Chapter 3: Care Across the Continuum(FREE) My Nursing Test Banks

Chapter 3: Care Across the Continuum

Test Bank

MULTIPLE CHOICE

1. An older female resident in the residential facility keeps a large collection of personal items and photographs of her late husband on her bedside table, but the nursing assistant and resident frequently argue about this. Why should the nurse intervene between the resident and the nursing assistant?

a.

Resident is attempting to maintain her sense of personal space.

b.

Resident needs to accept the reality of her spouses death.

c.

Residents argumentative nature can indicate early dementia.

d.

Clutter from all the personal items is a safety and liability risk.

ANS: A

A thoughtful nurse respects and supports the residents boundaries. Even if the resident needed to accept the reality of her spouses death, the residents grief process and personal space should be respected. Although the residents argumentative nature can indicate early dementia, the residents behavior can also be understood as a healthy defense of personal space. Although the rationale of the nurse assistant is probably that the clutter from all the personal items is a safety and liability risk, the assistant should realize that this resident is entitled to the personal use of her personal space.

PTS: 1 DIF: Apply REF: 12 TOP: Nursing Process: Evaluation

MSC: Psychosocial Integrity

2. Which statement is true about living arrangements for older adults?

a.

Older adults are more independent in their own homes than in a residential community.

b.

The increase in real estate values makes home ownership essential to security.

c.

Program for All-Inclusive Care for the Elderly (PACE) is a community alternative to nursing home care for frail older adults.

d.

Florida is an example of a naturally occurring retirement community (NORC).

ANS: C

PACE is an alternative to nursing home care for frail older people who want to live independently in the community with a high quality of life. Although relief from the burden of home maintenance can free a person for more independent living, this statement can or cannot be accurate, depending on the real estate market at the time. In addition, taxes and maintenance costs have also risen. A NORC is an organization formed by older adults living at home in geographic proximity to each other to provide supportive services for each other.

PTS:1DIF:UnderstandREF:5

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

3. As the nurse admits an older woman to a long-term care facility from her home of 50 years, she mistakes the nurse for her daughter. Which diagnosis does the nurse use to plan care for this woman?

a.

Hypoxia as a result of chronic disease

b.

Relocation stress syndrome

c.

Alzheimer disease (AD)

d.

Attention-seeking behavior

ANS: B

Relocation, especially if sudden, causes stress that may lead to altered mental status. Many conditions other than hypoxia can cause altered mental status, including relocation stress. Many conditions other than AD can cause altered mental status, including relocation stress. The nurse has no confirmatory evidence to regard the older womans error as something other than a mistake; in addition, it can be understood as relocation stress syndrome.

PTS: 1 DIF: Apply REF: 16 TOP: Nursing Process: Diagnosis

MSC: Safe, Effective Care Environment

4. Which statement is true about residential living for older adults?

a.

A residential care facility is the new term for a nursing home.

b.

An assisted living facility (ALF) must have an registered nurse (RN) on staff.

c.

Administrators are realizing that their duty is to care for the residents as people.

d.

A granny flat is an apartment in a high-rise building reserved for seniors.

ANS: C

The movement is under way from an institution-centered culture to a person-centered one. A residential care facility houses older adults who cannot live independently but do not need the round-the-clock, complex care capabilities of a nursing home. In most states, ALFs are not required to provide skilled nursing. A granny flat is the term used in Australia for a small, prefabricated housing unit where an older adult can live separately from, but close to, family on family property.

PTS:1DIF:UnderstandREF:12-13

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

5. A family that has three small children prepares to move an older female parent into their home knowing that she stays up all night. The nurse helps the family prepare for the change. Which part of planning should the nurse indicate is the familys priority?

a.

Sharing household responsibilities

b.

Preparing the house for her arrival

c.

Helping her use her skills and talents

d.

Setting limits on nighttime activities

ANS: B

To reduce the risk of injury and falls, the familys priority is to prepare the house for an older adults arrival including preparing the parents private space, removing hazards, providing adequate lighting, installing handrails where necessary, and completing other safety measures. In addition, the parent needs to prepare mentally for the challenges presented when the children create new safety hazards for an older adult, such as spills and leaving toys on the floor. Sharing household responsibilities should be part of the preparation; however, safety concerns are more important. Helping the older adult to use her skills and talents provides meaningful activities; however, safety concerns are more important. Setting limits on her nighttime activities is important preparation to avoid conflicts; however, safety concerns are the priority.

PTS: 1 DIF: Analyze REF: 3 TOP: Nursing Process: Planning

MSC: Safe, Effective Care Environment

6. A resident of a long-term care facility has been asking to have the drain in the bathroom sink repaired for 2 months. The nurse responds by saying that when they move to the new building, the sinks will work very well. Which right of a resident of a long-term care facility has the nurse violated?

a.

Right to be free of all forms of abuse

b.

Right to be transferred for appropriate reasons

c.

Right to voice grievances and have them remedied

d.

Right to information about conditions and treatments

ANS: C

The nurse has violated the residents right to voice a grievance and to have the problem fixed. If the residents were moving into the new building in a few days, then the nurses response might be suitable; however, without specifying a time limit, the nurse has violated the residents right to voice a grievance and have it remedied. A clogged sink is not abuse. The resident is not going to be transferred; all of the residents are moving to a new facility. A residents condition or treatments are not mentioned by the resident.

PTS:1DIF:ApplyREF:29 Text Box 3-5

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

7. A nursing home is converting to a person-centered culture from an institution-centered culture. Which nursing intervention will be suitable in the new culture?

a.

Maintain consistent resident assignments.

b.

Provide structured activities for the residents.

c.

Assign nursing assistants to perform bathing.

d.

Determine mealtime on the basis of staffing levels.

ANS: A

As part of a person-centered culture, nurses should have consistent resident assignments to establish rapport with their residents and become familiar with their unique qualities and preferences. Activities structured by the staff are part of the institution-centered culture. Assigning assistants to perform bathing is part of the institution-centered culture because it focuses on tasks. Schedules are determined for the staffs convenience as part of the institution-centered culture.

PTS: 1 DIF: Apply REF: 12-13 | Text Box 3-6 on 30

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

8. The nurse prepares to transfer an older adult to a long-term care facility and calls the facility to give a report. Which nursing actions are the responsibilities of the transferring nurse and the receiving nurse?

a.

Incorporating patient goals into the plan

b.

Ensuring the patient is stable for transfer

c.

Supplying patient documents for planning

d.

Providing continuity of care during the transfer

ANS: D

A shared responsibility of the sending and the receiving nurses or care team is to regard the transition as a transfer versus a discharge and to provide continuous and consistent nursing care throughout the transfer phase. To accomplish this, the two nurses or groups must have clear, comprehensive communication. The receiving nurse incorporates patient goals into the plan. The sending nurse ensures that the patient is stable for the transfer to prevent decompensation during the trip or shortly after arrival at the new facility. The sending nurse is responsible for providing clear, comprehensive, and complete patient documentation.

PTS:1DIF:UnderstandREF:12-15

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

9. The nurse assesses a resident who was transferred yesterday from an acute care hospital. Which should the nurse assess to determine whether this individual is under stress from the transfer?

a.

Length of the residents stay in the acute care facility

b.

Availability of disposition options before the transfer

c.

Presence of familiar people throughout the transfer

d.

Tour of the new facility shortly after transfer

ANS: B

To help assess the resident for stress, the nurse reviews the sequence of events that led to the relocation including whether the resident had relocation options and what those options were before relocation. If the resident played an active role in the choice of facilities and had several available options, then the resident is likely to experience less stress upon relocation. The length of stay in the acute care facility is an unreliable index of stress in a resident who has been recently relocated. The presence of familiar people is an unreliable predictor of relocation stress. Touring the new facility is an unreliable predictor of relocation stress; if the tour is conducted too soon or when the resident is in pain, tired, or distracted, then the resident is unlikely to benefit from the tour.

PTS:1DIF:ApplyREF:32 Text Box 3-8

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

10. Which is characteristic of relocation stress syndrome in a resident of a long-term care facility?

a.

Agitation

c.

Caring family

b.

Apprehension

d.

Hallucinations

ANS: B

Apprehension is a major defining characteristic of stress relocation syndrome. Agitation is uncharacteristic of stress relocation syndrome. An inadequate support system is characteristic of this syndrome. Hallucinations are uncharacteristic of this syndrome.

PTS:1DIF:RememberREF:16

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

11. A nurse completing a hospital discharge to home understands that which of the following interventions is most important before discharge.

a.

Medication reconciliation

b.

Providing a list of community resources

c.

Contacting a durable medical equipment facility

d.

Educating the client on appropriate range-of-motion exercises

ANS: A

Medication reconciliation is the most important intervention to complete before discharge. Medication discrepancies are the most prevalent adverse event after hospital discharge and the most challenging component of a successful hospital-to-home transition. Nurses attention to an accurate prehospital medication list, medication reconciliation during hospitalization and at discharge, and patient and family education about medications are required to enhance safety. Educating the client on appropriate range-of-motion exercises, providing a list of community resources, and contacting a durable medical equipment facility are all important and should be completed as well, but medication reconciliation should be the priority.

PTS: 1 DIF: Apply REF: 13-22| 22 Box Safety Alert

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

MULTIPLE RESPONSE

1. A family is touring selected nursing homes in preparation for their mothers future. Which qualities of a nursing home should the family include if they decide on a person-centered nursing home? (Select all that apply.)

a.

Staff members cover all nursing units.

b.

Residents and families have a council.

c.

Residents choose stimulating activities.

d.

Staff members respond to residents needs.

e.

Group activities are scheduled on the hour.

f.

Staff members help residents stay well-groomed.

ANS: B, C, D, F

A characteristic of a person-centered culture is family and resident councils to discuss resident issues, needs, and solutions. A second characteristic of a person-centered culture is residents choosing their own activities to suit their interests. A third characteristic of a person-centered culture is a responsive staff that promptly meets resident needs. A fourth characteristic of a person-centered culture is assisting residents to maintain their appearance and to stay well-groomed. Consistent nursing assignments are a characteristic of a person-centered culture. Predetermined schedules are characteristic of an institution-centered culture.

PTS:1DIF:UnderstandREF:12 Box 3-4

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

2. An elder-friendly community includes components that: (Select all that apply.)

a.

Address basic needs

b.

Optimize physical health

c.

Provide financial assistance

d.

Maximize independence

e.

Provide social engagement

ANS: A, B, D, E

Components of an elder-friendly community include addressing basic needs, optimizing physical health and well being, maximizing independence for the frail and disabled, and providing social and civic engagement. Elder-friendly communities do not provide financial assistance.

PTS:1DIF:UnderstandREF:2

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

3. Which home modification interventions are designed to enhance the ability of older adults to remain in their homes? (Select all that apply.)

a.

A 36-inch-wide doorway

b.

Entryways with less than two steps

c.

Electrical outlets at chest level

d.

A bathroom on the first floor

ANS: A, D

Many state and local governments are assessing the community and designing interventions to enhance the ability of older people to remain in their homes and familiar environments. Home design features such as 36-inch-wide doorways and hallways, a bathroom on the first floor, an entry with no steps, outlets at wheelchair level, and reinforced walls in bathrooms to support grab bars.

PTS:1DIF:UnderstandREF:2

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

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