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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.
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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.
Which information about an older-adult patient who is being assessed by the home health nurse is of most concern?
- A. The patient organizes medications in a marked pillbox 'so I don't forget them.'
- B. The patient uses three different medications for persistent heart and joint problems.
- C. The patient says, 'I don't go on my daily walks since I had pneumonia 3 months ago.'
- D. The patient tells the nurse, 'I prefer to manage my life without much help from others.'
Correct Answer: C
Rationale: Inactivity and immobility lead rapidly to loss of function in older persons. The nurse should develop a plan to prevent further deconditioning and restore function for the patient. Self-management is appropriate for independently living older persons. The use of three medications is not unusual for an older adult. The use of memory devices to assist with safe medication administration is recommended for older persons.
The nurse is teaching an older-adult female patient about her new medications and the patient replies that she 'just can't remember all that information anymore.' Which of the following changes may interfere with the patients' ability to learn about the new medications?
- A. Intellectual ability declines with age.
- B. All mental abilities slow as individuals age.
- C. Declining physical health can impair cognitive function.
- D. Impaired vocabulary and verbal function decrease reasoning with age.
Correct Answer: C
Rationale: Declining physical health is an important factor in cognitive impairment. Intellectual ability does not decline with age. All mental abilities do not slow as an individual ages. Vocabulary and verbal function do not decrease with age.
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 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.