Nokea
You have admitted a new patient to your unit with a diagnosis of stage IV breast cancer. This woman has a comorbidity of myasthenia gravis. While you are doing the initial assessment, the patient tells you that she felt the lump in her breast about 9 months ago. You ask the patient why she did not see her health care provider when she first found the lump in her breast. What would be a factor that is known to influence the patient in seeking health care services?
- A. Lack of insight due to the success of self-managing a chronic condition
- B. Lack of knowledge about treatment options
- C. Overly sensitive patient reactions to health care services
- D. Unfavorable interactions with health care providers
Correct Answer: D
Rationale: Because of unfavorable interactions with health care providers, including negative attitudes, insensitivity, and lack of knowledge, people with disabilities may avoid seeking medical intervention. The population of people who are disabled is not overly sensitive to the reactions of those providing health care services. This is more likely than lack of insight or knowledge on the part of the patient.
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A medical-surgical nurse is teaching a patient about the health implications of her recently diagnosed type 2 diabetes. The nurse should teach the patient to be proactive with her glycemic control in order to reduce her risk of what health problem?
- A. Arthritis
- B. Renal failure
- C. Pancreatic cancer
- D. Asthma
Correct Answer: B
Rationale: One chronic disease can lead to the development of other chronic conditions. Diabetes, for example, can eventually lead to neurologic and vascular changes that may result in visual, cardiac, and kidney disease and erectile dysfunction. Diabetes is not often linked to cancer, arthritis, or asthma.
A patient tells the nurse that her doctor just told her that her new diagnosis of rheumatoid arthritis is considered to be a chronic condition. She asks the nurse what chronic condition means. What would be the nurses best response?
- A. Chronic conditions are defined as health problems that require management of several months or longer.
- B. Chronic conditions are diseases that come and go in a relatively predictable cycle.
- C. Chronic conditions are medical conditions that culminate in disabilities that require hospitalization.
- D. Chronic conditions are those that require short-term management in extended-care facilities.
Correct Answer: A
Rationale: Chronic conditions are often defined as medical conditions or health problems with associated symptoms or disabilities that require long-term management (3 months or longer). Chronic diseases are usually managed in the home environment. They are not always cyclical or predictable.
A patient who is legally blind is being admitted to the hospital. The patient informs the nurse that she needs to have her guide dog present during her hospitalization. What is the nurses best response to the patient?
- A. Arrangements can be made for your guide dog to be at the hospital with you during your stay.
- B. I will need to check with the care team before that decision can be made.
- C. Because of infection control, your guide dog will likely not be allowed to stay in your room during your hospitalization.
- D. Your guide dog can stay with you during your hospitalization, but he will need to stay in a cage or crate that you will need to provide.
Correct Answer: A
Rationale: If patients usually use service animals to assist them with ADLs, it is necessary to make arrangements for the accommodation of these animals. The patient should be moved to a private room, and a cage would prevent the service dog from freely assisting the patient, so it is not necessary.
The nurse is caring for a young adult male with a traumatic brain injury and severe disabilities caused by a motor vehicle accident when he was an adolescent. Where does the nurse often provide care for patients like this young adult?
- A. Adult day-care facilities
- B. Step-down units
- C. Medical-surgical units
- D. Pediatric units
Correct Answer: C
Rationale: Patients with preexisting disabilities due to conditions that have been present from birth or due to illnesses or injuries experienced as an adolescent or young adult often require health care and nursing care in medical-surgical settings. Step-down units provide care between the ICU setting and the regular units. Pediatric units provide care for patients aged 19 and younger. Adult day care may or may not be appropriate.
The nurse is caring for a patient diagnosed with cancer of the liver who has chosen to remain in his home as long as he is able. The nurse reviews the care plan for the patient and notes that it focuses on palliative measures. The nurse also notes that over the last 3 weeks, the patients condition has continued to deteriorate. What is the nurses best response to this clinical information?
- A. Recognize that death will most likely occur in the next week.
- B. Recognize that the patient is in the trajectory phase of chronic illness and should be kept pain-free.
- C. Recognize that the patient is in the downward phase of chronic illness and should be reassessed.
- D. Recognize that the patient should immediately be admitted into the hospital.
Correct Answer: C
Rationale: The downward phase occurs when symptoms of chronic illness worsen despite attempts to control the course through proper regimen management. A downward turn does not necessarily lead to death. A downward trend can be arrested and the trajectory reestablished at any point, depending on the condition and the treatment. A patient who is palliative may not desire hospitalization and aggressive treatment.