Nokea
You are caring for a patient with late-stage Alzheimers disease. The patients wife tells you that the patient has now become completely dependent and that she feels guilty if she takes any time for herself. What outcomes would be appropriate for the nurse to develop to assist the patients wife?
- A. The caregiver learns to explain to the patient why she needs time for herself.
- B. The caregiver distinguishes essential obligations from those that can be controlled or limited.
- C. The caregiver leaves the patient at home alone for short periods of time to encourage independence.
- D. The caregiver prioritizes her own health over that of the patient.
Correct Answer: B
Rationale: For prolonged periods, it is not uncommon for caregivers to neglect their own emotional and health needs. The caregiver must learn to distinguish obligations that she must fulfill and limit those that are not completely necessary. The caregiver can tell the patient when she leaves, but she should not expect that the patient will remember or will not become angry with her for leaving. The caregiver should not leave the patient home alone for any length of time because it may compromise the patients safety. Being thoughtful and selective with her time and energy is not synonymous with prioritizing her own health over that of the patient; it is more indicative of balance and sustainability.
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Older people have many altered reactions to disease that are based on age-related physiological changes. When the nurse observes physical indicators of illness in the older population, that nurse must remember which of the following principles?
- A. Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged population.
- B. Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults.
- C. The same physiological processes that indicate serious health care problems in a younger population indicate mild disease states in the elderly.
- D. Middle-aged people do not react to disease states the same as a younger population does.
Correct Answer: B
Rationale: Physical indicators of illness that are useful and reliable in young and middle-aged people cannot be relied on for the diagnosis of potential life-threatening problems in older adults. Option A is incorrect because a potentially life-threatening problem in an older person is more serious than it would be in a middle-aged person because the older adult does not have the physical resources of the middle-aged person. Physical indicators of serious health care problems in a young or middle-aged population do not indicate disease states that are considered mild in the elderly population. It is true that middle-aged people do not react to disease states the same as a younger population, but this option does not answer the question.
A gerontologic nurse has been working hard to change the perceptions of the elderly, many of which are negative, by other segments of the population. What negative perceptions of older people have been identified in the literature? Select all that apply.
- A. As being the cause of social problems
- B. As not contributing to society
- C. As draining economic resources
- D. As competing with children for resources
- E. As dominating health care research
Correct Answer: B,C,D
Rationale: Retirement and perceived nonproductivity are responsible for negative feelings because a younger working person may falsely see older people as not contributing to society and as draining economic resources. Younger working people may actually feel that older people are in competition with children for resources. However, the older population is generally not seen as dominating health care research or causing social problems.
You are the nurse caring for patients in the urology clinic. A new patient, 78 years old, presents with complaints of urinary incontinence. An anticholinergic is prescribed. Why might this type of medication be an inappropriate choice in the elderly population?
- A. Gastrointestinal hypermotility can be an adverse effect of this medication.
- B. Detrusor instability can be an adverse effect of this medication.
- C. Confusion can be an adverse effect of this medication.
- D. Increased symptoms of urge incontinence can be an adverse effect of this medication.
Correct Answer: C
Rationale: Although medications such as anticholinergics may decrease some of the symptoms of urge incontinence (detrusor instability), the adverse effects of these medications (dry mouth, slowed gastrointestinal motility, and confusion) may make them inappropriate choices for the elderly.
An elderly patient, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if Medicare is going to cover the cost of the visit. What information can the nurse give the patient to help allay her concerns?
- A. Medicare has a copayment for many of the services it covers. This requires the patient to pay a part of the bill.
- B. Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be covered.
- C. Medicare will only pay the cost for acute-care services if the patient has a very low income.
- D. Medicare will not pay for the cost of acute-care services so the patient will be billed for the services provided.
Correct Answer: A
Rationale: The two major programs that finance health in the United States are Medicare and Medicaid, both of which are overseen by the Centers for Medicaid and Medicare Services (CMS). Both programs cover acute-care needs such as inpatient hospitalization, physician care, outpatient care, home health services, and skilled nursing care in a nursing. Medicare is a plan specifically for the elderly population, and Medicaid is a program that provides services based on income.
For several years, a community health nurse has been working with a 78-year-old man who requires a wheelchair for mobility. The nurse is aware that the interactions between disabilities and aging are not yet clearly understood. This interaction varies, depending on what variable?
- A. Socioeconomics
- B. Ethnicity
- C. Education
- D. Pharmacotherapy
Correct Answer: A
Rationale: Large gaps exist in our understanding of the interaction between disabilities and aging, including how this interaction varies, depending on the type and degree of disability, and other factors such as socioeconomics and gender. Ethnicity, education, and pharmacotherapy are not identified as salient influences on this interaction.