NURS 3325 Holistic Care Older Adult Test 1-5

1. A nurse assessesthe risk of the members of an older adult community. Which individuals is most likely to be living at or below the poverty line? • A couple who are both 72 years old • A Hispanic couple who are both in their 60s • A white 73-year-old man • An 83-year-old single woman Rationale: Women and those over the age of 75 are most likely to live in poverty. Couples and those 65 to 74 are less likely to live in poverty. Five percent of older white men live in poverty. 2. A nurse care for an older adult client whose current hospital admission is prompted by an exacerbation of chronic renal failure. Which action by the nurse will best emphasize the goal of client wellness? • Teach the client that health problems do not have to affect daily routines • Ask that the client’s code status be changed to “do not resuscitate” • Explore the client’s abilities and strengths • Show the client others who are more ill Rationale: A focus on existing strengths and abilities can foster wellness in older adults, even when they are experiencing health challenges. It is inappropriate to compare clients with each other, and changing client’s code status unlikely to promote wellness, even if this is necessary. It is inaccurate to claim that health problems do not affect daily routines. 3. A nurse assesses a community of older adults. Which person is at highest risk for a shortened life expectancy? • A nurse born in 1957 • A homemaker born in 1957 • A college professional born in 1956 • A nuclear engineer born in 1958 Rationale: Socioeconomic characteristicsthat are most strongly correlated with healthy aging are poverty and lower educational level. Limited English proficiency and poor health literacy skills are two variables that have a negative impact on health and functioning. The college professor, engineer, and nurse positions require more education that a homemaker. 4. A diabetes nurse is providing care for an older adult client who is a regular client of the hospital’s outpatient diabetes clinic. What assessment question most clearly addresses this client’s potential for optimal function? • “How can we help you to take ownership of your own health?” • “What are some goalsthat you have for maximizing your level of wellness?” • “Isthere anything that you’re doing that might be exacerbating your diabetes?” • How long do you think that you’ll be able to live independently?” Rationale: Eliciting and older adult’s goals for wellness and high functioning can help promote these outcomes. Questions about a client’sliving situation, disease management, and personal responsibility may or may not promote wellness. 5. A nurse performs a reflective culturalself-assessment. Which outcome should the nurse expect? • Progression from judgmental views of other culturesto recognition of positive attributes • An accurate ranking of different cultures according to theirspecific merits • The ability to assess clients according to their cultural affiliation that their individual characteristics • Identification of the flaws and weakness of the nurse’s own culture Rationale: The process of cultural competence is a progression from judgmental attitudes and practices to positive approaches. It does focus primarily on the deficits of one’s own culture, and it does not replace individualized assessment and care with cultural generalizations. Culturally competent care does not involve “ranking” different cultures. 6. A nurse has observed an increasing number of older Asian Americans in the hospital. Which statement regarding Asian cultures will best assist the nurse to plan nursing care for this group? • Asian Americans view health as a state of physical and spiritual harmony • Older Asian Americans are more likely than Americans to live alone • Asian Americans as a group have lower mortality rates • Asian Americans commonly care for older adults by placing them in institutional environments. Rationale: While it is true that Asian Americans as a group have lower mortality rates at all ages, the statement that best assists the nurse to plan care of the Asian client is that a common view of health from the Asian perspective isthat of harmony in the spiritual and physical contexts. Asian Americans are less likely to live alone. It is more common for older Asian Americans to live with family than in nursing homes. 7. A nurse at a long-term care facility has completed the admission assessment of an older adult resident. The resident identifies as gay and has expressed sadness at having to leave the resident’s partners of several decades in order to move to the facility. The nurse should recognize which in this individual’s history? • Homelessness • Nominal employment or unemployment • Stigmatization • Infectious diseases Rationale: Stigma is a common experience among LGBT (lesbian, bisexual, and transgender) older adults, and the likelihood of this is greater than the likelihood of homelessness, unemployment, or infectious diseases. 8. Following knee replacementsurgery 10 days earlier, an older adult client diagnosed with an infection in the knee has a synovial fluid culture ordered. Obtaining the sample helps to determine the causative microorganism and to select an appropriate antibiotic. The above course of events characterizes what major health belief system? • Holistic paradigm • Analytical paradigm • Scientific paradigm • Magico-religious paradigm Rationale: The scientific (biomedical) health paradigm prioritizes cause-andeffect relationships (i.e., microorganisms and infection) along with manipulation of these through pharmacologic interventions and surgery. The holistic paradigm emphasizes the interconnectedness of mind, body, and spirit, and the magicoreligious paradigm emphasizes supernatural factors. The “analytical paradigm” is not among the three major health belief systems. 9. A nurse in the long-term care facility plans care to improve an older adult client’s quality of life. Which action is most likely to enhance an older adult’s connectedness with family? • Advocating for a married couple to remain in the same room of a long-term care facility, as is the couple’s preference • Performing a focused respiratory assessment on a client who has a diagnosis of lung cancer • Organizing a client’sintravenous antibiotic therapy on an outpatient basis • Teaching a client who has had a below-the-knee amputation about how to care for the stump Rationale: Advocating for a married couple to remain in the same room of a longterm care facility, as is the couple’s preference, fosters connectedness, a component of older adult’s quality of life. Teaching wound care, organizing treatment, and adequately assessing a client are aspects of good care, but these are not direct contributors to connectedness. 10. A home health nurse performs an admission on an older adult client. The client expresses concern over “embarrassing urinary issues.” The client’s blood pressure 135/90 mm Hg, with the client’s last bowel movement 1 day ago. Which area addresses the client’s goals? • Blood pressure • Constipation • Incontinence • Safety Rationale: Although nurses addresssafety, blood pressure, and constipation as part of a comprehensive care plan, it is imperative to begin by addressing the older adult’s priority concerns. 11. A nurse is using the Functional Consequences Theory for planning client care in a health care facility. Which statement would assist the nurse in implementing thistheory? • “Most functional consequences cannot be addressed through nursing interventions.” • “The Functional Consequences Theory is an alternative to holistic nursing care.” • “Wellnessis a concept that is broader than just physiologic functioning.” • “Most problems affecting older adultsrelate to issues of aging.” Rationale: Within the Functional Consequences Theory, wellness is a central concept that encompasses more than the older adult’s level of physiological functional. Most problems affecting older adults are attributable to risk factors, even though age-related changes are indeed relevant and inevitable. Nursing interventions can address functional consequences. Holistic care is not an alternative to Functional Consequences Theory, but rather a component of the theory.