Question 1

A patient is being transferred from acute care to a rehabilitation facility. The patient's caregiver is present during the transition of care. Which function is the caregiver performing by asking how the patient will be transported to the new facility?

Accepted Answer

When caregivers assume the responsibility for arranging follow-up care for their relative and for asking practical questions such as how the patient will be transported, the caregiver is navigating the healthcare system. Watching the patient involves such activities as being a physical presence and an extra set of eyes and ears. When resources are scarce, providing care involves family members pitching in to provide direct care such as feeding the patient. Acting as an advocate for the patient involves any actions by the caregiver to assure that the patient's preferences are being honored.

Question 2

The nurse is providing care for a patient admitted to an extended care facility. The nurse notices the patient's family caregiver coming to the facility less often and staying for short time periods. Which additional manifestation does the nurse notice as an indication of caregiver stress?

Accepted Answer

When a visiting caregiver falls asleep at the bedside of the patient, the nurse needs to determine if the caregiver is stressed. The behavior can be indicative of the inability to sleep, of an illness, or the use of stress-relieving medications or substances. Dressing in plain, simple clothing may be common for the caregiver. Sharing the details of a busy schedule may be an attempt to include the patient in the caregiver's activities; this is not necessarily an indication of caregiver stress. Depending on the age of the caregiver, the wish to be home before dark is not a sign of stress, as older adults often do not care to drive after dark.

Question 3

The nurse is preparing to perform an assessment on the family member that the patient has identified as being the patient's caregiver. Which finding during the assessment indicates the caregiver is well suited for the function?

Accepted Answer

When the caregiver requests assistance from home care, the nurse recognizes the caregiver's willingness to provide whatever care the patient needs with assistance when necessary. If the caregiver has difficulty navigating in the home environment, the nurse will be concerned about the ability to care for the patient. The nurse will closely assess the caregiver for health and wellbeing. An extensive daily medication list for the caregiver is a concern, especially with multiple conditions. An important caregiver assessment is about the caregiver's relationships with the healthcare team; a negative attitude is a source of concern.

Question 4

Medical care in the United States is typically not designed to accommodate the special needs of patients with dementia and their caregivers. Which is a principle for the care of patients with dementia?

Accepted Answer

Callahan and colleagues describe the basic principle of care for dementia patients as "support for a patient-caregiver dyad." The other options describe some of the challenges and\or barriers related to the current clinical care model.

Question 5

The nurse is providing education for the caregiver of a patient diagnosed with moderate dementia. Which care suggestion by the nurse is appropriate?

Accepted Answer

Some thoughtful conversation with family caregivers may provide constructive suggestions for making the environment more age and dementia friendly. Too much stimuli, loud noise, bright lights, undressing, touching by strangers, and quick movements can increase confusion and sometimes provoke fear and behavioral outbursts in dementia patients.

Question 6

The nurse manager at an independent facility for patients with Alzheimer disease and dementia is preparing to hire nursing staff. Which qualification does the nurse manager consider the most important asset?

Accepted Answer

The most important characteristic in a caregiver being interviewed for a position with patients with Alzheimer disease or dementia is some basic training specifically about dementia. Working in an extended care facility may or may not be the most important characteristic; the specific experience with Alzheimer disease or dementia can vary. Personal experience with a family member is a positive characteristic; however, some specific basic training is most important. Nurses who work on Alzheimer\dementia units need to be able to modify clinical practices to accommodate the needs of patients with dementia. This ability alone is not the most important characteristic, and the skill is likely to be covered in an additional basic training program.

Question 7

Healthcare professionals are often faced with patients who are terminally ill or no longer able to make decisions about their care. Which suggestion helps to close the gap between medical treatment and end-of-life care?

Accepted Answer

An appropriate suggestion to help close the gap between medical treatment and end-of-life care requires learning what the patient and family are hoping for. A plan of care\management is important; however, the plan should be adjusted as needs change. A plan that covers all expected changes is not realistic. The plan for end-of-life care is created with the patient and the patient's family. End-of-life care focuses on the patient's needs for dignity and comfort; continuing to suggest medical interventions for a cure is contraindicated for the patient receiving end-of-life care.

Question 8

In response to increased stress, caregivers may turn to alcohol or prescription or psychotropic drugs.

Accepted Answer

The Family Caregiver Alliance (2006) has summarized the research on health issues related to the burden of caregiving. One conclusion is that in response to increased stress, caregivers may turn to alcohol or prescription or psychotropic drugs.

Question 9

The metaphor of "fighting" disease and death ingrained in both the broader American culture and the culture of medicine creates the potential for hospice and palliative care to be perceived as "giving up."

Accepted Answer

A medicalized culture with a preference for aggressive treatment exists among medical professionals and in the American culture. Many patients and families do not believe that nothing more can be done in the face of a terminal diagnosis and push for an aggressive approach, even when it is unlikely to help. Some physicians frame referrals to hospice and palliative care as "giving up."

Question 10

Regulatory barriers present obstacles to the widespread use of palliative care services.

Accepted Answer

Despite extensive research that proves that palliative care has the potential to improve patient quality of life and lower costs, there are many obstacles to the widespread use of palliative care services, including fragmented healthcare systems, lack of reimbursement, and regulatory barriers.

Quiz 11: High-Risk Gaps and Cracks II: Caregivers, Dementia, and End-Of-Life Care