NURS 4000 Gerontology Final Review Questions and Answers,100% CORRECT
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NURS 4000 Gerontology Final Review Questions and Answers
Questions from the Hartsfield Institute Issue 6.2
The Epworth Sleepiness Scale (ESS)
By: Carole Smyth MSN, APRN, BC, ANP/GNP, Montefiore Medical Center
WHY: Sleep at night is essential for good health. Sleepiness during the day can be an ...
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NURS 4000 Gerontology Final Review Questions and Answers
Questions from the Hartsfield
Institute Issue 6.2
The Epworth Sleepiness Scale (ESS)
By: Carole Smyth MSN, APRN, BC, ANP/GNP, Montefiore Medical
Center
WHY: Sleep at night is essential for good health. Sleepiness during the day
can be an antecedent to falls, declining quality of life, and less functional
recovery in older adults. Sleepiness during the day may also be an
indicator that hypertension and diabetes are not well controlled (Cuellar &
Ratcliffe, 2008; Goldstein, Ancoli-Israel, Shapiro, 2004). Assessment of
daytime sleepiness enables the nurse to intervene by implementing
interventions with the client, or by referring the client for further
assessment.
BEST TOOL: The Epworth Sleepiness Scale (ESS) is an effective
instrument used to measure average daytime sleepiness. The ESS
differentiates between average sleepiness and excessive daytime
sleepiness that requires intervention. The client self-rates on how likely it
is that he/she would doze in eight different situations. Scoring of the
answers is 0-3, with 0 being “would never doze” and 3 being “high chance
of dozing”. A sum of 10 or more from the eight individual scores
reflects above normal daytime sleepiness and need for further
evaluation (Johns,1992).
TARGET POPULATION: The ESS may be used for both initial
assessment and ongoing comparative measurements with older adults
across the health care continuum. The ESS is not an appropriate tool
for measuring changes in sleep over a period of hours.
VALIDITY AND RELIABILITY: There is a high level of internal
consistency between the eight items in the ESS as measured by
Cronbach’s alpha, ranging from 0.74 to 0.88. Numerous studies using the
ESS have supported high validity and reliability.
STRENGTHS AND LIMITATIONS: The ESS is a subjective measure of
sleepiness. Self reporting by clients though empowering and
revealing, may reflect inaccurate information if the client has
difficulty understanding what is written, or cannot see or physically
write out responses. The ESS has been translated into Spanish,
Portuguese, Italian, German, Swedish, Finnish, Greek, French, Mandarin,
,Japanese and Turkish. The tool has not been validated for phone
interviews.
Issue 30
Assessment of Fatigue in Older Adults: The FACIT Fatigue Scale
(Version 4)
By: Kathleen F. Tennant, PhD, APRN, BC, West Liberty University, West
Liberty, West Virginia
WHY: Fatigue is one of the most frequent complaints of the elderly
and is strongly associated with loss of independence and decreased
physical activity and functional decline. Mild depression, anemia,
insomnia, and poor nutrition have been associated with fatigue.
However, many older persons report complaints of “fatigue” and
“exhaustion” even when no underlying medical or psychiatric illness is
present (Avlund et al., 2003). Thus, the lack of an “underlying illness”
makes the impact of unexplained fatigue even more crucial.
BEST TOOL: Although there are several validated tools for the
measurement of fatigue, there is no gold standard (NIA, 2007). One self-
report questionnaire that has been validated for use with older adults is the
Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue
Scale (Version
,4). The FACIT Fatigue Scale is a short, 13-item, easy to administer tool that
measures an individual’s level of fatigue during their usual daily
activities over the past week. The level of fatigue is measured on a four
point Likert scale (4 = not at all fatigued to 0 = very much fatigued)
(Webster et al., 2003). The FACIT Fatigue Scale is one of many different
FACIT scales that are part of a collection of health-related quality of life
(HRQOL) questionnaires targeted to the management of chronic illness
referred to as The FACIT Measurement System. The group tests newly
constructed FACIT subscales on a sample of at least 50 subjects. The
FACIT tool has been translated in more than 45 different languages
permitting cross-cultural comparisons.
TARGET POPULATION: Older adults who report fatigue.
VALIDITY AND RELIABILITY: In a 2007 study, (Chandran et al., 2007)
the FACIT Fatigue Scale was found to have high internal validity
(Cronbach’s alpha = 0.96) and high test-retest reliability (ICC
= 0.95). The correlation between the FACIT and Fatigue Severity Scale
(FSS) was -0.79 tool comparison (Tennant et al., 2011). Thus, the FACIT
has demonstrated reliability and sensitivity to change in clients with a
variety of chronic health conditions and in the general population and in
special populations such as the elderly and those living in rural areas.
STRENGTHS AND LIMITATIONS: The FACIT Fatigue Scale is easy to
complete (in 5–10 minutes) and is written at the 4th grade reading level. It
has demonstrated equivalence in mode of administration (interview vs.
self-report) and can be used in a variety of clinical settings (community
health, inpatient, outpatient, etc). Although the FACIT has been highly
correlated with the FSS (Chandran et al., 2007; Tennant et al., 2011)
further evaluation of this tool with the geriatric population with regard to
cut-off points is recommended.
FOLLOW-UP: As needed or on a yearly basis to assess fatigue.
, A nurse assesses older adults at risk for pressure ulcers. Which of
the following assessment tools should the nurse use to identify those
who might benefit from interventions? (Select all that apply.)
A) Braden Scale
B) Norton Scale
C) PUSH Scale SPICE
S
D) Reverse staging
E) Waterloo Scale
An A, B, E
s
:
Pittsburgh Sleep Quality Index(PSQI)- asses sleep quality and patterns
over a month, determine good to poor sleep
Epworth Sleepiness Scale (ESS) - focuses on daytime sleepiness over the
past week. Total of 9 or greater= too sleepy during day, not enough sleep,
seek medical assistance
Stages of Change Model
Stage 1: Precontemplation- unaware of problem , is in denial of the need
for change or is resistant to change
Stage 2: Contemplation- intention to change in the foreseeable future (
person likely to ask questions and seek information)
Stage 3: Preparation- some ambivalence about the unhealthy behavior
but a strong inclination to change to healthier behaviors ( acknowledge
need for change express serious intent to adopt health behaviors)
Stage 4: Action- person has made change to behavior but behavior been
practiced for less than 6 months
Stage 5: Maintenance- person continued healthy behavior for 6 months or longer.
A 69-year-old cigarette smoker asks the nurse questions about the potential benefits
of quitting smoking, a subject avoided in past interactions. The nurse asks the client,
"Would you like to quit smoking?," to which the client replies, "I will give it some
serious thought.” What stage of the Stages of Change model is the client
demonstrating?
A) Precontemplation
B) Preparation
C) Contemplation
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