Chronic Illness and Older Adults Nursing Quiz for your nursing exam.More than one chronic condition is common among older persons. The cost of treating chronic illnesses accounts for a considerable amount of the US health care budget. The lives and identities of the patient, family, and caregiver can all be significantly impacted by the management of a chronic illness.
Chronic Illness Nursing Quiz
A 78-yr-old female patient is admitted with nausea, vomiting, anorexia, diarrhea, and dehydration. She has a history of diabetes mellitus and 2 years ago had a stroke with residual right-sided weakness. Identify which characteristics of chronic illness the nurse will probably find in this patient (select all that apply).
b. Residual disability
c. Permanent impairments
d. Infrequent complications
e. Need for long-term management
f. Nonreversible pathologic changes
b, c, e, f. The diabetes mellitus and residual right-sided weakness from the cerebrovascular accident (CVA) contribute to the residual disability and permanent impairments. Diabetes requires long-term management, and both problems contribute to nonreversible pathologic changes.
Seven tasks required for daily living with chronic illness have been identified. From Table 5-4, select at least one of these tasks that would specifically apply to the following common chronic conditions in older adults.
|Diabetes mellitus||Prevent and manage the crisis, carry out the prescribed regimen, control symptoms, and adjust to changes in the course of the disease|
|Visual impairment||Prevent social isolation, attempt to normalize interactions with others|
|Heart disease||Carry out prescribed regimen, control symptoms, prevent and manage a crisis|
|Hearing impairment||Prevent social isolation, attempt to normalize interactions with others|
|Alzheimer’s disease||Prevent and manage the crisis, reorder time, control symptoms, adjust to changes in the course of the disease, attempt to normalize interactions with others, and prevent|
|Arthritis||Control symptoms, carry out prescribed regimen, reorder time, adjust to changes in the course of the disease, prevent social isolation|
|Orthopedic impairment||Reorder time, prevent and manage the crisis, and prevent social isolation|
Consider the differences between primary and secondary prevention. Fill in the blanks.
a. Actions aimed at early detection of disease and interventions to prevent progression of disease are considered __ prevention.
b. Following a proper diet, getting appropriate exercise, and receiving immunizations against
specific diseases are considered __ prevention.
a. secondary b. primary
- What is the leading cause of death in the United States?
b. Diabetes mellitus
c. Coronary artery diseased
d. Cerebrovascular accident
e. Chronic obstructive pulmonary disease
c. Coronary artery disease is the leading cause of death in the United States.
According to the Corbin and Strauss chronic illness trajectory, which statement describes a
patient with an unstable condition?
a. Life-threatening situation
b. Increasing disability and symptoms
c. Gradual return to the acceptable way of life
d. Loss of control over symptoms and disease course
d. The trajectory defines a life-threatening situation as a crisis. Increasing disability is described as downward. A gradual return to an acceptable way of life is a comeback.
Which statement(s) about older people are only myths and illustrate the concept of ageism (select all that apply)?
a. You can’t teach an old dog new tricks.
b. Old people are not sexually active.
c. Most old people live independently.
d. Most older adults can no longer synthesize new information.
e. Most older people lose interest in life and wish they would die.
a, b, d, e. Ageism is a negative attitude based on age.
The nurse identifies the presence of age-associated memory impairment in the older adult who states
a. “I just can’t seem to remember the name of my granddaughter.”
b. “I make out lists to help me remember what I need to do, but I can’t seem to use them.”
c. “I forgot that I went to the grocery store this morning and didn’t realize it until I went again this afternoon.”
d. “I forget movie stars’ names more often now, but I can remember them later after the conversation is over.”
d. Age-associated memory impairment is characterized by a memory lapse or benign forgetfulness that is not the same as a decline in cognitive functioning. Forgetting a name, date, or recent event is not serious, but the other examples indicate abnormal functioning.
Indicate what the acronym SCALES stands for in the assessment of nutrition indicators in frail older adults.
S - Sadness (mood)
C - Cholesterol (high)
A - Albumin (low)
L - Loss (or gain of weight)
E - Eating problems
S - Shopping (and food preparation problems)
When working with older patients who identify with a specific ethnic group, the nurse recognizes that health care problems may occur in these patients because they
a. live with extended families who isolate the patient.
b. live in rural areas where services are not readily available.
c. eat ethnic foods that do not provide all essential nutrients.
d. have less income to spend on medications and health care services.
d. Older adults with an ethnic identity often have disproportionately low incomes and may not be able to afford Medicare deductibles or medications to treat health problems. Although they often live in older urban neighborhoods with extended families, they are not isolated. Ethnic diets have adequate nutrition, but health could be impaired if money is not available for food.
An 83-yr-old woman is being discharged from the hospital following stabilization of her international normalized ratio (INR) levels (used to assess the effectiveness of warfarin therapy). She has chronic atrial fibrillation and has been on warfarin (Coumadin) for several years. Discharge instructions include returning to the clinic weekly for INR testing. Which statement by the patient indicates that she may be unable to have the testing done?
a. “When I have the energy, I have taken the bus to get this test done.”
b. “I will need to ask my son to bring me into town every week for the test.”
c. “Should I just keep taking the same pill every day until I can get a ride to town?”
d. “It is very important to have this test every week. I have several church friends who can bring me.”
c. This statement indicates that this patient does not understand the importance of having the test every week and that the test results will determine ongoing dosing. The other three statements indicate that the patient is thinking about ways to get into town weekly.
The old-old population (85 years and older) has an increased risk for frailty. However, old age is just one element of frailty. Identify at least three other assessment findings that are considered criteria for frailty.
a. b. c.
Any three of the following are criteria for frailty: unplanned weight loss (≥10 lb in a year), self-reported exhaustion, weakness (measured by grip strength), slow walking speed, and low level of physical activity.
An 80-yr-old woman is brought to the emergency department by her daughter, who says her mother has refused to eat for 6 days. The mother says she stays in her room all of the time because the family is mean to her when she eats or watches TV with them. She says her daughter brings her only one meal a day, and that meal is cold leftovers from the family’s meals days before.
a. What types of elder mistreatment may be present in this situation?
b. How would the nurse assess the situation to determine whether abuse is present? The daughter says her mother is too demanding and she just cannot cope with caring for her mother 24 hours a day.
c. What may be an appropriate nursing diagnosis for the daughter?
d. What resources can the nurse suggest to the daughter?
Answer Key: a. Psychologic abuse, psychologic neglect, physical neglect, and perhaps a violation of personal rights b. Perform a very careful medical history and screening for mistreatment; interview the mother alone; use an assessment tool designed specifically for elder mistreatment; specifically assess for depression, dehydration, malnutrition, pressure ulcers, and poor personal hygiene; evaluate explanations about physical findings that are not consistent with what is seen or contradictory statements made by the daughter and the mother c. Caregiver role strain, spiritual distress, or dysfunctional family processes d. Community caregiver support group; and to help care for her mother, a formal support system for respite care, adult day care, Programs for All-Inclusive Care for the Elderly (PACE).
What are three common factors known to precipitate placement in a long-term care facility?
Factors that precipitate placement are rapid patient deterioration, caregiver exhaustion, and alteration in or loss of family support system. Possible factors that accelerate placement decisions are progressive dementia, incontinence, or a major health event.
An 88-yr-old woman is brought to the health clinic for the first time by her 64-yr-old daughter. During the initial comprehensive nursing assessment of the patient, what should the nurse do?
a. Ask the daughter whether the patient has any urgent needs or problems.
b. Interview the patient and daughter together so that pertinent information can be confirmed.
c. Refer the patient for an interprofessional comprehensive geriatric assessment because at her age she will have multiple needs.
d. Obtain a comprehensive health history using physical, psychologic, functional, developmental, socioeconomic, and cultural assessments.
d. During initial contact with an older adult, the nurse should perform a comprehensive nursing assessment that includes a health history using physical, psychologic, functional, developmental, socioeconomic, and cultural assessments. If available, a comprehensive interprofessional geriatric assessment may then be done to maintain and enhance the functional abilities of the older adult. The older adult and caregiver should be interviewed separately, and the older adult should identify his or her own needs, if possible.
What is a mental status assessment of the older adult especially important in determining?
a. Potential for independent living
b. Eligibility for federal health programs
c. Service and placement needs of the individual
d. Whether the person should be classified as frail
a. The results of mental status evaluation often determine whether the patient is able to manage an independent living, a major issue in older adulthood. Other elements of comprehensive assessment could determine eligibility for special problems, determination of frailty, and total service and placement needs.
What is the most important nursing measure in the rehabilitation of an older adult to prevent loss of function from inactivity and immobility?
a. Using assistive devices such as walkers and canes
b. Teaching good nutrition to prevent loss of muscle mass
c. Performance of active and passive range-of-motion (ROM) exercises
d. Performance of risk appraisals and assessments related to immobility
c. Exercise for all older adults is important to prevent deconditioning and subsequent functional decline from many different causes. Walkers and canes may improve mobility but can also decrease mobility if they are too difficult for the patient to use. Nutrition is important for muscles, but muscle strength is primarily dependent on use. Risk appraisals are usually performed for specific health problems.
Since most older adults take at least six prescription drugs, what are four nursing interventions that can specifically help prevent problems caused by multiple drug use in older patients?
Answer Key: Any of the following eight nursing interventions listed (1) Assess cognitive function, (2) Attempt to reduce medication use that is not essential, (3) Assess ability to self-administer medication, (4) Assess alcohol and illicit drug use, (5) Encourage the use of written or electronic medication-reminder systems, (6) Encourage the use of one pharmacy, (7) Work with HCPs and pharmacists to establish routine drug profiles on each older adult patient, (8) Advocate with drug companies and social work services for low-income prescription support services.
Which nursing actions would demonstrate the nurse’s understanding of the concept of providing safe care without using restraints (select all that apply)?
a. Placing patients with fall risk in low beds
b. Asking simple yes-or-no questions to clarify patient needs
c. Making hourly rounds on patients to assess for pain and toileting needs d. Placing a disruptive patient near the nurses’ station in a chair with a seat belt
e. Applying a jacket vest loosely so that the patient can turn but cannot climb out of bed
a, b, c. These actions are alternatives to restraints that may help to reduce falls and keep the patient safe. A jacket vest and a seat belt are forms of restraint and require an order and frequent reassessment and order renewal.
When teaching a 69-yr-old patient about self-care, what will promote health (select all that apply)?
a. Proper diet
c. Teaching chair yoga
d. Demonstrating balancing techniques
e. Participation in health promotion activities
a, b, c, d, e. Any of these actions will promote health.
The 58-yr-old male patient will be transferred from the acute care clinical unit of the hospital to another care area. The patient requires complicated dressing changes for several months. To which practice setting(s) could the patient be transitioned (select all that apply)?
a. Acute rehabilitation
b. Long-term acute care
c. Intermediate care facility
d. Transitional subacute care
e. Programs for All-Inclusive Care for the Elderly (PACE)
b, e. Long-term acute care provides acute care for an average length of greater than 25 days. Programs for All-Inclusive Care for the Elderly (PACE) provide skilled nursing home level care for adults age 55 and older if they have Medicare. Being dual-eligible will provide the care at no cost. Acute rehabilitation is a post-acute level of care with therapies for returning the patient to the patient's best level of functioning. Intermediate care facilities provide convalescent care. Transitional subacute care facilities are used for 5 to 21 days.
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