Chapter 16: Chronic Illness and Rehabilitation My Nursing Test Banks

Chapter 16: Chronic Illness and Rehabilitation

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. The nurse is preparing an older widowed patient with several chronic illnesses for discharge to home. The nurse addresses the primary nursing outcome for this patient when:

a.

assuring the patient that social services will arrange for help with medical expenses.

b.

arranging for in-home assistance in areas of activities of daily living (ADLs) and nursing care as needed.

c.

educating the patient regarding the safety risks caused by these conditions.

d.

identifying barriers to ensure adherence to the prescribed drug therapies.

ANS: D

A key role for the nurse caring for an older adult with a chronic condition is to help the patient achieve optimal physical and psychosocial health. Staying adherent with drug therapy can help achieve this outcome. Payment through a third party is not guaranteed. In-home assistance may or may not be needed. Education is always needed but is not the priority for achieving optimal wellness.

DIF: Applying (Application) REF: N/A OBJ: 16-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

2. The nurse is assessing patients diagnosed with chronic disease processes for the probability of hospitalization because of the exacerbation of related symptoms. The nurse recognizes that the patient with the highest probability is a(n):

a.

72-year-old male with congestive heart failure (CHF).

b.

82-year-old male with type 2 diabetes.

c.

72-year-old female with chronic bronchitis.

d.

82-year-old female with osteoporosis.

ANS: A

Individuals with chronic conditions typically have repeated hospitalizations to treat exacerbations of their illness. The most common reasons for hospitalization in older patients are heart disease, cancer, pneumonia, and stroke. The 72-year-old with CHF is at highest risk.

DIF: Remembering (Knowledge) REF: N/A OBJ: 16-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

3. An older patient has developed moderate muscle weakness on the left side as a result of a cerebral vascular accident (CVA, stroke). The nurse determines the patient possesses the healthiest view of self-wellness when heard stating:

a.

Ill certainly miss hiking, but I guess Ill find something else to do outdoors.

b.

I was getting too old to safely practice karate.

c.

Ive decided to take up oil painting because its difficult for me to knit.

d.

It was getting difficult to work in the garden anyway.

ANS: C

After learning and mastering the requirements imposed by the condition, older adults often view themselves as well. With a wellness-in the-foreground perspective, the disease is only one component of their life and is not their identity, so they substitute lost abilities and resulting pleasures with others.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 16-2

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

4. A 73-year-old patient has been diagnosed with congested heart failure (CHF). The nurse provides the greatest support for this patients positive view of self-wellness by presenting information regarding:

a.

how to minimize the exacerbation of symptoms.

b.

locally available supportive services.

c.

the importance of adherence to medical treatment.

d.

the need to report symptoms promptly.

ANS: A

Many older adults now seek education about health promotion and management of their illness. The nurse can support older adults by teaching self-care management in these areas. The other actions are also valued, but learning how to control symptoms gives patients the feeling of accomplishment.

DIF: Applying (Application) REF: N/A OBJ: 16-5

TOP: Teaching-Learning MSC: Physiologic Integrity

5. The nurse is caring for an older patient who recently immigrated to the United States from Asia. To best address the patients apparent resistance to the medical and nursing plan of care, the nurse:

a.

discusses the patients behavior with Asian staff members.

b.

researches the patients cultural views on health care.

c.

requests a cultural consultation from social services.

d.

asks family members to discuss the patients views on health care.

ANS: D

Concepts of health and illness are deeply rooted in culture, race, and ethnicity and influence an individuals (and familys) illness perceptions and health and illness behavior. The patients family should have the best insight into the patients culturally biased beliefs. Discussing behavior with other staff members might be a privacy violation. Researching culture may be helpful, but each patient is an individual and should not be stereotyped. Social services may or may not be able to provide cultural services.

DIF: Applying (Application) REF: N/A OBJ: 16-5

TOP: Communication and Documentation MSC: Psychosocial Integrity

6. The nurse feels most confident that an older patient is prepared to assume self-management of new type 2 insulin-dependent diabetes when the patient:

a.

is heard asking her son to check the insulins expiration date.

b.

is able to identify the symptoms of hypoglycemia.

c.

asks why she needs to test her glucose levels so frequently.

d.

inquires why she needs to have an A1C test every 3 months.

ANS: A

Adherence is greatly improved when the patient is in agreement with the treatment plan and shows a willingness to follow it. The patient is requesting help ensuring that the insulin is not expired. Knowledge about symptoms does not equate with adherence. Asking questions does not indicate adherence or not.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 16-2

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

7. The nurse impacts the trajectory of a patients type 2 insulin-dependent diabetes best by:

a.

evaluating the patients ability to administer insulin appropriately.

b.

providing the patient with a written copy of the treatment plan.

c.

explaining to the patient the importance of serum glucose control.

d.

providing the patient with research-based nursing care.

ANS: A

The illness trajectory can be modified by actions taken by the health care provider that directly affect the patients ability/interest to adhere to the treatment plan prescribed. The other actions are important but do not directly affect the illness trajectory.

DIF: Applying (Application) REF: N/A OBJ: 16-3

TOP: Nursing Process: Evaluation MSC: Health Promotion

8. An older patient diagnosed with severe osteoarthritis has recently moved in with his son ecause of a history of falls. The son describes how he and his family have eagerly assumed responsibility for meeting all Dads needs. The nurse is most concerned that this environment will result in the patient:

a.

developing a sense of powerlessness and possibly a loss of hope.

b.

becoming unnecessarily physically and emotionally dependent.

c.

losing his will to get better and become independent again.

d.

becoming resentful and argumentative with his sons family.

ANS: A

With no control over the meeting of his own needs, the patient may develop a sense of powerlessness, which can result in a loss of hope. The other concerns might be a problem for some patients, but powerlessness and loss of hope remain the priority.

DIF: Understanding (Comprehension) REF: Page 286 OBJ: 16-3

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

9. To best assist an older adult patient to cope with a new diagnosis of chronic renal failure, the nurse:

a.

asks the patient to describe her usual coping strategies.

b.

provides the patient with descriptions of new coping strategies.

c.

initiates discussions with the patient to explain the disease.

d.

offers to arrange a meeting with another patient with the diagnosis.

ANS: C

Understanding the illness and what to expect is directly related to the ability to cope. After the patient has information, the nurse can then assess psychosocial systems.

DIF: Applying (Application) REF: N/A OBJ: 16-3

TOP: Teaching-Learning MSC: Physiologic Integrity

10. To best help manage health care costs in older adults, the nurse entrepreneur would do which of the following?

a.

Create a telehealth system where nurses could check on patients daily.

b.

Provide local transportation services for older people to keep appointments.

c.

Create educational videos in multiple languages seen in the community.

d.

Build a nurse-run clinic to serve the homeless and underinsured population.

ANS: A

The majority of health care expenditure is spent on chronic illness. Patients with chronic illnesses have multiple hospitalizations for exacerbations of their conditions. Keeping chronic conditions under control would make a difference in health care cost. A telehealth service in which nurses could assess and counsel patients daily could help accomplish that goal. The other ideas are good too, but tight control of chronic conditions is a priority.

DIF: Applying (Application) REF: N/A OBJ: 16-5

TOP: Nursing Process: Implementation MSC: Health Promotion

11. A nurse is working with a patient who was diagnosed with type 2 diabetes 4 months ago. The patients blood sugars have stayed under control. What action by the nurse is best?

a.

Ask the patient what barriers to wellness still exist.

b.

Remind the patient about the A1C in 2 months.

c.

Review side effects of medications with the patient.

d.

Ask the patient how she or he feels about diabetes.

ANS: A

Older patients typically see chronic illness as one part of their lives. The nurse can support older adults by working with them to identify areas that may hinder progress along the wellness continuum and by teaching self-care management in these areas. The nurse should assess the patients needs from his or her point of view.

DIF: Applying (Application) REF: N/A OBJ: 16-5

TOP: Nursing Process: Assessment MSC: Health Promotion

12. A nurse is assessing quality of life (QOL) in older individuals with chronic illnesses who attend a community center. What information is most important to assess?

a.

How many days were lost to exacerbations in the last year

b.

How good each individual perceives his or her QOL to be

c.

How burdensome the patients treatment regime is daily

d.

How often the patient needs to see a health care provider

ANS: B

QOL is individualized for each patient, and each person is the only one who can rate his or her quality of life. It is not dependent on objective measures such as number of health care visits or how many days were spent sick.

DIF: Application (Applying) REF: N/A OBJ: 16-1

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

13. Nurses should evaluate health programs based on what data?

a.

Effect on quality of life

b.

Cost-benefit ratio of service

c.

Adherence statistics

d.

Ease of following through

ANS: A

Quality of life should drive treatment decisions. The patient and health care provider should set goals that are mutually acceptable and promote independence and quality of life. The other factors are considerations, but quality of life is most important.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 16-5

TOP: Nursing Process: Evaluation MSC: Health Promotion

14. A student learning about the early AIDS epidemic wonders why the patients were stigmatized. What response by the nurse was best?

a.

Fear of the unknown etiology

b.

Expense required government assistance

c.

Patients being ashamed of their illness

d.

Younger patients not having accomplishments

ANS: A

Stigma arises out of specific characteristics of a disease or an unknown etiology, which causes fear. In the early days of the AIDS epidemic, not much was known about transmission, which generated fear in health care workers and the general population.

DIF: Understanding (Comprehension) REF: Page 286 OBJ: 16-3

TOP: Teaching-Learning MSC: Psychosocial Integrity

15. When working with older adults with chronic illness and exacerbations, what action by the nurse is most appropriate?

a.

Continually assess the patients for adherence to the regime.

b.

Assess the patients for ways they can remain in control.

c.

Teach the patients about the illness trajectory.

d.

Routinely review all medications the patients are taking.

ANS: B

With exacerbations, the patient loses some control over an acute phase of the illness. The patient can be helped to maintain independence, control, and dignity by reassessing what is still within the patients ability and desire to control. The patient may or may not be adherent, but the nurse should not assume he or she is not. Teaching about the illness trajectory is one tool for giving control to patients. Medication reviews should be done but are not the best action.

DIF: Applying (Application) REF: N/A OBJ: 16-3

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

16. An older patient has moved into an adult childs home after an extended stay at a rehabilitation facility. The patient complains the child is now the boss and the child complains about caregiving duties. What action by the nurse is best?

a.

Help the older patient find another place to live.

b.

Suggest that it is time for assisted living.

c.

Mediate a family meeting to discuss roles.

d.

Listen empathetically but let them work it out.

ANS: C

Role reversals and role changes are common in families where an older adult has chronic illnesses. These lost roles need to be mourned by all involved. The nurse helps most in this situation by mediating a family meeting where roles, coping, and feelings can be discussed. The nurse can help problem solve by assisting the individuals to identify ways in which they can keep their traditional roles, if even only for a short time.

DIF: Applying (Application) REF: N/A OBJ: 16-3

TOP: Communication and Documentation MSC: Psychosocial Integrity

17. An older adult has chronic fatigue from several illnesses. The patient is frustrated at this symptom. What action by the nurse is best?

a.

Ask the patient to prioritize activities.

b.

Have the patient keep a fatigue diary.

c.

Encourage the patient to rest in the day.

d.

Instruct the patient on good sleep hygiene.

ANS: A

Helping the patient cope with fatigue is an important nursing intervention. The nurse should first ask the patient to prioritize the activities she or he most wants to do. Then the nurse and patient can plan strategies that will allow the patient to participate in these activities. Keeping a diary is helpful, but knowing what interests the patient most is more important. Rest and sleep are important, but they are not the priorities.

DIF: Applying (Application) REF: N/A OBJ: 16-3

TOP: Nursing process: Assessment MSC: Psychosocial Integrity

18. An older patient has been admitted to the nursing unit after a car crash and surgery. When does the nurse begin planning for rehabilitation?

a.

On admission

b.

When the patient is awake

c.

When the patient is stable

d.

When the family requests it

ANS: A

Planning for rehabilitation, like discharge planning, begins on admission.

DIF: Remembering (Knowledge) REF: Page 289 OBJ: 16-3

TOP: Nursing Process: Analysis MSC: Physiologic Integrity

19. A home health care nurse is conducting a functional assessment on an older woman who lives alone. What assessment question is likely to get the best information?

a.

How do you manage all your medications?

b.

Who shops and cleans your house for you?

c.

Can you show me how you prepare a meal?

d.

What parts of your body cant you wash?

ANS: C

Older patients may downplay or deny functional limitations, so the nurse gets more accurate data asking what the patient is able to do, rather than what she or he is not able to do.

DIF: Understanding (Comprehension) REF: Page 290 OBJ: 16-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

20. A nurse assesses a newly admitted patient to a nursing home using the Functional Independence Measure (FIM) and rates the patient at 20. What action by the nurse is best?

a.

Arrange admission to a rehabilitation center.

b.

Plan care for a nearly dependent person.

c.

Plan care for a nearly independent person.

d.

Tells the family the patient is cognitively impaired.

ANS: B

Eighteen measures are accounted for in the FIM with scores ranging from 1 (dependent) to 7 (independent). A score of 20 indicates near total dependence. The FIM does not measure cognitive status.

DIF: Applying (Application) REF: N/A OBJ: 16-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

MULTIPLE RESPONSE

1. Adherence to prescribed health care treatments by a patient with a chronic disease is best facilitated when the nurse does which of the following? (Select all that apply.)

a.

Provides the patient with information regarding his disease

b.

Assesses the patients ability to understand his disease

c.

Defines health and wellness for the patient

d.

Helps the patient identify barriers to his personal wellness

e.

Coordinates support services to facilitate the patients discharge

ANS: A, B, D, E

The five As of a patients self-management of care includes assess, advise, agree, assist, and arrange.

DIF: Remembering (Knowledge) REF: Page 284 OBJ: 16-3

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

2. The student learning about chronic disease and illness in the older population learns which facts about this situation? (Select all that apply.)

a.

One in two adults, or more than 133,000 Americans, has a chronic condition.

b.

Chronic disease is the leading cause of death in those over 65.

c.

About 75% of medical costs each year are spent on managing chronic disease.

d.

Formerly acute conditions are now manageable chronic diseases..

e.

The focus of Americas health care services is now on chronic illness

ANS: A, B, C, D

One in two adults has a chronic illness, and these problems are the leading cause of death in those over 65 and the largest cost to our health care system. One reason for this is that formerly acute, possibly fatal, conditions are now manageable as chronic conditions. Americas health care system continues to be focused on acute care.

DIF: Remembering (Knowledge) REF: Page 282 OBJ: 16-1

TOP: Teaching-Learning MSC: Physiologic Integrity

3. The nurse understands what about the Americans with Disabilities Act? (Select all that apply.)

a.

It outlaws discrimination on the job because of disabilities.

b.

It requires state governments to fund disability services.

c.

It prohibits discrimination in government services to the disabled.

d.

It requires all buildings to be retrofitted to allow access.

e.

It provides funding for barrier-free buildings and parks.

ANS: A, C

The ADA outlawed discrimination on the basis of disability in employment, in programs and services provided by state and local governments, and in the provision of goods and services provided by private companies and commercial facilities. It does not mandate government payment for disability services, require buildings to be retrofitted, or provide funding for barrier-free facilities.

DIF: Remembering (Knowledge) REF: Page 289-90 OBJ: 16-1

TOP: Teaching-Learning MSC: Safe Effective Care Environment

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