3B Adult Health Care Exam 1

Front 1

What type of pain is common with older adults?

Back 1

Chronic Pain

Front 2

What is pain in older adults normally associated with?

Back 2

Physical disability and psychosocial problems

Front 3

About how many community-dwelling older adults are estimated to have chronic pain problems?

Back 3

58%- 70%

Front 4

What condition in older adults is typically under assessed and treated?

Back 4

Pain

Front 5

Characteristics of Chronic Illness?
(5)

Back 5

-Permanent Impairments
-Deviations from normal
-Nonreversible pathologic changes
-Residual disability
-Special rehabilitation required
-Need for long-term medical and/or nursing management
-May have stable and unstable periods.

Front 6

Most Common painful conditions in older adults

Back 6

Musculoskeletal conditions
-Osteoarthritis
-Low back pain
-Previous fracture sites

Front 7

The nurse identifies the nursing diagnosis of risk for impaired skin integrity related to obesity and immobility for a patient. During the evaluation phase of the nursing process, the nurse would:

1. Assess the condition of the patient’s skin
2. Select new outcomes if the patient loses weight
3. Change the patient’s linens if they become moist or wrinkled
4. Change the patient’s position every 2 hrs to prevent pressure areas

Back 7

Assess the condition of the patient's skin.

Rationale: During evaluation, the nurse determines whether the patient’s outcomes have been met. The nurse assesses the patient’s skin to determine whether it has remained intact.

Front 8

When the nurse encourages a patient with heart failure to alternate rest and activity periods to reduce cardiac workload, the phase of the nursing process being used is

1. Planning
2. Diagnosis
3. Evaluation
4. Implementation

Back 8

Implementation

Rationale: Carrying out the specific, individualized plan constitutes the implementation phase of the nursing process. The nurse’s action of encouragement and instruction to the patient is part of carrying out a plan of action.

Front 9

A nursing unit is implementing evidence-based nursing practice where possible. A new graduate nurse who has been assigned to this unit would expect that:
1. all patient care provided is based on findings from research.
2. patient preferences do not influence care as much as research findings.
3. the care provided is based on the best evidence for quality care and desired outcomes.
4. clinical practice guidelines are used so that individual decisions about patient care are not necessary.

Back 9

The care provided is based on the best evidence for quality care and desired outcomes.

Rationale: Evidence-based practice is the use of best evidence (from research findings, quality improvement, and professional standards), clinician expertise, and patient preferences and values to support clinical decision making.

Front 10

A characteristic of a chronic illness is that it:

1. has reversible pathologic changes.
2. has a consistent, predictable clinical course.
3. is associated with many stable and unstable phases.
4. always starts with an acute illness and then progresses slowly.

Back 10

3. is associated with many stable and unstable phases.

Rationale: The following are characteristics of chronic illness: permanent impairments or deviations from normal, nonreversible pathologic changes, residual disability, special rehabilitation required, and need for long-term medical and/or nursing management. Chronic illness may have stable and unstable periods.

Front 11

A nurse is caring for a young adult who sustained a severe traumatic brain injury following a motor vehicle accident. Once the patient recovers from the acute aspects of this injury and is no longer ventilator dependent, the nurse anticipates that the patient will require extensive daily physical and occupational therapy. Which of the following settings would be most appropriate?

1. Home health care
2. Acute rehabilitation
3. Long-term acute care (LTAC)
4. Skilled nursing facility (SNF)

Back 11

Acute Rehabilitation

Rationale: Acute rehabilitation settings provide postacute care specializing in therapies for patients with neurologic or physical injuries such as with head trauma, spinal cord injury, and stroke. These patients require hours of exercise and other therapy daily.

Front 12

Standard precautions should be used when providing care for:

1. All patients regardless of diagnosis.
2. Pediatric and gerontologic patients.
3. Patients who are immunocompromised
4. Patients with a history of infectious diseases.

Back 12

All patients regardless of diagnosis

Rationale: CDC Guidelines indicate that standard precautions should be used for all care of all patients in hospitals and health care facilities.

Front 13

Which of the following are appropriate methods of patient identification before giving medications?

1. patient first & last name
2. Patient room number
3. Patient first and last name with room number
4. Patient first and last name with hospital ID #

Back 13

Patients first and last name with hospital ID #

Rationale: At least two patient identifiers should be used when providing care, treatment, and services. Acceptable identifiers may be the patient’s first and last name, and assigned identification number, telephone number, or other person-specific number. Room number is not an appropriate identifier.

Front 14

Which of the following precautions is appropriate for a patient who has a wound infected with methcillin resistant staphylococcus aureus (MRSA)?

1. standard precautions only
2. standard precautions with airborne precautions
3. standard precautions with droplet precautions
4. standard precautions with contact precautions

Back 14

Standard precautions with contact precautions

Rationale: Airborne precautions should be used in addition to standard precautions for patients known to be or suspected of being infected with microorganisms transmitted by airborne droplet. Examples include tuberculosis, measles, and varicella.

Front 15

Which of the following precautions is appropriate for a patient who has Hemophilus influenzae infection?

1. standard precautions
2. standard and airborne precautions
3. standard and droplet precautions
4. standard and contact precautions

Back 15

Standard precautions with droplet precautions

Rationale: Droplet precautions should be used in addition to standard precautions for patients known to be or suspected of being infected with microorganisms transmitted by droplets. Examples include Haemophilus influenza and Streptococcus pneumoniae.

Front 16

In which of the following situations is handwashing not required?

1. After contact with body fluids
2. After gloves are removed
3. Between taking vital signs and giving medications to the same patient
4. Between taking vital signs on one patient and giving medications to a different patient

Back 16

Between taking vital signs and giving medications to the same patient.

Rationale: Wash hands 1) after touching blood, body fluids, secretions, excretions, and contaminated items, regardless of whether gloves are worn; 2) immediately after gloves are removed; and 3) between patient contacts.

Front 17

The nurse informs the patient with bacterial pneumonia that the most important factor in antibiotic treatment is that:

1. antibiotics should have been used to prevent the pneumonia.
2. all of the supplied antibiotics should be taken even when symptoms have resolved.
3. enough antibiotics for 2 days’ treatment should be reserved in case symptoms recur.
4. patients should request antibiotics for upper respiratory infection to prevent development of streptococcal-related diseases.

Back 17

All of the supplied antibiotics should be taken even when symptoms have resolved.

Rationale: One of the most important factors in the development of antibiotic-resistant strains of organisms has been inappropriate use of antibiotics. Patients should be taught to take full courses of prescribed antibiotics without skipping doses, not to request antibiotics for viral infections, not to take antibiotics prophylactically unless specifically prescribed, and not to take leftover antibiotics.

Front 18

A hospital has seen a recent increase in the incidence of hospital-acquired infections (HAIs). Which of the following measures should be prioritized in the response to this trend?


1. Use of gloves during patient contact
2. Frequent and thorough hand washing
3. Prophylactic, broad-spectrum antibiotics
4. Fitting and appropriate use of N95 masks

Back 18

Frequent and thorough hand washing

Rationale: Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing.

Front 19

Which of the following statements about hand hygiene is not consistent with the CDC Hand Hygiene Guidelines?

1. Decontaminate hands after contact with a patient’s intact skin while taking vital signs.
2. When washing hands with soap and water, rub hands together vigorously for at least 10 seconds.
3. Decontaminate hands after removal of gloves
4. For an alcohol based hand rub, cover all surfaces and rub hands together until dry.

Back 19

When washing hands with soap and water, rub hands together vigorously for at least 10 seconds.

Rationale: CDC guidelines for handwashing with soap and water indicate that the hands should be rubbed together vigorously for at least 15 seconds.

Front 20

Patients are most at risk for medication errors:

1. during transitions in care
2. in the home
3. when a new drug is ordered
4. in the outpatient clinic

Back 20

During transitions care

Rationale: Patients are at high risk for harm from adverse drug events when communication about medications is not clear. The chance for communication errors increases whenever individuals involved in a patient’s care change.

Front 21

Guidelines for medication safety on admission to the hospital include:

1. Obtain and document a complete list of the patient’s current medications
2. Involve the patient in verifying the list is correct
3. Compare the home medication list to those ordered on admission
4. 1 and 2
5. 1, 2 and 3

Back 21

1, 2 and 3:
-Obtain and document a complete list of the patient’s current medications
- Involve the patient in verifying the list is correct
-Compare the home medication list to those ordered on admission
Rationale: Communicating about the medication list, making sure it is accurate, and reconciling any discrepancies whenever new medications are ordered or current medications are adjusted are essential to reducing the risk of transition-related drug events. When the patient enters the hospital, a complete list of medications the patient is taking at home should be documented. The patient and family as needed should be involved. The home medication list should be compared to those ordered in the hospital and any discrepancies should be reconciled and document

Front 22

The Occupational Safety and Health Administration (OSHA) policies implemented for infection control are primarily designed for the purpose of:

1. Protecting all persons from exposure to pathogenic agents
2. Protecting susceptible patients from cross-contamination from other patients
3. Protecting employees against transmission of blood-borne pathogens from patients
4. Preventing transmission of infectious diseases to patients from health care professionals

Back 22

Protecting employees against transmission of blood-borne pathogens from patients

Rationale: OSHA is a federal agency that protects workers from injury and illness in their places of employment by creating guidelines about the use of personal protective equipment (PPE) and safety equipment. For healthcare workers, the guidelines for use of PPE protect them from exposure to blood borne pathogens. The Center for Disease Control (CDC) develops guidelines to prevent transmission of organisms between all persons including patients, families, and health care providers.

Front 23

An appropriate care setting choice for an older adult living with an employed daughter but who requires assistance with activities of daily living is:

1. adult day care.
2. long-term care.
3. a retirement center.
4. an assisted-living facility.

Back 23

Adult Day Care

Rationale: Adult day care (ADC) programs provide daily supervision, social activities, and assistance with activities of daily living (ADLs) for persons who are cognitively impaired and persons who have problems with ADLs. ADC centers provide physical and emotional relief for the caregiver and allow continued employment for the caregiver.

Front 24

The nurse is caring for a diabetic patient in the ambulatory surgical unit who has just undergone debridement of an infected toe. Which task is most appropriate for the nurse to delegate to nursing assistive personnel (NAP)?

1. Check the patient's vital signs.
2. Evaluate the patient's awareness.
3. Monitor the site of the patient's IV catheter.
4. Evaluate the patient's tibial and pedal pulses

Back 24

Check patient's vital signs

Rationale: Specific activities that may be delegated to nursing assistive personnel (NAP) include routine vital signs on stable patients, feeding or assisting patients at mealtime, ambulating stable patients, and helping patients with bathing and hygiene. Nursing interventions that require independent nursing knowledge, skill, or judgment, such as assessment, patient teaching, and evaluation of care, cannot be delegated.

Front 25

Acute Rehabilitation settings provide what type of care for patients?

What type of patients utilize this type of care?

Back 25

Provides Postacute Care that provides therapies for patients.

Type of patients:
Neurologic or physical injuries such as with head trauma, spinal cord injury, and stroke.

(Require hours of exercise and other therapy daily)

Front 26

3 examples of microorganisms transmitted by airborne droplet:

Back 26

1. Tuberculosis
2. Measles
3. Varicella

Front 27

2 examples of microorganisms transmitted by droplets:

Back 27

1.Haemophilus influenza
2. Streptococcus pneumoniae

Front 28

What is one of the most important factors in the development of antibiotic-resistant strains of organisms?

Back 28

Inappropriate use of antibiotics

ie: not taking full courses of the antibiotic, skipping doses

Front 29

What is the role of OSHA?

Back 29

A federal agency that protects workers from injury and illness in their places of employment by creating guidelines about the use of PPE and safety equipment

Front 30

What specific activities can be delegated to nursing assistive personnel?

Back 30

-Routine vital signs on stable patients
-Feeding/assisting at mealtimes
-Ambulating stable patients
-Assisting patients with bathing and hygiene

(Assessment, patient teaching, and evaluation of care CANNOT be delegated)