Nokea
The nurse is caring for a patient diagnosed with cancer of the liver who has chosen to remain in his home as long as he is able. The nurse reviews the care plan for the patient and notes that it focuses on palliative measures. The nurse also notes that over the last 3 weeks, the patients condition has continued to deteriorate. What is the nurses best response to this clinical information?
- A. Recognize that death will most likely occur in the next week.
- B. Recognize that the patient is in the trajectory phase of chronic illness and should be kept pain-free.
- C. Recognize that the patient is in the downward phase of chronic illness and should be reassessed.
- D. Recognize that the patient should immediately be admitted into the hospital.
Correct Answer: C
Rationale: The downward phase occurs when symptoms of chronic illness worsen despite attempts to control the course through proper regimen management. A downward turn does not necessarily lead to death. A downward trend can be arrested and the trajectory reestablished at any point, depending on the condition and the treatment. A patient who is palliative may not desire hospitalization and aggressive treatment.
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A nurse is aware that the number of people in the United States who are living with disabilities is expected to continue increasing. What is considered to be one of the factors contributing to this increase?
- A. The decrease in the number of people with early-onset disabilities
- B. The increased inability to cure chronic disorders
- C. Changes in infection patterns resulting from antibiotic resistance
- D. Increased survival rates among people who experience trauma
Correct Answer: D
Rationale: The number of people with disabilities is expected to increase over time as people with early-onset disabilities, chronic disorders, and severe trauma survive and have normal or near-normal lifespans. There has not been a decrease in the number of people with early-onset disabilities. Acquired chronic disorders still cannot be cured.
The staff development nurse is presenting a class on the importance of incorporating people-first language into daily practice as well as documentation. What is an example of the use of people-first language when giving a verbal report?
- A. The schizophrenic
- B. The patient with schizophrenia
- C. The schizophrenic patient
- D. The schizophrenic client
Correct Answer: B
Rationale: Using people-first language means referring to the person first: the patient with diabetes rather than the diabetic, the diabetic patient, or the diabetic client.
You have admitted a new patient to your unit with a diagnosis of stage IV breast cancer. This woman has a comorbidity of myasthenia gravis. While you are doing the initial assessment, the patient tells you that she felt the lump in her breast about 9 months ago. You ask the patient why she did not see her health care provider when she first found the lump in her breast. What would be a factor that is known to influence the patient in seeking health care services?
- A. Lack of insight due to the success of self-managing a chronic condition
- B. Lack of knowledge about treatment options
- C. Overly sensitive patient reactions to health care services
- D. Unfavorable interactions with health care providers
Correct Answer: D
Rationale: Because of unfavorable interactions with health care providers, including negative attitudes, insensitivity, and lack of knowledge, people with disabilities may avoid seeking medical intervention. The population of people who are disabled is not overly sensitive to the reactions of those providing health care services. This is more likely than lack of insight or knowledge on the part of the patient.
A patient who undergoes hemodialysis three times weekly is on a fluid restriction of 1000 mL/day. The nurse sees the patient drinking a 355-mL (12 ounce) soft drink after the patient has already reached the maximum intake of fluid for the day. What action should the nurse take?
- A. Take the soft drink away from the patient and inform the dialysis nurse to remove extra fluid from the patient during the next dialysis treatment
- B. Document the patients behavior as noncompliant and notify the physician
- C. Further restrict the patients fluid for the following day and communicate this information to the charge nurse
- D. Reinforce the importance of the fluid restriction and document the teaching and the intake of extra fluid
Correct Answer: D
Rationale: Management of chronic conditions includes learning to live with symptoms or disabilities and coming to terms with identity changes resulting from having a chronic condition. It also consists of carrying out the lifestyle changes and regimens designed to control symptoms and to prevent complications. Although it may be difficult for nurses and other health care providers to stand by while patients make unwise decisions about their health, they must accept the fact that the patient has the right to make his or her own choices and decisions about lifestyle and health care.
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.