Which of the following is the most important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of heart failure (HF) in older adults?

Control fluid balance.

Control blood pressure.

Prevent deconditioning.

Maintain client safety.

Answer and Explanation

The Correct Answer is A

Choice A reason: Controlling fluid balance is the most important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults, as fluid overload is the main cause of HF worsening and hospital admission. Fluid balance can be controlled by monitoring weight, intake and output, edema, and lung sounds, and by administering diuretics, restricting sodium and fluid intake, and elevating the legs.

Choice B reason: Controlling blood pressure is an important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults, as hypertension is a risk factor and a complication of HF. However, it is not the most important goal, as blood pressure may not always reflect the fluid status or the severity of HF. Blood pressure can be controlled by administering antihypertensive medications, such as angiotensin-converting enzyme inhibitors, beta-blockers, or calcium channel blockers, and by encouraging lifestyle modifications, such as smoking cessation, weight management, and stress reduction.

Choice C reason: Preventing deconditioning is an important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults, as deconditioning is a common problem in HF patients due to reduced physical activity, fatigue, and muscle wasting. However, it is not the most important goal, as deconditioning may not directly affect the fluid balance or the cardiac function. Deconditioning can be prevented by providing exercise training, such as aerobic, resistance, or interval training, and by promoting self-care and adherence to the treatment regimen.

Choice D reason: Maintaining client safety is an important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults, as HF patients are at risk of falls, injuries, infections, or adverse drug reactions. However, it is not the most important goal, as client safety may not specifically address the fluid balance or the cardiac function. Client safety can be maintained by providing a safe environment, such as removing clutter, providing adequate lighting, and using assistive devices, and by preventing complications, such as monitoring for signs of infection, bleeding, or electrolyte imbalance, and by educating the client and the family about the medications, the signs and symptoms of HF worsening, and the emergency measures.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Choice A reason: Scabies is a skin infestation caused by tiny mites that burrow into the skin and lay eggs. It causes intense itching and a pimple-like rash, usually in the folds of the skin, such as the armpits, groin, or between the fingers. Scabies is highly contagious and can spread through direct skin contact or shared clothing or bedding.

Choice B reason: Herpes zoster, also known as shingles, is a viral infection that affects the nerves and the skin. It causes a painful, blistering rash that usually appears on one side of the body or face. Herpes zoster is caused by the same virus that causes chickenpox, which can reactivate later in life, especially in older adults or people with weakened immune systems.

Choice C reason: Skin cancer is an abnormal growth of skin cells that can be caused by exposure to ultraviolet (UV) radiation from the sun or tanning beds. It can appear as a new or changing mole, a sore that does not heal, or a scaly or crusty patch of skin. Skin cancer can vary in appearance, size, shape, and color, depending on the type and stage of the cancer.

Choice D reason: Actinic keratosis is a precancerous skin condition that is caused by chronic sun damage. It appears as rough, scaly, or crusty spots on the skin, usually on the face, ears, scalp, or hands. Actinic keratosis can sometimes develop into squamous cell carcinoma, a type of skin cancer, if left untreated.

A. Functional incontinence B. Stress incontinence C. Postvoid residual D. Urge incontinence E. None of the above

Correct Answer is A

Explanation

Choice A reason: Functional incontinence refers to a situation in which the lower urinary tract is intact, but the individual is unable to reach the toilet because of environmental barriers, physical limitations, or severe cognitive impairment. This is the most likely type of incontinence for an older female adult with severe cognitive impairments, as she may not be aware of her bladder sensations, forget where the bathroom is, or have difficulty communicating her needs.

Choice B reason: Stress incontinence is when urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the weakening of the pelvic floor muscles and the urethral sphincter.

Choice C reason: Postvoid residual is when the bladder does not empty completely after urination, causing frequent or constant dribbling of urine. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the obstruction of the bladder outlet, the underactivity of the bladder muscle, or the dysfunction of the bladder nerves.

Choice D reason: Urge incontinence is when you have a sudden, intense urge to urinate followed by an involuntary loss of urine. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the overactivity of the bladder muscle, the irritation of the bladder lining, or the infection of the urinary tract.

Choice E reason: None of the above is not the correct answer, as there is one choice that is the most likely type of incontinence for an older female adult with severe cognitive impairments.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Which of the following is the most important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of heart failure (HF) in older adults?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When an older female adult client complains of itching and pain and several days later shows you a rash, what do you realize she has?

Correct Answer is B

Explanation

You are taking care of an older female adult with severe cognitive impairments. She is unable to tell you when she needs to urinate and, as a result, is often incontinent. What do you realize she is experiencing?

Correct Answer is A

Explanation

Which are potential results of end-organ damage from chronic hypertension? (Select all that apply.)

During an assessment, an older adult male client reports that he fell the night before. What should you follow up with? (Select all that apply.)

The promotion of an adequate fluid balance which prevents medical complications is defined as?

The nurse is caring for a client diagnosed with hyperthyroidism. Which signs and symptoms indicate hyperthyroidism? (Select all that apply.)

A home health nurse is completing an admission on a client who recently experienced a transient ischemic attack (TIA). During the assessment, the client begins to report a severe headache and numbness in the left arm. Which action should the nurse take initially?

A large residual urine volume characterizes what type of incontinence?

An older adult reports symptoms of xerostomia. Which of the following interventions should the nurse implement for this patient? (Select all that apply.)