Chapter 9 Prep U
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
Chronic conditions occur in people of every age group, socioeconomic level, race, and culture. In 2000, an estimated 61 million people (21% of the population) had chronic illnesses. The prediction for 2050 is that what percent of the population will have a chronic illness?
50
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
Myocardial infarction is an example of which type of disability?
Acute nontraumatic
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
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 provides corrective instruction to the nursing assistant when the assistant refers to the client as the
Blind diabetic patient
The instructor provides corrective information to the nursing student when the student refers to the client as the
COPDer in 216
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 vomiting 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 client lives alone and holds a full-time job. Which type of disability would the nurse state the client has?
Developmental
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 disability model is most appropriate for the nurse to use as a guide for planning care?
Interface Model
Empowering the client with a disability will better serve him or her than will promoting dependency. This type of approach is seen in which type of model of disability?
Interface model
Nursing care of patients with chronic illness is varied and occurs in a variety of settings. Care must be direct and supportive. To provide supportive care, a nurse would do which of the following?
Make referrals for additional care.
Which model of disability views disability as a problem of the person?
Medical
Which statement provides 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
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
A nursing student shares that he read that chronic conditions are costly to people, families, and society, and that one of the major goals of nursing today should be the prevention of chronic conditions and the care of people with them. The student asks the instructor what can nurses do to help. Which of the following is a correct answer given by the instructor?
Promote wearing seatbelts
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 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.
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.
Chronic illness can be monitored using the Trajectory Model. In what phase can the nurse's nursing diagnosis help in care planning?
Trajectory
The nurse forms a nursing diagnosis during which phase of the trajectory model of chronic illness?
Trajectory onset
A client who will undergo emergency surgery suffers from chronic depression. The nurse is performing client teaching prior to the surgery. To make the client more comfortable, which of the following actions should the nurse take? Select all answers that apply.
Wait for the client to complete speaking even when answers are slow. • Face the client when speaking to the client. • Address the client by title and last name. • Allow extra time for this 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
A cause related to the increasing number of people with chronic conditions is
improved screening and diagnostic procedures.
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?
the nurse encourage a patient to improve that can significantly enhance quality of life with a chronic condition? Exercise
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.
A nurse is caring for a client with multiple chronic conditions and some physical disabilities. The nurse is using "people-first" language with the following statement during end-of-shift report:
"Last evening, Mr. Rudd, a 44-year-old patient with diabetes was admitted to the unit."
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
Evidence-based medical and nursing research (2009) has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following?
Write a prescription for a serum cholesterol level.
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
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."
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."
An elderly female client 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
A 65-year-old client was diagnosed with multiple sclerosis 10 years ago. The client has difficulty ambulating and is seeking a prescription for a wheelchair. The nurse assesses the type of disability the client has is
Acquired
The client has 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. The nurse assesses that the client is in the phase of the Trajectory Model of Chronic Illness known as
Acute
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.
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 statement is a misconception about chronic disease?
Chronic illnesses cannot be prevented.
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 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
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
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.
Most people with chronic conditions do not consider themselves sick or ill.
Improved screening and diagnostic procedures
A client with paraplegia for the past 12 years is hospitalized with pneumonia. It would be best for the nurse to
Place the client's wheelchair next to the bed for independent transfer.
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.
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
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.
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 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
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 of the Trajectory Model of Chronic Illness is characterized by reactivation of an illness?
Unstable
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 and explains the procedure to the client
Using clear and simple terms
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. Select all that apply.
• Alleviate and manage symptoms • Validate individual self-worth • Validate family functioning
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
The client with blindness is hospitalized following a myocardial infarction. Which of the following care measures would the nurse take with this client? Select all answers that apply.
• Identify self when walking into the client's room. • State when the nurse is leaving the room. • Leave the bathroom door either completely open or closed.
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
