Ch 9 Brunner PrepU

A client who is obese and the nurse have established a goal for the client to achieve a weight loss of 1 pound each week. One month later, the nurse evaluates that the client has lost 2 pounds. The nurse first states

"You have succeeded in making positive progress." Explanation: In the evaluation stage of the nursing process, the nurse validates even small increments toward goal achievement, as reflected in statement b. This is important for enhancement of client self-esteem and reinforcing client behavior. Change is a slow process, and success may be defined as making some progress. The nurse and client will then need to re-evaluate the goal, as in statement d, and either continue with the current goal, change the goal, or discontinue the goal. Statements a and c are negative criticisms and would diminish client self-esteem.

According to the U.S. Census (2010), what percentage of people are diagnosed with a disability

20 Explanation: The U.S. Census, last conducted in 2010, indicates that about 20% of people have a disability and 10% have a severe disability. The other numerical values are incorrect.

The nurse is performing an initial assessment of a client with a disability. The nurse should assess for which condition? Select all that apply.

Abuse Depression Explanation: Clients with a disability are at increased risk for physical, emotional, financial, and sexual abuse. The assessment should also include a screening for depression. The initial assessment of a client with a disability would not include an assessment for psychosis or bipolar disorder unless there client was exhibiting signs/symptoms or had a history of these disorders.

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 Explanation: 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.

The instructor provides corrective information to the nursing student when the student refers to the client as the

COPDer in 216 Explanation: "People-first" language means referring to the person first. Examples include patient who is disabled, man with an MI, and woman who has diabetes. Using "COPDer in 216" conveys that the illness or disability is of greater importance than the person.

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

Developmental Explanation: 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.

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

Identify self when walking into the client's room. State when the nurse is leaving the room. Orient the client to the room using a clock reference. Explanation: Suggestions when providing care to a client with low vision or blindness include identifying oneself to the client, stating when leaving the room, and orienting the client to the room. 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.

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 Explanation: It is important to all people, with and without disabilities, to not be equated with an illness or a physical condition. Therefore, it is important for health care providers to refer to all people using "people-first" language.

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. Explanation: When communicating with a client who has speech disabilities or difficulties, the nurse repeats what the nurse understands the client has stated for clarification. The nurse asks questions of the client who is able to provide information, not a family member. The nurse does not chart "unable to obtain the information." The client's situation could have changed since past medical records were written.

Which of the following is a characteristic of hardiness?

Sense of control over stress Explanation: A characteristic of hardiness is a sense of having control over sources of stress versus a feeling of helplessness, a commitment to something meaningful versus a sense of alienation, and the perception of life events as a challenge rather than a threat.

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 Explanation: In the Stable phase, the focus of nursing care is on reinforcing positive behaviors and offering ongoing monitoring. During the Pretrajectory phase, the focus is on referring the person for genetic testing and counseling, if indicated, and providing education about prevention of modifiable risk factors and behaviors. The trajectory onset phase provides explanation of diagnostic tests and procedures and reinforces information and explanation given by the primary health care provider. During the Unstable phase of the Trajectory Model, the focus of nursing care is on providing guidance and support and reinforcing previous teaching.

A nurse cares for a client with a chronic illness who has a diagnostic workup for the illness and announces the diagnosis to friends and family. According to the Trajectory Model of Chronic Illness, what phase is the client displaying?

Trajectory onset Explanation: According to the Trajectory Model of Chronic Illness, the trajectory onset phase includes the period of diagnostic workup and announcement of the illness. While the other answer choices are phases of the Trajectory Model of Chronic Illness, these are not the correct answer choices.

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

Trajectory onset Explanation: During the trajectory onset phase, a diagnosis is formulated and the patient begins to cope with the implications of the diagnosis.

A client experiencing a manic phase of bipolar disorder sustained cuts on the body from falling through a store window. The nurse is preparing to start an intravenous needle insertion. How should the nurse explain the procedure to the client?

Using clear and simple terms Explanation: When communicating with clients who have psychiatric or mental health disabilities, the nurses uses clear and simple communication. The nurse needs to listen to the client and wait for the client to finish speaking. The client makes independent decisions, and the nurse does not ignore the client's refusal.

The nurse is teaching a community group about emotions experienced with stress. What emotions will the nurse include in the teaching? Select all that apply.

helplessness anxiety inadequacy Explanation: The nurse will need to teach that people with stress often feel helpless, inadequate, anxious, angry, and powerless. Happiness and power are not seen with people experiencing stress.

A cause related to the increasing number of people with chronic conditions is

improved screening and diagnostic procedures. Explanation: The increasing number of people with chronic conditions is related to improved screening and diagnostic procedures. Mortality from infectious diseases has been decreasing. Chronic conditions tend to develop in the elderly population. People are living longer for various reasons.

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 Explanation: Chronic diseases or conditions are often defined as medical conditions or health problems with associated symptoms or disabilities that require long-term management. Some definitions use a duration of 3 months or longer, whereas others use a year or longer to indicate chronic disease. Definitions of chronic disease or chronic illness share the characteristics of being irreversible, having a prolonged course, and unlikely to resolve spontaneously (Lubkin & Larsen, 2013).

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need for which accomplishments? Select all that apply.

Alleviate and manage symptoms Validate individual self-worth Validate family functioning Explanation: The challenges of living with chronic conditions include the need to accomplish the following: alleviate and manage symptoms, validate individual self-worth and family functioning, manage threats to identity, and die with dignity and comfort.

A nurse identifies a nursing diagnosis of spiritual distress for a patient based on assessment of which of the following? Select all that apply.

Anger Ambivalence Despair Explanation: Spiritually distressed patients may show despair, discouragement, ambivalence, detachment, anger, resentment, or fear. They may question the meaning of suffering or life and express a sense of emptiness.

A client has a tentative diagnosis of lung cancer following computed tomography (CT) scanning. He is scheduled for a fiberoptic bronchoscopy with biopsy. In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse

Answers the client's questions about the bronchoscopy procedure Explanation: In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse provides explanations of diagnostic tests and procedures, such as the bronchoscopy with biopsy. The nurse will reinforce information and explanations provided by the physician.

Which statement is a misconception about chronic disease?

Chronic illnesses cannot be prevented. Explanation: A misconception regarding chronic disease is that chronic illnesses cannot be prevented. Almost half of chronic illness-related deaths occur prematurely in people younger than 70 years of age. Chronic illness typically does not result in sudden death. The major cause of chronic disease is known.

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 Explanation: In the dying phase of the Trajectory Model of Chronic Illness, the nurse provides direct care to the client and family through hospice programs. The other options are geared more toward the client who will respond to other treatments.

A nursing instructor is lecturing to the junior students about common misconceptions of chronic illness. The instructor asks the students to write down and share some misconceptions with one another. Which of the following are common misconceptions? Select all that apply.

Everyone has to die of something and so chronic illness should not be treated. Chronic diseases cannot be prevented. Chronic diseases mainly affect people who are rich. Explanation: Some common misconceptions about chronic illness include that because everyone has to die of something, there is nothing that can be done anyway; chronic diseases cannot be prevented; and chronic diseases mainly affect people who are rich (affluent). One truth about chronic illness is that 80% of deaths from them occur in low- and middle-income countries.

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 Explanation: Health-promoting behaviors, such as exercise, are essential to quality of life even in people who have chronic illnesses or disabilities, because they help to maintain functional status (Lubkin & Larsen, 2013).

A client is lethargic with a systolic blood pressure of 74, heart rate of 162 beats/min, and rapid, shallow respirations. Crackles are audible in the lungs. The nurse assesses frequently for which of the following? Select all answers that apply.

Increased paCO² levels Reports of chest pain Loss in consciousness Ecchymoses and petechiae Explanation: The client is in the progressive stage of shock. Continuation of shock leads to organ systems decompensating. The client will retain and exhibit increased levels of carbon dioxide. Because of the dysrhythmias and ischemia, the client may experience chest pain and suffer a myocardial infarction. As the client's lethargy increases, the client will begin to lose consciousness. Metabolic activities of the liver are impaired, and liver enzymes will increase.

A client who is an avid runner had an emergency below-the-knee amputation after a motor vehicle accident. The nurse hears a physical therapist tell the client that the client may have to stop running. The nurse considers this comment as an indication that the physical therapist has which frame of reference for caring for clients with disabilities?

Medical model Explanation: In this example, the physical therapist's frame of reference, or approach to providing care, stems from the medical model. By telling the client that she would need to stop running, the therapist equated the client with her disability, acted as the authority figure, and promoted the client's dependence, rather than allowing the client to define the problem and seek/direct solutions. Equating the client with the disability, acting as the authority, and promoting passivity and dependence are hallmarks of the medical model of disability.

The nurse is conducting a community education program on chronic illness. The nurse evaluates that additional education is needed when the participants make which of the following statements?

Out-of-pocket expenses for chronic illness are low. Explanation: The nurse determines that additional education is needed when the participants state that out-of-pocket expenses for chronic illness are low. Although the majority of patients with chronic illness have health insurance, out of pocket expenses are high and are increasing. Chronic illness is a leading cause of death and is on the rise in developing countries.

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 Explanation: The stable phase indicates that the symptoms and disability are under control or managed. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The comeback phase is the period in the trajectory marked by recovery after an acute period. The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.

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 Explanation: The nurse minimizes distractions so the client can focus on one thing, such as the physician who may impart important information. Distractions are having the television on, cleaning the room, and talking with someone else in the room. The nurse does not leave the room. The nurse remains so she can repeat information provided by or to the client.

A client has been diagnosed with diabetes and has received instructions about managing the disease. The client has undertaken an activity to improve quality of life and maintain functional status. The nurse recognizes this activity as

Walking at least one mile 5 days each week Explanation: Behaviors, such as exercise or walking, are essential to quality of life and maintaining functional status for a client who has a chronic illness. The other activities, such as ingesting low caloric foods, taking medications, and checking blood glucose level, relate to managing symptoms and avoiding complications.

The nurse is conducting a community education program on chronic illness. The nurse evaluates that additional education is needed when the participants make which statement?

"Out-of-pocket expenses for chronic illness are low." Explanation: The nurse determines that additional education is needed when the participants state that out-of-pocket expenses for chronic illness are low. Although the majority of clients with chronic illness have health insurance, out-of-pocket expenses are high and are increasing. Chronic illness is a leading cause of death and is on the rise in developing countries.

A client who is blind and has a guide dog is hospitalized. The nurse states

"What can I do to assist you in keeping your dog with you?" Explanation: Reasonable accommodations must be made for clients who have service animals that assist the clients with activities of daily living. The option that best meets reasonable accommodations is asking what can be done to assist the client. Healthcare facilities usually have policies about the responsibility of the nurse toward clients who have service animals. Nurses should become familiar with these policies. The policies usually include guide dogs are allowed, the client must provide someone to walk the dog, and the dog must be out of the way so the nurse can provide care. The dog does not need to be in the corner of the room.

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin and exenatide and reports adhering to a diet. The glycohemoglobin is 5.9%. According to the stable phase of the Trajectory Model of Chronic Illness, how should the nurse respond?

Acknowledges that the client is performing satisfactorily Explanation: In the stable phase of the Trajectory Model of Chronic Illness, the nurse reinforces positive behaviors. The glycohemoglobin is at a level of good control for a client with diabetes. No adjustments need to be made to the diet or the medications.

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

Acquired Explanation: Spinal cord injury is an example of an acquired disability. An acute nontraumatic injury is a stroke or myocardial infarction. Age-related disabilities include hearing loss, osteoporosis, and osteoarthritis. Cerebral palsy and muscular dystrophy are examples of developmental disabilities.

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 Explanation: Disabilities can be categorized as developmental disabilities, acquired disabilities, and age-associated disabilities. Developmental disabilities are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples of developmental disabilities are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy. Acquired disabilities may occur as a result of an acute and sudden injury (e.g., traumatic brain injury, spinal cord injury, traumatic amputation), acute nontraumatic disorders (e.g., stroke, myocardial infarction), or progression of a chronic disorder (e.g., arthritis, multiple sclerosis, chronic obstructive pulmonary disease, blindness due to diabetic retinopathy). A chronic disability is one that has a long disease course and is likely incurable. An impairment is a loss or abnormality of psychological physiologic, or anatomic structure or function at the organ level.

The client who has the chronic condition of diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. What phase of the Trajectory Model of Chronic Illness does the nurse assess this client is in?

Acute Explanation: In the acute phase of the Trajectory Model of Chronic Illness the client has severe and unrelieved symptoms or complications that necessitate hospitalization. The client's blood glucose level is high enough that hospitalization may be required. The pretrajectory phase is one in which lifestyle behaviors place a client at risk for a chronic condition. The stable phase is characterized by symptoms of illness being under control. The comeback phase is one in which there is a gradual recovery to an acceptable way of life.

When providing education to the patient with a chronic illness, what is a priority intervention for the nurse to perform?

Adapt teaching strategies and materials to the individual patient. Explanation: Educational strategies and materials should be adapted to the individual patient so that the patient and family can understand and follow recommendations from health care providers.

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. Explanation: The pre-trajectory phase involves the prevention of a chronic illness. For example, the focus of nursing care would be to refer the patient for genetic testing and counseling, if indicated, and provide education about prevention of modifiable risk factors and behaviors.

A client has been hospitalized with heart failure multiple times. The home health nurse is visiting the client with the overall goal of decreasing the frequency of hospitalizations. Using the nursing process, outline the steps the nurse would do in the correct order from 1 to 5.

Assesses the client's weight as 88 kg, 117% of ideal body weight Establishes the nursing diagnosis as Excess Fluid Volume Identifies a goal for the client to weigh 86 kg within 1 week Intervenes by teaching the client about weighing self every day Evaluates the client's weight as 86 kg 1 week later Explanation: The nurse uses the nursing process when providing care for clients, including clients with chronic health problems such as heart failure. The order of the nursing process is assessment, diagnosis, planning, implementation, and evaluation.

The nurse is working with a client with a chronic condition. The nurse includes which elements in the plan of care? Select all that apply.

Assessment for identity changes Interventions to manage symptoms Interventions to prevent complications Explanation: The nurse should assess for identity changes, plan interventions to manage the client's symptoms, and prevent complications of the chronic condition. Chronic conditions do not resolve spontaneously.

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 Explanation: Attitudinal barriers are barriers in which bias, mistaken beliefs, and prejudices impose limitations for people with disabilities. This client experienced no barrier to health care, no structural barrier, and no transportation barrier as currently defined.

The nurse provides corrective instruction to the nursing assistant when the assistant refers to the client as the

Blind diabetic patient Explanation: It is important to use "people-first" language, which means referring to the person first. Examples include person who is disabled, man with a stroke, and woman who has multiple sclerosis. Using "blind diabetic patient" conveys that the illness or disability is of greater importance than the person.

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

Cerebral palsy Explanation: Developmental disabilities are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples of developmental disabilities are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy.

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 Explanation: When establishing a goal, the nurse should collaborate with the client. The nurse does not dictate to the client what the goal will be. Goals must be consistent with the abilities and motivation of the client. The long-term and short-term goals may not be realistic for this client.

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

Comeback Explanation: The acute phase is characterized by severe and unrelieved symptoms or the development of illness complications necessitating hospitalization, bed rest, or interruption of the person's usual activities to bring the illness course under control. The crisis phase is characterized by a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed. The comeback phase is characterized by a gradual recovery after an acute period and learning to live with or overcome disabilities and return to an acceptable way of life within the limitations imposed by the chronic condition or disability. It involves physical healing, limitations stretching through rehabilitative procedures, psychosocial coming-to-terms, and biographical reengagement with adjustments in everyday life activities. The downward phase is characterized by rapid or gradual worsening of a condition, including physical decline accompanied by increasing disability or difficulty in controlling symptoms. It requires biographical adjustment and alterations in everyday life activities with each major downward step.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Despite various medication regimes, the client's symptoms are gradually increasing. The nurse realizes that this client is which phase of the Trajectory Model of Chronic Illness?

Downward Explanation: The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management. The unstable phase is characterized by development of complications or reactivation of the illness. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The dying phase is characterized by gradual or rapid shutting down of life-maintaining functions.

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 Explanation: 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.

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 Explanation: Improved screening and diagnostic procedures enable early detection and treatment of diseases, resulting in improved outcomes of management of cancer and other disorders. Lifestyle factors, such as smoking, chronic stress, and sedentary lifestyle, increase the risk of chronic health problems such as respiratory disease, hypertension, cardiovascular disease, and obesity. Longer lifespans are because of advances in technology and pharmacology, and a decrease in mortality from infectious diseases

A client had a previous myocardial infarction and has been experiencing angina from occluded coronary arteries. What teaching should the nurse provide in the stable phase of the Trajectory Model of Chronic Illness?

Encourage the family to support the client's exercise plan. Explanation: The focus for the nurse in the Trajectory Model of Chronic Illness phase should be to provide explanations of diagnostic tests and procedures, reinforce information and explanations given by the primary provider, and provide emotional support to the patient and the patient's family. Discussion of surgical techniques, collaboration with the health care team, and discussion of end-of-life preferences are activities in other phases of the Trajectory Model of Chronic Illness.

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 Explanation: Certain illnesses require advanced technology for survival, or intensive care for periods of weeks or months, as in end-stage renal disease (ESRD). People with this condition are chronically critical and progressively ill. Some chronic illnesses have little effect on quality of life, but others, like ESRD, have a considerable effect because it can result in a chronic progressive deterioration.

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.

Immobility Anemia Increased moisture Explanation: Risk factors associated with pressure ulcer development include immobility, decreased sensory perception, anemia, decreased tissue perfusion, and increased moisture.

A client who is legally blind had orthopedic surgery 3 days ago and wants to urinate. She is using a walker for ambulation. It would be best for the nurse to

Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode. Explanation: When the nurse offers seating to a client with low vision or blindness, the nurse should place the client's hand on the arm of the chair. This helps to guide the client in sitting. Though placing the bedside commode next to the bed is a good idea, it is not the best choice. The nurse will encourage the client to use the bedside commode, not the bedpan, for better emptying of the urinary bladder.

A client has chronic obstructive pulmonary disease (COPD). He researches information on the internet about COPD, seeking out new treatments and medications. The client frequently asks his physician and nurse about the new ways of treating his disease. This type of client behavior is seen in which type of model of disability?

Interface model Explanation: In the interface model of disability the client seeks or directs solutions to the problem.

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. Explanation: Chronic illnesses are often defined as medical illnesses or health problems with associated symptoms or disabilities that require long-term management (3 months or longer). Chronic illness refers to diseases that are caused by non-reversible pathology; are characterized by a slow progressive decline in normal physiological function; are permanent with cure unlikely; and require long-term surveillance, leaving residual disability.

A nursing instructor is discussing characteristics of chronic illness with a class. The instructor asks the students to name one characteristic. Which of the following answers is correct?

Managing chronic conditions must be a collaborative process. Explanation: Managing chronic conditions must be a collaborative process. Chronic illness does affect the entire family to the extent that family life can be dramatically altered. One chronic disease can lead to the development of other chronic conditions. Chronic conditions usually involve many different phases over the course of a person's lifetime.

Which statement provides accurate information related to chronic illness?

Most people with chronic conditions do not consider themselves sick or ill. Explanation: Most people with chronic conditions do not consider themselves sick or ill and try to live as normal a life as possible. Research has demonstrated that some people with chronic conditions may take on a "sick role" identity, but they are not the majority. Chronic conditions may be due to illness, genetic factors, or injury. Many chronic conditions require therapeutic regimens to keep them under control.

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 Explanation: Obesity, caused by an improper diet and physical inactivity, is the major cause of pre-diabetes.

A client who is blind is hospitalized for hip surgery. The nurse notices that the containers on the client's lunch tray are unopened, the client is fumbling with items, and food is on the front of the client's gown. The nurse assists the client by

Opening containers and orienting the client to placement of items on the tray Explanation: During hospitalization clients with pre-existing disabilities may require assistance with activities of daily living that they may be able to manage at home. For clients who have impaired vision, it is necessary to orient them to the environment to assist with their independence. The option that best meets these criteria is the nurse opening containers for the client and telling the client where items are found on the tray.

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. Explanation: The nurse should work with the client and family to identify ways to implement the treatment regimen. The nurse does not tell the client what the client must do. The other options may be appropriate interventions for this client, but these would not be the next step.

The nurse is providing teaching for a client in a wheelchair. How will the nurse provide teaching?

Sitting down in a chair during the teaching. Explanation: In order to appropriately care for a client in a wheelchair, the nurse should sit at the client's eye level, in a chair during the teaching. Standing next to the client in a wheelchair may be intimidating to the client. There is not any information in the question to indicate that the client needs an alternative communication device or modified teaching materials.

The nurse is caring for a client with COPD who was recently admitted to the hospital with an acute exacerbation of the illness. What indicates to the nurse that the client is in the comeback phase of the Trajectory Model of Chronic Illness?

The client gradually returns back to an acceptable way of life within the limits imposed by the illness. Explanation: In the comeback phase of the Trajectory Model of Chronic Illness, the client gradually returns back to an acceptable way of life within the limits imposed by the illness. The acute phase has unrelieved symptoms that result in the interruption of the client's everyday life activities. In the stable phase, the illness course and symptoms are under control and the client's everyday life activities are managed. In the trajectory onset phase, the client begins to cope with implications of the illness.

Which of the following describes the crisis phase of the trajectory model of chronic illness?

The client is experiencing a critical or life-threatening situation requiring emergency treatment. Explanation: The crisis phase is characterized by a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed. The stable phase is when the illness course and symptoms are under control. The unstable phase may require more diagnostic tests. The dying phase is the period in the trajectory marked by the final days or weeks before death and characterized by gradual or rapid shutting down of body processes.

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. Explanation: Clients who experience a chronic illness may stop taking medications or alter dosages of medications due to side effects that they consider more disturbing or disruptive than the chronic illness. Many clients and their families have the chronic illness become the focal point of their life. For many clients, the effects of the chronic illness threaten identity and body image. Clients have difficulty adhering to a therapeutic regimen due to the realities of daily life and culture, values, and socioeconomic factors.

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 finger spelled. Explanation: If a nurse is speaking through a sign language interpreter, the interpreter may lag a few words behind-especially if names or technical terms are to be finger spelled. So the nurse should pause occasionally to allow the interpreter time to translate completely and accurately. The facility should provide an interpreter for the client with a disability. Family members should not serve as interpreters due to concern for misinterpretations of information and the need to maintain client privacy and confidentiality. The nurse should talk directly to the person who has hearing loss, not to the interpreter. However, although it may seem awkward, the person with hearing loss will look at the interpreter and may not make eye contact with the nurse during the conversation

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. Explanation: Management of chronic conditions is a process of discovery. Chronic illness affects the entire family to the point that family life can be dramatically altered. Managing chronic conditions must be a collaborative process. Chronic conditions usually involve many different phases over the course of a person's lifetime. Chronic illness involves not only treating the medical problems but may also include the psychological and social problems

The number of people with disabilities is expected to increase over time. What is a major contributor to this prediction?

The survival of people with severe trauma, chronic disorders, and early-onset disabilities Explanation: The number of people with disabilities is expected to increase over time as people with early-onset disabilities, chronic disorders, and severe trauma survive and have normal or near-normal lifespans. There has not been a decrease in the number of people with early-onset disabilities. Acquired chronic disorders still cannot be cured. Genetic risk factors for early-onset disabilities have not decreased.

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

Unstable Explanation: The unstable phase is characterized by an exacerbation of illness symptoms, development of complications, or reactivation of an illness in remission. The pretrajectory phase is described as the genetic factors or lifestyle behaviors that place a person or community at risk for a chronic condition. In the stable phase the course and symptoms of illness are under control, as symptoms, resulting disability, and everyday life activities are being managed within the limitations of the illness. The crisis phase is a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed.