Besides lasting a long time, what else must a health problem do to meet the definition of a chronic disease?
Require ongoing medical attention or limit daily activities
✓
Be caused by an infectious organism
Begin before adulthood
Be curable with surgery
Correct Answer
Require ongoing medical attention or limit daily activities
A chronic disease is a long-lasting health problem that needs ongoing medical attention, limits activities of daily living, or both. Be caused by an infectious organism is not part of the definition; most chronic diseases, such as hypertension and osteoporosis, are not infections. Begin before adulthood is wrong because many chronic diseases start in middle or older age. Be curable with surgery is wrong because chronic diseases are managed over time rather than cured.
Category: Chronic Disease Concepts
Question 2
The spouse who cares for a patient with advanced COPD says, "I haven't slept well in weeks, and I can't keep up with everything." Which nursing action addresses this concern?
Explain that exhaustion is a normal part of caregiving
Assess the spouse's own health and discuss sources of support
✓
Advise the spouse to hide these feelings from the patient
Suggest that the spouse take on more of the patient's care
Correct Answer
Assess the spouse's own health and discuss sources of support
Caring for a person with a chronic illness can strain the caregiver's own physical and emotional health, so the nurse assesses the caregiver's needs and discusses help such as other family members, community services or short breaks from caregiving. Explain that exhaustion is a normal part of caregiving dismisses a problem that can harm both the spouse and the patient. Advise the spouse to hide these feelings from the patient discourages open communication and adds stress. Suggest that the spouse take on more of the patient's care would add to an already heavy load.
Category: Nursing Care in Chronic Illness
Question 3
Why do certain chronic diseases, such as diabetes mellitus and cardiovascular disease, often occur together in the same patient?
They are spread by the same infectious organism
Treating one condition reliably cures the other
They share disease processes and risk factors
✓
Both are inherited through a single gene
Correct Answer
They share disease processes and risk factors
Comorbid conditions cluster because they share an anatomic location, an underlying pathophysiology or similar causes, as diabetes and cardiovascular disease share vascular damage and lifestyle risk factors. They are spread by the same infectious organism is wrong because neither condition is an infection. Treating one condition reliably cures the other is wrong because each needs its own ongoing management. Both are inherited through a single gene is wrong because both arise from many genetic and lifestyle factors.
Category: Comorbidity and Costs
Question 4
An older adult with heart failure, diabetes and arthritis sees a different specialist for each condition. Which nursing action helps prevent conflicting treatment?
Have the patient keep each provider's instructions separate
Advise the patient to stop seeing all but one specialist
Assume each specialist already knows the other orders
Review all current medications and share the list among providers
✓
Correct Answer
Review all current medications and share the list among providers
When several providers treat one patient, the nurse coordinates care by reviewing every current medication and treatment and making sure each provider works from the same complete list, which lowers the risk of duplicate or conflicting orders. Have the patient keep each provider's instructions separate leaves each provider unaware of the others' plans. Advise the patient to stop seeing all but one specialist removes needed specialty care. Assume each specialist already knows the other orders is unsafe, because records are not always shared between providers.
Category: Comorbidity and Costs
Question 5
A patient with vision loss from diabetes relies on an adult daughter to manage medications at home. Which approach supports safe care after discharge?
Include the daughter in teaching with the patient's permission
✓
Teach the patient alone to protect independence
Mail written instructions to the daughter after discharge
Leave medication teaching to the community pharmacist
Correct Answer
Include the daughter in teaching with the patient's permission
People with chronic illness or disability often depend on family or friends to carry out the treatment plan, so the nurse, with the patient's consent, teaches the support person along with the patient and checks that both understand. Teach the patient alone to protect independence leaves out the person who will actually manage the medications. Mail written instructions to the daughter after discharge gives no chance to ask questions or confirm understanding. Leave medication teaching to the community pharmacist shifts a nursing responsibility and delays teaching until after the patient is home.
Category: Access and Home Care
Question 6
A patient with diabetes has missed several follow-up visits and has not refilled prescriptions. What does the nurse do first?
Document that the patient is noncompliant
Ask what makes the visits and refills difficult
✓
Warn the patient that care will end
Schedule visits more often
Correct Answer
Ask what makes the visits and refills difficult
Missed visits and refills often have causes such as cost, transportation, side effects or confusion about the plan, so the nurse first asks about barriers and then works with the patient on solutions that support adherence. Document that the patient is noncompliant labels the patient without finding the cause. Warn the patient that care will end is threatening and damages trust. Schedule visits more often does not address why the patient is missing the visits already scheduled.
Category: Nursing Care in Chronic Illness
Question 7
A patient with severe arthritis reports difficulty walking and climbing stairs. Which type of disability does this describe?
Cognition
Self-care
Mobility
✓
Vision
Correct Answer
Mobility
A mobility disability involves difficulty walking or climbing stairs. Cognition refers to difficulty concentrating, remembering or making decisions. Self-care refers to difficulty performing activities of daily living such as bathing and dressing. Vision refers to blindness or severe vision loss.
Category: Disability and Wellness
Question 8
A patient with long-standing diabetes manages the condition well and has close friendships, meaningful work and an active spiritual life. Where does this patient most likely fall on the wellness continuum?
Near the premature death end
Off the continuum because of the diagnosis
At the midpoint because the disease is permanent
Near the high-level wellness end
✓
Correct Answer
Near the high-level wellness end
Wellness has many dimensions, including emotional, social, spiritual and occupational health, so a person with a chronic disease can still sit near the high-level wellness end by being strong in those areas. Near the premature death end describes increasing, poorly controlled disease. Off the continuum because of the diagnosis is wrong because everyone falls somewhere on the continuum. At the midpoint because the disease is permanent ignores that the non-physical dimensions can move a person toward wellness.
Category: Disability and Wellness
Question 9
Which federal law requires public businesses to give people with disabilities equal access to goods and services through reasonable accommodations such as ramps and sign language interpreters?
Americans with Disabilities Act
✓
Individuals with Disabilities Education Act
Affordable Care Act
Health Insurance Portability and Accountability Act
Correct Answer
Americans with Disabilities Act
The Americans with Disabilities Act is the federal civil rights law that bars discrimination against people with disabilities and requires reasonable accommodations in public settings. Individuals with Disabilities Education Act guarantees a free, appropriate public education for children with disabilities. Affordable Care Act expanded health insurance coverage. Health Insurance Portability and Accountability Act protects the privacy of health information.
Category: Disability and Wellness
Question 10
A patient with advanced heart failure says that the priority now is comfort and time at home rather than more aggressive treatment in the hospital. Which approach fits this goal?
Curative care
Palliative care
✓
Acute care
Preventive care
Correct Answer
Palliative care
Palliative care focuses on relieving symptoms and improving quality of life for a person with serious illness, and it builds the plan around the patient's own goals. Curative care aims to cure the disease, which is not the goal the patient describes. Acute care treats sudden or short-term problems, often in the hospital. Preventive care aims to stop disease from developing or to find it early.
Category: Nursing Care in Chronic Illness
Question 11
A nurse is planning diabetes care with an adult who was recently diagnosed. Which approach reflects shared decision-making?
The nurse chooses the goals and explains them
The family selects the goals for the patient
The patient and team weigh options and agree on goals
✓
The goals follow one standard plan for all patients
Correct Answer
The patient and team weigh options and agree on goals
Shared decision-making means the patient and clinicians discuss the options, risks and benefits and agree on goals that fit the patient's values, a key part of patient-centered chronic care. The nurse chooses the goals and explains them leaves the patient out of the decision. The family selects the goals for the patient removes the patient's own voice. The goals follow one standard plan for all patients ignores individual needs and preferences.
Category: The Chronic Care Model
Question 12
A patient being treated for depression mentions drinking alcohol heavily most days. How does the nurse interpret this finding?
The two problems are unrelated
Alcohol protects against low mood
Heavy drinking needs no follow-up
Mood and substance use disorders often coexist
✓
Correct Answer
Mood and substance use disorders often coexist
Mood disorders such as depression and anxiety commonly occur together with substance use disorders, so the nurse assesses the drinking further and shares the finding with the care team. The two problems are unrelated ignores this well-known comorbid pattern. Alcohol protects against low mood is wrong because alcohol is a depressant that can worsen mood. Heavy drinking needs no follow-up misses a health risk that affects both conditions.
Category: Comorbidity and Costs
Question 13
An older adult who lives alone is hospitalized after a fall. What is the main goal of the interdisciplinary discharge evaluation?
A safe discharge to the right level of care
✓
The shortest possible hospital stay
A return home regardless of risk
Avoiding any home health referral
Correct Answer
A safe discharge to the right level of care
Medicine, nursing and physical and occupational therapy assess whether the patient can safely return home, and the team, often through case management or social services, arranges home health, assisted living or rehabilitation if needed. The shortest possible hospital stay is not the goal if it leads to an unsafe discharge. A return home regardless of risk ignores the patient's safety. Avoiding any home health referral could leave a patient who lives alone without needed support.
Category: Access and Home Care
Question 14
Which change to a typical American diet does the nurse recommend to lower the risk of chronic disease?
Replacing fruit with processed snacks
Replacing refined grains with whole grains
✓
Replacing water with sugary drinks
Replacing nuts and seeds with salted chips
Correct Answer
Replacing refined grains with whole grains
A diet built on whole grains, fruits, vegetables, low-fat dairy, nuts, seeds and omega-3 fatty acids lowers the risk of cardiovascular disease, diabetes and other chronic conditions. Replacing fruit with processed snacks adds the processed food, fat and sugar that raise risk. Replacing water with sugary drinks adds sugar. Replacing nuts and seeds with salted chips swaps healthy fats for salty processed snacks.
Category: Prevention and Lifestyle
Question 15
A patient whose parent and sibling both had colorectal cancer asks about screening. What does the nurse explain?
Screening is unnecessary until symptoms appear
Screening follows the average-risk schedule
Screening may start earlier and be done more often
✓
Genetic testing replaces the need for screening
Correct Answer
Screening may start earlier and be done more often
Many chronic conditions run in families, so people with a strong family history or other added risk are screened earlier and more often and may be referred for genetic counseling. Screening is unnecessary until symptoms appear defeats the purpose of early detection. Screening follows the average-risk schedule ignores the added risk. Genetic testing replaces the need for screening is wrong because testing informs risk but does not detect existing disease.
Category: Prevention and Lifestyle
Question 16
A nurse helps a patient with hypertension agree on a goal for lowering dietary salt and works through ways to reach it at home. Which Chronic Care Model element does this represent?
Decision support
Delivery system design
Clinical information systems
Self-management support
✓
Correct Answer
Self-management support
Self-management support gives patients the education, individualized plan, goal setting and problem solving they need to manage a condition day to day. Decision support builds evidence-based guidelines into clinicians' practice. Delivery system design organizes team roles and follow-up so care is effective and efficient. Clinical information systems use records and data to plan care and track patients.
Category: The Chronic Care Model
Question 17
A clinic defines each team member's role, schedules regular follow-up by phone, home visits and appointments, and assigns case management for complex patients. Which Chronic Care Model element does this represent?
Delivery system design
✓
Self-management support
Decision support
Clinical information systems
Correct Answer
Delivery system design
Delivery system design shapes how care is organized, including team roles, planned follow-up, case management for complex cases and evidence-based care. Self-management support focuses on helping the patient manage the condition day to day. Decision support gives clinicians quick access to best-practice guidelines. Clinical information systems use electronic records and data to plan care and track outcomes.
Category: The Chronic Care Model
Question 18
Which teaching helps a patient with COPD manage the disease at home and avoid a preventable emergency visit?
Wait until breathing is severe before calling for help
Recognize early signs of a flare and when to call the provider
✓
Stop prescribed treatments on days when breathing feels normal
Avoid all physical activity to save energy
Correct Answer
Recognize early signs of a flare and when to call the provider
Self-management teaching helps the patient spot early warning signs, such as more breathlessness, cough or sputum, and act on them promptly, which can head off a severe exacerbation and an emergency visit. Wait until breathing is severe before calling for help delays care until the flare is dangerous. Stop prescribed treatments on days when breathing feels normal allows the disease to worsen. Avoid all physical activity to save energy leads to deconditioning; activity within the patient's tolerance is encouraged.
Category: Nursing Care in Chronic Illness
Question 19
A patient with long-standing heart failure is admitted because the symptoms suddenly became much worse. Which term describes this event?
Remission
Comorbidity
Acute exacerbation
✓
Disability
Correct Answer
Acute exacerbation
An acute exacerbation is a sudden worsening of a chronic disease, such as acute-on-chronic heart failure, and it often requires hospital admission. Remission is a lessening or disappearance of disease activity. Comorbidity is the presence of more than one condition at the same time. Disability is a limitation in performing everyday activities.
Category: Nursing Care in Chronic Illness
Question 20
A patient is admitted because COPD symptoms have suddenly worsened. Which question helps the nurse identify a knowledge deficit?
Who should we call in an emergency?
Which meal times do you prefer here?
Would you like the door open or closed?
What do you know about your condition and its treatment?
✓
Correct Answer
What do you know about your condition and its treatment?
Asking what the patient knows about the condition, the current treatment and available resources reveals gaps that the nurse can address in teaching and discharge planning. Who should we call in an emergency gathers contact information, not knowledge. Which meal times do you prefer here addresses comfort, not understanding of the disease. Would you like the door open or closed is a comfort preference.
Category: Nursing Care in Chronic Illness