Chapter 14: Living with Chronic Illness My Nursing Test Banks

Chapter 14: Living with Chronic Illness

Test Bank

MULTIPLE CHOICE

1. An older female patient is diagnosed with a chronic illness. Which of the following principles should the nurse apply when answering her questions?

a.

The most prevalent form of disease in the United States is acute illness.

b.

Usually, chronic disease has a negligible impact on the family.

c.

Chronic illness is unending, and coping can be influenced by the perception of uncertainty.

d.

Older adults successfully cope with chronic disease by learning about the disease.

ANS: C

Chronic illnesses are enduring and necessitate lifetime adaptations. Uncertainty exacerbates the impact of a chronic disease. At this time, the prevalent form of disease is chronic illness. The effect on the family, as on the patient, can be profound. There are no guarantees. Knowledge requires effort on the part of all concerned to apply it.

PTS: 1 DIF: Apply REF: 225-228 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

2. Which of the following is a true statement about Medicare for older adults?

a.

Eighty percent of Medicares annual expenditures are for individuals with chronic illnesses.

b.

Medicare enrollees spend under $1500 annually for out-of-pocket expenses related to chronic illnesses.

c.

Complementary and alternative medicines (CAM) are not covered by Medicare.

d.

Medicare covers care for those who have trouble with activities of daily living.

ANS: A

Eighty percent of Medicares expenditures are spent on care provided to those suffering from chronic illness. On average, Medicare enrollees spend over $3000 annually for out-of-pocket expenses related to chronic conditions. Medicare now covers some CAM therapies. Assistance with activities of daily living is not a covered expense with Medicare.

PTS:1DIF:RememberREF:225-226

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

3. Which of the following describes the nurses role for an older patient with a chronic illness?

a.

Implement an individualized therapeutic regimen that brings about a cure.

b.

Provide caring to help the patient live at the optimal level of health and wellness.

c.

Suggest that the patient accept eventual death to reduce the burdens on the patients family.

d.

Encourage the patient to minimize the use of services to control costs.

ANS: B

A chronic illness cannot be cured, but with caring, the nurse can assist the patient to live without being dominated by the demands of the illness. Chronic illnesses are long-term problems, and cures are not usually available. If a patient has an incurable illness, then the nurse can provide a caring environment to facilitate the implementation of the patient and familys wishes. The nurse can help the patient and family to formulate cost-cutting measures, if so requested; however, because the nurse is the patients advocate, the nurse avoids making recommendations about not using services.

PTS: 1 DIF: Understand REF: 227-231 TOP: Caring

MSC:Health Promotion and Maintenance

4. Which of the following statements is true about rehabilitation and restorative care for older adults?

a.

The purpose of rehabilitation and restorative care is to regain specific abilities lost because of a condition.

b.

Rehabilitation consists primarily of regular physical therapy sessions.

c.

A person can learn skills and gain abilities that enable functioning.

d.

The patients capabilities are recognized at the time of admission.

ANS: C

A patient with a severe stroke, for example, may not be able to walk again but may recover mobility by learning to drive a motorized wheelchair. The purpose of rehabilitation is to enable the person to regain function but not necessarily specific abilities, which can involve the development of compensating abilities (e.g., motorized chair driving) rather than the recovery of original abilities (e.g., walking). Rehabilitation involves activities involving the entire day, not merely those within an allotted time period. On admission, the patient is in crisis and his or her actual abilities may not be evident.

PTS:1DIF:RememberREF:229-231

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

5. Which of the following statements is the most suitable for establishing goals when teaching an older adult with a chronic illness about potential changes in the health maintenance regimen?

a.

Management of the patients chronic disease rests on the patient and the caregiver; therefore the goals should be collaboratively set.

b.

The patient will be able to make needed changes in his or her life if the nurse provides accurate, written instructions.

c.

Psychological functioning is usually impaired only to a small extent in a patient with a chronic illness.

d.

The patients values, culture, and beliefs will have little to do with the types of changes he or she will be able to make.

ANS: A

The patient must remain involved in the decision making; the patient and the caregiver may have different priorities. Instructions, by themselves, are not sufficient. Psychological functioning may be more impaired than physical functioning. The patients values, cultures, and beliefs profoundly shape the patients response to chronic illness and to therapeutic interventions.

PTS: 1 DIF: Understand REF: 229-231 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

6. Acute illness is to chronic illness as to which of the following comparisons?

a.

An emergency department is to a nursing home

b.

A hospital staff nurse is to a nurse practitioner

c.

Health insurance is to Medicare for older adults

d.

Inpatient surgical care is to outpatient medical care

ANS: A

Acute illness can be likened to an emergency department because it treats conditions with sudden onset and sudden exacerbations of existing conditions with short-term treatment options, as compared with a nursing home, which cares for individuals with long-term conditions that warrant admission after a decline in health or to individuals with long-term health care needs. The acute-chronic analogy is a comparison of sudden and short-term versus gradual and long-term.

The comparison between a nurse and a nurse practitioner is one of the practice settings and the scope of the practice. Medicare is a type of health insurance; however, chronic illness is not a type of acute illness. Inpatient surgical care can be emergent and elective, and outpatient medical care is usually for ongoing health care but can also be applied to emergent conditions.

PTS:1DIF:AnalyzeREF:225-233

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

7. An older woman has severe osteoporosis in the long bones, impaired mobility, and chronic pain. Which acute illness or condition is this woman most likely to experience as a result of osteoporosis?

a.

Peripheral neuropathy

c.

Intertrochanteric fracture

b.

Chronic stable depression

d.

Opioid analgesic addiction

ANS: B

Chronic pain is more likely to cause depression than osteoporosis. This woman has no predictive indicators for a peripheral neuropathy. A hip fracture from the greater to the lesser trochanter because of osteoporosis is the most likely acute condition this older adult will face, because osteoporosis commonly attacks long bones and the proximal end of the femur, in particular. As a result, the older woman is more likely to fracture her hip and then fall than she is to fall and then fracture her hip. Research data support the claim that individuals with real pain have a low risk of dependency.

PTS: 1 DIF: Analyze REF: 225-227 TOP: Nursing Process: Diagnosis

MSC:Health Promotion and Maintenance

8. Over 50% of the population, aged 65 years and older, suffers from which one of the following chronic health conditions?

a.

Hypertension

c.

Multiple sclerosis

b.

Renal failure

d.

Cancer

ANS: A

Over 50% of the population, aged 65 years and older, suffers from hypertension and arthritis, followed by heart disease and diabetes.

PTS: 1 DIF: Understand REF: 227 TOP: Nursing Process: Diagnosis

MSC:Health Promotion and Maintenance

9. An older man who is right-handed works as a carpenter, but he has been left with a flaccid right arm after a thrombus occluded a cerebral artery. Which is the most important goal for the plan of care to help this man achieve his optimal state of health and wellness?

a.

Maintain skin integrity of right arm.

b.

Collaborate with occupational therapy (OT).

c.

Promote plaque-reversing strategies.

d.

Support effective coping mechanisms.

ANS: B

The dominant arm, vital to the skill of a carpenter, is useless to this man unless he can adapt to the impairment with adaptive skills. Collaborating with OT is the most important goal for this older adult because adaptation is the greatest factor in establishing wellness, and OT can assist this man with adaptive tools, skills, and abilities to manage living with a flaccid dominant hand and arm. Maintaining skin integrity should be included in this mans plan of care because a flaccid extremity is at risk for skin breakdown, but it is not the first priority. Promoting plaque-reversing strategies, including diet and antilipid medication, should be part of this mans plan of care. However, these strategies are not the most important goal for this man; adaptation is the most important factor in establishing health and wellness. Supporting effective coping mechanisms is a goal that should be included in this mans plan of care; however, given the flaccidity of his dominant arm, the most effective measures toward adaptation are to help him develop the new skills and abilities he will need to cope effectively. Supporting effective coping mechanisms can help enhance the work of OT.

PTS: 1 DIF: Analyze REF: 227-232 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

10. An older woman has diabetes mellitus. Which patient assessment validates the nurses conclusion that she is in the foreground perspective of the shifting perspectives model of chronic illness?

a.

Has an amputation of two toes.

b.

Lives at home with her husband.

c.

Frequently self-checks her blood sugar.

d.

Changes the battery in her glucometer.

ANS: A

An older adult thinks and acts about diabetes mellitus in the foreground perspective when signs of disease progression occur, which is evidenced by the need for the amputation of two toes, because hyperglycemia damaged the lining of vessels and led to peripheral artery disease. The perfusion to this womans toes deteriorated to the extent that the tissue died; the dead tissue had to be removed to avoid infection.

Living at home indicates she has a functional status that is sufficient to maintain independent living. This woman is able to monitor her blood sugar independently and retains enough functional ability to change a battery.

PTS:1DIF:ApplyREF:228-229

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

11. Which of the following qualities does the nurse need to provide caring?

a.

Sensitivity to the needs of other nurses

b.

Longing to help others live a healthy life

c.

Desire to have a stable career and income

d.

Ability to create a trusting environment

ANS: D

Along with competence, compassion, conscience, and a commitment to provide caring, the nurse must be able to inspire confidence in the nursing care. The nurse with compassion has sensitivity to the needs of others in general. The desire to help others lead a healthy life is admirable; however, to provide caring, the nurse should not impose personal beliefs on patients. Nurses can provide caring by dedicating themselves to nursing as a lifelong commitment and not solely as a means to provide a living.

PTS:1DIF:UnderstandREF:229-232

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

12. An older man who has osteoarthritis (OA) tells the nurse that he has experienced fatigue for the past 2 weeks. Which nursing intervention should the nurse implement to help him manage his fatigue?

a.

Recommend an antidepressant.

b.

Help him plan exercise and rest.

c.

Plan two or three naps every day.

d.

Tell him the fatigue is due to his OA.

ANS: B

With no clues about the cause of the fatigue, the nurse helps this older adult balance exercise and rest to help alleviate fatigue. The fatigue can be due to decreased physical activity that, in turn, is due to pain from the OA, in which case a balance of exercise and rest should help attenuate the effects of the pain from the OA. This older adult has no indicators of depression except for fatigue. Although a balance of rest and exercise can help relieve depressive symptoms, exercise is not an effective therapy for severe depression. Decreasing physical exercise is likely to contribute to fatigue and deconditioning. Fatigue is an unusual characteristic of OA.

PTS:1DIF:ApplyREF:230

TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which of the following types of phases are included in the chronic illness trajectory (CIT)? (Select all that apply.)

a.

Caring

b.

Plateau

c.

Instability

d.

Bargaining

e.

Deterioration

f.

Rehabilitation

ANS: B, C, E

The CIT includes a stable (plateau) phase, an unstable (instability) phase, and a downward and dying (deterioration) phase. The CIT does not include a caring phase, a bargaining phase, or a rehabilitation phase.

PTS:1DIF:RememberREF:228

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

2. An older man with myasthenia gravis lives with his wife. Which patient characteristics should the nurse use to identify areas for nursing care in the disability assessment of this man? (Select all that apply.)

a.

Successfully manages his finances.

b.

Lives in an adults-only community.

c.

Walks around the house for exercise.

d.

Health care is provided through Medicare.

e.

Has a history of peptic ulcer disease.

f.

Wife is in good health but has poor eyesight.

ANS: A, B, D, F

An older adult with myasthenia gravis has a chronic, progressive disorder characterized by muscle weakness, especially after exercise. Crises can develop as a myasthenic crisis, characterized by severe, generalized, muscle weakness with life-threatening consequences, or a cholinergic crisis, generally caused by an excessive dose of medication and characterized by excessive salivation and lacrimation, tachycardia, and diarrhea. The nurse recognizes the cognitive function to manage his finances successfully as a potential for self-care of his condition and can use this potential ability to plan care in the disability assessment. Living in an adult community implies independent living and some ability to perform self-care activities. Skilled nursing services in the home must be necessary to have Medicare health coverage; therefore if this patient requires assistance with activities of daily living, then he must depend on his wife or another resource. Living with another adult can be an asset. For this man, his wife identifies an area of a needed self-care resource because, although she can be trained to identify deteriorating muscle strength in this man, her ability to manage a crisis effectively is impaired with poor eyesight. Thus, the nurse uses the gap between his cognitive function and the wifes ability to manage a crisis to plan his nursing care.

Walking around the house is not an asset for this man; individuals who have extrapyramidal symptoms from an antipsychotic medication can walk around the house. Walking around the house is probably more indicative of limitations from myasthenia gravis; however, it does not indicate a resource need. The history of peptic ulcer disease is a neutral aspect of this mans disability assessment.

PTS: 1 DIF: Analyze REF: 228-233 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

3. Which factor(s) is(are) modifiable health risk behaviors for chronic illness? (Select all that apply.)

a.

Physical activity

c.

Poor nutrition

b.

Prescription medication use

d.

Tobacco use

ANS: A, C, D

Physical activity is modifiable; patients can begin an exercise program at any time. Nutrition is also a modifiable health risk behavior; patients have the ability to increase or decrease intake, depending on their weight and nutritional status. Tobacco use is also a modifiable behavior; patients can participate in a smoking cessation program or use other assistance to stop smoking.

PTS: 1 DIF: Understand REF: 227 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

OTHER

1. The CIT includes eight phases. List the phases in order, beginning with the first phase.

A. Crisis

B. Unstable

C. Downward

D. Dying

E. Stable

F. Acute

G. Trajectory onset

H. Pretrajectory

ANS:

H, G, A, F, E, B, C, D

The phases of the CIT are pretrajectory, trajectory onset, crisis, acute, stable, unstable, downward, and dying.

PTS: 1 DIF: Understand REF: 227 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

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