Lewis Test Bank - Medical-Surgical Nursing 10th Edition Chapter 5

Chapter 05: Chronic Illness and Older Adults Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. When caring for an older patient with hypertension who has been hospitalized after a transient ischemic (TIA), which topic is the most important for the nurse to include in the discharge teaching? a. Effect of atherosclerosis on blood vessels b. Mechanism of action of anticoagulant drug therapy c. Symptoms indicating that the patient should contact the health care provider d. Impact of the patient‘s family history on likelihood of developing a serious stroke ANS: C One of the tasks for patients with chronic illnesses is to prevent and manage a crisis. The patient needs instruction on recognition of symptoms of hypertension and TIA and appropriate actions to take if these symptoms occur. The other information may also be included in patient teaching but is not as essential in the patient‘s self-management of the illness. DIF: Cognitive Level: Analyze (analysis) REF: 60 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 2. The nurse performs a comprehensive assessment of an older patient who is considering admission to an assisted living facility. Which question is the most important for the nurse to ask? a. ―Have you had any recent infections?‖ b. ―How frequently do you see a doctor?‖ c. ―Do you have a history of heart disease?‖ d. ―Are you able to prepare your own meals?‖ ANS: D The patient‘s functional abilities, rather than the presence of an acute or chronic illness, are more useful in determining how well the patient might adapt to an assisted living situation. The other questions will also provide helpful information but are not as useful in providing a basis for determining patient needs or for developing interventions for the older patient. DIF: Cognitive Level: Analyze (analysis) REF: 62 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. An alert older patient who takes multiple medications for chronic cardiac and pulmonary diseases lives with a daughter who works during the day. During a clinic visit, the patient verbalizes to the nurse that she has a strained relationship with her daughter and does not enjoy being alone all day. Which nursing diagnosis should the nurse assign as the priority for this patient? a. Social isolation related to fatigue b. Risk for injury related to drug interactions c. Caregiver role strain related to family employment schedule Downloaded by: aaalishba | Distribution of this document is illegal Lewis Test Bank - Medical-Surgical Nursing 10th Edition Chapter 5 S - The Marketplace to Buy and Sell your Study Material d. Compromised family coping related to the patient‘s care needs ANS: B The patient‘s age and multiple medications indicate a risk for injury caused by interactions between the multiple drugs being taken and a decreased drug metabolism rate. Problems with social isolation, caregiver role strain, or compromised family coping are not physiologic priorities. Drug–drug interactions could cause the most harm to the patient and are therefore the priority. DIF: Cognitive Level: Analyze (analysis) REF: 73 OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis MSC: NCLEX: Health Promotion and Maintenance 4. Which method should the nurse use to gather the most complete assessment of an older patient? a. Review the patient‘s health record for previous assessments. b. Use a geriatric assessment instrument to evaluate the patient. c. Ask the patient to write down medical problems and medications. d. Interview both the patient and the primary caregiver for the patient. ANS: B The most complete information about the patient will be obtained through the use of an assessment instrument specific to the geriatric population, which includes information about both medical diagnoses and treatments and about functional health patterns and abilities. A review of the medical record, interviews with the patient and caregiver, and written information by the patient are all included in a comprehensive geriatric assessment. DIF: Cognitive Level: Analyze (analysis) REF: 74 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 5. Which intervention should the nurse implement to provide optimal care for an older patient who is hospitalized with pneumonia? a. Plan for transfer to a long-term care facility. b. Minimize activity level during hospitalization. c. Consider the preadmission functional abilities. d. Use an approved standardized geriatric nursing care plan. ANS: C The plan of care for older adults should be individualized and based on the patient‘s current functional abilities. A standardized geriatric nursing care plan will not address individual patient needs and strengths. A patient‘s need for discharge to a long-term care facility is variable. Activity level should be designed to allow the patient to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process. DIF: Cognitive Level: Apply (application) REF: 69 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 6. The nurse cares for an older adult patient who lives in a rural area. Which intervention should the nurse plan to implement to meet this patient‘s needs? a. Suggest that the patient move closer to health care providers. Downloaded by: aaalishba | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material b. Obtain extra medications for the patient to last for 4 to 6 months. c. Ensure transportation to appointments with the health care provider. d. Assess the patient for chronic diseases that are unique to rural areas. ANS: C Transportation can be a barrier to accessing health services in rural areas. The patient living in a rural area may lose the benefits of a familiar situation and social support by moving to an urban area. There are no chronic diseases unique to rural areas. Because medications may change, the nurse should help the patient plan for obtaining medications through alternate means such as the mail or delivery services, not by purchasing large quantities of the medications. DIF: Cognitive Level: Apply (application) REF: 64 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 7. Which nursing action will be most helpful in decreasing the risk for drug-drug interactions in an older adult? a. Teach the patient to have all prescriptions filled at the same pharmacy. b. Make a schedule for the patient as a reminder of when to take each medication. c. Instruct the patient to avoid taking over-the-counter (OTC) medications or supplements. d. Ask the patient to bring all medications, supplements, and herbs to each appointment. ANS: D The most information about drug use and possible interactions is obtained when the patient brings all prescribed medications, OTC medications, and supplements to every health care appointment. The patient should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but use of supplements and herbal medications also need to be considered in order to prevent drug–drug interactions. Use of a medication schedule will help the patient take medications as scheduled, but will not prevent drug–drug interactions. DIF: Cognitive Level: Analyze (analysis) REF: 65 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 8. A patient who has just moved to a long-term care facility has a nursing diagnosis of relocation stress syndrome. Which action should the nurse include in the plan of care? a. Remind the patient that making changes is usually stressful. b. Discuss the reason for the move to the facility with the patient. c. Restrict family visits until the patient is accustomed to the facility. d. Have staff members write notes welcoming the patient to the facility. ANS: D Having staff members write notes will make the patient feel more welcome and comfortable at the long-term care facility. Discussing the reason for the move and reminding the patient that change is usually stressful will not decrease the patient‘s stress about the move. Family member visits will decrease the patient‘s sense of stress about the relocation. DIF: Cognitive Level: Apply (application) REF: 69 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity Downloaded by: aaalishba | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material 9. An older patient complains of having ―no energy‖ and feeling increasingly weak. The patient has had a 12-lb weight loss over the past year. Which action should the nurse take initially? a. Ask the patient about daily dietary intake. b. Schedule regular range-of-motion exercise. c. Discuss long-term care placement with the patient. d. Describe normal changes associated with aging to the patient. ANS: A In a frail older patient, nutrition is frequently compromised, and the nurse‘s initial action should be to assess the patient‘s nutritional status. Active range of motion may be helpful in improving the patient‘s strength and endurance, but nutritional assessment is the priority because the patient has had a significant weight loss. The patient may be a candidate for long-term care placement, but more assessment is needed before this can be determined. The patient‘s assessment data are not consistent with normal changes associated with aging. DIF: Cognitive Level: Analyze (analysis) REF: 65 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 10. The nurse is admitting an acutely ill, older patient to the hospital. Which action should the nurse take? a. Speak slowly and loudly while facing the patient. b. Obtain a detailed medical history from the patient. c. Perform the physical assessment before interviewing the patient. d. Ask a family member to go home and retrieve the patient‘s cane. ANS: C When a patient is acutely ill, the physical assessment should be accomplished first to detect any physiologic changes that require immediate action. Not all older patients have hearing deficits, and it is insensitive of the nurse to speak loudly and slowly to all older patients. To avoid tiring the patient, much of the medical history can be obtained from medical records. After the initial physical assessment to determine the patient‘s current condition, then the nurse could ask someone to obtain any assistive devices for the patient if applicable. DIF: Cognitive Level: Apply (application) REF: 70 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 11. The nurse cares for an alert, homeless older adult patient who was admitted to the hospital with a chronic foot infection. Which intervention is the most appropriate for the nurse to include in the discharge plan for this patient? a. Teach the patient how to assess and care for the foot infection. b. Refer the patient to social services for assessment of resources. c. Schedule the patient to return to outpatient services for foot care. d. Give the patient written information about shelters and meal sites. ANS: B Downloaded by: aaalishba | Distribution of