Nokea
The nurse is assessing the nutritional status of an older-adult patient using the SCALES acronym. Which of the following should the nurse assess when completing the 'S'?
- A. Serum potassium level
- B. Sadness or mood change
- C. Social support
- D. Sexual intimacy
Correct Answer: B
Rationale: The acronym SCALES can be used to remind the nurses to assess important nutritional indicators. In the case of the 'S,' the nurse is to assess sadness or mood changes.
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The home health nurse is caring for an older-adult patient who lives alone and is taking seven different prescribed medications for persistent health problems. Which of the following nursing interventions would be most appropriate to ensure medication regimen adherence?
- A. Use a marked pillbox to set up the patient's medications.
- B. Discuss the option of moving to an assisted-living facility.
- C. Remind the patient about the importance of taking medications.
- D. Visit the patient daily to administer the prescribed medications.
Correct Answer: A
Rationale: Since forgetting to take medications is a common cause of medication errors in older persons, the use of medication reminder devices is helpful when older persons have multiple medications to take. There is no indication that the patient needs to move to assisted living or that the patient does not understand the importance of medication regimen adherence. Home health care is not designed for the patient who needs ongoing assistance with activities of daily living (ADLs) or instrumental ADLs (IADLs).
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.
The nurse suspects that elder abuse may be occurring when a frail older-adult patient with a broken arm is brought to the emergency department by a family member. Which of these actions should the nurse take first?
- A. Notify an elder protective services agency about the possible abuse.
- B. Make a referral for a home assessment visit by the home health nurse.
- C. Have the family member stay in the waiting area while the patient is assessed.
- D. Ask the patient how the injury occurred and observe the family member's reaction.
Correct Answer: C
Rationale: The initial action should be assessment and interviewing of the patient. The patient should be interviewed alone because the patient will be unlikely to give accurate information if the abuser is present. If abuse is occurring, the patient should not be discharged home for a later assessment by a home health nurse. The nurse needs to collect and document physiological data before notifying the elder protective services agency.
Which nursing actions will the nurse take to assess for possible malnutrition in an older-adult patient?
- A. Observe for depression.
- B. Review laboratory results.
- C. Assess teeth and oral mucosa.
- D. Ask about transportation needs.
- E. Determine food likes and dislikes.
Correct Answer: A,B,C,D
Rationale: The laboratory results, especially albumin levels, may indicate persistent poor protein intake. Transportation impacts patients' ability to shop for groceries. Depression may lead to decreased appetite. Oral sores or teeth in poor condition may decrease the ability to chew and swallow. Food likes and dislikes are not necessarily associated with malnutrition.
The nurse is providing care to older persons in a Northern outreach clinic. Which nursing action will be most helpful in decreasing the risk for drug-drug interactions?
- A. Teach the patient to have all prescriptions filled at the same pharmacy.
- B. Instruct the patient to avoid taking over-the-counter (OTC) medications.
- C. Make a medication schedule for the patient as a reminder about when to take each medication.
- D. Have the patient bring all the medications, supplements, and herbs to every health care appointment.
Correct Answer: D
Rationale: The most information about drug use and possible interactions is obtained when the patient brings all prescribed medications, OTC medications, and supplements to every health care appointment. The patient should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but use of supplements and herbal medications also need to be considered in order to prevent drug-drug interactions. Use of a medication schedule will help the patient take medications as scheduled but will not prevent drug-drug interactions.