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Saunders Comprehensive Review for the NCLEX-RN® Examination EIGHTH EDITION: CHAPTER 5 Care of Special Populations; With Practice Q&A.

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C H A P T E R 5 Care of Special Populations Priority Concepts Caregiving, Health Disparities General Background Questions ▪ Are you comfortable talking to me? ▪ What name would you like us... to use to address you? ▪ Do you feel you are able to adequately answer questions regarding your health? ▪ What is your age? ▪ Is there a specific gender in which you identify yourself with? ▪ What is your ethnicity? ▪ What is your primary language spoken? ▪ Do you understand and speak English? ▪ In which language do you wish to communicate? ▪ Do you need an interpreter? ▪ Do you have any cultural, religious, or spiritual preferences you would like us to consider in your plan of care? ▪ Do you have any dietary preferences that you would like us to include in your plan of care? Describe your eating patterns in a 24-hour period. ▪ Do you exercise? What do you do and how often? ▪ Do you use any remedies when you are sick? ▪ What do you do when you are sick? ▪ What is your living situation? Where do you live? Who do you live with? Do you have children? ▪ Do you have a support system? ▪ Would you like to name a support person or emergency contact person? ▪ Do you have access to financial resources needed to live? ▪ Do you have health insurance? 137 ▪ Do you feel safe at home or where you live? Have you been abused within the last 12 months? Do you encounter crime or violence in your life? Is anyone hurting you, physically or emotionally or in any other way? Have you ever or are you being bullied? ▪ Do you smoke, drink alcohol, or use any type of drug? ▪ Do you have or need a health care proxy? ▪ Do you have an advance directive? If not, would you like more information about this? ▪ When was the last time you sought health care? For what reason? ▪ Do you have any fears about seeing your provider? ▪ Do you currently or have you ever had a communicable disease? ▪ Have you traveled outside of the country recently? ▪ Do you have a history of mental illness? ▪ Have you ever had feelings of committing suicide? ▪ Are you a veteran or member of the military? ▪ Do you have any chronic, long-term illness, disability, or other past medical history? ▪ Have you ever been incarcerated? ▪ Are you an immigrant or refugee? Further Questions Based on Living Situation ▪ Do you have a home? Do you live alone? Who do you live with at home? ▪ Do you drink alcohol? Any other type of drug use? ▪ Have you been exposed to environmental irritants? ▪ Have you had problems with asthma, anemia, lead exposure, ear infections, gastrointestinal illness, or mental illness? ▪ Are you willing to follow-up on your health care recommendations if given the necessary resources? Further Questions Based on Financial Status and Access to Resources ▪ What is your education level? ▪ What is your income? ▪ Do you have family you are in contact with? ▪ Is anyone in your immediate family disabled? ▪ Do you have a support system? ▪ Do you live in a safe community? ▪ Do you seek health care on a routine basis? ▪ Are you willing to work with a social worker to increase your access to community resources? Further Questions Based on Health Insurance Coverage 138 ▪ What health insurance do you have? ▪ Do you have the financial means to pay for your health care? ▪ Are you willing to work with a social worker to seek health coverage? Further Questions Related to Abuse ▪ Do you have or have you had any bruises, sprains, broken bones, fatigue, shortness of breath, muscle tension, involuntary shaking, changes in eating or sleeping, sexual dysfunction, or fertility problems? ▪ Do you experience nightmares, anxiety, uncontrollable thoughts, depression, anxiety, or low self-esteem? ▪ Do you have anxiety or depression? Felt suicidal? ▪ Do you ever feel hopeless, worthless, apprehensive, discouraged, lack motivation, lack faith, or question your trust for others? ▪ If a child: do you have any problems at school? Are you bullied? Further Questions Based on Racial/Ethnic Background ▪ Are there any resources you need to ensure your ability to follow-up on your health care recommendations? ▪ Do you have any past medical history or family history of chronic diseases such as diabetes mellitus, hypertension, heart disease, stroke, cancer, renal disease, injuries or accidents, depression, or anxiety? Further Questions Based on Gender and Sexual Orientation ▪ Can you describe your sexual orientation preferences? ▪ Which pronoun would you like to be referred to by (he, she, other)? ▪ Do you seek regular and routine health care? When were you last seen? ▪ When was your last breast exam, mammogram, Pap smear, testicular exam, prostate exam? ▪ Do you do a breast self-examination or a testicular self- examination? ▪ Do you have any past medical history? ▪ Are you sexually active? If so, how many partners do you have? ▪ Do you have any difficulties with eating or maintaining a stable weight? ▪ Do you smoke, drink alcohol, or use any other type of drugs? ▪ Do you ever feel suicidal? If so, do you have a plan? ▪ Do you have any problems with depression or anxiety? Have you ever felt suicidal? ▪ Do you take hormone therapy? ▪ Are you up-to-date on your immunizations? ▪ Do you have children? If not, do you wish to or plan on having children? ▪ Do you feel you have access to necessary resources such as health care or other 139 benefits? Further Questions Related to Mental Illness ▪ Do you seek routine health care? ▪ Describe your eating habits in a 24-hour period. ▪ Describe your activity level. ▪ Do you have any past medical history? ▪ Do you take any medications? If so, do you experience any side effects? ▪ Do you smoke, drink, or use any other type of drugs? ▪ Do you experience depression or anxiety? Have you ever had thoughts of suicide? ▪ Are you sexually active? If so, do you employ safe sex practices? How many partners do you have? Further Questions Related to Veteran/Military Status ▪ Do you have any problems with mental illness, such as post-traumatic stress disorder? ▪ Have you had any traumatic brain injuries? ▪ Have you had any injuries? ▪ Describe your living situation. ▪ Are you interested in any community support groups? Further Questions Related to Incarceration ▪ Have you ever been a victim of abuse or rape? ▪ Do have any past medical history, particularly asthma, diabetes mellitus, hypertension, heart disease, mental illness, or communicable diseases? Further Questions Related to Immigration ▪ Do you have problems with mental illness? ▪ Are you able to speak English? ▪ Do you have access to resources such as housing, transportation, health care, education services? ▪ Do you have any past medical history such as accidents, injuries, hypothermia, gastrointestinal illness, heart problems, pregnancy complications, diabetes, hypertension, malnutrition, or infectious or communicable disease? Further Questions Related to Chronic Illness ▪ Do you have access to a primary health care provider? 140 ▪ Do you see a specialist on a regular basis? ▪ Are you able to follow-up on the recommendations made by your primary health care provider and/or specialist? Summary ▪ Is there anything else you would like to share regarding your ability to maintain your health or any other issue or concern? Authors of the Special Populations: Needs Assessment Tool: Linda A. Silvestri, Angela E. Silvestri, and Paula Richards Box 5-3 Common Problems in the Homeless Population Anxiety Bipolar disorder Cognitive disorders Communicable diseases Complications from poor hygiene, poor living conditions, prolonged sun exposure, and prolonged standing Coronary artery disease Dental problems Diabetes mellitus Domestic violence and rape Frostbite Heart failure Heat exhaustion Hyperlipidemia Hypertension Injury from violence Lice, scabies, bacterial infections Major depressive disorders Peripheral vascular disease Post-traumatic stress disorder Schizophrenia Sexually transmitted infection Skin and foot conditions Substance abuse Suicide Traumatic brain injury Unintended pregnancy 141 Box 5-4 Some Medications That Should Be Avoided in the Homeless Population Albuterol Benzodiazepines Beta blockers Bupropion Calcium channel blockers Clonidine Nonsteroidal antiinflammatory drugs Quetiapine Some diabetic medications, particularly sulfonylureas Statins Maness, D. L. & Khan, M. (2014). Care of the homeless: An overview. American Family Physician, 89(8), 634-640. Box 5-5 Mental Health Concerns for Foster Children Attention-deficit hyperactivity disorder Aggressive behavior Anxiety disorder Bipolar disorder Depression Mood disorder Post-traumatic stress disorder Reactive detachment disorder Sleep problems Personality disorder Prenatal drug and alcohol exposure effects Box 5-6 Some Health Problems That Occur in Older Adults Alzheimer’s disease Arthritis Cancer Dementia Depression 142 Diabetes Mellitus Falls Heart disease Influenza Obesity Oral/dental health problems Osteoporosis Pneumonia Poverty Respiratory diseases Shingles Substance abuse Practice Questions 1. Which teaching method is most effective when providing instruction to members of special populations? 1. Teach-back 2. Video instruction 3. Written materials 4. Verbal explanation 2. Which health concern(s) should the nurse be aware of as risk factors when caring for clients of African American descent? Select all that apply. 1. Cancer 2. Obesity 3. Hypertension 4. Heart disease 5. Hypothyroidism 6. Diabetes mellitus 3. The nurse is planning care for a client of Native Hawaiian descent who recently had a baby. The nurse develops a teaching plan and includes information about which measure that is related to a newborn complication within this ethnic group? 1. Safe sleeping 2. Car seat safety 3. Breast-feeding 4. Baby-proofing 4. The nurse is planning care for an assigned client. The nurse should include information in the plan of care about prevention of human immunodeficiency virus (HIV) for which individuals specifically at risk? 1. Lesbian persons 2. Men-who-have-sex-with-men (MSM) 3. Women-who-have-sex-with-women (WSW) 143 4. Female-to-male (FTM) transgender persons 5. Which therapeutic communication technique is most helpful when working with transgender persons? 1. Using open-ended questions 2. Using their first name to address them 3. Using pronouns associated with birth sex 4. Anticipating the client’s needs and making suggestions 6. Which special population should be targeted for breast cancer screening by way of mammography? Select all that apply. 1. Male-to-female (MTF) 2. Female-to-male (FTM) 3. Men-who-have-sex-with-men (MSM) 4. Women-who-have-sex-with-men (WSM) 5. Women-who-have-sex-with-women (WSW) 7. The nurse is volunteering with an outreach program to provide basic health care for homeless people. Which finding, if noted, should be addressed first? 1. Blood pressure 154/72 mm Hg 2. Visual acuity of 20/200 in both eyes 3. Random blood glucose level of 206 mg/dL (11.47 mmol/L) 4. Complaints of pain associated with numbness and tingling in both feet 8. The nurse is preparing discharge resources for a client being discharged to the homeless shelter. When looking at the discharge medication reconciliation form, the nurse determines there is a need for follow-up if which medication was prescribed? 1. Glipizide 2. Lisinopril 3. Metformin 4. Beclomethasone 9. The nurse is completing the admission assessment for a client who is intellectually disabled. Which part of the client encounter may require more time to complete? 1. The history 2. The physical assessment 3. The nursing plan of care 4. The readmission risk assessment 10. The nurse working in a correctional facility is caring for a new prisoner. The client asks about health risks associated with living in a prison. How should the nurse respond? 1. “Health care is very limited in the prison setting.” 2. “Living in a prison isn’t different than living at home.” 3. “Living in a prison can predispose a person to different health conditions.” 4. “Living in a prison is similar to living in a condominium complex or dormitory.” 144 11. The nurse is caring for a female client in the emergency department who presents with a complaint of fatigue and shortness of breath. Which physical assessment findings, if noted by the nurse, warrant a need for follow-up? 1. Reddened sclera of the eyes 2. Dry flaking noted on the scalp 3. A reddish-purple mark on the neck 4. A scaly rash noted on the elbows and knees 12. The nurse working in a community outreach program for foster children plans care knowing that which health conditions are common in this population? Select all that apply. 1. Asthma 2. Claustrophobia 3. Sleep problems 4. Bipolar disorder 5. Aggressive behavior 6. Attention-deficit hyperactivity disorder (ADHD) 13. The nurse planning care for a military veteran should prioritize nursing interventions targeted at managing which condition, if present, that commonly occurs in this population? 1. Hypertension 2. Hyperlipidemia 3. Substance abuse disorder 4. Post-traumatic stress disorder 14. The nurse caring for a refugee considers which health care need a priority for this client? 1. Access to housing 2. Access to clean water 3. Access to transportation 4. Access to mental health care services 15. Which action by the nurse will best facilitate adherence to the treatment regimen for a client with a chronic illness? 1. Arranging for home health care 2. Focusing on managing a single illness at a time 3. Communicating with one provider only to avoid confusion for the client 4. Allowing the client to teach a support person about their treatment regimen Answers [Show More]

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