Community Quiz 5 - Ch 19 and 22

13. 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.

12. Which is the most prevalent type of substance use problem among male and female veterans? a. Binge drinking b. Overuse of prescription drugs c. Marijuana use d. Use of smokeless tobacco

ANS: A Binge drinking and cigarette smoking are the most prevalent types of substance use problems among male and female veterans, affecting about 11% of the veteran population, with disorders more common among males younger than 25 years of age. Substance use disorders (SUDs) involve a pattern of use of alcohol, tobacco, and illegal and prescription drugs that results in marked distress and/or impairment

10. "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.

18. 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.

15. 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

5. A nurse is interviewing a client to determine if she is eligible for VA benefits. Which question would assist the nurse in determining the requirement of service? a. "Did you serve active duty for 24 consecutive months?" b. "Which branch of the military service did you serve?" c. "Were you dishonorably discharged?" d. "How long has it been since you left the military?"

ANS: A Veterans—and sometimes their survivors and dependents—are eligible for VA benefits when they fulfill two requirements related to service and separation. (1) Service: they must have served in active duty for 24 consecutive months or for a full period of call (Reserves and Guard). There are some exceptions to the length of service minimum, the most important being when a person is discharged for disability incurred or aggravated in the line of duty. (2) Separation: they must have been separated under any condition other than dishonorable.

13. A nurse is caring for a veteran who served in Vietnam. Which exposure is the client most likely to report? a. Agent Orange b. Chromium c. Mustard gas d. Burn pits

ANS: A Vietnam veterans suffer health disorders related to exposure to Agent Orange—an herbicide used to kill the vegetation that provided cover for the enemy. Gulf War and GWOT veterans were exposed to a number of health threats in the desert, including chromium, burn pits, and heat stroke or heat exhaustion. WWII veterans who were in the Battle of the Bulge, fought in December 1944 through January 1945, were exposed to extreme cold and may have sustained cold injuries. Some volunteers were exposed to mustard gas experiments, in which the DoD evaluated equipment for their protection against mustard gas attacks. About 4000 soldiers were subjected to severe, full-body exposures during testing.

9. A veteran has recently been diagnosed with posttraumatic stress disorder (PTSD). Which information obtained from the client during a health history would align with this diagnosis? a. The client reports that he has a history of hypertension and hyperlipidemia. b. The client states that he served as a sniper during the Gulf War. c. The client states that he was stationed in Japan. d. The client reports that his wife has a substance abuse problem.

ANS: B PTSD is a mental illness that develops in some individuals who have experienced a shocking, frightening, or dangerous event. Factors that contribute to an individual developing PTSD include getting injured or seeing another person injured, viewing a dead body, feeling helpless, having little or no social support after a traumatic event, dealing with extra stress after the event (e.g., loss of a loved one, pain and injury), or having a history of mental illness or substance abuse.

2. A spouse of a veteran inquires as to if he will qualify for the Civilian Health and Medical Program of the Department of Veteran's Affairs (CHAMPVA). Which describes what criteria will need to be met? (Select all that apply.) a. The veteran has been rated permanently and totally disabled for a service-connected disability by a VA regional office b. The spouse is a survivor of a veteran who died from a VA-rated service-connected disability c. The veteran has been diagnosed with PTSD by a VA regional office d. The spouse is a survivor of a veteran who died in the line of duty e. The spouse has been diagnosed with a terminal illness f. The veteran has been diagnosed with a terminal illness

ANS: A, B, D The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some health care services for eligible civilian beneficiaries are covered by the VA. According to Benefits.gov (2017), to be eligible for CHAMPVA benefits and services, individuals must be in one of these categories: the spouse or child of a veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office; the surviving spouse or child of a veteran who died from a VA-rated service-connected disability; the surviving spouse or child of a veteran who was at the time of death rated permanently and totally disabled from a service-connected disability; the surviving spouse or child of a military member who died in the line of duty, not because of misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).

3. An elderly woman shared that she had six different physicians, each focusing on one particular health problem. Which would be of immediate concern for the home health nurse? (Select all that apply.) a. Whether the client has a family physician who was coordinating her care b. Whether the physicians communicate with each other c. If each physician was prescribing medications, what drug interactions might be occurring? d. Were all these health care providers licensed physicians? e. Who was helping her with transportation to all these physicians? f. Would all these physician visits add up to more than what Medicare would reimburse the client?

ANS: A, C The client needs a family physician or a nurse case manager who is coordinating her care and ensuring that the medications are not having interaction effects. A pharmacist might also do this, but the client may be using several different pharmacies. Errors associated with preventable adverse drug events occur most often at the stages of prescribing and monitoring (i.e., the same medication[s], or different medications for the same condition, being prescribed by different health providers).

5. A woman admitted, "I did fall once, but it was an accident that I'm sure won't happen again." Which responses would be most appropriate for the nurse? (Select all that apply.) a. "Are you getting lots of calcium and vitamin D? Are you drinking milk or taking calcium pills?" b. "Do you have a couple glasses of wine each evening to relax you before you go to bed?" c. "Do you live in a one-story house and are your floors even without rugs to trip you up?" d. "Let me give you some balance and leg muscle exercises to practice at home each day." e. "Remember that if you start to fall, fall sideways if you can to minimize injury." f. "Review what medications you are taking."

ANS: A, C, D, F Simple exercises that strengthen leg muscles and exercises that can improve balance are recommended to be done daily. Adequate amounts of calcium and vitamin D, obtaining a bone density test, and taking medications that are available for slowing bone loss are activities that can help prevent falls. Seniors can also improve their environment to reduce their risk of falling by checking floor surfaces and curb heights; identifying weather-related problems before venturing outside; wearing supportive, low-heeled shoes; making sure that rooms are well lit; and ensuring that safety equipment is installed in bathrooms and stairwells. In the event of a fall, if the senior remembers to fall forward or backward or to land on their hands to break a fall, it will lessen the risk of hip fracture. Uneven surfaces such as sidewalks, curbs, or floor elevations; wet or slippery ground; and climbing up on household items not intended for climbing can result in loss of footing or loss of traction. Drinking alcoholic beverages increases the risk of falling because alcohol slows reflexes and response time; causes dizziness, sleepiness, or light-headedness; and alters balance. Medications such as blood pressure pills, heart medicines, diuretics, and tranquilizers may increase the risk of falling.

16. A nurse is assessing a female veteran for military sexual trauma (MST). Which would be the most appropriate question for the nurse to ask? a. During your military service, were you ever raped? b. Did anyone ever use force or threat of force to have sexual contact with you against your will? c. Can you describe any incidents of sexual harassment that you have been involved in? d. How long did you serve in the military?

ANS: B Because of stigma and shame, many veterans will not volunteer information regarding sexual trauma exposure. When screening for history of MST, it is best to avoid words that are emotionally or politically loaded (e.g., "rape") or words that are poorly defined (e.g., "sexual harassment"). Nonjudgmental, descriptive general questions are recommended, such as: Did anyone ever use force or threat of force to have sexual contact with you against your will?

14. 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.

1. Which person meets the legal definition of a veteran? a. A 32-year-old male who has been dishonorably discharged from the Army b. A 50-year-old female who retired from the Navy c. A 65-year-old male who served in the National Guard d. A 22-year-old female who is currently serving in the Air Force

ANS: B Legally, a veteran is an individual who has served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable. Any individual who completed service for any branch of armed forces is a veteran as long as they were not dishonorably discharged. Personnel serving in the National Guard are considered to be part-time employees and not active duty, full-time personnel.

9. 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 attend school.

25. "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.

4. A veteran is receiving veteran's health care benefits. Which department directly coordinates these benefits? a. Veterans Benefits Administration (VBA) b. Veterans Health Administration (VHA) c. U.S. Department of Veterans Affairs (VA) d. Civilian Health and Medical Program of the Department of Veteran's Affairs (CHAMPVA)

ANS: B The Department of Veterans Affairs has three subdivisions: the VHA, the Veterans Benefits Administration (VBA), and the National Cemetery Administration. The VHA provides all types of health care in every setting, including inpatient, outpatient, and long-term care. The VBA is an administrative arm responsible for unemployment and pension payments, home loans, vocational training, and educational benefits. The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some health care services for eligible civilian beneficiaries are covered by the VA.

3. A veteran has been diagnosed with a mild traumatic brain injury (mTBI). Which symptoms would most likely be reported to the nurse? (Select all that apply.) a. Diarrhea b. Headaches c. Appetite loss d. Dizziness e. Increased thirst f. Memory problems

ANS: B, D, F Symptoms of mTBIs can include headaches, tinnitus, sleep disorders, irritability, memory problems, mood and anxiety disorders, suicidality, chronic pain, and dizziness or balance problems (Johnson et al., 2013).

4. A veteran reports to the nurse that she believes that she may be suffering from PTSD. Which would the nurse anticipate the client experiencing during the past month? (Select all that apply.) a. Restless leg syndrome b. Difficulty sleeping c. Death of a parent d. Heightened awareness of her surroundings e. Negative feelings about oneself f. Avoiding communication with others from her troop

ANS: B, E, F To be diagnosed with PTSD, an individual must have experienced a "stressor criterion," which means that the person has been exposed to an event that is considered traumatic (Friedman, 2016). In addition, an adult must experience all of these symptoms for at least a month: at least one reexperiencing symptom (e.g., flashbacks, bad dreams, frightening thoughts); at least one avoidance symptom (e.g., staying away from places, events, or objects that are reminders of the experience; avoiding thoughts or feelings related to the event); at least two arousal and reactivity symptoms (e.g., being easily startled, feeling tense or on edge, difficulty sleeping, angry outbursts); at least two cognition and mood symptoms (e.g., trouble remembering key features of the event, negative thoughts about oneself or the world, distorted feelings of guilt or blame, loss of interest in enjoyable activities) (NIMH, 2017).

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.

7. A veteran tells the nurse that he hates the VA health insurance program and wishes that he would be allowed to see the local doctor instead of traveling to the VA clinic. Which statement would be most appropriate to be made by the nurse? a. "I will check to see if your local doctor can be added to the list of approved providers." b. "Yes, you pay premiums for this health insurance and should be able to have a choose what providers you see." c. "The VA does not provide health insurance, rather this is a benefit that you receive for compensation for your service to our country." d. "The VA provides different benefit plans. Let me see if the local doctor is a provider on a different benefit plan."

ANS: C Many veterans do not realize that their care at their VA hospitals and clinics is not a type of health insurance. Instead, it is a benefit that they receive in compensation for their duty and service to the country. The difference between health insurance and VA health benefits is twofold. First, veterans do not have to "pay into" their VA benefits the way one would pay premiums for a health insurance plan. Second, the "coverage" received in the form of VA benefits is not transferable to other non-VA providers, except through formal contracts deemed appropriate by the VA and its providers.

12. 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.

11. A nurse is caring for a veteran who has suffered a polytraumatic injury. Which would be the primary consideration for the nurse when working with this client? a. Use of an assistive device for ambulation may be necessary. b. Diagnosis of posttraumatic stress disorder will be likely. c. Physical and cognitive abilities to complete ADLs independently may be lacking. d. A psychiatric referral will be needed.

ANS: C The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event, and frequently includes TBI. For example, a soldier who has lost a limb, suffered a TBI, and lost his eyesight from a rocket-propelled grenade attack is said to have a polytraumatic injury. Care for veterans with these injuries is especially complicated because of the presence of several overlapping physical and cognitive impairments affecting their ability to perform ADLs. The primary consideration would relate to the client's impairments in completing ADLs.

17. A veteran is receiving treatment for posttraumatic stress disorder (PTSD). As part of the therapy, the veteran identifies negative thoughts and emotions while focusing on specific sounds and movements. Which trauma-focused therapy is the client receiving? a. Cognitive processing therapy b. Prolonged exposure therapy c. Eye movement desensitization and reprocessing d. Cognitive behavioral therapy

ANS: C There are variations of trauma-focused therapies. These include (1) prolonged exposure therapy (where the individual is repeatedly questioned by the therapist about the trauma to encourage control of the thoughts and feelings to reduce fear of the memories); (2) cognitive processing therapy, which involves talking with the therapist about the negative thoughts and beliefs and development of strategies to manage the recollection of the trauma in a way that is less upsetting; and (3) eye movement desensitization and reprocessing, which involves identification of the negative thoughts, emotions, and feelings while focusing on specific sounds or movements, helping the brain work through the traumatic memories.

6. A client reports hearing loss and tinnitus following military duty in the Gulf War. Which term would best describe this client's injury? a. Posttraumatic stress disorder b. Polytrauma c. Traumatic brain injury d. Service-connected disability

ANS: D A service-connected disability is a disease or injury that was incurred as a result of or during the veteran's active duty, or one that was aggravated by military service. Posttraumatic stress disorder is a mental illness that develops in some individuals who have experienced a shocking, frightening, or dangerous event. A traumatic brain injury is a disruption of brain function caused by an external mechanical force, including blunt force trauma, penetration by a foreign object, acceleration or deceleration movements, and pressure waves from explosive blasts. The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event and frequently includes TBI.

18. Which best describes the role of the suicide prevention coordinator (SPC) at the VHA center? a. Serve as a hotline responder for the National Veterans Crisis Line b. Create a suicide prevention safety plan for the client c. Provide counseling for suicidal veterans d. Assist veterans to access timely mental health care

ANS: D A suicide prevention coordinator (SPC) works at every VHA center. The SPC's primary role is to help veterans access timely mental health care, particularly in times of crises, and to assist health care treatment teams with managing the care of suicidal veterans. SPC's maintain weekly contact with the veteran and ensure that the veteran's treatment team works with him or her to develop a suicide prevention safety plan that helps the veteran cope with suicidal ideation. The National Veterans Crisis Line provides veterans with immediate access to mental health crisis intervention and support 24 hours a day/7 days a week. Hotline responders are not SPC's, instead they are trained in suicide prevention and crisis intervention and assist callers by initiating dispatch of emergency services to callers in imminent suicidal crisis and refer veterans to VA suicide prevention coordinators to ensure that veterans are connected to local mental health care.

11. 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.

2. 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.

21. 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.

10. Which statement about military sexual trauma (MST) is accurate? a. MST is more common among male veterans. b. The majority of women who report MST state the perpetrator was an intimate partner. c. An Army veteran is at greatest risk to report MST. d. Insomnia is more severe among veterans who report a history of MST.

ANS: D MST is more common among women veterans, with 32.4% reporting MST compared with 4.6% of their male counterparts (Klingensmith et al, 2014). It is estimated that in one of seven women who report MST, the trauma was perpetrated by an intimate partner (Mercado et al, 2015). Insomnia is more common and more severe among veterans who report a history of MST (Jenkins et al, 2015). One of the risk factors/characteristics of veterans experiencing MST is being a Navy veteran, not Army.

22. 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."

ANS: 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.

8. A veteran has been diagnosed with an immersion foot injury. Which finding should the nurse anticipate when completing an assessment on the client? a. A foot that is deformed b. A foot that is unable to tolerate immersion in water c. A foot that the client is unable to bear weight on d. A foot that has occasional numbness

ANS: D The major cold injuries veterans suffer include frostbite, nonfreezing cold tissue damage, immersion foot (formerly called trench foot), and hypothermia. Cold injuries may result in long-term health problems, including the following signs and symptoms (at the site of exposure): changes in muscle, skin, nails, ligaments, and bones; skin cancer in frostbite scars; neurological injury with symptoms such as bouts of pain in the extremities, hot or cold, tingling sensations, and numbness; vascular injury with Raynaud phenomenon with symptoms such as extremities becoming painful and white or discolored when cold.

19. 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.