Chapter 5 - Chronic Illness and Older Adults

A 70-year-old man has just been diagnosed with chronic obstructive pulmonary disease (COPD). At what point should the nurse begin to include the patient's wife in the teaching around the management of the disease? a) As soon as possible b) When the patient requests assistance from his spouse and family c) When the patient becomes unable to manage his symptoms independently d) After the patient has had the opportunity to adjust to his treatment regimen

a

An appropriate care choice for an older adult living with an employed daughter but who requires assistance with activities of daily living is: A. Adult day care B. Long term care C. A retirement center D. An assisted living facility

a

The home care nurse is visiting an older female client whose husband died 6 months ago. Which behavior by the client indicates ineffective coping? a. neglecting her personal grooming b. looking at old snapshots of her family c. participating in a senior citizens' program d. visiting her husband's grave once a month

a

When interviewing an elderly patient, it would be most appropriate for the nurse to a) Ensure all assistive devices are in place. b) Interview the patient and caregiver together. c) Perform the interview before administering analgesics. d) Move on to the next question if the patient does not respond quickly.

a

Which of the following criteria must an older adult meet in order to qualify for Medicare funding? a) A documenting improvement in function b) A documented absence of family caregivers c) A validated need for long-term residential care d) A history of failed responses to standard medical treatments

a

The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated the skin of this client? a. crusting b. wrinkling c. deepening of expression lines d. thinning and loss of elasticity in the skin

a, normal changes that occur include thinning, and loss of elasticity in the skin, wrinkling, and deepening of expression lines

Examples of primary prevention strategies include: a. colonoscopy at age 50 b. avoidance of tobacco products c. intake of a diet low in saturated fat in a pt with high cholesterol d. teaching the importance of exercise to a pt with hypertension

b

Which of the following are normal age related physiological changes? Select all that apply a. increased heart rate b. decline in visual acuity c. decreased respiratory rate d. decline in long term memory e. increased susceptibility to urinary tract infections f. increased incidence of awakening after sleep onset

b, e, f

Ageism is characterized by: a. denial of negative stereotypes regarding age b. positive attitudes toward the elderly based on age c. negative attitudes toward the elderly based on age d. negative attitudes toward the elderly based on physical ability.

c

An important nursing action helpful to a chronically ill older adult is to: a. avoid discussing future lifestyle changes b. assure the pt that the condition is stable c. treat the pt as a competent manager of the disease d. encourage the pt to fight the disease as long as possible

c

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

The nurse is performing an assessment on an older client who is having difficulty sleeping at night. Which statement, if made by the client indicates that teaching about improving sleep is necessary? a. I swim 3x a week b. I have stopped smoking cigars c. I drink hot chocolate before bedtime d. I read for 40 minutes before bedtime

c

The nurse is providing an educational session to new employees, and the topic is abuse of the older client. The nurse helps the employees identify that which client is most typical of a victim of abuse? a. a 78 yo man who has moderate hypertension b. a 68 yo man who has newly diagnosed cataracts c. a 90 yo woman who has advanced Parkinson's disease d. a 70 yo woman has early diagnosed lyme disease

c

An ethnic older adult may experience a loss of self-worth when the nurse: a. informs the pt about ethnic support services b. allows the pt to rely on ethnic beliefs and practices c. has to use an interpreter to provide explanations and teaching, d. emphasizes that a therapeutic diet does not allow ethnic foods.

d

The nurse employed in a LTC facility is caring for an older male client. Which nursing action contributes to encouraging autonomy in the client? a. planning his meals b. decorating his room c. scheduling his barber appointments d. allowing him to choose social activities

d

The nurse is providing medication instructions to an older client who is taking digoxin daily. The nurse notes that which age related body changes cold place the client at risk for digoxin toxicity? a. decreased muscle strength and loss of bone density b. decreased cough efficiency and decreased vital capacity c. decreased salivation and decreased gastrointestinal motility d. decreased lean body mass and decreased glomerular filtration rate

d

A 67-year-old woman who has a long-standing diagnosis of incontinence is in the habit of arriving 20 minutes early for church in order to ensure that she gets a seat near the end of a row and close to the exit so that she has ready access to the restroom. Which of the following tasks of the chronically ill is the woman enacting (select all that apply)? j) Controlling symptoms k) Preventing social isolation l) Preventing and managing a crisis m) Denying the reality of the problem n) Adjusting to changes in the course of the disease

j, l

The home health nurse is visiting a client for the first time. While assessing the client's medication, it is noted that there are at least 19 prescriptions and several OTC medications that the client has been taking. Which intervention should the nurse take first? a. check for drug-drug interactions b. determine whether there are any adverse side effects c. determine whether there are medication duplications d. call the prescribing physician and report any polypharmacy

c, check for duplication, then interactions and side effects, then call to report any polypharmacy

A characteristic of chronic illness is that it (select all): a. has reversible pathologic changes b. has a consistent, predictable clinical course c. results in permanent deviation from the normal d. is associated with many stable and unstable phases e. always starts with an acute illness and then progresses slowly

c, d

The nurse is providing instructions to a nursing assistant regarding care of an older client with hearing loss. The nurse tells the assistant that clients with a hearing loss: a. are often distracted b. have middle ear changes c. respond to low pitched tones d. develop moist cerumen production

c, presbycusis leads to a decreased response to high frequency sounds, low pitched sounds are heard easily.

The visiting nurse observes that the older male client is confined by his daughter in law to his room. When the nurse suggests that he walk to the den and join the family, he says, I'm in everyone's way; my daughter in law needs me to stay here. The most important action for the nurse to take is to: a. say nothing, because it is best for the nurse to remain neutral and wait to be asked for help b. Suggest to the client and daughter in law that they consider a nursing home for the client c. say to the daughter in law, confining your father in law to his room is inhuman d. suggest appropriate resources to the client and daughter in law, such as respite care and a senior citizen's center.

d

When older adults become ill, they are more likely than younger adults to: a. complain about the symptoms of the problem b. refuse to carry out lifestyle changes to promote recovery c. seek medical attention because of the limitations on their lifestyle d. alter their daily living activities to accommodate new symptoms.

d

A nurse who is providing care for an 81-year-old female patient recognizes the need to maximize the patient's mobility during her recovery from surgery. Which of the following statements provides the best rationale for the nurse's actions? e) Continued activity prevents deconditioning. f) Pharmacokinetics are improved by patient mobility. g) Lack of stimulation contributes to the development of cognitive deficits in older adults. h) Regularly scheduled physical rehabilitation provides an important sense of purpose for older patients.

e

Which of the following assessment findings would alert the nurse to possible elder mistreatment (select all that apply)? e) Agitation f) Depression g) Weight gain h) Weight loss i) Hypernatremia

e, f, h, i