this disability as

Acquired An acquired disability results from an acute and sudden injury, such as trauma to the spinal cord. The paralysis may be temporary. It may not be known to be permanent until swelling in the spinal cord has decreased. This may take weeks to months. A developmental disability is one that occurs prior to age 22 years. An age-related disability occurs in the elderly population as a result of the aging process.

A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have?

Acquired disability

A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as

Downward The downward phase of the Trajectory Model of Chronic Illness is characterized by a worsening of the client's condition with alterations in everyday activities. The stable phase is one in which the client's symptoms are under control. The acute phase is characterized as severe and unrelieved symptoms necessitating hospitalization, bedrest, or interruption of the client's usual activities to bring the disease under control. The crisis phase is one in which the situation is critical or life-threatening and requires emergency care.

Which model views disability as a problem of the person?

Medical The medical model equates disabled people with their disability and views disability as a problem of the person, directly caused by disease or trauma that requires medical care. The interface model is based on the life experiences of the person with a disability and views disability at the intersection of the medical diagnosis of disability and environmental barriers. The rehabilitation model regards disability as a deficiency that requires a rehabilitation specialist or other helping professional to fix the problem. The social model views disability as socially constructed as a political issue that is a result of social and physical barriers in the environment.

Chronic illness can be monitored using the Trajectory Model. In what phase can the nurse's nursing diagnosis help in care planning?

Trajectory

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need to accomplish the following. Choose all that apply.

• Alleviate and manage symptoms • Validate individual self-worth • Validate family functioning

A 36-year-old mother of three was recently diagnosed with a chronic illness. The nurse prepared information for the patient on how to manage her illness. To help her cope with the shock and resentment that she was experiencing, the nurse gave her facts about her illness with honesty and empathy. Which of the following are the best comments that the nurse can include when talking to the patient about chronic illness? Select all that apply.

• It is characterized by a progressive decline in normal physiologic function • It can be associated with exacerbations and remissions. • It results in residual disability due to non-reversible pathology.

Clients must contend with chronic illness daily. Nurses relate more effectively to clients when they understand the following as characteristics of chronic illness. Choose all that apply.

• The management of chronic conditions is a process of discovery. • Managing chronic conditions must be a collaborative process. • Chronic illness affects the entire family.