Nokea
The old-old population (85 years and older) has an increased risk for frailty. However, old age is just one element of frailty. Identify at least three other assessment findings that contribute to frailty.
- A. Decreased muscle mass
- B. Weight loss
- C. Reduced physical activity
- D. Increasing disability and symptoms
Correct Answer: A
Rationale: Decreased muscle mass, unintentional weight loss, and reduced physical activity are key contributors to frailty in older adults.
You may also like to solve these questions
Identify the specific component of acquiring cultural competence reflected in creating a safe environment in which collection of relevant cultural data can be obtained during the health history and physical examination.
- A. Cultural skill
- B. Cultural encounter
- C. Cultural awareness
- D. Cultural knowledge
Correct Answer: A
Rationale: Creating a safe environment involves using cultural skills to gather accurate and meaningful cultural data during assessments.
According to the Corbin and Strauss chronic illness trajectory, which statement describes a patient with an unstable condition?
- A. Life-threatening situation
- B. Increasing disability and symptoms
- C. Gradual return to acceptable way of life
- D. Loss of control over symptoms and disease course
Correct Answer: D
Rationale: An unstable condition reflects loss of control over symptoms and disease progression, indicating difficulty managing health effectively.
The patient will be placed under moderate sedation to allow realignment of a fracture in the emergency department. When the family asks about this anesthesia, what should the nurse tell them?
- A. Includes inhalation agents
- B. Induces high levels of sedation
- C. Frequently used for traumatic injuries
- D. Patients remain responsive and breathe without assistance
Correct Answer: D
Rationale: Moderate sedation keeps patients responsive and maintains spontaneous breathing.
While caring for an unconscious patient, the nurse discovers a stage 2 pressure ulcer on the patient’s heel. During care of the ulcer, what is the nurse’s understanding of the patient’s perception of pain?
- A. The patient will have a behavioral response if pain is perceived.
- B. The area should be treated as a painful lesion, using gentle cleansing and dressing.
- C. The area can be thoroughly scrubbed because the patient is not able to perceive pain.
- D. All nociceptive stimuli that are transmitted to the brain result in the perception of pain.
Correct Answer: B
Rationale: The correct answer is B. Even in unconscious patients, the area should be treated gently to avoid exacerbating potential pain.
Which nursing actions would demonstrate the nurse’s understanding of the concept of providing safe care without using restraints (select all that apply)?
- A. Placing patients with fall risk in low beds.
- B. Making hourly rounds on patients to assess for pain and toileting needs.
- C. Applying a jacket vest loosely so the patient can turn but cannot climb out of bed.
- D. Placing a disruptive patient near the nurses’ station in a chair with a seat belt.
Correct Answer: B
Rationale: Low beds, frequent checks, and strategic placement reduce risks without resorting to physical restraints.