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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.
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The nurse is caring for an older-adult patient with multiple health problems who states that who reports having 'no energy' and feeling increasingly weak. The patient has had a 5 kg weight loss over the last year. Which of the following interventions should the nurse implement initially?
- A. Ask the patient about daily dietary intake.
- B. Schedule regular range-of-motion exercise.
- C. Discuss long-term care placement with the patient.
- D. Describe normal changes with aging to the patient.
Correct Answer: A
Rationale: In the frail elderly patient, nutrition is frequently compromised, and the nurse's first action should be to assess the patient's nutritional status. Active range of motion may be helpful in improving the patient's strength and endurance, but nutritional assessment is the priority because the patient has had a significant weight loss. The patient may be a candidate for long-term care placement, but more assessment is needed before this can be determined. The patient's assessment data are not consistent with normal changes associated with aging.
The nurse is visiting a homeless shelter for older persons to provide a health-promotion activity. Which of the following factors are associated with adult homelessness?
- A. Low income
- B. Reduced cognitive capacity
- C. Decreased health problems
- D. Abundance of affordable housing
- E. Living alone
Correct Answer: A,B,E
Rationale: Key factors associated with homelessness are low income, reduced cognitive capacity, and living alone. There is a shortage of affordable housing and homeless adults generally have an increase in health problems.
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.
Which of the following actions would enable the nurse to obtain the most complete information when doing an assessment with an older-adult patient?
- A. Interview both the patient and the primary patient caregiver.
- B. Use a geriatric assessment instrument to evaluate the patient.
- C. Review the patient's chart for the history of medical problems.
- D. Ask the patient to write down medical problems and medications.
Correct Answer: B
Rationale: The most complete information about the patient will be obtained through the use of an assessment instrument specific to the geriatric population, which includes information about both medical diagnoses and treatments and about functional health patterns and abilities. A review of the chart, interviews of the patient and caregiver, and written information by the patient will all be included in a comprehensive geriatric assessment.
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.