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Case Study #1
Alicia is an 8-week old infant admitted with severe gastroenteritis. Alicia weighed 7 pounds at birth and now weighs 8 pounds 3 ounces. Normally, Alicia takes 3 ounces of formula every 4 hours. She has been placed on NPO and has IV fluids for hydration. She is fretful and restless. Alicia’s mom is an 18-year-old single parent, but does receive assistance and support from her parents. All are present and very apprehensive about Alicia’s
condition.
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1.
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True
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False
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Alicia’s weight is normal for her age
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2.
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True
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False
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Alicia’s mother reports that Alicia normally sleeps 18 - 20 hours a day. This is normal for most infants at this age.
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3.
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True
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False
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It is important to Alicia’s recovery for her mother and grandmother to remain at the bedside as much
as possible.
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4.
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True
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False
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Alicia is likely to respond positively to mobiles and
bright colored objects from home.
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5.
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True
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False
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When caring for Alicia, it is best to awaken the infant
to do a complete assessment.
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6.
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True
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False
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When Alicia is held upright, head control is absent. This is abnormal and should be reported to the
physician immediately.
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7.
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True
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False
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Alicia’s mom reports that she has been having 10-12 loose,
green stools/day. This is abnormal.
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8.
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True
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False
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It is normal for Alicia to exhibit the “rooting reflex” by turning her head toward anything that
touches her cheek.
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9.
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True
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False
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Alicia is listless with little movement of her arms and legs. This is normal for an infant this age
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10.
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True
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False
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You encourage Alicia’s family to hold, cuddle or rock her because infants at this age tend to
be comforted by such actions.
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Case Study #2
Gina is a 3-year-old patient in the intensive care unit with the diagnosis of status asthmaticus. Gina was admitted yesterday through the emergency room in respiratory arrest that occurred en route to the emergency room. The attack began on the playground at preschool and 911 was called. Gina is intubated and on the ventilator. She has a history of asthma for 2 years but this is the first occurrence of this severity. Her mother, Ann, age 40, has been at the hospital since her arrival and has not left. Her father, Bob, age 44, has also been here all night and went into work for a while this morning.
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1.
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True
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False
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1. Gina will be less apprehensive if one of her parents is allowed to stay with her as much as possible.
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2.
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True
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False
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1. It would be less stressful to Gina if her caregivers could adhere to her routine activities as much as possible.
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3.
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True
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False
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1. Since few of Gina’s teeth have come in, she will need baby food to be adequately nourished.
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4.
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True
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False
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1. Gina’s environment needs to be safe because at this age it is difficult to differentiate actions that may be dangerous.
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5.
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True
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False
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1. A good way to explain medical procedures to Gina is to use “play” to teach her and allow her to express her fears.
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6.
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True
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False
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1. It would be abnormal for Gina to wet her bed at night since she has been potty-trained since the age of 18 months.
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7.
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True
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False
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1. Since speech is very limited at this age, it would be very difficult for Gina to communicate her needs.
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8.
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True
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False
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1. Temper tantrums and negative behavior are common for 3-4 year olds.
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Case Study #3
Billy is a 5-year-old preschooler that comes to the hospital for a routine tonsillectomy. His mother is present, but his father is out of town on business. Billy has never been in the hospital before and is very frightened. Lab is here to draw blood, and Billy will not cooperate.
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1.
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True
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False
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1. Billy’s blood pressure is 84/50 on admission. This is abnormal and you phone the physician immediately.
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2.
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True
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False
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1. Children Billy’s age are easily distracted.
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3.
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True
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False
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1. It would be good if you encourage Billy to do certain things on his own since at this age self-help skills are increasing.
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4.
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True
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False
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1. It would be normal for Billy to wake up during the night with night terrors.
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5.
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True
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False
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1. It would be best not to speak in terms of time, since Billy has no concept of time in hours.
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6.
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True
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False
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1. Billy would enjoy reading stories, board games, and imitative play during his hospitalization.
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Case Study #4
Melanie Grace is an 8-year-old female who was involved in a motor vehicle accident. She has a fractured femur with traction, a fractured pelvis with suprapubic drains and a foley cathether. She will be out of school for at least 3 months. She has 2 IV’s and has received 3 units of blood. Her mother was critically injured in this same accident. Her father was not involved in the accident.
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1.
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True
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False
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1. 1. Melanie’s vital signs are: 78/50-140-46. These are normal vital signs for an 8-year-old.
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2.
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True
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False
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1. Melanie does not have coordinated movements of her arms. This is a normal finding.
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3.
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True
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False
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1. Melanie’s friends should be encouraged to visit as much as possible.
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4.
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True
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False
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1. The caregiver should explain all procedures to Melanie, their purpose and how they will make the patient better.
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5.
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True
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False
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1. A child of this age is able to concentrate on concrete reality and is able to focus, reason, and deal with several concepts in sequence.
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6.
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True
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False
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1. It would be inappropriate for Melanie’s father to “room in” with her.
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Case Study #5
Seventeen-year-old Jonathan was admitted to ICU with injuries sustained in a MVA. He has a chest tube, multiple broken bones, and severe lacerations to his face. Jonathon’s family recounts that he was driving under the influence of alcohol and was not wearing his seatbelt. His father verbalizes, “How could he be so stupid?”. His mother is very concerned because Jonathon appears very depressed. He is eating very little, refuses to let someone bathe him, and refuses all visits by his friends.
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1.
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True
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False
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1. It is common for boys Jonathon’s age to experience mood changes and unpredictable reactions.
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2.
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True
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False
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1. Jonathon’s decision to drink and drive and to not wear his seatbelt indicates that he is an alcoholic.
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3.
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True
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False
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1. It is normal for Jonathon to be scared and to try to hide it.
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4.
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True
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False
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1. Since Jonathon is not eating anything, it would be important to determine any likes or dislikes and preferences.
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5.
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True
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False
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1. It probably would help Jonathon’s parents understand his recent behavior if you discussed the normal growth and development of an adolescent with them.
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6.
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True
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False
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1. It is best to force the adolescent to do the right things, i.e., eating, bathing, etc., than to encourage them to make their own decisions.
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7.
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True
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False
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1. Normal blood pressure for an adolescent is 150/80.
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8.
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True
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False
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1. Jonathon’s reluctance to allow his friends to visit could be because he is embarrassed for them to see his physical appearance.
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Case Study #6
Mary, a 25-year-old female, is admitted with the diagnosis of pre-eclampsia. She had 4+ pitting edema of her extremities and her B/P is 200/100. She and her husband have 2 other children, ages 3 years and 18 months, who are staying with her best friend, Debbie. She begins crying during the admission process and verbalizes fear for her unborn child as well as for her other children. Her parents live 13 hours away and are unable to make the trip to be with her. She begs the physician to let her go home. She is employed as a legal secretary for the District Attorney.
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1.
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True
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False
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1. Establishing parental independence is a major developmental task for this age group.
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2.
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True
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False
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1. Self concepts and a positive body image are not really important to an early adult.
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3.
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True
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False
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1. Mary and her husband’s personal set of values and their philosophy of life are important aspects in planning her care.
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4.
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True
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False
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1. Mary’s insistence to go home is common in this age group because one of the developmental tasks for an early adult is establishing and maintaining a residence.
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5.
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True
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False
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1. Mary should be discouraged from verbalizing her fears and feelings since this makes her condition worse.
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6.
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True
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False
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1. Mary’s concern for her job and career are normal since this provides personal satisfaction and economic security.
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Case Study #7
Mrs. Joyce Smith is a 43-year-old female with a history of heavy smoking. She is married, has a stepson and stepdaughter. The stepdaughter is a 17-year-old unwed mother. Both children live with she and her husband. Her husband has lost his job from which he was employed for 25 years. They have just moved to a new location in the country after having sold their beautiful home in the suburbs.
Mrs. Smith is admitted to the hospital for breast biopsy, probable modified radical mastectomy. She is also a newly diagnosed diabetic to be converted to insulin therapy. She has been taking Diabinese at home and monitoring her blood sugars, although she does not follow a diabetic diet. She is extremely thin and pale.
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1.
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True
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False
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1. Major causes of death in this age group reflect the impact of unhealthy lifestyles.
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2.
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True
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False
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1.1. Since Mrs. Smith is already a heavy smoker, there is no need to stress the dangers of substance abuse.
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3.
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True
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False
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1. Mrs. Smith will need discharge teaching on developing healthy lifestyle habits.
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4.
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True
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False
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1. Concerns about maintaining family responsibilities should be dismissed until after surgery.
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Case Study #8
Mr. Jackson, age 62, has been admitted to the hospital with a tentative diagnosis of R/O myocardial infarction. He has a history of smoking for 20 years, quit for 10 years, and resumed 1 ½ years ago at 2 packs a day. He was married 4 years ago to Marcie, age 31, after he had been divorced for 5 years. All of his family is here at the hospital. He has 2 sons, ages 28 and 31, and a daughter age 37 from his first marriage. He is depressed about the possibility that he may have heart disease. He has always watched his weight and exercises 3-4 times a week. Recently, the company where he has worked for 30 years has merged with a larger company. He is currently the director of finance.
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1.
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True
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False
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1. It is an important task for the health care provided to assist Mr. Jackson in prolonging the period of optimal physical, mental and social activity throughout this illness.
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2.
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True
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False
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1. Developing a personal view of death is too stressful for Mr. Jackson and any references to such should be avoided.
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3.
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True
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False
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1. It will be a major source of stress for Mr. Jackson to accept his life with physical limitations.
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4.
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True
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False
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1. Mr. Jackson and his wife have the same developmental tasks in common which will make his illness easier to accept.
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5.
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True
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False
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1. Physical changes that accompany cardiovascular disease will be a major source of stress for Mr. Jackson.
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6.
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True
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False
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1. It is important to assist Mr. Jackson in redirecting his energy and talents as he adjusts to his chronic condition.
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Case Study #9
Mrs. Anna Mays is a 75-year-old female who lives alone and does not drive. She has high blood pressure, an anxiety disorder, and a right modified radical mastectomy. She is admitted to the hospital with severe chest pain and shortness of breath.
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1.
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True
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False
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1. It is common for depression to occur at this stage of life.
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2.
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True
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False
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1. A person at this stage of life must deal with the thought of dying.
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3.
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True
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False
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1. Some common health problems in this age group are limited mobility, limited vision and hearing, and declining cognitive abilities.
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4.
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True
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False
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1. Visits from family members are not necessary since patients of this age group must deal with loneliness.
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5.
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True
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False
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1. It would not be uncommon for a patient of this age group to be confused, especially in the hospital.
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6.
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True
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False
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1. Mrs. Mays is at increased risk of skin breakdown due to her age.
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ACKNOWLEDGEMENT OF TRAINING
I have read and understand the training guidelines for Age Appropriate Care
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