Exam 1 - Chapter 21 Flashcards
A nurse is caring for an older adult who is in the pre-trajectory phase of the Chronic Illness
Trajectory. The nurse knows that this phase is characterized by which of the following:
a. The absence of signs or symptoms of the illness
b. Diagnostic testing being conducted
c. A progressive decline in physical and or mental status
d. A period of temporary remission from the crisis
A - The pre-trajectory phase is characterized by the absence of signs or symptoms of the illness.
The trajectory onset includes the diagnostic period. The downward phase is characterized by a
progressive decline in physical/mental status, characterized by increasing
disability/symptoms. The comeback phase is characterized as a period of temporary remission
from the crisis.
A major difference in the diagnosis of chronic disease between younger adults and older
adults is that:
a. chronic disease is often diagnosed earlier in younger adults and measures can be
implemented to prevent later problems.
b. chronic disease is often diagnosed earlier in older adults since they are more likely
to seek medical care.
c. chronic disease is usually not identified in older adults because of the many
age-related changes.
d. chronic illness is uncommon in younger adults.
A - In a younger adult, the early signs of a pending chronic disease may be identified early
enough to prevent later problems (e.g., a finding of an elevated cholesterol level). In older
adults, a chronic disease may not be diagnosed until some amount of “end organ damage” has
already occurred. For example, diabetic retinopathy may be found during an annual eye
examination indicating that the diabetes has been present for some time. Although there are
many age-related changes in the older adult, it is still possible to identify chronic illness.
Chronic illness is common in younger adults, although it is more common in older adults.
An older man who is a smoker is hospitalized for orthopedic surgery. A nurse takes the
opportunity to provide smoking cessation education. The patient asks the nurse: “I have been
smoking for most of my life, and I am an old man. Why are you wasting your time telling me
to stop smoking? Isn’t it too late?” The nurse bases the response on the knowledge that:
a. smoking cessation as late as age 75 can reduce premature death by up to 50%.
b. smoking cessation as late as age 75 can completely eliminate premature death.
c. smoking cessation at a late age will not impact the smoker but can reduce exposure
of family members to second-hand smoke.
d. smoking cessation education is only effective in individuals under age 75.
A - Smoking cessation as late as age 75 can reduce premature death by up to 50%. The remaining
options are not true.
A nurse cares for an older adult who is described as being “frail.” The nurse understands that
in order to be characterized as frail an individual must possess which of the following
characteristics? (Select all that apply.)
a. Slow walking speed
b. Low activity level
c. Self-reported exhaustion
d. Taking at least five prescribed medications
e. A diagnosis of at least two chronic conditions
A,B,C - Frailty is defined as evidence of three of the following: unexplained weight loss, self-reported
exhaustion, weak grip strength, slow walking speed
and low activity.
Neither the number of medications that an individual is prescribed nor the number of chronic
conditions is part of the diagnosis of frailty.
A nurse is planning health education on chronic illnesses for a group of seniors in the
community. When deciding upon which illnesses to focus upon, the nurse knows that which
of the following are the most common diseases in the United States? (Select all that apply.)
a. Heart disease
b. Hypertension
c. Asthma
d. Osteoarthritis
e. Diabetes
A,B,D - The most common chronic diseases in the United States are heart disease, hypertension, and
osteoarthritis
The role of a nurse caring for an older patient who is in the stable phase of a chronic illness
may include which of the following? (Select all that apply.)
a. Coordinating care with members of the interdisciplinary team
b. Administering medications to the patient
c. Providing assistance with bathing and dressing
d. Ensuring that the patient’s immunizations are up to date
e. Providing emergency care
A,B,C - Options A, B, and C are all roles of the nurse in the stable phase of chronic illness. Option d is
a role of the nurse in the preventive phase of chronic illness. Option E is a role of the nurse in
the acute phase of chronic illness
A nurse is teaching a group of older adults about healthy aging. The nurse discusses global
lifestyle risk factors for chronic disease. The nurse includes which of the following in the
education? (Select all that apply.)
a. Smoking cessation and avoidance of tobacco
b. Maintenance of high levels of physical activity
c. Importance of eating a balanced diet
d. Development of advance directives
e. Maintenance of blood pressure readings at a level of 120/80 or lower
A,B,C - Major global lifestyle risk factors for the development of chronic disease include tobacco use,
unhealthy diet, physical inactivity, and alcohol abuse. Development of advance directives and
maintenance of healthy blood pressure readings are important, however, are not global
lifestyle risk factors for chronic disease.
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.
C - Chronic illnesses are enduring and necessitate lifetime adaptations. Uncertainty exacerbates the impact of a chronic disease. At this time, the most 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.
Which of the following describes the nurse’s 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 accepts eventual death to reduce the burdens on the patient’s family.
d.
Encourage the patient to minimize the use of services to control costs.
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 family’s wishes. The nurse can help the patient and family to formulate cost-cutting measures, if so requested; however, because the nurse is the patient’s advocate, the nurse avoids making recommendations about not using services.
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 patient’s 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 patient’s values, culture, and beliefs will have little to do with the types of changes he or she will be able to make.
A - The patient must remain involved in the decision-making process; 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 patient’s values, cultures, and beliefs profoundly shape the patient’s response to chronic illness and to therapeutic interventions.
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
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, 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.
More than 50% of the population aged 65 years and older has which one of the following chronic health conditions? a. Hypertension b. Renal failure c. Multiple sclerosis d. Cancer
A - More than 50% of the population aged 65 years and older has hypertension and arthritis followed by heart disease and diabetes.
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.
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 man’s 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 man’s 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 man’s 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.
An older woman has diabetes mellitus. Which patient assessment validates the nurse's 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
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 woman’s 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.
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
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 healthy lives 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.
