Which of the following interventions is most effective in preventing the development of pressure ulcers in older adults with limited mobility?
- A. Strict bed rest and minimal repositioning to reduce pressure
- B. Use of high-protein diets and supplemental vitamins only
- C. Regular repositioning every 2 hours, along with the use of pressure-relieving devices
- D. Ensuring that all wounds are left uncovered to facilitate air circulation
Correct Answer: C
Rationale: The correct answer is C because regular repositioning every 2 hours, along with the use of pressure-relieving devices, is the most effective intervention to prevent pressure ulcers in older adults with limited mobility. Repositioning helps to redistribute pressure, reducing the risk of tissue damage. Pressure-relieving devices like cushions or mattresses further help to alleviate pressure points.
Choice A is incorrect because strict bed rest and minimal repositioning can actually increase the risk of pressure ulcers by concentrating pressure on specific areas. Choice B is incorrect as high-protein diets and supplements alone do not address the primary cause of pressure ulcers, which is prolonged pressure on the skin. Choice D is incorrect because leaving wounds uncovered can increase the risk of infection and hinder the healing process.
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What is the best indicator of a successful transition to hospice care for older adults?
- A. Complete cessation of all medical treatments
- B. Improvement in physical strength
- C. Relief from physical, emotional, and spiritual suffering
- D. Long-term emotional stability
Correct Answer: C
Rationale: The correct answer is C: Relief from physical, emotional, and spiritual suffering. This is the best indicator of a successful transition to hospice care for older adults because hospice care focuses on providing comfort and improving quality of life rather than curative treatments. Relief from suffering aligns with the goals of hospice care, addressing the holistic needs of patients. Choice A is incorrect as complete cessation of all medical treatments may not be appropriate for all patients in hospice care. Choice B is incorrect as improvement in physical strength may not be the primary goal in hospice care. Choice D is incorrect as long-term emotional stability is important but not necessarily the best indicator of a successful transition to hospice care.
An older man is transferred to a hospice facility with end-stage disease. Which is a suitable nursing intervention for this older adult and his family according to the goals of long-term care?
- A. Decrease the analgesic dose to prevent sedation.
- B. Provide a basin and towels for morning self-care.
- C. Inform family members about strict visiting hours.
- D. Facilitate family rituals related to death and dying.
Correct Answer: D
Rationale: The correct answer is D: Facilitate family rituals related to death and dying. In end-of-life care, it is essential to support the older adult and their family in their cultural and spiritual practices to promote comfort and closure. This intervention aligns with the goals of long-term care by addressing the psychological and emotional needs of the patient and family. Providing a basin and towels (B) focuses on physical self-care, which may not be a priority in end-stage disease. Decreasing analgesic dose (A) can compromise pain management and quality of life. Informing family members about strict visiting hours (C) can hinder emotional support and connection during this critical time.
The nurse is performing an assessment on an older client. What would indicate a potential complication associated with the skin?
- A. Crusting
- B. Wrinkling
- C. Thinning/loss of elasticity
- D. Crusting
Correct Answer: A
Rationale: The correct answer is A: Crusting. Crusting on the skin of an older client can indicate a potential complication such as an infection or skin condition. It suggests that there may be an issue with the skin's integrity, leading to the formation of crusts. Wrinkling (B) and thinning/loss of elasticity (C) are common age-related changes and not necessarily indicative of a complication. Choice D is a duplicate of choice A, so it is incorrect. In summary, crusting is a sign of a potential skin complication, while the other choices are more likely to be normal age-related changes.
All of the following nursing actions except____________ will help maintain safety for the elderly.
- A. Modify environment to reduce obstacles and barriers to ambulation
- B. Provide for consistent, regular checks of clients' ambulation abilities
- C. Orient to new surroundings and repeat frequently as needed
- D. Promote independence without assistance to all clients
Correct Answer: D
Rationale: The correct answer is D because promoting independence without assistance to all clients may not always maintain safety for the elderly. Elderly individuals may require some level of assistance for certain activities to prevent falls or other safety risks. Providing assistance when needed is crucial for ensuring their safety.
A: Modifying the environment to reduce obstacles and barriers to ambulation helps prevent falls.
B: Consistent checks of ambulation abilities ensure early detection of any decline in mobility.
C: Orienting to new surroundings and repeating as needed helps prevent confusion and disorientation.
Which of the following is considered a key component of successful aging?
- A. Avoiding chronic diseases at all costs
- B. Maintaining cognitive function and social engagement
- C. Relying on medical interventions for every health concern
- D. Living independently without any assistance
Correct Answer: B
Rationale: Step 1: Maintaining cognitive function is crucial for adapting to changes and problem-solving in older age.
Step 2: Social engagement helps combat loneliness and promotes mental well-being.
Step 3: Both factors contribute to a higher quality of life and overall well-being in older individuals.
Summary: A is incorrect as chronic diseases are common in aging. C is incorrect due to over-reliance on medical interventions. D is incorrect as independence doesn't necessarily equate to successful aging.
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