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The case manager is working with an 84-year-old patient newly admitted to a rehabilitation facility. When developing a care plan for this older adult, which factors should the nurse identify as positive attributes that benefit coping in this age group? Select all that apply.
- A. Decreased risk taking
- B. Effective adaptation skills
- C. Avoiding participation in untested roles
- D. Increased life experience
- E. Resiliency during change
Correct Answer: B,D,E
Rationale: Because changes in life patterns are inevitable over a lifetime, older people need resiliency and coping skills when confronting stresses and change. It is beneficial if older adults continue to participate in risk taking and participation in new, untested roles.
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After a sudden decline in cognition, a 77-year-old man who has been diagnosed with vascular dementia is receiving care in his home. To reduce this mans risk of future infarcts, what action should the nurse most strongly encourage?
- A. Activity limitation and falls reduction efforts
- B. Adequate nutrition and fluid intake
- C. Rigorous control of the patients blood pressure and serum lipid levels
- D. Use of mobility aids to promote independence
Correct Answer: C
Rationale: Because vascular dementia is associated with hypertension and cardiovascular disease, risk factors (e.g., hypercholesterolemia, history of smoking, diabetes) are similar. Prevention and management are also similar. Therefore, measures to decrease blood pressure and lower cholesterol levels may prevent future infarcts. Activity limitation is unnecessary and infarcts are not prevented by nutrition or the use of mobility aids.
An elderly patient, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if Medicare is going to cover the cost of the visit. What information can the nurse give the patient to help allay her concerns?
- A. Medicare has a copayment for many of the services it covers. This requires the patient to pay a part of the bill.
- B. Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be covered.
- C. Medicare will only pay the cost for acute-care services if the patient has a very low income.
- D. Medicare will not pay for the cost of acute-care services so the patient will be billed for the services provided.
Correct Answer: A
Rationale: The two major programs that finance health in the United States are Medicare and Medicaid, both of which are overseen by the Centers for Medicaid and Medicare Services (CMS). Both programs cover acute-care needs such as inpatient hospitalization, physician care, outpatient care, home health services, and skilled nursing care in a nursing. Medicare is a plan specifically for the elderly population, and Medicaid is a program that provides services based on income.
The nurse is providing patient teaching to a patient with early stage Alzheimers disease (AD) and her family. The patient has been prescribed donepezil hydrochloride (Aricept). What should the nurse explain to the patient and family about this drug?
- A. It slows the progression of AD.
- B. It cures AD in a small minority of patients.
- C. It removes the patients insight that he or she has AD.
- D. It limits the physical effects of AD and other dementias.
Correct Answer: A
Rationale: There is no cure for AD, but several medications have been introduced to slow the progression of the disease, including donepezil hydrochloride (Aricept). These medications do not remove the patients insight or address physical symptoms of AD.
Older people have many altered reactions to disease that are based on age-related physiological changes. When the nurse observes physical indicators of illness in the older population, that nurse must remember which of the following principles?
- A. Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged population.
- B. Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults.
- C. The same physiological processes that indicate serious health care problems in a younger population indicate mild disease states in the elderly.
- D. Middle-aged people do not react to disease states the same as a younger population does.
Correct Answer: B
Rationale: Physical indicators of illness that are useful and reliable in young and middle-aged people cannot be relied on for the diagnosis of potential life-threatening problems in older adults. Option A is incorrect because a potentially life-threatening problem in an older person is more serious than it would be in a middle-aged person because the older adult does not have the physical resources of the middle-aged person. Physical indicators of serious health care problems in a young or middle-aged population do not indicate disease states that are considered mild in the elderly population. It is true that middle-aged people do not react to disease states the same as a younger population, but this option does not answer the question.
You are the nurse caring for an 85 -year-old patient who has been hospitalized for a fractured radius. The patients daughter has accompanied the patient to the hospital and asks you what her father can do for his very dry skin, which has become susceptible to cracking and shearing. What would be your best response?
- A. He should likely take showers rather than baths, if possible.
- B. Make sure that he applies sunscreen each morning.
- C. Dry skin is an age-related change that is largely inevitable.
- D. Try to help your father increase his intake of dairy products.
Correct Answer: A
Rationale: Showers are less drying than hot tub baths. Sun exposure should indeed be limited, but daily application of sunscreen is not necessary for many patients. Dry skin is an age-related change, but this does not mean that no appropriate interventions exist to address it. Dairy intake is unrelated.