Nokea
You are admitting an elderly woman who is accompanied by her husband. The husband wants to know where the information you are obtaining is going to be kept and you follow up by describing the system of electronic health records. The husband states, I sure am not comfortable with that. It is too easy for someone to break into computer records these days. What is your best response?
- A. The Institute of Medicine has called for the implementation of the computerized health record so all hospitals are doing it.
- B. Weve been doing this for several years with good success, so I can assure you that our records are very safe.
- C. This hospital is as concerned as you are about keeping our patients records private. So we take special precautions to make sure no one can break into our patients medical records.
- D. Your wifes records will be safe, because only people who work in the hospital have the credentials to access them.
Correct Answer: C
Rationale: Nurses must be sensitive to the needs of the older adults and others who may not be comfortable with computer technology. Special precautions are indeed taken. Not every hospital employee has access and referencing the IOM may not provide reassurance.
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The nurse is performing an admission assessment of a 72-year-old female patient who understands minimal English. An interpreter who speaks the patients language is unavailable and no members of the care team speak the language. How should the nurse best perform data collection?
- A. Have a family member provide the data.
- B. Obtain the data from the old chart and physicians assessment.
- C. Obtain the data only from the patient, prioritizing aspects that the patient understands.
- D. Collect all possible data from the patient and have the family supplement missing details.
Correct Answer: D
Rationale: The informant, or the person providing the information, may not always be the patient. The nurse can gain information from the patient and have the family provide any missing details. The nurse should always obtain as much information as possible directly from the patient. In this case, it is not likely possible to get all the information needed only from the patient.
An 89-year-old male patient is wheelchair bound following a hemorrhagic stroke and has been living in a nursing home since leaving the hospital. He returns to the adjacent primary care clinic by wheelchair for follow-up care of hypertension and other health problems. The nurse would modify his health history to include which question?
- A. Tell me about your medications: How do you usually get them each day?
- B. Tell me about where you live: Do you feel your needs are being met, and do you feel safe?
- C. Your wheelchair would seem to limit your ability to move around. How do you deal with that?
- D. What limitations are you dealing with related to your health and being in a wheelchair?
Correct Answer: B
Rationale: The question, Tell me about where you live: Do you feel your needs are being met and do you feel safe? seeks to explore the specific issue of the safety in the home environment. People who are older, have a disability, and live in the community setting are at a greater risk for abuse. An explicit focus on limitations may be counterproductive.
You are conducting a home visit as part of the community health assessment of a patient who will receive scheduled wound care. During assessment, the nurse should prioritize which of the following variables?
- A. Availability of home health care, current Medicare rules, and family support
- B. The community and home environment, support systems or family care, and the availability of needed resources
- C. The future health status of the individual, and community and hospital resources
- D. The characteristics of the neighborhood, and the patients socioeconomic status and insurance coverage
Correct Answer: B
Rationale: The community or home environment, support systems or family care, and the availability of needed resources are the key factors that distinguish community assessment from assessments in the acute-care setting. The other options fail to address the specifics of either the community or home environment.
An older adult's unexplained weight loss of about 15 pounds over the past 3 months has prompted a thorough diagnostic workup. What is the nurse's rationale for prioritizing biochemical assessment when appraising a person's nutritional status?
- A. It identifies abnormalities in the chemical structure of nutrients.
- B. It predicts abnormal utilization of nutrients.
- C. It reflects the tissue level of a given nutrient.
- D. It predicts metabolic abnormalities in nutritional intake.
Correct Answer: C
Rationale: Biochemical assessment reflects both the tissue level of a given nutrient and any abnormality of metabolism in the utilization of nutrients. It does not focus on abnormalities in the chemical structure of nutrients. Biochemical assessment is not predictive.
A home care nurse is teaching meal-planning to a patients son who is caring for his mother during her recovery from hip replacement surgery. Which of the following meals indicates that the son understands the concept of nutrition, based on the U.S. Department of Agricultures MyPlate?
- A. Cheeseburger, carrot sticks, and mushroom soup with whole wheat crackers
- B. Spaghetti and meat sauce with garlic bread and a salad
- C. Chicken and pepper stir fry on a bed of rice
- D. Ham sandwich with tomato on rye bread with peaches and yogurt
Correct Answer: D
Rationale: This menu has a choice from each of the food groups identified in MyPlate: grains, vegetables, fruits, dairy, and protein. The other selections are incomplete choices.