Chapter 5: Chronic Illness and Older Adults

Question 1

diseases that have a rapid onset and short duration

Answer 1

acute disease

Question 2

diseases that are prolonged, do not resolve spontaneously, rarely cured completely

Answer 2

chronic disease

Question 3

Name this chronic illness trajectory phase.

• signs and symptoms are present
• disease diagnosed

a. onset
b. stable
c. acute
d. comeback

Answer 3

a. onset

Question 4

Name this chronic illness trajectory phase.

• illness course and symptoms controlled by treatment plan
• person maintains daily activities

a. onset
b. stable
c. acute
d. comeback

Answer 4

b. stable

Question 5

Name this chronic illness trajectory phase.

• active illness with severe and unrelieved symptoms or complications
• hospitalization may be needed for management

a. onset
b. stable
c. acute
d. comeback

Answer 5

c. acute

Question 6

Name this chronic illness trajectory phase.

gradual return to an acceptable way of life

a. onset
b. stable
c. acute
d. comeback

Answer 6

d. comeback

Question 7

Name this chronic illness trajectory phase.

• life-threatening situation occurs
• emergency services are necessary

a. crisis
b. unstable
c. downward
d. dying

Answer 7

a. crisis

Question 8

Name this chronic illness trajectory phase.

• unable to keep symptoms or disease course under control
• life disrupted while patient works to regain stability
• hospitalization not required

a. crisis
b. unstable
c. downward
d. dying

Answer 8

b. unstable

Question 9

Name this chronic illness trajectory phase.

• gradual and progressive deterioration in physical or mental status
• accompanied by increasing disability and symptoms
• continuous changes in daily life activities

a. crisis
b. unstable
c. downward
d. dying

Answer 9

c. downward

Question 10

Name this chronic illness trajectory phase.

• patient has to relinquish life interests and activities, let go peacefully
• immediate weeks, days, hours preceding death

a. crisis
b. unstable
c. downward
d. dying

Answer 10

d. dying

Question 11

Primary, secondary or tertiary prevention?

diet, exercise, immunizations

Answer 11

primary

Question 12

Primary, secondary or tertiary prevention?

early detection/screening

Answer 12

secondary

Question 13

Primary, secondary or tertiary prevention?

rehabilitation; limit progression of disease

Answer 13

tertiary

Question 14

a person’s ability to manage their health, especially in response to living with a chronic illness

Answer 14

self-management

Question 15

young-old adult age

Answer 15

65 to 74 years old

Question 16

old-old adult age

Answer 16

75+

Question 17

The frail, old adult is __________ years old and older.

Answer 17

75

Question 18

negative attitude based on age

Answer 18

ageism

Question 19

a multifactorial process involving genetics, diet, and enviornment

Answer 19

biologic aging

Question 20

The incidence of chronic illness triples after age ______.

Answer 20

45

Question 21

What is the top barrier to healthcare for rural older adults?

Answer 21

transportation

Question 22

specialty area of providing culturally competent care to older adults

Answer 22

ethnogeriatrics

Question 23

Intentional acts of omission or commission by a caregiver or “trusted other”.

Answer 23

elder mistreatment

Question 24

A federally funded health insurance program for people ages 65 years or older.

Answer 24

medicare

Question 25

A state-administered, needs-based program to help eligible low-income people, including Medicare beneficiaries, with certain medical expenses.

Answer 25

medicaid

Question 26

T/F

In older adults, disease symptoms are often atypical.

Answer 26

true

Question 27

T/F

Depression is a normal part of aging.

Answer 27

false

Question 28

The trajectory of chronic illness includes (SATA):

a. periods of crisis

b. episodes of exacerbations and stability

c. a gradual return to an acceptable way of life

d. a straight trajectory without overlapping phases

e. symptoms that can be controlled by proper treatment

Answer 28

a. periods of crisis

b. episodes of exacerbations and stability

c. a gradual return to an acceptable way of life

e. symptoms that can be controlled by proper treatment

Question 29

A patient is ordered cardiac rehabilitation following cardiac bypass surgery. The nurse recognizes this as:

a. primary prevention for atelectasis
b. secondary prevention for atherosclerosis
c. tertiary prevention to reduce the progression of heart disease
d. a recommended treatment to prevent DVT

Answer 29

c. tertiary prevention to reduce the progression of heart disease

Question 30

Demographic trends among older Americans in the US suggest:

a. there are fewer people living past age 85

b. more frailty in persons between 65 and 75 years

c. a growth in racial and ethnically diverse populations

d. women having a decreased life expectancy when compared to men

Answer 30

c. a growth in racial and ethnically diverse populations

Question 31

A nurse is discharging an older adult patient who is homeless. Which actions demonstrate the nurse’s understanding of the needs of this population? (SATA)

a. instructs the patient to check his blood pressure daily

b. asks the patients if they have a social worker or case manager

c. inquires if the patient has concerns about staying in the local shelter

d. asks the physician if enoxaparin can be changed to an oral anticoagulant

e. informs the patient that the hospital will call with his cult test results next week

Answer 31

b. asks the patients if they have a social worker or case manager

c. inquires if the patient has concerns about staying in the local shelter

d. asks the physician if enoxaparin can be changed to an oral anticoagulant

Question 32

In which situation would the nurse suspect elder mistreatment?

a. patient admitted with recurrent syncope

b. creatinine of 1.1 mg/dL and BUN of 10 mg/dL

c. sacral pressure injury on a patient who lives at home

d. patient with dementia who becomes more confused at night

Answer 32

c. sacral pressure injury on a patient who lives at home

Question 33

Which action is aligned with the 4M model of an age-friendly health system?

a. silencing a bed alarm so the patient can sleep at night

b. assessing if the patient needs a mobility device, such as a walker

c. asking for haloperidol for a patient with dementia who is pulling on their IV

d. telling the patient that they need to eat their dinner in order to avoid a feeding tube

Answer 33

b. assessing if the patient needs a mobility device, such as a walker

Question 34

Which action is a priority for a newly admitted patient?

a. checking for pressure ulcers
b. planning for post-discharge needs
c. administering an influenza vaccine
d. assessing the patient’s mental status

Answer 34

d. assessing the patient’s mental status

Question 35

Nursing interventions directed at health promotion in the older adult are mainly focused on:

a. performing IADLs
b. symptom management
c. reducing risk for illness or injury
d. assessing if the patient has an advanced directive

Answer 35

c. reducing risk for illness or injury

Question 36

When caring for an older patient with hypertension who has been hospitalized after a transient ischemic (TIA), which topic is the priority important for the nurse to include in the discharge teaching?

a. Mechanism of action of anticoagulant therapy

b. Effect of atherosclerosis on cerebral blood vessels

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

Answer 36

c. Symptoms indicating that the patient should contact the health care provider

Question 37

The nurse performs a comprehensive assessment of an older patient who is considering admission to an assisted living facility. Which question would help the nurse assess the patient‘s level of daily functioning?

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?”

Answer 37

d. “Are you able to prepare your own meals?”

Question 38

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 tells the nurse that she has a strained relationship with her daughter and does not enjoy being alone all day. In planning care for this patient, which problem should the nurse consider as the priority?

a. Risk for injury

b. Impaired socialization

c. Caregiver role strain

d. Difficulty coping

Answer 38

a. Risk for injury

Question 39

Which method would the nurse use to obtain a 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.

Answer 39

b. Use a geriatric assessment instrument to evaluate the patient.

Question 40

Which action would the nurse include in planning optimal care for an older patient who is hospitalized with pneumonia?

a. Use a standardized geriatric care plan.

b. Consider the patient‘s current functional abilities.

c. Minimize physical activity during hospitalization.

d. Plan for the patient‘s transfer to a long-term care facility.

Answer 40

b. Consider the patient‘s current functional abilities.

Question 41

The nurse cares for an older adult patient who lives in a rural area. Which intervention would the nurse plan to implement to meet this patient‘s needs?

a. Suggest that the patient move closer to health care providers.

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.

Answer 41

c. Ensure transportation to appointments with the health care provider.

Question 42

Which nursing action would 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. Ask the patient to bring all medications, supplements, and herbs to each appointment.

d. Instruct the patient to avoid taking any over-the-counter medications or supplements.

Answer 42

c. Ask the patient to bring all medications, supplements, and herbs to each appointment.

Question 43

A patient who has just relocated to a long-term care facility is exhibiting signs of stress related to the move. Which action would 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.

Answer 43

d. Have staff members write notes welcoming the patient to the facility.

Question 44

An older patient who reports having “no energy” and feeling increasingly weak has lost 12 pounds over the past year. Which action would the nurse take?

a. Ask the patient about daily dietary intake.

b. Schedule regular range-of-motion exercise.

c. Describe normal changes associated with aging.

d. Discuss long-term care placement with the patient.

Answer 44

a. Ask the patient about daily dietary intake.

Question 45

The nurse is admitting an acutely ill, older adult to the hospital. Which action would the nurse take?

a. Speak slowly and loudly while facing the patient.

b. Perform a physical assessment before interviewing the patient.

c. Ask all family members to leave now and return the next day.

d. Begin by obtaining a detailed medical history from the patient.

Answer 45

b. Perform a physical assessment before interviewing the patient.

Question 46

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 priority 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.

Answer 46

b. Refer the patient to social services for assessment of resources.

Question 47

The home health nurse cares for an older adult patient who lives alone and takes several different prescribed medications for chronic health problems. Which intervention by the nurse would support both the patient‘s self-management and medication adherence?

a. Use a marked pillbox to set up the patient‘s medications.

b. Discuss the option of moving to an assisted living facility.

c. Remind the patient about the importance of taking medications.

d. Visit the patient daily to administer the prescribed medications.

Answer 47

a. Use a marked pillbox to set up the patient‘s medications.

Question 48

The home health nurse visits an older patient with mild forgetfulness. Which new information would be of most concern to the nurse in planning care?

a. The patient has lost 10 lb (4.5 kg) during the past month.

b. The patient tells the nurse that a close friend recently died.

c. The patient is cared for by a daughter during the day and stays with a son at night.

d. The patient‘s son uses a marked pillbox to set up the patient‘s medications weekly.

Answer 48

a. The patient has lost 10 lb (4.5 kg) during the past month.

Question 49

Which statement, if made by an older adult patient, would be of most concern to the nurse in planning care?

a. “I prefer to manage my life without much help from other people.”

b. “I take three different medications for my heart and joint problems.”

c. “I don‘t go on daily walks anymore since I had pneumonia 3 months ago.”

d. “I set up my medications in a marked pillbox so I don‘t forget to take them.”

Answer 49

c. “I don‘t go on daily walks anymore since I had pneumonia 3 months ago.”

Question 50

Which patient is most likely to need a referral for long-term nursing care management?

a. 72-yr-old who had a hip replacement after a fall at home

b. 64-yr-old who developed sepsis after a ruptured peptic ulcer

c. 76-yr-old who had a cholecystectomy and bile duct drainage

d. 63-yr-old with bilateral knee osteoarthritis who weighs 350 lb (159 kg)

Answer 50

d. 63-yr-old with bilateral knee osteoarthritis who weighs 350 lb (159 kg)

Question 51

An older adult being admitted is assessed at high risk for falls. Which action would the nurse take first?

a. Use a bed alarm system on the patient‘s bed.

b. Administer the prescribed PRN sedative medication.

c. Ask the health care provider to order a vest restraint.

d. Position the patient in a geriatric recliner with locking tray.

Answer 51

a. Use a bed alarm system on the patient‘s bed.

Question 52

An older adult patient presents to the emergency department with a broken arm and visible scattered bruises healing at different stages. Which action would the nurse take first?

a. Make a referral for a home assessment visit by the home health nurse.

b. Ask the patient and family member to explain how the injury occurred.

c. File a report with an elder protective services agency about possible abuse.

d. Have the family member stay in the waiting area while the patient is assessed.

Answer 52

d. Have the family member stay in the waiting area while the patient is assessed.

Question 53

An older patient has chronic health problems and increasing weakness. The patient‘s family members are considering placement for the patient in a long-term care (LTC) facility. Which action by the nurse will be most helpful in assisting the patient to make this transition?

a. Have the family select an LTC facility that is relatively new.

b. Ask the patient‘s preference for the choice of an LTC facility.

c. Explain the reasons for the need to live in LTC to the patient.

d. Request that the patient be placed in a private room at the facility.

Answer 53

b. Ask the patient‘s preference for the choice of an LTC facility.

Question 54

The nurse manages the care of older adults in an adult health daycare center. Which action can the nurse delegate to assistive personnel (AP)?

a. Plan daily activities based on the individual patient needs and desires.

b. Obtain information about food and medication allergies from patients.

c. Take blood pressures daily and document in individual patient records.

d. Teach family members how to cope with patients who are cognitively impaired.

Answer 54

c. Take blood pressures daily and document in individual patient records.

Question 55

A family caregiver tells the home health nurse, “I feel like I can never get away to do anything for myself.” Which action by the nurse would directly address this concern?

a. Assist the caregiver in finding respite services.

b. Assure the caregiver that the work is appreciated.

c. Encourage the caregiver to discuss feelings openly with the nurse.

d. Tell the caregiver that family members provide excellent patient care.

Answer 55

a. Assist the caregiver in finding respite services.

Question 56

Which nursing actions would the nurse take to assess for possible malnutrition in an older adult patient? (Select all that apply.)

a. Screen for depression.

b. Review laboratory results.

c. Determine food preferences.

d. Inspect teeth and oral mucosa.

e. Ask about transportation needs.

Answer 56

a. Screen for depression.

b. Review laboratory results.

d. Inspect teeth and oral mucosa.

e. Ask about transportation needs.

Question 57

The nurse is assessing an older adult patient who lives at home. Which factors would increase the risk for the patient to experience elder mistreatment? (SATA.)

a. Immobility

b. Depression

c. Alcohol use

d. Low income

e. Social support

f. Cognitive decline

g. Living with a spouse

Answer 57

a. Immobility

b. Depression

c. Alcohol use

d. Low income

f. Cognitive decline