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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.
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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.
The nurse is admitting an older-adult patient who is hospitalized with an acute illness. Which of the following interventions should the nurse do first?
- A. Orientate the patient to their room.
- B. Administer the prescribed PRN sedative medication.
- C. Ask the health care provider to order a vest restraint.
- D. Place the patient in a 'geri chair' near the nurse's station for observation.
Correct Answer: A
Rationale: The older adult who moves to a different location needs a thorough orientation to the environment. The nurse should repeatedly reassure the patient that he or she is safe and attempt to answer all questions. The unit should foster patient orientation by displaying large-print clocks, avoiding complex or visually confusing wall designs, clearly designating doors, and using simple bed and nurse-call systems. Physical or chemical restraints may be necessary, but the nurse's first action should be to provide an ongoing and clear physical orientation. There is no indication that the patient needs observation at this time.
The nurse is admitting an older-adult patient who has urinary urgency and a possible urinary tract infection (UTI). Which of the following actions should the nurse implement first?
- A. Assess the patient's orientation.
- B. Inspect for abdominal distension.
- C. Question the patient about hematuria.
- D. Invite the patient to use the bathroom.
Correct Answer: D
Rationale: Before beginning the assessment of an older patient with a UTI and urgency, the nurse should have the patient empty the bladder because bladder fullness or discomfort will distract from the patient's ability to provide accurate information. The patient may seem disoriented if distracted by pain or urgency. The physical assessment data are obtained after the patient is as comfortable as possible.
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 home health nurse is caring for an older-adult patient who lives alone and is taking seven different prescribed medications for persistent health problems. Which of the following nursing interventions would be most appropriate to ensure medication regimen adherence?
- A. Use a marked pillbox to set up the patient's medications.
- B. Discuss the option of moving to an assisted-living facility.
- C. Remind the patient about the importance of taking medications.
- D. Visit the patient daily to administer the prescribed medications.
Correct Answer: A
Rationale: Since forgetting to take medications is a common cause of medication errors in older persons, the use of medication reminder devices is helpful when older persons have multiple medications to take. There is no indication that the patient needs to move to assisted living or that the patient does not understand the importance of medication regimen adherence. Home health care is not designed for the patient who needs ongoing assistance with activities of daily living (ADLs) or instrumental ADLs (IADLs).