The home care nurse is performing an environmental assessment in the home of an older adult. Which of the following requires immediate nursing action?

Correct Answer: A

Rationale: The correct answer is A: Unsecured scattered rugs. This requires immediate nursing action as it poses a significant fall risk for the older adult. Rugs can cause tripping hazards, leading to potential injuries. The nurse should secure or remove the rugs to ensure the safety of the patient. Summary of other choices: B: Operable smoke detector - While important for safety, it does not require immediate nursing action as it is already in working condition. C: Prefilled medication cassette - This is not an immediate safety concern and can be addressed during routine medication management. D: Unsecured scattered rugs (repeated) - This choice is the same as the correct answer, so it is incorrect.

Correct Answer: A

Rationale: The correct answer is A: Diarrhea. Diarrhea is not a risk factor for developing pneumonia in elderly individuals. The rationale for this is that pneumonia is primarily caused by respiratory infections, not gastrointestinal issues like diarrhea. Neurological disease, heart failure, and COPD are all risk factors for pneumonia because they can weaken the immune system or impair lung function, making individuals more susceptible to respiratory infections. These conditions can lead to aspiration, impaired cough reflex, or compromised lung function, increasing the likelihood of developing pneumonia.

Correct Answer: C

Rationale: The correct answer is C because regular repositioning and the use of pressure-relieving devices are essential to prevent skin breakdown in immobile older adults. Repositioning helps redistribute pressure, maintaining blood flow to the skin and preventing tissue damage. Pressure-relieving devices such as cushions or special mattresses further reduce pressure on vulnerable areas. Choices A and B do not address the root cause of skin breakdown and may even exacerbate the issue. Choice D is incorrect as complete bed rest can lead to further complications like pressure ulcers. In summary, choice C is the most effective intervention as it directly targets the risk factors for skin breakdown in immobile older adults.

Correct Answer: C

Rationale: The correct answer is C: Cognitive-behavioral therapy (CBT) and physical therapy. CBT helps older adults manage pain through changing thought patterns and behaviors, improving coping skills. Physical therapy helps maintain mobility and reduce pain. Both approaches address the physical and psychological aspects of chronic pain, leading to better quality of life. Complete bed rest (A) can worsen pain and lead to muscle weakness. Unsupervised use of opioids (B) can be dangerous, leading to addiction and other health issues. Isolation and minimal social interaction (D) can contribute to depression and exacerbate pain.

Correct Answer: A

Rationale: The correct answer is A because neglecting personal grooming indicates a lack of self-care, which is a common sign of ineffective coping after the loss of a loved one. This behavior suggests the client may be struggling emotionally and unable to engage in basic self-care tasks. Looking at old pictures, participating in social activities, and visiting the husband's grave are all healthy coping mechanisms that can help the client process her grief and maintain connections with her late husband.

Correct Answer: A

Rationale: The correct answer is A: Pneumonia. Older adults are more susceptible to pneumonia due to weakened immune systems and other health conditions. Pneumonia can lead to severe complications requiring hospitalization. Stroke (B) affects a significant number of older adults but is not the leading cause of hospitalization. Diabetes (C) and Congestive heart failure (D) are prevalent in older adults but are not the primary reason for hospitalization. Pneumonia's severity and impact on older adults' health make it the leading cause of hospitalization.

Correct Answer: B

Rationale: The correct answer is B because the holistic health movement emphasizes treating the whole person - mind, body, and spirit. This shifts the focus from merely treating symptoms to considering individual well-being and lifestyle factors. Choice A is not the best answer because while disease prevention is part of holistic health, it is not the primary impact on health care. Choice C is incorrect as the movement does not directly improve access to health care. Choice D is also incorrect as while alternative modalities are part of holistic health, they are not the main impact on health care.

Correct Answer: A

Rationale: Step 1: Gerontological nursing certification focuses on advanced knowledge and skills for caring for older adults. Step 2: This certification is not a requirement for all nurses in long-term care or limited to rehabilitation centers. Step 3: Nurses with various levels of education, not just a master's degree, can obtain gerontological certification. Therefore, option A is correct as it accurately states that gerontological nursing certification signifies advanced knowledge and skills specific to older adult care. Options B, C, and D are incorrect as they provide inaccurate information about the certification requirements and scope.

Correct Answer: D

Rationale: The correct answer is D because reluctance of older adults to report pain is a significant barrier to effective pain management. Older adults may underreport pain due to various factors such as fear of being seen as a burden, denial of aging-related changes, or belief that pain is a natural part of aging. This can lead to under-treatment of pain and decreased quality of life. Choices A, B, and C are not the most common barriers in this context. Fear of addiction to opioids, insufficient knowledge among healthcare providers, and inadequate access to specialists are important factors but are not as prevalent as older adults' reluctance to report pain.