Activities of Daily Living (ADLs)

Every question here, with the answer

1. An outpatient nurse is assessing an older adult whose spouse reports that the patient was independent last month but now suddenly needs help dressing, shopping, and preparing food. What is the nurse’s best response?

   1. Explain that ADL loss is expected with aging and schedule routine follow-up only.
   2. Assess only instrumental ADLs because basic ADLs are not related to safety risks.
   3. Reassess ADL ability and escalate the rapid functional change for prompt evaluation.
   4. Delay action until the patient has lost at least three ADL abilities.

   Answer: Reassess ADL ability and escalate the rapid functional change for prompt evaluation.

   A rapid decline in ADL ability is not presented as a normal expected change; it is a cause for alarm in any patient. Waiting or minimizing the change could miss safety and health risks associated with unidentified ADL limitations.

2. A nurse is completing discharge planning and wants to identify limitations in basic ADLs rather than instrumental ADLs. Which patient statements indicate BADL limitations? Select all that apply.

   1. “I need help arranging bus transportation.”
   2. “I cannot manage my bank accounts.”
   3. “I need someone to help me bathe.”
   4. “I cannot get to and use the toilet without help.”
   5. “I need help moving from my bed to my wheelchair.”

   Answer: “I need someone to help me bathe.”, “I cannot get to and use the toilet without help.”, “I need help moving from my bed to my wheelchair.”

   Transferring, bathing, and toileting are basic ADLs. Managing finances and transportation are instrumental ADLs, which involve more complex skills needed for independent community living.

3. An older adult hospitalized with an acute illness has become less able to perform ADLs. Which nursing actions are consistent with strategies described for improving outcomes? Select all that apply.

   1. Discourage urinary catheterization when possible.
   2. Encourage the provider to order physical therapy.
   3. Participate in early mobilization efforts.
   4. Keep the patient in bed until the acute illness has completely resolved.
   5. Answer call lights promptly to reduce reliance on adult briefs.

   Answer: Discourage urinary catheterization when possible., Encourage the provider to order physical therapy., Participate in early mobilization efforts., Answer call lights promptly to reduce reliance on adult briefs.

   The section identifies physical therapy, early mobilization, prompt call-light response, and discouraging urinary catheterization when possible as nursing actions that can improve outcomes. Keeping the patient in bed is not consistent with early mobilization efforts.

4. A nurse completes a Katz ADL Index assessment. The patient can dress, bathe, toilet, transfer, and feed himself independently, but he cannot reliably control his bladder and uses pads. What Katz ADL Index score should the nurse expect?

   1. 5 out of 6
   2. 0 out of 6
   3. 6 out of 6
   4. 4 out of 6

   Answer: 5 out of 6

   The Katz ADL Index gives 1 point for each BADL performed independently and 0 if assistance is required or independence is not present. Loss of reliable continence with independence in the other five areas results in a score of 5 out of 6.

5. A patient has been diagnosed with early-stage dementia. The nurse is helping the family plan for needs that often appear before limitations in basic ADLs. Which areas should the nurse include? Select all that apply.

   1. Paying bills
   2. Waiting until long-term care is needed before discussing future plans
   3. Planning only for bathing and feeding because BADLs usually decline first
   4. Taking medications as ordered
   5. Purchasing groceries

   Answer: Paying bills, Taking medications as ordered, Purchasing groceries

   In early dementia, planning should address IADLs such as medication management, grocery purchasing, and bill paying because these limitations often appear before BADL limitations. Delaying planning or focusing only on BADLs misses the earlier functional needs described in the section.

6. A rehabilitation center wants to monitor a patient’s ADL progression using a tool that provides a more nuanced assessment of BADLs, including whether the patient is independent, needs assistance, or is dependent. Which tool is most appropriate?

   1. Barthel Index
   2. Katz ADL Index
   3. Cleveland Scale
   4. Lawton-Brody Instrumental Activities of Daily Living Scale

   Answer: Barthel Index

   The Barthel Index is frequently used in rehabilitation centers and allows more nuanced reporting of BADL abilities. The Katz ADL Index is a yes-or-no BADL tool, the Lawton Scale measures IADLs, and the Cleveland Scale is identified for individuals who have Alzheimer disease.