chapter 4

  1. The nurse reminds the 70-year-old male patient with hypertension who is on a sodium-restricted diet that the most effective health practice to reduce sodium intake is to:

    a.

    avoid all salty foods.

    b.

    discontinue eating at restaurants.

    c.

    read food labels on food containers carefully.

    d.

    limit the amount of salt added to food.
    ANS:  CReading labels will prevent the purchase of sodium-laden foods. Sodium-restricted foods are available on most menus. Simply avoiding salty foods does not guarantee less sodium because there are many foods containing sodium that are not salty. Adding salt should be absolutely restricted, not diminished
  2. The nurse takes into consideration that older adults may abuse alcohol because they use it as a(n):

    a.

    sleep aid.

    b.

    appetite stimulant.

    c.

    socialization activity.

    d.

    food source.
    ANS:  A

    Many older adults abuse alcohol to make themselves drowsy enough to sleep.
  3. When the 70-year-old female patient says, “Keeping up with when to take the flu vaccine is a big hassle. I’m not going to add trying to keep up with a pneumonia vaccine as well. It’s too expensive.” The nurse explains that the patient:

    a.

    can take both vaccines at the same time every fall.

    b.

    needs to take the pneumonia vaccine every 10 years.

    c.

    has Medicare coverage for both vaccines.

    d.

    can obtain both vaccines free of charge from the Public Health Department.
    ANS:  B

    Pneumonia vaccine is given to individuals usually between the ages of 65 and 70 years and is repeated every 10 years. Both inoculations can usually be obtained from community clinics for a small fee.
  4. The nurse reminds the 75-year-old that older adults should have visual and hearing examinations every:

    a.

    6 months.

    b.

    12 months.

    c.

    2 years.

    d.

    3 years.
    ANS:  B

    Annual examinations for vision and hearing to check for glaucoma and diminished hearing are recommended.
  5. To prevent polypharmacy or potential drug-drug interactions, the nurse encourages the 75-year-old male patient to:

    a.

    seek medical care from only one physician.

    b.

    read up on all drugs that are prescribed.

    c.

    keep a list of drugs that he is currently taking.

    d.

    use only one pharmacy to fill prescriptions.
    • ANS:  C
    • Keeping a current drug list as a quick reference for any licensed professional to review before prescribing medication is one method to prevent polypharmacy
  6. The 65-year-old overweight, hypertensive male farmer tells the home health nurse that he eats two fried eggs, four pieces of bacon, and biscuits with cream gravy every morning for breakfast because he believes that a robust breakfast keeps him healthy. The nurse’s best approach would be to say:

    a.

    “That sort of food is not on your low-sodium diet.”

    b.

    “You won’t be healthy long with a diet like that.”

    c.

    “One egg and whole wheat toast would be even healthier.”

    d.

    “You should eat whole-grain cereal with fruit instead of all that fat and sodium.”
    ANS:  C

    Health maintenance practices of the older adult are influenced by personal, religious, and cultural beliefs. Using the patient’s beliefs as a basis for changing eating habits will be more successful than radically departing from lifetime habits or suggesting that they are ineffective.
  7. The 60-year-old Asian man tells the home health nurse that he has stopped taking his antihypertensive medication because it causes him to be impotent. He reports that he is using acupuncture to control his hypertension. The nurse’s most effective response would be to say:

    a.

    “Uncontrolled hypertension is a real health problem.”

    b.

    “Does your acupuncturist check your blood pressure?”

    c.

    “Let me check your blood pressure to see how acupuncture is working.”

    d.

    “You need to talk to your real doctor about stopping this drug.”
    ANS:  C

    Problems can occur when cultural remedies are used in place of conventional medicine. Assessment of the effectiveness of the alternate therapy for treating hypertension is necessary to encourage further discussion about his treatment choice. Acupuncture can be very effective.
  8. The nurse takes into consideration that the success of instructions about a diabetic diet will be largely reliant on the:

    a.

    clarity of the instructions.

    b.

    severity of the disease.

    c.

    timing of the instructions.

    d.

    motivation of the patient.
    ANS:  D

    Motivation is necessary for mastery of material and compliance with the new health information.
  9. The nurse is aware that the best predictor of a hypertensive patient complying with a low-sodium diet would be the fact that the patient:

    a.

    has adequate knowledge about the diet.

    b.

    is distressed about his illness.

    c.

    has followed a weight reduction program and lost 15 lb.

    d.

    does not want to have hypertensive complications.
    ANS:  C

    Previous behavior is a good indicator of future practice.
  10. An 80-year-old resident in an extended-care facility injured her foot on a piece of rusty wire. She tells the nurse she had a tetanus booster when she was 75. The nurse’s response will be based on the knowledge that tetanus boosters:

    a.

    should be repeated every 5 years.

    b.

    are not necessary for persons older than 70.

    c.

    do little good for the older adult.

    d.

    should be repeated with every injury, regardless of the previous booster.
    ANS:  D

    Tetanus boosters should be repeated every 10 years, unless an injury prompts the need for a booster.
  11. When a 70-year-old male patient taking corticosteroids for rheumatoid arthritis asks the nurse if he should take the vaccination to prevent shingles, the nurse’s most helpful response would be:

    a.

    “No. Persons with impaired immune systems should not take that vaccine.”

    b.

    “Yes. It would be a good idea to protect yourself from shingles.”

    c.

    “No. That vaccine is only effective in about 10% of the cases.”

    d.

    “Yes. The vaccine is very inexpensive and very effective.”
    ANS:  A

    The shingles vaccine should not be given to anyone with an impaired immune system. Corticosteroids impair the immune system. The vaccine is very expensive and is only effective in about 50% of the cases.
  12. The home health nurse suggests to the 82-year-old man that he should wear a Medic Alert bracelet to notify emergency personnel about his:

    a.

    artificial leg.

    b.

    congestive heart failure.

    c.

    pacemaker.

    d.

    eye prosthesis.
    ANS:  C

    Such health information as pacemakers, heparin therapy, and drug allergies should be made available to emergency workers.
  13. The nurse suggests to the caregiver of a cognitively impaired patient that to assist in maintenance of personal hygiene, the caregiver might try to:

    a.

    give the patient a sponge bath every 3 days.

    b.

    establish a consistent daily schedule of meals, hygiene, and rest.

    c.

    verbally remind the patient to bathe.

    d.

    set out personal hygiene materials for easy access.
    ANS:  B

    A consistent daily schedule is helpful in setting a pattern every day and a time for self-care activities.
  14. When the home health nurse observes that there is still about half of the month’s supply of Glucophage medication in the bottle at the end of the month, the nurse should ask:

    a.

    “Do you know what inadequately treated diabetes can do?”

    b.

    “Have you told your physician you are not taking your prescription?”

    c.

    “Are you trying to make the medication stretch for 2 months?”

    d.

    “Why are you being so noncompliant?”
    ANS:  C

    Many older adults with limited finances and limited access to a pharmacy will take less of a prescribed drug to conserve money.
  15. In addition to supervision of medication protocols and nutrition needs, the presence of the caregiver provides a(n):

    a.

    assurance of safety.

    b.

    service for deep housecleaning.

    c.

    source of motivation.

    d.

    source of care that is free of charge.
    ANS:  C

    A caregiver can be a potent motivational source for adhering to health maintenance practices. The presence of a caregiver does not guarantee safety and housecleaning. Although many caregivers are family members and do not charge for providing care, other caregivers do require a fee.
  16. The caregiver who provides daily meals and attends to the daily needs of the older adult is classified as the _____ caregiver.

    a.

    basic

    b.

    organizing

    c.

    primary

    d.

    designated
    ANS:  C

    The caregiver responsible for the day-to-day needs of the older adult is classified as the primary caregiver.
  17. The RN case worker reminds the patient who is the recipient of home health care that the unlicensed home health aide may not:

    a.

    transfer the patient into a bathtub.

    b.

    measure or dispense medication.

    c.

    contact family members independently.

    d.

    accompany the patient outside the home.
    ANS:  B

    Unlicensed persons are not allowed to dispense drugs in any setting.
  18. Because unpaid caregivers are so significant to the successful health maintenance of the older adult, the licensed home health coordinator should:

    a.

    tell them to call the agency if they need any further assistance.

    b.

    leave them entirely on their own so as not to interfere with the care they provide.

    c.

    critique care to improve its effectiveness.

    d.

    be generous with positive feedback.
    ANS:  D

    The recognition of a job well done and morale boosting are essential to the unpaid, frequently overworked, and frustrated caregiver.
  19. In counseling an older adult about exercising, the nurse suggests that activities such as walking or swimming for as little as ____ minutes a day is beneficial.

    a.

    15

    b.

    30

    c.

    45

    d.

    60
    ANS:  B

    As little as 30 minutes preserves muscle mass and keeps joints flexible.
  20. The home health nurse reminds the older adult to add to the health maintenance of his teeth the practice of:

    a.

    a dental appointment every 2 years.

    b.

    using a fluoride toothpaste.

    c.

    thorough flossing every week.

    d.

    use of an electric toothbrush.
    ANS:  B

    The use of fluoride toothpaste, daily brushing and flossing, and annual dental care will enhance dental health. An electric toothbrush is not necessary.
  21. When the 84-year-old male complains of dry mouth, the nurse suggests that he:

    a.

    keep hard candy in his mouth to stimulate salivation.

    b.

    drink iced cola drinks several times daily for hydration.

    c.

    wash his mouth with an astringent mouth wash.

    d.

    limit alcohol intake.
    ANS:  D

    The reduction of alcohol will help eliminate dry mouth. Excessive use of hard candies, caffeinated drinks like colas, and astringent mouth washes will increase the discomfort from dry mouth.
  22. The nurse lists recommended health practices for older adults, which includes __________. (Select all that apply.)

    a.

    compliance with dietary restrictions

    b.

    performance of regular exercise daily

    c.

    cessation of smoking

    d.

    arrangement for regular medical examinations

    e.

    annual psychological testing
    ANS:  A, B, C, D

    Psychological testing is not part of the recommended health practices. All of the other options listed are recommended health-seeking behaviors.
  23. The nurse stresses to the older adult female that even a small amount of daily exercise can __________. (Select all that apply.)

    a.

    build muscle mass

    b.

    control weight

    c.

    retard bone loss

    d.

    control the blood glucose level

    e.

    promote a sense of well-being
    ANS:  B, C, D, E

    Regular mild exercise will maintain, not build, muscle mass; control weight and glucose levels; retard bone loss; and promote a sense of well-being.
  24. The nurse makes a list of the health evaluations that should be conducted during an annual physical examination for the older female adult, which includes __________. (Select all that apply.)

    a.

    measurement of height and weight

    b.

    lipid study

    c.

    electrocardiography

    d.

    rectal examination

    e.

    mammography
    ANS:  A, B, D, E

    Electrocardiography is not a routine part of a physical examination.
  25. When assessing for ineffective health maintenance, the nurse should assess __________. (Select all that apply.)

    a.

    willingness to follow a health maintenance plan

    b.

    possible conflict between a health maintenance plan and culture

    c.

    the presence of prohibited items such as sweets, alcohol, and cigarettes

    d.

    the family’s perception of effectiveness of a health maintenance plan

    e.

    the level of cognitive impairment
    ANS:  A, B, C, E

    It is the patient’s, not the family’s, perception that the nurse needs to assess. All the other options listed would be a significant barrier to compliance.
  26. The 80-year-old woman tells the home health nurse, “I can only eat cereal because I just can’t make those dentures work!” The nurse’s most helpful suggestion would be to __________. (Select all that apply.)

    a.

    take only tiny bites of food

    b.

    chew slowly

    c.

    use a dental adhesive

    d.

    select soft, nonsticky foods (e.g., ground meat, boiled carrots)

    e.

    purée all food
    ANS:  A, B, C, D

    Puréeing food does not address the inability to eat with dentures.
  27. The nurse assesses factors in a 76-year-old patient’s history that might interfere with willingness to participate in health maintenance activities, which includes __________. (Select all that apply.)

    a.

    a belief that diminished health is part of aging

    b.

    loss of a spouse 3 months ago

    c.

    having a physical examination every year

    d.

    living in an assisted living facility and not driving

    e.

    having no family
    ANS:  A, B, E

    Belief that age is synonymous with declining health, loss of spouse, and no close family are all impediments to learning new health-seeking behaviors.
Author
mayjher
ID
342066
Card Set
chapter 4
Description
health promotion, health maintenance, and home health considerations
Updated