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Nursing Interventions

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Total Questions : 4

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Question 1:

A nurse is assessing an older adult client who reports feeling lonely and isolated since retiring from work.

Which of the following questions should the nurse ask to assess the client’s psychosocial changes?

A. How do you spend your time during the day?. B. Do you have any hobbies or interests that you enjoy?. C. Do you have any friends or family members that you keep in touch with?. D. How do you cope with stress and challenges in your life?.

Answer and Explanation

Choice A:

How do you spend your time during the day?.

This question is relevant to assess the client’s psychosocial changes because it can reveal the client’s level of activity, engagement, and satisfaction with their daily routine.Older adults may face various psychosocial challenges that can affect their well-being and social relationships, such as isolation, loss of identity, mistrust, guilt, and financial anxiety.

Asking about the client’s daily activities can help the nurse identify any signs of depression, anxiety, loneliness, boredom, or cognitive impairment that may require further intervention.

Choice B:

This is wrong because it is not directly related to the client’s psychosocial changes.

Asking about hobbies or interests may provide some information about the client’s personality and preferences, but it does not address the client’s current emotional or social state.

Choice C:

This is wrong because it is too specific and may not capture the full extent of the client’s social network and support.

Asking about friends or family members may indicate the client’s level of connectedness and attachment, but it does not explore the quality or frequency of those relationships.

Choice D:

This is bacause it is too broad and may not elicit useful information for the nurse.

Asking about coping strategies may be helpful to assess the client’s resilience and adaptability, but it does not focus on the client’s present psychosocial issues or needs.

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Question 2:

A nurse is planning care for an older adult client who has arthritis, hypertension and mild cognitive impairment.

Which of the following interventions should the nurse include in the care plan to promote health and wellness in this client?

(Select all that apply.).

A. Encourage the client to perform range-of-motion exercises daily. B. Monitor the client’s blood pressure and medication adherence C. Provide the client with a calendar and a clock to orient them to time and date D. Refer the client to a social worker for financial assistance E. Teach the client relaxation techniques and coping skills.

Answer and Explanation

Choice A:

This is correct because range-of-motion exercises can help improve the mobility and flexibility of the joints affected by arthritis.

They can also reduce stiffness and pain, especially after long periods of inactivity.Some examples of range-of-motion exercises for knee arthritis are ball kicks, glute kicks, knee flexion exercises, and hamstring stretch.

Choice B:

This is correct because monitoring the client’s blood pressure and medication adherence is essential for managing hypertension, which is a common chronic condition among older adults.

Hypertension can increase the risk of cardiovascular complications, such as stroke and heart failure.Medication adherence can help lower blood pressure and prevent adverse effects from drug interactions or overdosing.

Choice C:

This is correct because providing the client with a calendar and a clock to orient them to time and date can help with mild cognitive impairment, which is a decline in memory and thinking skills that is not severe enough to interfere with daily life.

Mild cognitive impairment can affect the ability to remember appointments, events, or tasks.A calendar and a clock can serve as memory aids and reminders for the client.

Choice D:

This is wrong because referring the client to a social worker for financial assistance is not directly related to promoting health and wellness in this client.

While financial stress can affect the mental and physical health of older adults, it is not a priority intervention for this client who has arthritis, hypertension and mild cognitive impairment.The nurse should focus on interventions that address the client’s specific health needs and goals.

Choice E:

This is correct because teaching the client relaxation techniques and coping skills can help reduce stress and anxiety, which can worsen arthritis pain and inflammation, as well as blood pressure.

Relaxation techniques can include deep breathing, meditation, progressive muscle relaxation, or guided imagery.Coping skills can include positive self-talk, problem-solving, or seeking social support.

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Question 3:

A nurse is educating an older adult client and their caregiver about the normal aging process and health promotion strategies. The nurse wants to empower the client to participate in decision-making and self-care.

Which of the following statements should the nurse make?

A. “You should follow the advice of your health care providers and do what they tell you to do.”. B. “You have the right to make your own choices about your health care and lifestyle.”. C. “You need to depend on your caregiver for most of your daily activities and needs.”. D. “You have no control over your health condition and how it affects your life.”.

Answer and Explanation

Choice A:

This is wrong because it implies that the client should be passive and obedient, which does not respect their autonomy or preferences.

Choice B:

This statement reflects the principle ofautonomy, which means respecting the client’s right to self-determination and decision-making.The nurse should empower the client to participate in their own care and promote their dignity and independence.

Choice C:

This is wrong because it suggests that the client is dependent and helpless, which does not foster their self-esteem or confidence.

Choice D:

This is wrong because it indicates that the client has no control or influence over their health condition, which does not encourage their coping or adaptation.

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Question 4:

A nurse is evaluating the outcomes of interventions for an older adult client who has diabetes, depression and hearing loss. The nurse wants to support the dignity, autonomy and quality of life of the client.

Which of the following statements should the nurse make?

A. “I’m sorry that you have to deal with these health problems.It must be hard for you.”. B. “You have done a great job managing your blood sugar levels and taking your medications.”. C. “You should be more active and socialize more with other people.It will make you feel better.”. D. “You need to wear your hearing aid at all times.It will help you communicate better.”.

Answer and Explanation

Choice A:

This is wrong because it expresses pity and sympathy, which can undermine the client’s dignity and self-esteem. It also does not address the client’s depression or hearing loss.

Choice B:

This statement supports the dignity, autonomy and quality of life of the client by acknowledging their efforts and achievements in managing their chronic conditions. It also reinforces positive behaviors and encourages self-care.

Choice C:

This is wrong because it implies that the client is not doing enough to cope with their depression and hearing loss.

It also does not respect the client’s preferences and choices regarding their social activities.

Choice D:

This is wrong because it is too directive and does not consider the client’s autonomy or reasons for not wearing their hearing aid. It also does not address the client’s diabetes or depression.

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Total Questions : 4

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Nursing Interventions

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