Ne 104 Test 3 Older adult & end of life care

A hospice nurse sits at the bedside of a male patient in the final stages of cancer. He and his parents made the decision that he would move home and they would help him in the final stages of his disease. The family participates in his care, but lately the nurse has increased the amount of time she spends with the family. Whenever she enters the room or approaches the patient to give care, she touches his shoulder and tells him that she is present. This is an example of what touch? 1. Caring touch 2. Protective touch 3. Task-oriented touch 4. Interpersonal touch

Answer: 1 Rationale: Caring touch is a form of nonverbal communication. You express this in the way that you hold a patient's hand, give a back massage, gently position a patient, or participate in a conversation. When using a caring touch, you connect with the patient physically and emotionally.

A patient who is newly diagnosed with breast cancer states, "Although I am really scared about what is going to happen to me, I know my family will learn from this experience, and we will be stronger in the end." What term does the nurse use in the patient's medical record to describe the characteristic displayed in this statement? 1. Resiliency 2. End-of-life care 3. Family functioning 4. Family's culture

Answer: 1 Rationale: Family resiliency helps families maintain a healthy response even when they are experiencing stressful events.

The nurse is performing an assessment on an older client. Which assessment data would indicate a potential complication associated with the skin? 1. Crusting 2. Wrinkling 3. Deepening of expression lines 4. Thinning and loss of elasticity in the skin

Answer: 1 Rationale: The normal physiological changes that occur in the skin of older adults include thinning of the skin, loss of elasticity, deepening of expression lines, and wrinkling. Crusting noted on the skin would indicate a potential complication.

During a home visit, a patient states, "I am really upset about my heart failure. I can't go out to eat anymore with my friends, I have no energy, and I don't even want to talk on the phone. All i do is focus on how this disease has changed my life and how much time I have left to live." How should the nurse respond? Select all that apply.

Answer: 1,2,5 Rationale: The patient's responses to these statements and questions will help the nurse better understand how heart failure is affecting the patient's ability to cope with the diagnosis and will guide topics for patient education. Option 3 provides false reassurance that is not supportive, and option 4 changes the focus of conversation away from the patient's concerns.

The nurse sees a 76-year-old woman in the outpatient clinic. She states that she recently started noticing a glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. Which of the following nursing interventions is appropriate? Select all that apply. 1. Refer her to an ophthalmologist 2. Suggest large-print books and playing cards 3. Reassure her that this is a part of normal aging 4. Suggest lower-wattage light bulbs to decrease glare 5. Assess her home environment for safety

Answer: 1,2,5 Rationale: This patient most likely has cataracts and should be referred to an ophthalmologist. While common, cataracts are not considered to be part of normal aging. In the meantime, using large-print books or playing cards and reducing home safety hazards would be beneficial. Lower-wattage light bulbs would not be helpful.

Before implementing touch, what does a nurse need to know about touch? Select all that apply. 1. Some cultures may have specific restrictions about non-skill-based touch 2. Touch is a type of verbal communication 3. Touch can successfully influence a patient's level of comfort 4. There is never a problem with using touch at any time 5. Touch only reduces physical pain

Answer: 1,3 Rationale: Some cultures have restrictions as to who can touch and when to touch. Assess your patient to determine whether there are any restrictions. Touch is a method of nonverbal communication. Touch can help improve a patient's sense of comfort and leads to a connection between nurse and patient. Not all patients perceive touch to be therapeutic. Know and understand whether your patients accept touch and how they interpret your intentions. Touching a patient can reduce physical pain and discomfort and decrease anxiety and fear.

A nurse is caring for a 66 year old patient who lives alone and is receiving chemotherapy and radiation for a new cancer diagnosis. He is unable to care of himself because of severe pain and fatigue. He moves into his 68 year old brothers home so his brother can help care for him. Which assessment findings indicate that this family caregiving situation will be successful? Select all that apply. 1. Both the patient and the brother attend church together regularly 2. The brothers are living together and enjoy eating the same foods 3. Other siblings live in the same city and are willing to help 4. The patient and his brother have a close network of friends 5. The patient has obsessive-compulsive disorder and has difficulty throwing away possessions

Answer: 1,3,4 Rationale: Many older adults use their faith and spirituality to cope with life changes. Having a close social network and other family members who are willing to assist with caregiving helps to alleviate the stress experienced by caregivers. Potential risk factors for caregiver distress and burden in this relationship include that the brother s are living together and that one of the brothers has a mental illness.

A nurse is providing education to a patient with type 2 diabetes. Which characteristics does the nurse include in her teaching to explain why type 2 diabetes is considered a chronic disease? Select all that apply. 1. Type 2 diabetes lasts throughout a person's life 2. Genetic mutations drive the treatment for type 2 diabetes 3. People with type 2 diabetes have to modify some of their daily activities 4. People with type 2 diabetes require ongoing medical care

Answer: 1,3,5 Rationale: A chronic disease is a pathophysiologic condition that lasts more than 1 year, requires ongoing medical care, and often limits a person's usual activities of daily living due to symptoms of the disease or self-care activities required to manage the disease.

A 63 year old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are the major concerns for this patient? Select all that apply. 1. The loss of his work role 2. The risk of social isolation 3. A determination on whether the wife will need to start working 4. How the wife expects household tasks to be divided in the home in retirement 5. The age the patient chose to retire

Answer: 1,4 Rationale: The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to lose the the work role. Often there are new expectations of the retired person. This patient is not likely to become socially isolated because of the size of the family. Whether the wife will have to work is not a major concern at this time, nor is the age of the patient.

A nurse demonstrates caring by helping family members to: Select all that apply. 1. Become active participants in care 2. Remove themselves from personal care 3. Make health care decisions for the patient 4. Plan uninterrupted time for family and patient to be together 5. Discuss their concerns

Answer: 1,4,5 Rationale: Caring for the family takes into consideration the context of the patient's illness and the stress that it imposes on all members. Encouraging family members to provide some care and discuss concerns helps the family to feel involved. Lastly, providing time for the family to just be together without any "care-tasks" or interruptions encourages "presence" for the patient and family.

A 71 year old patient enters the emergency department after falling down the stairs at church. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable at 130/70. The patient does not exercise regularly and states that he experiences weakness in his legs when climbing stairs. He is alert and oriented, and able to answer questions clearly. What are the fall risk factors for this patient? Select all that apply. 1. Impaired vision 2. Residence design 3. Blood pressure 4. Leg weakness 5. Exercise history

Answer: 1,4,5 Rationale: Risk factors for falling include sensory changes such as visual loss, musculoskeletal conditions affecting mobility (in this case weakness) and deconditioning (from lack of exercise). The mere presence of a chronic disease is not a risk factor unless it is a condition such as a neurologic disorder that alters mobility or cognitive function. The patient's blood pressure is stable, and there is no report of orthostatic hypotension. A one-floor residence should not pose risks.

A nurse conducted an assessment of a new patient who came to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the assessment. He recently moved to a new apartment, and his pet beagle just died 2 months ago. He is most likely experiencing: 1. Dementia 2. Depression 3. Delirium 4. Anxiety

Answer: 2 Rationale: Factors that often lead to depression include presence of a chronic disease or a recent change or life event, such as loss. Patients are alert but easily distracted in conversation.

A nurse is completing a health history with the daughter of a newly admitted patient who is confused and agitated. The daughter reports that her mother was diagnosed with Alzheimer's disease 1 year ago but become extremely confused last evening and was hallucinating. She was unable to calm her, and her mother thought she was a strange. On the basis of this history; the nurse suspects that the patient is experiencing: 1. Normal aging 2. Delirium 3. Depression 4. Worsening dementia

Answer: 2 Rationale: Hallmark characteristics of delirium are acute confusion, hallucinations, and agitation. These symptoms are not part of the normal aging process. AS dementia worsens, there is a gradual rather than sudden change in memory, usually not accompanied by hallucinations. Depression does not present with acute confusion and agitation.

The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first? 1. Check for medication interactions 2. Determine whether there are medication duplications 3. Determine whether a family member supervises medication administration. 4. Call the prescribing primary health care provider (PHCP) and report polypharmacy.

Answer: 2 Rationale: Polypharmacy is a concern in the older client. Duplication of medications needs to be identified before medication interactions can be determined, because the nurse needs to know what the client is taking. Asking about medication administration supervision may be part of the assessment but is not the first action. The phone call to the PHCP is the intervention after all other information has been collected.

A nurse is assessing an older adult brought to the emergency department following a fall and wrist fracture. The patient is very thin and unkempt, has a stage 3 pressure injury on her coccyx, and has old bruising to the extremities in addition to her new bruises from the fall. She defers all of the questions to her caregiver son, who accompanied her to the hospital. What's the nurse's next step? 1. Call social services to begin nursing home placement 2. Ask the son to step out of the room so that she can complete her assessment 3. Call adult protective services because you suspect elder mistreatment 4. Assess the patient's cognitive status

Answer: 2 Rationale: The assessment leads you to suspect elder mistreatment, but the nurse needs more information directly from the patient before calling social services or the adult protective services or telling the patient she cannot return home. The nurse will best get this information by asking the son to leave the room so that she can privately ask the patient direct questions. If the son refuses to leave, this will be another indication that elder mistreatment may be occurring. Cognitive testing will be important but is not the priority.

The nurse is providing medication instructions to an older client who is taking digoxin daily. The nurse explains to the client that decreased glomerular filtration rate, which are age-related body changes, could place the client at risk for which complication with medication therapy? 1. Decreased absorption of digoxin 2. Increased risk for digoxin toxicity 3. Decreased therapeutic effect of digoxin 4. Increased side effects related to digoxin

Answer: 2 Rationale: The older client is at risk for medication toxicity because of decreased lean body mass and an age-associated decreased glomerular filtration rate. This age-related change is not specifically associated with decreased absorption, decreased therapeutic effect, or increased risk for side effects. Toxicity, or toxic effects, occurs as a result of excessive accumulation of the medication in the body.

Which of the family caregivers listed below will the nurse expect to be most at risk for experiencing poor health outcomes? 1. A 20 year old daughter caring for a mother who needs help setting up her medications weekly 2. The 68 year old spouse of a patient who is experiencing worsening dementia 3. A 32 year old parent of a child who has an ear infection 4. A married couple who is sharing the caregiving responsibilities for a parent who was recently diagnosed with hypertension and coronary artery disease

Answer: 2 Rationale: This family caregiver is elderly, has most likely cared for the patient who has significant needs for more than a year, lives with the patient, and is married to the patient. Factors that put the caregiver at risk for poor health outcomes include providing care for more than 1 year, being 65 years of age or older, providing care for someone with Alzheimer's disease or dementia, and living with the care recipient. Spouses report the largest impact on their health.

A hospice nurse is caring for a family that is providing end-of-life care for their grandmother, who has terminal breast cancer. The nurse focuses on symptom management for the grandmother and on helping the family with developing coping skills. This approach is an example of which of the following? 1. Family as context 2. Family as patient 3. Family as a system 4. Family as structure

Answer: 2 Rationale: When the family as patient is the approach, the family's needs, processes, and relationships are the primary focuses of the nursing care.

The home care nurse is visiting an older client whose spouse died 6 months ago. Which behaviors by the client indicates effective coping? Select all that apply 1. Neglecting personal grooming 2. Looking at old pictures of family 3. Participating in a senior citizens program 4. Visiting the spouse's grave once a month 5. Decorating the wall with the spouse's pictures and awards received

Answer: 2,3,4,5 Rationale: Coping mechanisms are behaviors used to decrease stress and anxiety. In response to a death, ineffective coping is manifested by an extreme behavior that in some cases may be harmful to the individual physically or psychologically. Neglecting personal grooming is indicative of a behavior that identifies ineffective coping in the grieving process. The remaining options identify appropriate and effective coping mechanisms.

A nurse is participating in a health and wellness event at the local community center. A women approaches and relates that she is worried that her widowed father is becoming more functionally impaired and may need to move in with her. The nurse asks about his ability to complete ADL's , which include the independence with: Select all that apply. 1. Driving 2. Toileting 3. Bathing 4. Daily exercise 5. Eating

Answer: 2,3,5 Rationale: Activities of daily living are self-care tasks that measure function and are markers for the ability to live independently. Although driving and daily exercise are important to quality of life and health maintenance, they would not necessarily impact a person's ability to live independently.

A patient's family member is considering having her mother placed in a nursing center. The nurse has talked with the family before and knows that this is a difficult decision. Which of the following criteria does the nurse recommend in choosing a nursing center? Select all that apply. 1. The center needs to be clean, and rooms should look like a hospital room 2. Adequate staffing is available 3. Social activities are available 4. The center provides three meals a day with a set menu and serving schedule 5. Staff encourage family involvement in care planning and assisting with physical care

Answer: 2,3,5 Rationale: Adequate staffing, provision of social activities, and active family involvement are essential. Meals should be high quality with options for what to eat and when it is served. A nursing center should be clean, but it should look like a person's home rather than a hospital.

During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings places him at risk for an adverse drug event? Select all that apply. 1. Taking two medications for hypertension 2. Taking a total of eight different medications during the day 3. Having one physician who reviews all medications 4. Patient's health history of renal disease 5. Involvement of the caregiver in assisting with medication administration

Answer: 2,4 Rationale: The patient is at risk for an adverse drug event (ADE) because of polypharmacy and his history of renal disease, which affects drug excretion. Taking two medications for hypertension is common. Having one physician review all medications and involving a family caregiver are desirable and are safety factors for preventing ADEs.

The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological changes the nurse expect to note? Select all that apply. 1. Increased heart rate 2. Decline in visual acuity 3. Decreased respiratory rate 4. Decline in long-term memory 5. Increased susceptibility to urinary tract infections 6. Increased incidence of awakening after sleep onset

Answer: 2,5,6 Rationale: Anatomical changes to the eye affect the individual's visual ability, leading to potential problems with activities of daily living. Light adaption and visual fields are reduced. Although lung function may decrease, the respiratory rate usually remains unchanged. Heart rate decreased and heart valves thicken. Age-related changes that affect the urinary tract increase an older client's susceptibility to urinary tract infections. Short-term memory may decline with age, but long-term memory usually is maintained. Change in sleep patterns is a consistent age-related change. Older people experience an increased incidence of awakening after sleep onset.

The nurse is providing instructions to the assistive personnel (AP) regarding care of an older client with hearing loss. What should the nurse tell the AP about older clients with hearing loss? 1. They are often distracted 2. They have middle ear changes 3. They respond to low-pitched tones 4. They develop moist cerumen production

Answer: 3 Rationale: Presbycusis refers to the age-related irreversible degenerative changes of the inner ear that lead to decreased hearing ability. As a result of these changes, the older client has a decreased response to high-frequency sounds. Low-pitched voice tones are heard more easily and can be interpreted by the older client. Options 1, 2, and 4 are not accurate characteristics related to aging.

The nurse is performing an assessment of an older client who is having difficulty sleeping at night. Which statement by the client indicates the need for further teaching measures to improve sleep? 1. "I swim 3 times a week." 2. "I have stopped smoking cigars." 3. "I drink hot chocolate before bedtime." 4. "I read for 40 minutes before bedtime."

Answer: 3 Rationale: The client should avoid caffeinated beverages and stimulants such as tea, cola, and chocolate. The client should exercise regularly, because exercise promotes sleep by burning off tension that accumulates during the day. A 20 t0 30 minute walk, swim, or bicycle ride 3 times a a week is helpful. Smoking and alcohol should be avoided. Reading is also helpful measure and is relaxing.

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 which client as most typically a victim of abuse? 1. A man who has moderate hypertension 2. A man who has newly diagnosed cataracts 3. A woman who has advanced Parkinson's disease 4. A woman who has an early diagnosed Lyme disease

Answer: 3 Rationale: Elder abuse includes physical, sexual, or psychological abuse; misuse of property; and violation of rights. The typical abuse is a woman of advances age with few social contacts and at least 1 physical or mental impairment that limits her ability to perform activities of daily living. In addition, the client usually lives alone or with the abuser and depends on the abuser for care.

Older adults frequently experience a change in sexual activity. Which best explains this change? 1. The need to touch and be touched is decreased 2. The sexual preferences of older adults are not as diverse 3. Medication side effects often impact sexual functioning 4. Frequency and opportunities for sexual activity may decline

Answer: 4 Rationale: As a result of loss of a loved one or a chronic illness in themselves or their partner, opportunities for sexual activity may decline. Aging does not change the need for touch, and older adults are diverse. Only select medications impact sexual functioning.

The nurse is caring for an older client in a long-term care facility. Which action contributes to encouraging autonomy with the client? 1. Planning meals 2. Decorating the room 3. Scheduling haircut appointments 4. Allowing the resident to choose social activities

Answer: 4 Rationale: Autonomy is the personal freedom to direct one's own life as long as it does not impinge on the rights of others. An autonomous person is capable of rational thought. This individual can identify problems, search for alternatives, and select solutions that allow continued personal freedom as long as others and their rights and property are not harmed. Loss of autonomy, and therefore independence, is a real fear of older clients. The correct option is the one that allows the client to be a decision maker.

An experienced nurse is explaining the use of touch from a caring perspective. What information does the nurse include in the discussion with the student about touch? 1. Nurses touch patients only while performing procedures or during assessments 2. Touch is a type of verbal communication 3. Nurses use touch only when a patient is in pain 4. Touch forms a connection between nurse and patient

Answer: 4 Rationale: Touch is relational and leads to a connection between nurse and patient. It involves contact and non-contact touch. Contact touch involves skin-to-skin contact, whereas noncontact touch refers to eye contact.

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." Which is the most important action for the nurse to take? 1. Say to the daughter-in-law, "Confining your father-in-law to his room is inhumane." 2. Suggest to the client and daughter-in-law that they consider a nursing home for the client. 3. Say nothing, because it is best for the nurse to remain neutral and wait to be asked for help. 4. Suggest appropriate resources to the client and daughter-in-law , such as respite care and a senior citizens center.

Answer: 4 Rationale: Assisting clients and families to become aware of available community support systems is a role and responsibility of the nurse. Observing that the client has begun to be confined to his room makes it necessary for the nurse to intervene legally and ethically, so option 3 is not appropriate and is passive in terms of advocacy. Option 2 suggests committing the client to a nursing home and is a premature action on the nurse's part. Although, the data provided the nurse that this client requires nursing care, the nurse does not know the extent of the nursing care required. Option 1 is incorrect and judgmental.

The nurse is caring for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing 2. Make the decisions for the family 3. Encourage expansion of feelings, concerns, and fears 4. Explain everything that is happening to all family members 5. Touch and hold the client's or family member's hand if appropriate 6. Be honest and let the client and family know they will not be abandoned by the nurse

Answers: 3,5,6 Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know they will not be abandoned. The nurse should touch or hold the client's or family member's hand, if appropriate.