In managing older adults with multiple chronic conditions, which factor has the most significant impact on reducing hospital readmissions?

Correct Answer: C

Rationale: The correct answer is C: Home health care support. This is because having access to home health care support can provide ongoing monitoring, medication management, and assistance with activities of daily living, which can help prevent complications and reduce the need for hospital readmissions. Minimizing polypharmacy (A) is important but may not have as significant an impact as continuous home health care support. Frequent medication adjustments (B) may lead to confusion and potential adverse effects in older adults. Specialized geriatric assessments (D) are beneficial but may not directly address the day-to-day support needed to prevent hospital readmissions.

Correct Answer: B

Rationale: The correct answer is B: Delirium in older adults results from reversible metabolic changes, such as electrolyte imbalances. Delirium is a multifactorial condition often triggered by physiological imbalances, including electrolyte disturbances. These imbalances can disrupt normal brain function, leading to confusion and cognitive impairment. Other choices are incorrect: A is more typical of sepsis, C is more associated with conditions like dementia, and D is not a primary cause of delirium.

Correct Answer: C

Rationale: The correct answer is C because regular repositioning every 2 hours, along with the use of pressure-relieving devices, is the most effective intervention to prevent pressure ulcers in older adults with limited mobility. Repositioning helps to redistribute pressure, reducing the risk of tissue damage. Pressure-relieving devices like cushions or mattresses further help to alleviate pressure points. Choice A is incorrect because strict bed rest and minimal repositioning can actually increase the risk of pressure ulcers by concentrating pressure on specific areas. Choice B is incorrect as high-protein diets and supplements alone do not address the primary cause of pressure ulcers, which is prolonged pressure on the skin. Choice D is incorrect because leaving wounds uncovered can increase the risk of infection and hinder the healing process.

Correct Answer: D

Rationale: The correct answer is D, EKG and serial enzymes for determination of an MI. In this scenario, the patient's symptoms of nausea and sudden onset shortness of breath raise concern for a possible myocardial infarction (MI). Conducting an EKG and serial enzymes helps in diagnosing an MI by assessing for cardiac ischemia or injury. Upper endoscopy (choice A) is not indicated for these symptoms. A CT of the head (choice B) is unnecessary as the symptoms are suggestive of a cardiac issue, not a neurological one. Liver function studies (choice C) do not align with the presenting symptoms and are not a priority in this acute setting. Conducting an EKG and serial enzymes is the most appropriate initial workup to assess for a possible MI in this elderly patient with concerning symptoms.

Correct Answer: A

Rationale: The correct answer is A: peripheral arterial disease. Altered level of consciousness in an 81-year-old female is unlikely to be directly caused by peripheral arterial disease. Instead, hypoglycemia, pneumonia, and hypotension from dehydration are common causes of altered mental status in the elderly. Hypoglycemia can lead to brain dysfunction, pneumonia can cause low oxygen levels affecting brain function, and dehydration-induced hypotension can reduce blood flow to the brain. Therefore, peripheral arterial disease is not typically a direct cause of altered consciousness in this scenario.