Deck 11: High-Risk Gaps and Cracks II: Caregivers, Dementia, and End-Of-Life Care

Question 1

A patient is being transferred from acute care to a rehabilitation facility. The patient's caregiver is present during the transition of care. Which function is the caregiver performing by asking how the patient will be transported to the new facility?

A) Watching the patient
B) Providing actual physical care
C) Navigating the health care system
D) Acting as an advocate for the patient

Answer 1

C
Explanation: When caregivers assume the responsibility for arranging follow-up care for their relative and for asking practical questions such as how the patient will be transported, the caregiver is navigating the healthcare system. Watching the patient involves such activities as being a physical presence and an extra set of eyes and ears. When resources are scarce, providing care involves family members pitching in to provide direct care such as feeding the patient. Acting as an advocate for the patient involves any actions by the caregiver to assure that the patient's preferences are being honored.

Question 2

The nurse is providing care for a patient admitted to an extended care facility. The nurse notices the patient's family caregiver coming to the facility less often and staying for short time periods. Which additional manifestation does the nurse notice as an indication of caregiver stress?

A) The caregiver wears plain, simple clothing for visitation.
B) The caregiver falls asleep at the bedside of the patient.
C) The caregiver frequently shares details of a busy daily schedule.
D) The caregiver expresses a need to return home before darkness.

Answer 2

B
Explanation: When a visiting caregiver falls asleep at the bedside of the patient, the nurse needs to determine if the caregiver is stressed. The behavior can be indicative of the inability to sleep, of an illness, or the use of stress-relieving medications or substances. Dressing in plain, simple clothing may be common for the caregiver. Sharing the details of a busy schedule may be an attempt to include the patient in the caregiver's activities; this is not necessarily an indication of caregiver stress. Depending on the age of the caregiver, the wish to be home before dark is not a sign of stress, as older adults often do not care to drive after dark.

Question 3

The nurse is preparing to perform an assessment on the family member that the patient has identified as being the patient's caregiver. Which finding during the assessment indicates the caregiver is well suited for the function?

A) The caregiver uses a lift chair to reach the upstairs bedroom and bathroom.
B) The caregiver's daily medication list is extensive and covers multiple conditions.
C) The caregiver requests home care to assist with bathing and dressing the patient.
D) The caregiver seems reluctant and defensive when answering the nurse's questions.

Answer 3

C
Explanation: When the caregiver requests assistance from home care, the nurse recognizes the caregiver's willingness to provide whatever care the patient needs with assistance when necessary. If the caregiver has difficulty navigating in the home environment, the nurse will be concerned about the ability to care for the patient. The nurse will closely assess the caregiver for health and wellbeing. An extensive daily medication list for the caregiver is a concern, especially with multiple conditions. An important caregiver assessment is about the caregiver's relationships with the healthcare team; a negative attitude is a source of concern.

Question 4

Medical care in the United States is typically not designed to accommodate the special needs of patients with dementia and their caregivers. Which is a principle for the care of patients with dementia?

A) Providers will need to redesign their clinical practice.
B) Providers will obtain specialized training for geriatrics.
C) Providers will focus on support of the patient-caregiver dyad.
D) Providers will adhere to best clinical practice components.

Question 5

The nurse is providing education for the caregiver of a patient diagnosed with moderate dementia. Which care suggestion by the nurse is appropriate?

A) A nightly back and neck massage will promote sleep.
B) TV volume is kept loud enough to attract the patient.
C) Lights are turned up to assure safety when ambulating.
D) Touch from a stranger is used sparingly to avoid fear\confusion.

Question 6

The nurse manager at an independent facility for patients with Alzheimer disease and dementia is preparing to hire nursing staff. Which qualification does the nurse manager consider the most important asset?

A) Some basic training about dementia
B) Work experience in another extended care facility
C) Experience with a family member with dementia
D) The ability to modify clinical practice as needed

Question 7

Healthcare professionals are often faced with patients who are terminally ill or no longer able to make decisions about their care. Which suggestion helps to close the gap between medical treatment and end-of-life care?

A) Develop a plan that covers expected changes.
B) Work with nursing staff to establish realistic goals.
C) Learn what the patient and family are hoping for.
D) Continue to suggest medical interventions for a cure.

Question 8

In response to increased stress, caregivers may turn to alcohol or prescription or psychotropic drugs.

Question 9

The metaphor of "fighting" disease and death ingrained in both the broader American culture and the culture of medicine creates the potential for hospice and palliative care to be perceived as "giving up."

Question 10

Regulatory barriers present obstacles to the widespread use of palliative care services.