Nokea
The nurse is admitting an older-adult patient who is hospitalized with an acute illness. Which of the following interventions should the nurse do first?
- A. Orientate the patient to their room.
- B. Administer the prescribed PRN sedative medication.
- C. Ask the health care provider to order a vest restraint.
- D. Place the patient in a 'geri chair' near the nurse's station for observation.
Correct Answer: A
Rationale: The older adult who moves to a different location needs a thorough orientation to the environment. The nurse should repeatedly reassure the patient that he or she is safe and attempt to answer all questions. The unit should foster patient orientation by displaying large-print clocks, avoiding complex or visually confusing wall designs, clearly designating doors, and using simple bed and nurse-call systems. Physical or chemical restraints may be necessary, but the nurse's first action should be to provide an ongoing and clear physical orientation. There is no indication that the patient needs observation at this time.
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The nurse is planning care for an alert and active older-adult patient who takes multiple medications for persistent cardiac and respiratory disease and lives with a daughter who works during the day. Which nursing diagnosis is most appropriate?
- A. Risk for injury as evidenced by exposure to toxic chemical (drug-drug interactions)
- B. Social isolation related to social behavior incongruent with norms (weakness and fatigue)
- C. Disabled family coping related to differing coping styles between support person and patient
- D. Caregiver role strain related to increase in care needs
Correct Answer: A
Rationale: The patient's age and multiple medications indicate a risk for injury caused by interactions between the multiple drugs being taken and a decreased drug metabolism rate. The patient data do not indicate problems with social isolation, caregiver role strain, or compromised family coping.
Which information obtained by the home health nurse when making a visit to a frail older-adult patient with mild forgetfulness is of concern?
- A. The patient tells the nurse that a close friend recently died.
- B. The patient has lost 4.5 kg during the last month.
- 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.
Correct Answer: B
Rationale: A 4.5 kg weight loss may be an indication of elder neglect or depression and requires further assessment by the nurse. The use of a marked pillbox and planning by the family for 24-hour care are appropriate for this patient. It is not unusual that an elderly adult would have friends who have died.
Which action will the nurse take when planning for discharge of an older-adult patient who will need daily assistance with activities such as shopping and transportation?
- A. Complete a referral to Medicare.
- B. Apply for transfer to an assisted-living facility.
- C. Arrange for home health care visits.
- D. Apply for attendance at an adult day care program.
Correct Answer: C
Rationale: Home health care visits, from an unregulated health care worker, can enable the patient to remain at home but obtain assistance with shopping and transportation. Medicare, assisted-living facilities, and adult day care programs provide funding for specific medical services, but not for needs such as shopping or transportation.
Which of the following actions should the nurse consider when developing the plan of care for an older adult who is hospitalized for an acute illness?
- A. Use a standardized geriatric nursing care plan.
- B. Minimize activity level during hospitalization.
- C. Plan for transfer to a long-term care facility after the hospitalization.
- D. Consider preadmission functional abilities when setting patient goals.
Correct Answer: D
Rationale: The plan of care for older persons should be individualized and based on the patient's current functional abilities. A standardized geriatric nursing care plan will not address individual patient needs and strengths. A patient's need for discharge to a long-term care facility is variable. Activity level should be designed to allow the patient to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process.
The nurse is caring for patients in a geriatric family practice clinic with a primary health care provider. Which of the following actions should the nurse do when caring for older persons who live in rural areas?
- A. Assess the patient for persistent diseases that are unique to rural areas.
- B. Ensure transportation to appointments with the health care provider.
- C. Schedule appointments for the patient in an urban area for better health care.
- D. Obtain adequate medications for the patient to last for 4-6 months.
Correct Answer: B
Rationale: Transportation can be a barrier to accessing health services in rural areas. There are no persistent diseases unique to rural areas. Because medications may change, the nurse should help the patient plan for obtaining medications through alternate means such as the mail or delivery services, not by purchasing large quantities of the medications. The patient living in a rural area may lose the benefits of a familiar situation and social support by moving to an urban area.