CH 19 Community
A nurse overheard an adult woman, shaking her head in exasperation as she said, "Dad, you're being unreasonable. It's not safe!" Which is the most likely reason for this argument? a. The dad wants to keep driving. b. The dad wants to keep cooking his own meals. c. The dad wants to keep taking care of himself each day without assistance. D. The dad wants to marry some young woman who may just want his money.
A One of the quality-of-life factors that is important to seniors is the ability to drive. Many older adults depend on driving in order to maintain independence and personal mobility. Age-related declines in vision, hearing, and other abilities as well as certain medical conditions and medications can affect driving skills. Thus, safety is a concern for any elderly driver. This safety concern outweighs the other concerns of cooking one's own meals, providing self-care, and marrying a younger woman.
A woman said, "I've never been retired before. I didn't plan it but it's OK. I'm still doing what I used to do otherwise; I go to church, make quilts for charity, and babysit my grandkids. Do you think I should be trying to find another job for a few years?" Which would be the most appropriate response by the nurse? A. "For lots of people, retirement, even if unplanned, is much like life has always been." B. "It's okay to slow down at your age; why look for problems?" C. "You really need to get out of your house more and be more active, even if you don't get paid at the position." D. "Without a job, you really don't have an identity. Have you been to the unemployment office?"
A The continuity theory of aging suggests that a person continues through life in a similar fashion as in previous years. Because the woman stated she is doing what she has previously done, and has not suggested any particular problems other than concern that what she is doing is acceptable behavior, she should be supported. The statement that best supports her decision states that retirement life is much like life has always been. The other statements do not support her current satisfaction with her activities in her life.
Which group would most need adult daycare services? A. Caregivers who work all day B. Elderly who are bored staying home alone C. Elderly in whom Alzheimer's has been diagnosed D. Older men who want an opportunity to meet older women E. Older women who want to engage in arts and crafts activities
ANS: A Adult daycare provides a safe and supportive environment during the day for adults who cannot or choose not to stay alone. This service is often needed by caregivers who work during regular hours or need respite.
I don't understand," a woman said. "I know I'm eligible for Medicare part A and it's free. Part B isn't free. When will I ever use it?" Which would be the most appropriate response by the nurse? A. "Part A is only for hospital bills. Most care is given on an outpatient basis. Part B pays a large portion of those costs." B. "Part A is a benefit because you paid into Social Security for more than 10 years. In comparison, part B is optional if you want that additional insurance." C. "Part B is easy to pay for; they take the cost out of your Social Security check each month." D. "Researchers have found that people don't waste health care resources if they have to pay a bit for them.
ANS: A All the responses are true, although the woman may not care about research findings. Further, she may well prefer the money from her Social Security benefit to be paid to her rather than go for additional insurance. However, the reason the woman needs to know why she should pay for part B is that so much care today is given on an outpatient basis, including diagnostic procedures, physicals, speech and occupational therapy, ambulances, durable medical equipment, and some home health care services.
Which is the most common reason for visual impairment in older adults? A. Cataracts B. Glaucoma C. Macular degeneration D. Presbyopia
ANS: A Among older adults, the three most common pathological eye conditions are cataracts, macular degeneration, and glaucoma. Cataracts are the leading cause, as well as the most reversible cause, of visual impairment in older adults. A cataract is a clouding of the normally clear lens of the eye. Presbyopia, loss of elasticity of the lens of the eye causing difficulty with near vision, generally occurs in the 40s.
17. A nurse explained that the elderly are twice as likely to die in a home fire as younger persons and therefore suggested some safety measures. Which strategy would most likely have been suggested by the nurse? A. Have smoke detectors installed in the house B. Invite a family member to sleep in the house at night C. Practice escaping quickly from the house in case of an emergency D. Program your phone so the fire department can be reached by pushing only one
ANS: A Community health nurses making home visits can assess their elderly client's home for fire risk and teach fire safety, including the importance of home smoke detectors and fire extinguishers. Inviting family members to spend the night, practicing a quick escape, and programming one's phone for the fire department are irrelevant if a smoke detector is notinstalled to alert the elderly client that there is a fire in the home.
My health problems are too much to handle," said an elderly woman at her annual clinical checkup. "What's most important for me to do?" Which would be the most appropriate response by the nurse? A. "Focus on eating properly and staying active." B. "Get the shingles immunization along with your flu shot this year." C. "Keep active mentally—do you do crossword puzzles or Sudoku puzzles?" D. "Stay involved with others. Do you ever go to the senior citizens center?"
ANS: A Health care professionals must inform and educate elders about the benefits of health care screenings and examinations, physical activity and fitness, and good nutrition. As the woman was already getting an annual checkup, the nurse should stress nutrition and exercise.
In the supermarket checkout, a young woman complained to her friend, "Old people think we taxpayers should pay for them to be in a nursing home. Seems like a waste of money." Which would be the most appropriate response by the nurse? A. "Did you know more than 90% of all the elderly live in their own homes while fewer than 5% live in care facilities?" B. "Those old people built our society; we owe it to them to support them now." "C. Would it be better to put each person to sleep when they reach a certain age such as 80 years?" D."You know, you'll get old someday too. Won't you want someone to take care of you when you can't anymore?"
ANS: A In 2013, 93% of the Medicare population aged 65 years and older resided in traditional community settings. Three percent resided in community housing with at least one service available, and approximately 4% resided in long-term-care facilities. The other responses do not support a therapeutic response by the nurse in this situation.
An elderly gentleman was shoveling his snow when you arrived for a home visit. You notice that when he comes inside he is very pale, is shivering, and seems a bit confused. His skin is very cold when you touch it. Which action would be most appropriate for the nurse to take first? A. Apply warm moist towels to his head, neck, chest, and groin B. Give him hot coffee with sugar to drink C. Have him get in a tub of very hot water immediately D. Call 911
ANS: A Initial management is to prevent further loss of heat. Rewarming of the core temperature at a safe, slow rate is important to avoid lethal side effects. The reason for rewarming the core first is to prevent vasodilation that would place the individual in ventricular fibrillation. Measures that can be taken are: (1) remove the individual from the cold area as soon as possible; (2) add more clothing, especially to the head (e.g., use a hat or scarf); (3) provide a warm sweetened drink (no coffee or tea); and (4) apply mild heat to the head, neck, chest, and groin areas using hot water bottles or warm moist towels. Medical help is imperative, and hospitalization may be needed depending on the stage of hypothermia.
An ambulance medic reported a client was on the way with a traumatic brain injury (TBI). Which symptom would the nurse expect this client to display? A. Blurred vision and a headache B. Hypotension and tachycardia C. Irregular heart rate D. fecal incontinence
ANS: A TBI symptoms may be mild, moderate, or severe. Symptoms of mild TBI include headache, confusion, light-headedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, and a change in sleep patterns or thinking. Moderate or severe TBI may demonstrate the same symptoms as mild TBI plus a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. The other symptoms are not indicative of TBI.
A daughter tells the nurse that her mother is frequently confused, but what is really upsetting is that she is incontinent during the night. "All I do is watch her and wash sheets," the daughter says. Which suggestion should the nurse provide to the daughter? A. Explain about respite care or the need to ask other family members to help so the daughter can have some time off. B. It's time to have her mother go into a nursing home where they can give her the care she needs. c. Refer the daughter to Adult Protective Services so responsibility for her mother's care may be assumed by an agency prepared for such tasks. d. Teach the daughter how to establish a toileting routine for the mother to help control the incontinence.
ANS: A The best approach—because the daughter is willing to share her feelings with you—is to see whether there is anyone else in the family to help so the daughter can be less overwhelmed. If the mother has Alzheimer's, any number of resources are available for respite for the caregiver, support groups for both client and family, and daycare facilities for the client. Adult Protective Services assists in cases of abuse. The daughter is stressed and may become an abuser if assistance is not found. A toileting routine would probably not be successful during the night. Although a nursing home is possible, many families cannot afford such care or do not want a family member sent there.
A nurse completed the health assessment but needed to use the elderly woman's bathroom. The nurse noticed perineal pads under the sink. Which question would the nurse most likely ask the woman? A. "Can you tell me why you need to have perineal pads?" B. "Do you know how to do Kegel exercises to help control your urine?" C. "Does another woman live with you or visit often?" D. "Why do you have perineal pads? Are you bleeding down there?"
ANS: B Because the woman did not mention incontinence, it may be assumed to be very embarrassing. Therefore, the nurse should matter-of-factly address urine control problems by suggesting a self-help intervention of Kegel exercises. It may be assumed that the nurse, having completed a health assessment, would know about bleeding, as well as frequent visitors or family nearby.
Which best describes why grandparents would be the primary caregivers for their grandchildren? A. Because they fell in love with the newborn and wanted that small person to be a part of their lives B. Because the parents were drug abusers or in the prison system C. Raising a grandchild is easier because grandparents have already been experienced parents D. Raising a child gives purpose to life for the grandparents
ANS: B Many older adults are faced with raising their grandchildren, often without the presence of the grandchildren's parents. Reasons include neglect related to parental substance abuse, abandonment, emotional and physical abuse, parental death, mental and physical illness, incarceration, teen pregnancy, and grandparents' assisting adult children who work or attendschool.
"Do you have any advice?" a young woman asked. "I'm eating lunch with my dad but he can't hear and he won't wear his hearing aid." Which suggestion should be made by the nurse? A. Encourage your dad to wear his hearing aid—if only for you B. Find a very quiet place with good lighting and very little background noise for lunch C. Repeat yourself several times using exactly the same words and gestures D. Talk very loudly while facing him directly
ANS: B Suggestions include to find a quiet place to talk to help reduce background noise, especially in restaurants and social gatherings; stand in good lighting and use facial expressions or gestures to give clues; face the person and talk clearly; speak a little more loudly than normal, but do not shout; and repeat yourself if necessary, using different words.
Which best explains why all family members should want their aged relatives to have a living will? A. To confirm that the attorney is serving as guardian and family members do not have to be responsible B. To fulfill the federal Patient Self-Determination Act requirements C. To help family members know what their loved one does or does not want if he or she becomes incapacitated D. To keep physicians from writing a do-not-resuscitate order
ANS: C A living will is a legal document that allows individuals to specify what type of medical treatment they would or would not want if they became incapacitated or had an irreversible terminal illness. Living wills can direct physicians to withhold life-sustaining procedures and can assist family members in making decisions when they are unable to consult a comatose or medically incompetent relative. The purpose of a living will is not to appoint an attorney as a guardian. The Patient Self-Determination Act requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess an advance directive; it does not require that patients complete one.
Which is the most useful way to discuss aging? A. By divisions—young-old, middle-old, old-old, and elite-old B. Chronological age C. Functional age D. Number of chronic comorbidities
ANS: C Functional age refers to functioning and the ability to perform activities of daily living, such as bathing and grooming, and instrumental activities of daily living, such as cooking and shopping. This definition of aging is a better measure of age than chronological age. After all, most older adults are more concerned with their functional ability than their chronological age. Assisting older adults to remain independent and functional is a major focus of nursing care.
A nurse is making the first home visit to a recently discharged elderly client. Which should the nurse most likely expect to find? A. A client who is unhappy with the disorganization of the house B. A client who will expect the nurse to do everything now that the nurse is at his or her house c. A client who may have hearing or vision problems or both D. A client who is upset with being discharged while still so ill and having to take on problems at home
ANS: C Sensory disabilities increase with age and may seriously affect an older person's quality of life and ability to carry out routine daily activities. The NHI Survey found that 7.3 million noninstitutionalized American adults 65 years and older reported significant vision loss. One in three adults 65 to 74 years of age and nearly half of adults 75 years old or older have difficulty hearing. Thus, the nurse should be anticipating the needs of the client rather than being concerned about the potential factors that the client may be upset about.
A man stated, "I used to work out at the exercise room at work, but now that I'm retired I sit and watch TV. My wife keeps nagging me to do something. What do you think I should be doing at my age?" Which would be the most appropriate response by the nurse? A. "I think you should try to please your wife. What is it she wants you to do?" B. "It's okay to slow down at your age; why look for problems?" C. "You should try to exercise just as you did before. Is there a YMCA or club nearby?" D. "You've worked all your life; you have a right to rest now."
ANS: C The activity theory posits that activity is necessary to maintain life satisfaction. Physical activity is beneficial for the health of people of all ages, including older adults. Therefore, because the man has previously been physically active, he should continue to be physically active to maintain satisfaction with his life.
A nurse needed to do a quick assessment of a client's lifestyle behaviors to counsel appropriately. Which strategy would be the easiest way to determine the elderly woman's nutritional status? A. Ask the woman to keep a food diary for 2 weeks and bring it to the clinic B. Have the clinic dietitian interview the woman about her eating habits C. Quiz the woman verbally as to her usual meals during the day D. Use the DETERMINE mnemonic
ANS: D All the responses are good approaches. However, the nurse should take a broad view of what assets or barriers are involved in relation to nutrition. A nutrition checklist, described by the mnemonic DETERMINE, reviews warning signs and risk factors of poor nutritional health.
Which is an example of a nonstochastic theory of aging? A. Cross-link theory B. Error theory C. Free radical theory D. Immunologic theory E. Somatic mutation theory F. Wear and tear theory
ANS: D All the theories except one are stochastic theories, that is, theories that are based on the assumption that events occur randomly and accumulate over time, which results in aging. The only nonstochastic theory, which views aging as predetermined, is the immunologic theory.
A wife, who had just come home after major abdominal surgery, explained to the home health nurse that she was really worried about her husband. He had not been sleeping well or eating well, seemed to have no energy, and did not seem to enjoy anything including activities he used to love. Which suggestion should the nurse give to the client? A. Ask what medications the husband is taking, because many medications can affect mood B. Explain her husband has probably been worried sick about her and the surgery, and she should reassure him frequently that she is OK C. Point out that many people get sad during the winter months and he should be fine when spring arrives, but in the meantime put full-spectrum light bulbs in all the household lamps d. Share that her husband seems depressed and that they should see his doctor immediately
ANS: D Depressed people may experience several or all symptoms: changes in appetite or weight; changes in sleep patterns, restlessness, loss of energy, feelings of worthlessness or guilt; and repeated thoughts of death or suicide. If any of these symptoms exist, the client should be referred to a physician for diagnosis. A physician can only make a diagnosis of clinical depression in the presence of five or more of the symptoms mentioned above.
Which accounts for the largest source of per capita family income? A. Employment income B. Pensions C.Savings D.Social Security
ANS: D In 2014, the median household income of older adults was $36,895. Aggregate income for the population aged 65 years and over came largely from four sources: Social Security, earnings, pensions, and asset income. Social Security accounted for 49% of per capita family income. Among older Americans in the lowest fifth of the income distribution, Social Security accounted for 67% and earnings accounted for 13% of per capita family income, and public assistance accounted for 8%. For those in the highest fifth of the income distribution, Social Security accounted for 18% of per capita family income, pension income accounted for 26%, and earnings accounted for 40%.
A male nurse is enjoying a very hot summer day at the zoo when he notices a family approaching. An elderly member of the family is moving very slowly and being scolded by another adult, saying "You are not sick. Let's keep moving." The nurse touches the elderly adult who has a flushed face and notices clammy and moist skin. What should the nurse say to the adult? a. "I'm a nurse, and your family member needs to go to the emergency department right now." B. "I'm a nurse, and your family member has heat stroke. I'm calling 911." C. "Take your family member to the air-conditioned restaurant, and have him drink a cold soda immediately." D. "Take your family member to the air-conditioned restaurant, and let your family rest for a while."
ANS: D There is not enough evidence to be quite sure what is wrong with the elderly adult, but clearly the elderly person is suffering from being in the hot sun for a period of time. The elderly adult—and probably the rest of the family as well—needs to be moved to a cooler environment and be made to lie down and rest. Drinking chilled water (not soda with caffeine) would also be helpful. In that cooler environment, the nurse can assess the situation to determine whether further action should be taken.
A wife explained to the nurse that her husband was becoming awfully forgetful, and now he's started getting lost on the way home from the golf club. She's scared he may be getting Alzheimer's disease. Which would be most appropriate action for the nurse to take? A. Ask the husband to explain why he thinks he got lost coming home B. Explain that all elderly persons get a little forgetful and not to worry C. Ask the husband to count backwards by 7 from 100 D. Hand the husband pencil and paper and ask him to draw a clock
D Clients with Alzheimer's disease are unable to draw a normal clock. The clock drawing test has become one of the most widely used screening instruments in clinical and research settings. It has been found to be an effective and easy-to-administer tool to screen for dementia. This should be the first action taken by the nurse to screen the client for Alzheimer's disease and take appropriate action as necessary.
A son explained to the home health nurse that since his mother died, his father did not seem to have any interest in life and had even told his son he was considering suicide. Which would be the most appropriate response by the nurse? A. "If he really wants to kill himself, he will, and there really isn't anything you can do to stop him." B. "If you talk to him about it, you're strengthening the idea." C. "People who talk about suicide rarely do it, so don't worry." D. "Suicide is a serious concern; let's talk to his doctor about what you've noticed."
D Suicide is a serious health concern. Elder suicide is associated with depression, chronic illness, physical impairment and conditions that significantly limit functioning or life expectancy, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Warning signs to watch for in the elderly are loss of interest in things or activities that are usually found enjoyable; social isolation; self-care neglect; not following medical regimens (e.g., going off diets, not taking prescriptions); experiencing or expecting a significant personal loss (e.g., death of spouse or friend); feeling hopeless or worthless; putting affairs in order; giving things away; making changes in a will; and stockpiling medications or obtaining other lethal means for committing suicide. The most significant warning sign is any expression of intent. Because the father is at high risk for suicide, the son must discuss the problem with the father's physician so that care can be obtained.
