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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.
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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 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.
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.
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.
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.