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What is the most common barrier to effective pain management in older adults?
- A. Fear of addiction to opioid medications
- B. Insufficient healthcare provider knowledge of geriatric pain management
- C. Inadequate access to pain management specialists
- D. Reluctance of older adults to report pain
Correct Answer: D
Rationale: The correct answer is D because reluctance of older adults to report pain is a significant barrier to effective pain management. Older adults may underreport pain due to various factors such as fear of being seen as a burden, denial of aging-related changes, or belief that pain is a natural part of aging. This can lead to under-treatment of pain and decreased quality of life. Choices A, B, and C are not the most common barriers in this context. Fear of addiction to opioids, insufficient knowledge among healthcare providers, and inadequate access to specialists are important factors but are not as prevalent as older adults' reluctance to report pain.
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An older adult who is a traditional Chinese man has a blood pressure of 80/54 mm Hg and refuses to remain in the bed. Which intervention should the nurse use to promote and maintain his health?
- A. Have the health care provider speak to him.
- B. Use principles of the holistic health system.
- C. Ask about his perceptions and treatment ideas.
- D. Consult with a practitioner of Chinese medicine.
Correct Answer: C
Rationale: Rationale:
C is correct as it involves understanding the patient's beliefs and preferences, crucial in culturally competent care. A would not address the patient's perspective directly. B is broad and lacks specificity. D assumes all traditional Chinese individuals seek Chinese medicine, which may not be the case.
A nurse is caring for a culturally diverse patient who has missed follow-up appointments. The patient says: “You don’t understand—in my culture, we don’t do things like that.” The nurse understands which of the following about the patient’s culture?
- A. The culture does not value Western medicine.
- B. The culture has a different orientation to time than Western medicine.
- C. The culture is an interdependent culture.
- D. The culture does not believe in preventative care.
Correct Answer: B
Rationale: The correct answer is B: The culture has a different orientation to time than Western medicine. This is because the patient's statement about not following up on appointments due to cultural reasons suggests a difference in the perception and importance of time. In some cultures, time is more fluid and flexible compared to the rigid scheduling of Western medicine. This understanding helps the nurse provide culturally sensitive care.
Choices A, C, and D are incorrect:
A: The culture does not value Western medicine - This is not necessarily implied by the patient's statement about cultural differences.
C: The culture is an interdependent culture - The patient's statement does not provide direct evidence of the culture being interdependent.
D: The culture does not believe in preventative care - There is no indication in the patient's statement that the culture does not believe in preventative care.
A nurse in a long-term care facility is using the TimeSlips program with a group of cognitively impaired older adults. The nurse is using which of the following techniques?
- A. Provides a picture for all group members to look at and use to create a story
- B. Records the responses of all participants
- C. Compliments each member for his or her contribution to the story
- D. Reads the story back during the session, noting the contributions of each participant
Correct Answer: A
Rationale: The correct answer is A because the TimeSlips program involves providing a picture as a creative prompt for group members to collaboratively create a story. This technique stimulates imagination and communication in cognitively impaired individuals. Choice B is incorrect as recording responses is not specific to the TimeSlips method. Choice C is incorrect as complimenting contributions is not a core component of the TimeSlips program. Choice D is incorrect as reading back the story during the session does not align with the collaborative, creative process of TimeSlips.
What is the most effective intervention to prevent skin breakdown in immobile older adults?
- A. Frequent use of powder to keep skin dry
- B. Application of a thick layer of moisturizer
- C. Regular repositioning and use of pressure-relieving devices
- D. Ensuring complete bed rest to limit movement
Correct Answer: C
Rationale: The correct answer is C because regular repositioning and the use of pressure-relieving devices are essential to prevent skin breakdown in immobile older adults. Repositioning helps redistribute pressure, maintaining blood flow to the skin and preventing tissue damage. Pressure-relieving devices such as cushions or special mattresses further reduce pressure on vulnerable areas. Choices A and B do not address the root cause of skin breakdown and may even exacerbate the issue. Choice D is incorrect as complete bed rest can lead to further complications like pressure ulcers. In summary, choice C is the most effective intervention as it directly targets the risk factors for skin breakdown in immobile older adults.
Mr J., an 80 yr old who has had flu like symptoms with diarrhea and has vomited 4 times in the last 24 hours is seen in the ED. Mr. J seems confused and is lethargic. The nurse notes that Mr. J has dry skin, a brown tongue, sunken cheeks and concentrated urine. This array of symptoms indicates:
- A. congestive heart failure
- B. dehydration
- C. urinary tract infection
- D. bowel obstruction
Correct Answer: B
Rationale: The correct answer is B: dehydration. Mr. J's symptoms of flu-like illness, diarrhea, vomiting, confusion, lethargy, dry skin, brown tongue, sunken cheeks, and concentrated urine are indicative of severe dehydration. Dehydration can lead to electrolyte imbalances, decreased blood volume, and impaired organ function, resulting in confusion and lethargy. Skin changes, dry mucous membranes, and concentrated urine are also classic signs of dehydration. The other choices (A, C, D) do not align with the constellation of symptoms presented by Mr. J and are less likely based on the information provided.