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An elderly patient has presented to the clinic with a new diagnosis of osteoarthritis. The patients daughter is accompanying him and you have explained why the incidence of chronic diseases tends to increase with age. What rationale for this phenomenon should you describe?
- A. With age, biologic changes reduce the efficiency of body systems.
- B. Older adults often have less support and care from their family, resulting in illness.
- C. There is an increased morbidity of peers in this age group, and this leads to the older adults desire to also assume the sick role.
- D. Chronic illnesses are diagnosed more often in older adults because they have more contact with the health care system.
Correct Answer: A
Rationale: Causes of the increasing number of people with chronic conditions include the following: longer lifespans because of advances in technology and pharmacology, improved nutrition, safer working conditions, and greater access (for some people) to health care. Also, biologic conditions change in the aged population. These changes reduce the efficiency of the bodys systems. Older adults usually have more support and care from their family members. Assuming the sick role can be a desire in any age group, not just the elderly.
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A patient tells the nurse that her doctor just told her that her new diagnosis of rheumatoid arthritis is considered to be a chronic condition. She asks the nurse what chronic condition means. What would be the nurses best response?
- A. Chronic conditions are defined as health problems that require management of several months or longer.
- B. Chronic conditions are diseases that come and go in a relatively predictable cycle.
- C. Chronic conditions are medical conditions that culminate in disabilities that require hospitalization.
- D. Chronic conditions are those that require short-term management in extended-care facilities.
Correct Answer: A
Rationale: Chronic conditions are often defined as medical conditions or health problems with associated symptoms or disabilities that require long-term management (3 months or longer). Chronic diseases are usually managed in the home environment. They are not always cyclical or predictable.
A home care nurse is making an initial visit to a 68-year-old man. The nurse finds the man tearful and emotionally withdrawn. Even though the man lives alone and has no family, he has been managing well at home until now. What would be the most appropriate action for the nurse to take?
- A. Reassess the patients psychosocial status and make the necessary referrals
- B. Have the patient volunteer in the community for social contact
- C. Arrange for the patient to be reassessed by his social worker
- D. Encourage the patient to focus on the positive aspects of his life
Correct Answer: A
Rationale: The patient is exhibiting signs of depression and should be reassessed and a referral made as necessary. Patients with chronic illness are at an increased risk of depression. It would be simplistic to arrange for him to volunteer or focus on the positive. Social work may or may not be needed; assessment should precede such a referral.
A patient has recently been diagnosed with type 2 diabetes. The patient is clinically obese and has a sedentary lifestyle. How can the nurse best begin to help the patient increase his activity level?
- A. Set up appointment times at a local fitness center for the patient to attend.
- B. Have a family member ensure the patient follows a suggested exercise plan.
- C. Construct an exercise program and have the patient follow it.
- D. Identify barriers with the patient that inhibit his lifestyle change.
Correct Answer: D
Rationale: Nurses cannot expect that sedentary patients are going to develop a sudden passion for exercise and that they will easily rearrange their day to accommodate time-consuming exercise plans. The patient may not be ready or willing to accept this lifestyle change. This is why it is important that the nurse and patient identify barriers to change.
You are caring for a patient with a history of chronic angina. The patient tells you that after breakfast he usually takes a shower and shaves. It is at this time, the patient says, that he tends to experience chest pain. What might you counsel the patient to do to decrease the likelihood of angina in the morning?
- A. Shower in the evening and shave before breakfast.
- B. Skip breakfast and eat an early lunch.
- C. Take a nitro tab prior to breakfast.
- D. Shower once a week and shave before breakfast.
Correct Answer: A
Rationale: If the nurse determines that one of the situations most likely to precipitate angina is to shower and shave after breakfast, the nurse might counsel the patient to break these activities into different times during the day. Skipping breakfast and eating an early lunch would not decrease the likelihood of angina in the morning. Taking a nitro tablet before breakfast is inappropriate because the event requiring the medication has not yet occurred. Also, suggesting that the patient shower once a week and shave prior to breakfast is an incorrect suggestion because showering and shaving can both be done every day if they are spread out over the course of the day.
A nurse is planning the care of a patient who has been diagnosed with renal failure, which the nurse recognizes as being a chronic condition. Which of the following descriptors apply to chronic conditions? Select all that apply.
- A. Diseases that resolve slowly
- B. Diseases where complete cures are rare
- C. Diseases that have a short, unpredictable course
- D. Diseases that do not resolve spontaneously
- E. Diseases that have a prolonged course
Correct Answer: B,D,E
Rationale: Chronic conditions can also be defined as illnesses or diseases that have a prolonged course, that do not resolve spontaneously, and for which complete cures are unlikely or rare.