Chapter 5, Chronic Illness and Older Adults Video Solutions, Study Guide for Medical-Surgical Nursing: Assessment and Management of Clinical Problems

Problem 1

A 78-year-old female patient is admitted with nausea, vomiting, anorexia, diarrhea, and dehydration. She has a history of diabetes mellitus and 2 years ago had a stroke with residual right-sided weakness. Identify which characteristics of chronic illness the nurse will probably find in this parient (select all that apply).
a. Self-limiting
b. Residual disability
c. Permanent impairments
d. Infrequent complications
c. Need for long-term management
f. Nonreversible pathologic changes

Asma Venkitta

Numerade Educator

Problem 2

Seven tasks required for daily living with chronic illness have been identified. From Table 5-4, select at least one of these tasks that would specifically apply to the following common chronic conditions in older adults.
$$
\begin{array}{|l|l|}
\hline \text { Chronic Condition } & \text { Task } \\
\hline \text { Diabetes mellitus } & \\
\hline \text { Visual impairment } & \\
\hline \text { Heart disease } & \\
\hline \text { Hearing impairment } & \\
\hline \text { Alzheimer's disease } & \\
\hline \text { Arthritis } & \\
\hline \text { Orthopedic impairment } & \\
\hline
\end{array}
$$

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Problem 3

Consider the differences between primary and secondary prevention. Fill in the blanks.
a. Actions aimed at early detection of disease and interventions to prevent progression of disease are considered _____prevention.
b. Following a proper diet, getting appropriate exercise, and receiving immunizations against specific disease is considered______ prevention.

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01:18

Problem 4

What is the leading cause of death in the United States?
a. Cancer
b. Diabetes mellitus
c. Coronary artery disease
d. Cerebrovascular accident
e. Chronic obstructive pulmonary disease

Joanna Quigley

Numerade Educator

00:37

Problem 5

According to the Corbin and Strauss chronic illness trajectory, which statement describes a patient with an un condition?
a. Life-threatening situation
b. Increasing disability and symptoms
c. Gradual return to acceptable way of life
d. Loss of control over symptoms and disease course

Lara Gossage

Numerade Educator

02:48

Problem 6

Which statement(s) ahout older people are only myths and illustrate the concept of ageism (select all that apply)?
a. Can't teach an old dog new tricks.
b. Old people are not sexually active.
c. Most old people live independently.
d. Most older adults can no longer synthesize new information.
c. Most older people lose interest in life and wish they would die.

Sarah Howell

Numerade Educator

Problem 7

For each of the nursing diagnoses listed, identify at least two normal expected physiologic changes related to aging that could be etiologic factors of the diagnosis. Changes related to aging are found in the chapters identified in Table 5 -6.
a. Imbalanced nutrition: less than body requirements (sce Table 39-5, p. 871.) Chunge:
Change:
b. Activity intolerance (see Table 62-1, p. 1494.) Chunge:
Change:
c. Risk for injury (see Table 56-4, p. 1344; Table 21-1, p. 371.) Change:
Change:
d. Urge urinary incontinence (see Table 45-2, p. 1051.) Change:
Change:
e. Ineffective airway clearance (sce Table 26-4, p. 481.) Change:
Chinge:
f. Risk for impaired skin integrity (see Table 23-1, p. 417.) Change:
Change:
g. Ineffective peripheral tissue perfusion (see Table 32-1, p. 691.) Change:
Change:
h. Constipation (see Table 39-5, p. 871.) Change:
Change:

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01:43

Problem 8

The nurse identifies the presence of age-associated memory impaiment in the older adult who states
a. "I just can't seem to remember the name of my granddaughter."
b. "I make out lists to help me remember what I need to do but I can't seem to use them."
c. "I forgot that I went to the grocery store this morning and didn't realize it until I went again this afternoon."
d. "I forget movie stars' names more often now but 1 can remember them later after the conversation is over."

Dennis Howard

Numerade Educator

01:14

Problem 9

Indicate what the acronym SCALES stands for in assessment of nutrition indicators in frail older adults.
$$
\begin{array}{|l|l|}
\hline \mathbf{S} & \\
\hline \mathbf{C} & \\
\hline \mathbf{A} & \\
\hline \mathbf{L} & \\
\hline \mathbf{E} & \\
\hline \mathbf{S} & \\
\hline
\end{array}
$$

Vysakh M

Numerade Educator

Problem 10

When working with older patients who identify with a specific ethnic group, the nurse recognizes that health care problems may occur in these patients because they
a. live with extended families who isolate the patient.
b. live in rural areas where services are not readily available
c. eat ethnic foods that do not provide all essential nutrients.
d. have less income to spend for medications and health care services.

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01:34

Problem 11

An 83-year-old woman is being discharged from the hospital following stabilization of her internutional normalized ratio (INR) levels (used to assess effectiveness of warfarin therapy). She has chronic atrial fibrillation and has been on warfarin (Coumadin) for several years. Discharge instructions include returning to the clinic weekly for INR testing. Which statement by the patient indicates that she may be unable to have the testing done?
a. "When I have the energy, I have taken the bus to get this test done."
b. "I will need to ask my son to bring me into town every week for the test."
c. "Should I just keep taking the same pill every day until I can get a ride to town?"
d. "It is very important to have this test every week. I have several church friends who can bring me."

Nick Johnson

Numerade Educator

01:23

Problem 12

The old-old population ( 85 years and older) has an increased risk for frailty. However, old age is just one element of frailty. Identify at least three other ascessment findings that contribute to frailty.
a.
b.
c.

Emily Himsel

Numerade Educator

Problem 13

An 80-year-old woman is brought to the emergency department by ber daughter, who says her mother has refused to eat for 6 days. The mother says she stays in her room all of the time because the family is mean to her when she eats or watches TV with them. She says her daughter brings her only one meal a day and that meal is cold leftovers from the family's meals days before.
a. What types of elder mistreatment may be present in this situation?
b. How would the nurse assess the situation to determine whether abuse is present?
The daughter says her mother is too demanding and she just cannot cope with caring for her 24 hours a day.
c. What might be an appropriate nursing diagnosis for the daughter?
d. What resources can the nurse suggest to the daughter?

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01:03

Problem 14

What are three common factors known to precipitate placement in a long-term care facility?
a.
b.
c.

John Nicolle

Numerade Educator

Problem 15

An 88-year-old woman is brought to the health clinic for the first time by her 64-year-old daughter. During the initial comprehensive nursing assessment of the patient, what should the nurse do?
a. Ask the daughter whether the patient has any urgent needs or problems.
b. Interview the patient and daughter together so that pertinent information can be confirmed.
c. Obtain a health history using a functional health pattern and axsess activities of daily living (ADLs) and mental status.
d. Refer the patient for an interdisciplinary comprehensive geriatric assessment because at her age she will have multiple needs.

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Problem 16

What is a mental status assessment of the older adult especially important in determining?
a. Potential for independent living
b. Eligibility for federal health programs
c. Service and placement needs of the individual
d. Whether the person should be classified as frail

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Problem 17

What is an important nursing measure in the rehabilitation of an older adult to prevent loss of function from inactivity and immobility?
a. Using assistive devices such as walkers and canes
b. Teaching good nutrition to prevent loss of muscle mass
c. Performance of active and passive range-of-motion (ROM) exercises
d. Performance of risk appraisals and assessments related to immobility

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Problem 18

In view of the fact that most older adults take at least six prescription drugs, what are four nursing interventions that can specifically help prevent problems caused by multiple drug use in older patients?
s.
b.
c.
d.

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Problem 19

Which nursing actions would demonstrate the nurse's understanding of the concept of providing safe care without using restraints (select all that apply)?
a. Placing patients with fall risk in low beds.
b. Asking simple yes-or-no questions to clarify patient needs.
c. Making hourly rounds on patients to assess for pain and toilleting needs.
d. Placing a disruptive patient near the nurses" station in a chair with a seat belt.
e. Applying a jacket vest loosely so the patient can turn but cannot climb out of bed.

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Problem 20

When teaching a 69 -year-old patient about self-care, what will promote health (select all that apply)?
a. Proper diet
b. Immunizations
c. Teaching chair yoga
d. Demonstrating balancing techniques
e. Participation in health promotion activities

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Problem 21

The 58-year-old male patient will be transferred from the acute care clinical unit of the bospital to another care area. The patient requires complicated dressing changes for several weeks. To which practice setting should the patient be transitioned?
a. Acute rehabilitation
b. Long-term acute care
c. Intermediate care facility
d. Transitional subacute care

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