Deck 18: Chronic Illness and the Aprn

Question 1

Mr.Smith, 82 years old, is seen by a nurse practitioner and is potentially diagnosed with treatment burden.The nurse practitioner recommends the Chronic Disease Self-Management Program (CDSMP).This program addresses which of the following skills? Select all that apply.
1)Techniques to deal with problems.
2)Decision making.
3)Using resources available.
4)Patient-practitioner relationship.
5)Taking action.

Answer 1

1, 2, 3, 4, 5

Question 2

Mrs.Morrison is 85 years old and on Medicare with supplemental insurance.She is obese and has diabetes and heart failure.The nurse practitioner collaborates with a social worker and with a representative from Medicare about the cost of her treatment choices.The nurse practitioner analyzes treatment burden and the costs of care to develop a practical and cost-effective plan of care.Which of the following puts Mrs.Morrison at risk for a financial burden for health care? Select all that apply.
1)Chronic medical conditions.
2)Obesity and diabetes.
3)No history of hospitalization in the last 5 years.
4)Higher costs of prescriptions.
5)Lower total out-of-pocket expenses.

Answer 2

1, 2, 4

Question 3

The family of Mr.Moore, 90 years old, meets with the nurse practitioner to discuss a change in the care of Mr.Moore.He appears to be less comfortable, more irritable, and has less appetite.He has diabetes, chronic obstructive pulmonary disease (COPD), kidney disease, and chronic colitis.The family and practitioner agree that Mr.Moore is not near end of life, and yet there is not an apparent cure for his conditions.The nurse practitioner discusses palliative care for Mr.Moore.Why might palliative care be a good option? Select all that apply.
1)It will provide relief from his symptoms.
2)It can manage symptoms until treatment is found to provide a cure.
3)Nearly half of Medicare patients can qualify for palliative care when they have two to four chronic care conditions.
4)The health-care providers are aware of updated treatment that can alleviate his symptoms.
5)It may provide a better quality of life and mood enhancement.

Answer 3

1, 2, 5

Question 4

The nurse practitioner is conducting a health of older adults in-service with a group of older adults at a community center.The first concept she presents is a definition of chronic illness. Which of the following is the best definition?
1)A situation that considers the meaning of the more than one long-term illness on the patient, family, and provider.
2)A condition that requires medical attention for at least 6 months.
3)Any condition that requires time-limited adjustments.
4)There is only one definition of chronic illness.

Question 5

Mrs.Koslowski, 95 years old, comes to the nurse practitioner with her daughter to discuss her medical regime.She complains that she thinks some of the therapies are doing more harm than good.Mrs.Koslowski wants to discontinue some of the medical orders.The nurse practitioner reviews her medical plan and discusses a new model of care called minimally disruptive medicine (MDM).She explains to the daughter and to Mrs.Koslowski that this model does which of the following? Select all that apply.
1)Recognizes the difference between patient-centered and disease-centered treatment.
2)May suggest limitations on some traditional therapies for the frail patient with MCCs.
3)Revises clinical practice guidelines to consider minimally disruptive medicine.
4)Recognizes that older adults have improved results when treated with disease-specific orders.
5)Has clinicians use approaches that include patient values so that better decisions are made.

Question 6

Mrs.Jones, 80 years old, comes to the clinic for management of heart failure, diabetes, and depression.The nurse practitioner assesses that this patient is not compliant with the medication plan and has missed a couple of recent appointments.The nurse practitioner analyzes this information and concludes that perhaps Mrs.Jones is experiencing treatment burden because:
1)At the age of 80 years, she may not understand the workload she is carrying daily.
2)The comorbidities Mrs.Jones is dealing with are similar and do not necessitate many different specific tasks.
3)She is supposed to deal with several activities regarding her health daily.
4)The depression may inhibit her from proper self-care.

Question 7

The nurse practitioner whose practice consists of geriatric-aged patients must consider which of the following when working with patients who experience multiple chronic illnesses?
1)Addictions in older adults are predicted to decline in the next 20 years.
2)Mental illness or behavior problems must be included as chronic conditions.
3)Fragility and disability typically have multiple chronic conditions.
4)Co-occurrence of mental and medical conditions is not necessarily disabling.

Question 8

The U.S.health-care system functions by managing and paying for illness by focusing on one problem at a time.The nurse practitioner analyzes this system and concludes it is ineffective because:
1)As the number of comorbidities increases, so do the risks.
2)Unintended outcomes of the one disease model include the collaboration of medical advice.
3)There is no knowledge gap regarding people with multiple chronic conditions (MCCs).
4)One in ten Medicare recipients has more than one chronic illness.

Question 9

The nurse practitioner is conducting an initial history and physical examination, along with a health assessment on a new patient.Mr.Carter is African American and 68 years old.He presents with complaints of dizziness, unstable gait, and polyuria.This combination of symptoms is blamed for his frequent falling at home.The nurse practitioner analyzes the findings of the examination and suggests which of the following diagnostics? Select all that apply.
1)Blood pressure measurements, including measuring for hypostatic hypertension to rule out hypertension.
2)Fasting blood sugar and a glucose tolerance test to rule our diabetes.
3)Testing for chronic kidney disease (CKD).
4)Measurement of BMI.
5)Definitive testing for Alzheimer's disease.

Question 10

While teaching a family about the risks of chronic illness for James, who is 69 years old and the patriarch of the family, the nurse practitioner includes which of the following information?
1)The American Heart Association reports that there is an increase in cardiovascular disease with low levels of smoking, excluding second-hand smoke.
2)Drinking high levels of alcohol contributes to an increase in chronic obstructive lung disease.
3)Obesity is correlated with a higher risk for type 2 diabetes.
4)The lower the body mass index (BMI)the lower the risk of chronic illness.

Question 11

The nurse practitioner has conducted a thorough health assessment for Mr.York, who is 83 years old.As the nurse practitioner synthesizes the information and creates the discharge instructions, consideration must be given to which of the following? Select all that apply.
1)His level of understanding of his health condition.
2)His ability to provide self-care.
3)His willingness to obtain preventive services.
4)His number of medication errors.
5)His basic reading level.

Question 12

The nurse practitioner is speaking to a group of student nurses about the causes of death of older adults.Which of the following statements is true regarding mortality and morbidity of people older than 65 years?
1)Seventy percent of the cohort older than 65 years dies of chronic conditions.
2)Conditions that contribute to significant chronic illness include fractures.
3)The number one cause of death of both older men and women is heart disease.
4)Dyslipidemia is the leading cause of mortality of people over 65 years of age.

Question 13

Mrs.Kesler, 91 years old, is considered frail and yet she is active and lives alone with supervision from her daughter.Her frailty is based on which of the following? Select all that apply.
1)A 10-pound weight gain in the last month.
2)Self-reported exhaustion.
3)Strength based on grip.
4)Low walking speed.
5)Decreased physical activity.

Question 14

Mrs.Hupp, 91 years old, lives with her daughter, Kim.Kim loves her mother and does everything she can to assist in providing a good quality life for her mother.Recently, Kim has been telling her nurse practitioner that she is experiencing lack of sleep, higher blood sugars, and anxiety.The nurse practitioner discusses which of the following with Kim? Select all that apply.
1)The mother's treatment burden.
2)Caregiver burden.
3)The possibilityof referring the mother to a long-term facility.
4)The possibility of the caregiver not practicing self-care and not experiencing good health.
5)Caregivers experience varying degrees of burden in caring for their parents.