Chapter 27- Caring for Older Adults During Illness 2021 questions and answers.

Which of the following statements best captures the typical character of health problems in the lives of older adults? A) Older adults' lives are dominated by the increasing number of acute health problems due to age-related changes. B) Most older adults experience an interplay between a number of chronic conditions and occasional acute health problems. C) Older adults can expect a relatively consistent decline in their health over time as a result of acute health problems. D) Chronic conditions account for the normal downward direction of an older adult's health status Ans: B The interplay between chronic and occasional acute conditions is typical of the health trajectory of many older adults. The most salient factor is not acute problems alone, nor are health problems necessarily attributable to age-related changes. Changes in health status are rarely consistent and do not exclude chronic conditions or acute problems 2. During assessment of an older adult, the nurse discovers that the individual has been reluctant to divulge recent losses in activities of daily living to his primary care provider. Which of the following factors has been demonstrated to contribute to such reluctance? A) The older adult may fear a loss of independence if problems are disclosed. B) The older adult may realize that age-related changes are normally not treatable. C) The older adult may be experiencing cognitive deficits that influence decision making. D) The older adult may recognize that health care systems are not able to address psychosocial problems. Ans: A Many older adults have been shown to fear losing their independence or becoming institutionalized if they divulge health problems. It has not been demonstrated that age-related changes and psychosocial problems are not treatable, nor that cognitive changes influence such behaviors. 00:28 01:46 3. A nurse is teaching new graduates about the nature of palliative care on her unit. Which of the following statements by a new nurse indicates a need for further teaching? A) "I can see how important it is for us to educate patients and their families and friends on the unit." B) "It certainly requires a change in thinking to understand why we don't provide any medical interventions for patients." C) "I can see how comfort and psychosocial well-being take precedence over physical functioning." D) "Purpose in life and quality of life seem to be the overarching goals of palliative care." Ans: B While the focus of palliative care is not on curing disease, this does not mean that treatments of all kinds are absent. Distressing symptoms are addressed from both a nursing perspective and a medical perspective. Education is a key component of palliative care, and comfort and psychosocial well-being trump physical functioning. Purpose in life and quality of life are similarly emphasized 4. A nurse is teaching an older adult's family about the concept of caregiver burden. Which of the following points is priority for the nurse to communicate to the family? A) "Don't feel guilty about having to hire help. Most older Americans' care is currently provided by professionals and formal services." B) "If you do eventually feel overburdened, moving your loved one to a nursing home will provide you with relief." C) "You'll find it difficult to provide for your loved one's needs if you yourself don't have a strong support system." D) "You'll actually find that for you, the benefits of providing for your loved one outweigh the negative consequences." Ans: C A strong support system is a prerequisite for anyone who is planning to become a caregiver for a friend or family member. Most care is provided by friends and family, not professionals. It has been shown that moving a loved one to a nursing home does not diminish stress and burden on caregivers. While there are psychosocial benefits to being a caregiver, the negative functional consequences of caregiving outweigh the positive 5. Which of the following statements by the new nurse best conveys an understanding of diabetes in older adults? A) "A combination of lifestyle factors and age-related changes contributes to high rates of diabetes among older adults." B) "Development of diabetes later in life is considered a normal, age-related change." C) "Health care providers should avoid drawing conclusions about diabetes risk based on ethnicity." D) "The diagnosis of diabetes in older adults is complicated by subtle signs and symptoms." Ans: A The high prevalence and incidence of diabetes among older adults is attributable to lifestyle, genetic, and age-related factors. Ethnicity is a valid variable that needs to be considered, given that some minority groups have significantly higher rates of diabetes. Some symptoms of hypoglycemia are subtle in the older adult, but diagnosis is based on laboratory data that do not change with aging. While age-related changes contribute to a susceptibility to diabetes, the development of the disease should not be considered a normal, age-related change in and of itself 6. An 81-year-old client was diagnosed with colon cancer several months ago. Both the patient and the family have been made aware of the potential for metastasis and the poor prognosis associated with this disease. At what point in the client's disease trajectory should the principles of palliative care be implemented? A) After chemotherapy and radiation therapy have been proven unsuccessful B) Early in the course of the client's cancer and before symptoms become unmanageable C) Soon after the client has made a decision to change her code status to "do not resuscitate" D) When the client's care team determines that there is less than 2 months to live Ans: B The principles and practices of palliative care should not be exclusively reserved for late in a disease trajectory. It is applicable early in the course of an illness and should be offered as needs develop and before they become unmanageable. Palliative care can be provided concurrently with life-prolonging therapies or as a main focus of care. 7. A 66-year-old has been conscientious about health as an adult and is disappointed at having been recently diagnosed with type 2 diabetes. The client had been unwilling to discuss this new diagnosis for the past several weeks but has now begun asking the nurse questions about this disease. Which of the following nursing diagnoses is most appropriate for this client? A) Readiness for enhanced knowledge B) Readiness for enhanced self-care C) Readiness for enhanced power D) Readiness for enhanced comfort Ans: A An expressed willingness to know more about how a health problem is diagnosed and managed suggests a nursing diagnosis of readiness for enhanced knowledge. This is not synonymous with enhanced self-care, but is a likely precursor. The client's questions are not clearly indicative of enhanced comfort or power 8. A 68-year-old client has a long history of poor eating habits and low activity levels. The client now has a diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions should be the priority? A) Adherence to diabetes screen protocols B) Education about the role that his lifestyle has played in his diagnosis C) Maintenance of function and activities of daily livings D) Self-care measures to aid in the management of his disease Ans: D The care of older adults with diabetes should prioritize self-care measures such as diet, exercise, medications, and glucose monitoring. Screening is not relevant since the client has already been diagnosed with the disease in question. Education about lifestyle factors and maintenance of function are relevant and appropriate, but these are superseded by the importance of facilitating self-care 9. A palliative care team has taken over primary responsibility for the care of an older adult who has recently experienced a stroke. A visitor asks, "What is palliative care?" Which of the following is the best response by the nurse? A) "Spiritual and psychosocial care that takes place near the end of life" B) "Nursing care and medical treatment that prioritizes the wishes of patients and families" C) "The prioritization of complementary and alternative measures over biomedical interventions" D) "The provision of holistic care to patients experiencing incurable health states" Ans: D Palliative care is a holistic approach to care that may be applied during complex and/or declining health states. It is not necessarily limited to the end of life and does not involve a rejection of biomedical interventions. The wishes of patients and their families are prioritized, but this is not the defining feature of palliative care. It includes spiritual and psychosocial care, but is not limited to these domains 10. An older adult with a diagnosis of heart failure has been admitted to the hospital with an exacerbation of this condition. Which of the following are consequences of heart failure for which the nurse must monitor? (Select all that apply.) A) Arrhythmias B) Autoimmune disorders C) Drug interactions D) Hypotension E) Sleep disorders Ans: A, C, D, E Common consequences of heart failure in older adults include increased likelihood for developing arrhythmias, increased risk for hypotension and falls, increased risk for drug interactions, and high incidence of sleep disorders. Autoimmune disorders do not commonly result directly or indirectly from heart failure 11. A nurse in the long-term care facility assesses an 86-year-old woman who has recently become lethargic and difficult to arouse. Her vital signs are all stable and within normal limits. Her breath sounds are diminished. Which action by the nurse should be the priority? A) Call the family and give them an update. B) Place her on high fall risk precautions. C) Send her to the emergency department. D) Tell the aides to keep an eye on her. Ans: C Atypical presentation is especially common in those who are older than 85 years. Changes in behavior or functioning and increased fatigue are common atypical presentations of infection (e.g., pneumonia or urinary tract infection). In addition, the expected manifestations of an infection, such as elevated temperature or specific complaints of pain or discomfort, may be absent. While the family should be made aware of the update on the condition, the care of the client is the priority. It is not appropriate to delegate this to the certified nursing assistant (CNA). Placing her on fall prevention does not address the assessment data. 12. A wellness center nurse teaches a class of older adults about healthy habits. Which of the following interventions will make a difference in the clients' lives and as such be included by the nurse? A) Avoid alcohol consumption. B) Avoid fried foods and red meats. C) Avoid secondhand smoke. D) Avoid sunlight. Ans: C Nurses must not be influenced by ageist attitudes suggesting that older adults are too old to change behaviors and to benefit from improved health behaviors. Health promotion behaviors include the following: avoid secondhand smoke; limit intake of fats, red meats, and fried foods; avoid excessive exposure to sunlight; and avoid excessive alcohol consumption