ADVANCED PRACTICE CARE OF OLDER ADULTS NRNP 6540 FINAL EXAM 2024/ ACCURATE SPRING- SUMMER, Exams of Nursing

Download ADVANCED PRACTICE CARE OF OLDER ADULTS NRNP 6540 FINAL EXAM 2024/ ACCURATE SPRING- SUMMER and more Exams Nursing in PDF only on Docsity! 1 ADVANCED PRACTICE CARE OF OLDER ADULTS NRNP 6540 NEW 2023-2024 ADVANCED PRACTICE CARE OF OLDER ADULTS NRNP 6540 FINAL EXAM ACCURATE SPRING- SUMMER QUARTER COMPLETE EXAM QUESTIONS WITH ANSWERS & REFERENCES 1.Mrs. Smith, 75 years old, reports that she is weak, has difficulty urinating, and is dehydrated. Although she is afebrile, the nurse conducts a thorough physical examination, including urinalysis and complete blood count (CBC). The total assessment is necessary because: 1.All body systems interact, and symptoms could indicate a variety of diagnoses. 2.The symptoms are vague and may be signs of aging. 3.There may be other signs or symptoms more indicative of the condition. 4.Mrs. Smith may not be reporting all significant information. - 1. Selected answer: 1Page: 2 Feedb a ck 1. The clinician must be aware that all the systems interact and, in doing so, can increase the older person's vulnerability to illness/disease. 2. The nurse must not attribute symptoms only to the aging process. 3. There may be comorbidities accompanying this condition. 4. Assumptions of not reporting properly may not be true. 2. A patient with renal disease has blood work drawn, and the results show an increase in serum creatinine. The nurse practitioner needs to know which of the following laboratory values before 1 ordering medications? 1.CBC 2.Culture and sensitivity of the urine 3.Creatinine clearance 4.Uric acid levels - 2. Selected answer: 3Page: 3 1 Feedb a ck 1. Knowledge of the bimodality of age onset of certain disease conditions will aid the advanced practice nurse in avoiding misdiagnosis or delay in diagnosis due to lack of recognition. 1 2. Symptoms of rheumatoid arthritis may be different depending on the age of the patient. 1 NRNP 6540 Advanced Practice Care Of Older Adults NEW 2023 APPROVED EXAM 3. Younger patients may not experience constitutional symptoms such as fever, malaise, weight loss, and depression. 4. In late-onset rheumatoid arthritis, the joint involvement is more often in the larger joints. 5.The nurse practitioner is examining an 85-year-old man with reports of abdominal pain, weakness, and loss of appetite. Which is the most likely condition to be tested for and ruled out? 1.Neoplasms and carcinomas 2.Partial seizure 3.Sarcopenia 4.Hirschsprung's disease - 5. Selected answer: 1Page: 4 Feedb a ck 1. Certain diseases, such as neoplasms and carcinomas, are more common in the elderly, and an understanding of the epidemiology is critical in the interpretation. 2. Partial seizure is more common in early old age. 3. Sarcopenia is more common in early old age. 4. Hirschsprung's disease is most common in infancy. 6.For individuals over 65 years old, the most common morbidities are related to: 1.Heart disease, arthritis 2.Respiratory problems, cancer 3.Diabetes, stroke 4.All of these are common morbidities. - 6. Selected answer: 4Page: 5 1 Heart disease, cancer, and diabetes combined are the most common morbidities in older patients. 7.A gerontological patient is being examined for a report of pain in the shoulder. The nurse practitioner completes a thorough systemic examination because: 1.Older patients with one morbidity often express difficulties in general. 2.Arthritis of the shoulder is accompanied by other neurological symptoms. 3.Older patients with arthritis often experience pain in lower extremities. 4.The patient may not report significant signs and symptoms. - 7. Selected answer:1 Page: 5 Feedb a ck 1. Older patients with late-onset rheumatoid arthritis experience joint involvement more often in the larger joints, such as the shoulder, and they also experience systemic symptoms such as fever, malaise, weight loss, and depression. 2. Older patients may express symptoms in any other physical systems. 3. Patients more often experience arthritis in smaller joints. 4. A thorough examination will detect objective indicators. 8.The nurse practitioner performs a thorough systemic examination of a patient who reports diarrhea and pain in the upper left quadrant of the abdomen. One possible diagnosis would be: 1.Hirschsprung's disease 2.Pancreatitis 3.Appendicitis 4.Gastrointestinal inflammatory bowel disease (GIBD) - 8. Selected answer:4 Page: 5 Feedb 1 a ck 1. Hirschsprung's disease is an obstruction of the colon in infancy. 2. Diarrhea is not associated with pancreatitis. 3. 1 Appendicitis is more common in younger patients than in older patients. 4. GIBD is manifested differently in a bimodal pattern. 1 NRNP 6540 Advanced Practice Care Of Older Adults NEW 2023 APPROVED EXAM Many factors can influence the health of elders, including lifestyle and medications. 1 3. Many factors can influence the health of elders, including changes in the immune system. 4. Viruses and other infections are not the only considerations for infections. 5. Biochemical individuality is important in detecting asymptomatic abnormalities in older adults. Significant homeostatic disturbances in the same individual may be detected through serial laboratory tests, even though all individual test results may lie within normal limits of the reference interval for the entire group. 11. An older woman is seen in the ambulatory clinic for a routine checkup. The patient asks about results of her blood work compared to last year's results. How is it best for the clinician to respond? Select all that apply. 1.They are likely to be the same if you have had no diseases since then. 2.Blood work results may be different just because of your aging process. 3.Your results may be different because the body changes with disease and medications you are taking. 4.Blood work is not a reliable indicator of health because many things can affect your health that may not show up in the results of your blood work. 5.There is likely no significant difference as your body remains stable in its functioning. - 11. Selected answer: 2, 3 Page: 4, 5 Feedb a ck 1. Biochemical individuality variation is often much smaller than variation within the larger group. 2. The aging process and decline in organ function may affect the health of elders. 3. Disease, nutrition, and medications affect the health of elders. 4. Although abnormal laboratory findings are often attributed to old age, rarely are they true aging changes. 5. Many factors can influence laboratory value interpretation in the elderly, including the physiological changes with aging, the prevalence of chronic disease, changes in nutritional and fluid intake, lifestyle 1 (including activity), and the medications that are taken. 12. An elderly couple is discussing health concerns with the nurse practitioner. The couple is concerned that each of their individual blood studies show 1 much as possible. 5.Signs and symptoms of illness are the same for each disease regardless of age. - 13. Selected answer: 2, 3Page: 5 Feedb a ck 1. 1 Ordering more tests than needed violates the principle of "Do no harm." 2. MG is bimodal and can be found in younger women, as well as in both men and women. 1 3. Knowledge of the bimodality of age onset of certain disease conditions will aid the nurse practitioner in avoiding misdiagnosis or delay in diagnosis due to lack of recognition. 4. There should be a need for ordering a test and value attributed to the results. 5. The manifestations of illness and disease in the elderly can be very different, even if the underlying pathological process is the same as in younger individuals. 14. Mrs. Smith is 75 years old and has had type 2 diabetes for 30 years. She sees her nurse practitioner on a regular basis. Mrs. Smith asks the nurse practitioner why her treatment has not been changed, even though her laboratory values are seemingly out of normal range. Which of the following answers are best? Select all that apply. 1.A decision to make changes must be based on a pattern and not on one set of laboratory results. 2.The normal range charts are based on patients younger than 75 years. 3.Currently, it is too expensive to change your treatment. 4.Comparing new results with your prior results gives a more accurate picture. 5.Normal values for laboratory tests differ as one gets older. - 14. Selected answer: 1, 4, 5Page: 3 Feedb a ck 1. Blood studies are more valuable when assessing for an increase or decrease in values. 2. It is not helpful to use aging as an explanation for possible abnormal results. 3. If a change in treatment is appropriate, the least expensive alternative should be sought. 4. Significant disturbances in the same individual may be detected through serial laboratory tests. 5. The clinician must determine whether a value obtained reflects a normal aging change, a disease, or the potential for disease. 15. Mr. Adams is 90 years old. In the last few months he appears unable to comply with the health- care plan developed by the nurse practitioner. The nurse practitioner considers which of the following 1 Page: 5 Feedb a ck 1. As a patient ages, this correlates with more medications having been ordered. 2. Patients with multimorbidity are known to have a treatment burden in terms of understanding and self- care management of their conditions. 3. Patients with multimorbidity are known to have a treatment burden in terms of understanding and self- care management of their conditions. 4. This burden entails affording complex drug regimens. 5. Though cognitive ability may be a factor, there is much more to consider when noncompliance is an issue. 1.A patient asks the nurse practitioner what is meant by health promotion. Which of the following is the nurse practitioner's best response? Health promotion: 1. Includes activities that an individual performs proactively to increase health and well-being. 2. Is a process of keeping track of immunizations. 3. Includes a set of programs that help people cope with the disease. 4. Includes strategies that prolong life. - 1. Selected answer: 1 Page: 6 Feedb a ck 1. Health promotion includes not only preventive and health-protective measures, but also actualization of one's health potential 2. Immunizations are only one part of health promotion. 3. Health promotion occurs before the onset of disease. 4. Quality of life is the important focus of health promotion, not a prolongation of life. 1 2. The nurse practitioner knows that health promotion is accomplished on a broader scale by: 1.Maintaining current health services. 1 2.Maintaining federal legislation regarding health care at the current level. 3.Encouraging healthy lifestyle and healthy public policy formulation. 1 1.The botanical is expensive and not approved for use. 2.Medicare only covers treatments that are approved according to the stringent guidelines of the U.S. Preventive Services Task Force (USPSTF). 1 3.There is no reason to use these botanicals when opioids are proven effective. 4.This botanical is not on the Medicare list of approved medications. - 4. Selected answer: 2Page: 6 Feedb a ck 1. Although this botanical may not be approved by the U.S. Food and Drug Administration (FDA), its cost will depend on the distributor. 2. Medicare will only pay for A and B level recommendations that meet the USPSTF stringent evidence guidelines, leaving other beneficial interventions without coverage. 3. Opioids are not recommended for older patients. 4. It is important to use only prescribed and approved medications/treatments. 5.When a patient is seen by a nurse practitioner, the care plan is developed keeping which of the following objectives in mind? 1.Increasing the use of the emergency department for injuries from falls. 2.Maintaining the patient living in his or her home. 3. Increasing safety checks in the home. 4. Increasing use of the Welcome to Medicare visit. - 5. Selected answer: 4Page: 6 Feedb a ck 1. The objective is to decrease the use of the emergency department for falls. 2. There are many factors involved in the decision for an older adult to remain in the home. 3. Although it is useful to conduct home safety checks, they are not part of the Healthy People 2020 objectives. 4. The Healthy People 2020 program has set specific objectives for prevention in older adults; use of the Welcome to Medicare visit is one of those objectives. 1 6.The focus of advanced nurse practitioners is primary care. This is defined as activities that focus on: 1.Preventing the occurrence of a disease or condition. 2.Treating an illness after symptoms appear. 1 1.Patient's health beliefs and goals. 2.Present levels of function. 1 3.Benefit of treatment. 4.Patient's involvement in a religious community. 1 5.Primary disease or condition affecting the patient. - 8. Selected answer: 1, 2, 3Page: 6 Feedb a ck 1. The nurse practitioner develops a collaborative plan that includes consideration of the patient's health beliefs and goals. 2. The nurse practitioner considers present and anticipated levels of function. 3. Risks need to be considered in light of benefits offered by interventions. 4. The nurse practitioner may consider whether the patient is connected to a religious community but cannot prescribe or recommend any specific plan. 5. Many disorders in older adults encompass multiple risk factors that involve several systems and interventions to achieve outcomes; this presents a challenge when measuring and synthesizing evidence, and reporting outcomes. 9.As the nurse practitioner is teaching about the need for more exercise, the patient says that it takes away too much energy needed for other activities. The nurse practitioner explains that the benefits of exercise include which of the following? Select all that apply. 1. Increased flexibility. 2.Increased muscle mass. 3.Maintenance of optimal weight. 4.Lower blood pressure. 5.Decreased urinary output. - 9. Selected answer: 1, 2, 3, 4Page: 7 Feedb a ck 1. The health benefits of regular physical activity are well documented and include flexibility. 2. Exercise increases muscle tone and mass. 3. Exercise uses calories from stored fat and allows for weight loss. 4. 1 Active involvement in community activities does not reflect what the older person is eating. 2. 1 The nurse practitioner needs the current state of nutrition to develop a plan for increasing or maintaining positive nutrition. 3. 1 Knowing how much activity the person has affects the need for calories and nutrients. 4. Knowing the current height and weight aids in determining the body mass index, which is an indicator of normal weight or overweight. 5. Before initiating counseling about diet, obtain baseline information on other health status information. 12. A major concern for older adults is safety. The nurse practitioner addresses safety issues when assessing the following. Select all that apply. 1.Presence of a gun in the home. 2.Fear of falling. 3.Strength of the patient. 4.Presence of rugs and other hazards in the home. 5.Urinary incontinence. - 12. Selected answer: 1, 2, 3, 4,5 Page: 8 Feedb a ck 1. Possession of a firearm combined with depression, caregiver stress, irreversible illness, or decline in functional abilities can invite self- inflicted injury, suicide pacts, or other acts of violence. 2. Fear of falling causes a person to walk guardedly and unevenly. 3. Potential recommendations include exercise programs to build strength. 4. Rugs, furniture, and pets can become obstacles for the older person to stumble over. 5. Urinary incontinence, day or night, causes the person to rush to the bathroom and increases the risk of falling. 13. Albert is 72 years old and complains of burning upon urination. He has recently returned from a vacation to another country. The nurse practitioner conducts a physical examination and observes that there is a white discharge from his penis. What does the nurse practitioner include in the treatment plan? Select all that apply. 1 Feedb a ck 1. Older adults are less likely to practice safe sex and use condoms. 2. Older people may be at increased danger from STIs because of the decreased perception of risk. 3. Current sexual history may determine the need for continued screening for STIs, HPV, and cervical cancer. 4. Encounters may be with fellow travelers, locals, or commercial sex workers. 5. Using the patient's sexual history, explore patient needs, preferences, and medical or psychological obstacles to sexual expression. 14. Mary, 72 years old, goes to the pharmacy to pick up her prescriptions. The pharmacist asks if she has had her immunizations. Mary replies, "I had all my childhood shots, so I do not need any now." What should the nurse practitioner teach her about senior immunizations? Select all that apply. 1.Because the immune system may be weakened in older persons, immunizations are suggested. 2.Persons over the age of 50 years should have a yearly influenza vaccine. 3.The new Shingrix vaccine will help protect her from shingles. 4.The side effects of immunizations outweigh the benefits of immunizations. 5.The pneumococcal vaccine is given as a one-time dose. - 14. Selected answer: 1, 2, 3Page: 12 Feedb a ck 1. The older person is susceptible to organisms that cause infection due to decreased immunity, nutrition, hydration, and other factors. 2. The influenza virus mutates each year and an updated version of the vaccine is needed to provide immunity. Influenza vaccine is now recommended annually for all adults over 50 years old, unless contraindicated. 3. Recently released Shingrix has been found to be more effective than the Zostavax, which was given previously. 1 4. Side effects are most often mild and localized. Viruses can cause serious or even lethal conditions. 5. 1 Pneumococcal vaccine is recommended as follows: Administer one- time dose to PCV13-naïve adults at age 65 years, followed by a dose of PPSV23 12 months later. 1 Feedb a ck 1. Although there may be some herbal supplements that can help with arthritis, this is not the best suggestion because it does not promote increased physical activity. 2. 1 Increased physical activity in older adults promotes wellness and quality of life. 3. Medication may be helpful for relief of symptoms but does not necessarily promote increased physical activity, which can help lead to better health. 4. Massage may provide temporary relief for arthritic joints, but physical activity is what can help lead to better health. 2.Many adults find reasons or barriers for not being able to exercise. Which of the following is an example of a patient barrier? 1.Good health, no functional limitations. 2.Insurance incentive. 3.High body mass index (BMI). 4.Frequent contact with prescriber. - 2. Selected answer: 3Page: 20 Feedb a ck 1. Good health, no functional limitations is an example of a patient facilitator because it is not counterintuitive to pursuing good health. 2. Insurance incentive is an example of a patient facilitator because it provides incentive for the patient. 3. High BMI is an example of a patient barrier because it is something that may seem insurmountable to a patient. 4. Frequent contact with the prescriber is an example of a patient facilitator because it provides accountability in the pursuit of good health. 3.Mr. Osorio is a 65-year-old male who recently retired because of a medical condition. He has good family support and is very motivated to start a wellness program to prevent worsening of his condition. These factors are an example of: 1.Barriers 2.Incentives 3.Positive self- efficacy 1 4.Facilitators - 3. Selected answer: 4Page: 20 1 Feedb a ck 1. 1 Joining a gym is not the best suggestion to counter excuses not to exercise because having to go to the gym may become another excuse. There may also be financial and transportation issues adding to the reasons not to exercise. 1 2. Finding an exercise "buddy" may be helpful but still may impose the excuse of not being able to find one. 3. Taking a 10-minute walk every day is the best suggestion. With this suggestion a patient cannot make the excuse of not having time or equipment. 4. Going to the YMCA is not the best suggestion to counter excuses for the same reasons as joining a gym is not the best suggestion. 6.Older adults who have chronic conditions and are considering an increase in their physical activity should: 1.Start slowly, using lower weights with high repetitions. 2.Consult with a personal trainer. 3.Consult a health-care provider to help set physical activity goals that are realistic and safe. 4.Start with low repetitions but heavier weights. - 6. Selected answer: 3 Page: 21 Feedb a ck 1. Starting slowly with low weights and high repetitions may be a good start but must be monitored or initiated by an appropriate medical professional for instruction in proper use. 2. A consultation with a personal trainer is not the best option because some trainers may not be familiar with chronic conditions. 3. Consulting a health-care provider for physical activity goals that are realistic and safe is the best option. 4. Starting with low repetitions but heavier weights is not a good way to start an exercise program because it may result in injury. 7.Challenges to increasing physical activity are different for everyone. For instance, some patients may be experiencing depression or loss, some may have had significant life changes, and others may be dealing with functional limitations. As relates to increasing physical activity, 1 Feedb a ck 1. Depression, interpersonal loss, significant life event changes, and functional limitations are not choices that one makes so are not excuses. 2. Patient facilitators are things that encourage a patient to do what is needed for good health. 3. These examples are not the result of what one doesn't know. 4. These are examples of patient barriers because they discourage a patient from a desire to promote health. 8.Which of the following is the focus of additional studies about the relationship between physical activities and cognitive changes? 1.Diet and supplements 2.Provider and patients 3.Social support and patients 4.Medical conditions and medications - 8. Selected answer: 1Page: 19 Feedb a ck 1. Diet and supplements are the focus of these additional studies. 2. Although provider and patient relationship is important, these are not the focus of these additional studies. 3. Although a patient's social support is important, it is not the focus of these additional studies. 4. Medical conditions and medications should be considered in physical activity, but it is not the focus of these additional studies. 9.With the recognition that baby boomers will increase the over 65 population exponentially, guidelines for increasing physical activity in older adults have been issued. Which of the following programs is dedicated to health promotion in older adults? Select all that apply. 1 1.The Healthy People 2020 initiative 2.The Center for Medicare and Medicaid 3.The American Medical Association 4.The National Institute on Aging 1 5.The American Heart Association (AHA) - 9. Selected answer: 1, 2, 4Page: 19 Feedb a ck 1. The Healthy People 2020 initiative has several sections dedicated to health promotion for older adults. 2. The Center for Medicare and Medicaid has programs to promote wellness and quality of life in older adults. 3. The American Medical Association promotes the art and science of medicine and the betterment of public health. 4. The National Institute on Aging has programs to promote wellness and quality of life in older adults. 5. The AHA publishes the scientific guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, which form the foundation of lifesaving protocols used by health-care professionals, companies, and hospitals in the United States and throughout the world. 10. Mr. Fekjar is diagnosed with unstable angina. Which of the following is a contraindication for exercise therapy and prevents patients from joining an exercise program? Select all that apply. 1.Uncontrolled hypertension 2.Fibromyalgia 3.Unstable aortic aneurysm 4.Chondromalacia 5.Hypoxemia - 10. Selected answer: 1, 3Page: 20 Feedb a ck 1. Uncontrolled hypertension is a medical contraindication for exercise therapy. 2. 1 various symptoms, such as shortness of breath and dizziness during exercise. Though it is not a contraindication for exercise therapy, its symptoms could be a barrier. 11. Which of the following may be included in the healthy lifestyle counseling during the initial Welcome to Medicare visit? Select all that apply. 1.Level of physical activity assessment. 2.Physical therapy consultation. 3.Referral to an herbalist. 4.Referral to a health coach. 5.Referral to an acupuncturist. - 11. Selected answer: 1, 2, 4Page: 20 Feedb a ck 1. Current level of physical activity is assessed during the initial Welcome to Medicare visit. 2. Physical therapy consultation may be recommended for patients with disabilities or functional limitations. 3. Referral to an herbalist is not part of the initial Welcome to Medicare visit. 4. Referral to a health coach may be recommended to patients during the initial Welcome to Medicare visit to keep them engaged. 5. Referral to an acupuncturist is not part of the initial Welcome to Medicare visit. 12. Incorporating exercise into patients' lifestyles can be effectively achieved by including which of the following in your discussions with patients? Select all that apply. 1.Talking about the importance of exercise. 2.Encouraging goal setting and self-monitoring by the patient. 3.Recommending the purchase of exercise equipment to use at home. 4.Informing the patient about resources that are available in the community for 1 group exercise. 5.Giving an illustration of the exercises. - 12. Selected answer: 2, 4Page: 21 1 Feedb a ck 1. Handing a program or exercise prescription to the patient is more effective than just talking about it. 2. 1 A personal trainer may not have the proper training for more complicated conditions. 14. The AHA Council on Nutrition, Physical Activity, and Metabolism identified patient facilitators to increasing physical activity in older adults. Which of the following is an example of patient facilitators? Select all that apply. 1 1.Frequent contact with prescriber. 2.Planned program. 3.Making time. 4.Purchasing new equipment. 5. Ignorance of exercise. - 14. Selected answer: 1,2 Page: 20 Feedb a ck 1. Frequent contact with a prescriber has been seen to be a patient facilitator. 2. A planned program has resulted in facilitation toward health motivation. 3. Making time is a patient choice rather than a facilitator toward making changes. 4. Purchasing new equipment is not an example of a patient facilitator and may not be doable for all patients. 5. Ignorance of what to do is not a patient facilitator but a barrier to increasing physical activities. 15. To perform physical activity safely and reduce the risk of injuries and other adverse events, which of the following are advisable? Select all that apply. 1.Start fast to get acclimated to the activities. 2.Use their instincts. 3.Use appropriate protective gear. 4.Follow rules and policies. 5.Have an exercise "buddy." - 15. Selected answer: 3, 4Page: 21 Feedb a ck 1. Starting fast could actually increase the possibility of injury. 2. There is no guarantee that 1 instincts are correct. 3. Using appropriate protective gear is recommended to reduce the risk of injuries. 4. Rules and policies are made to inform and protect, therefore, following them will help to reduce the risk of injuries. 1 a ck 1. A comprehensive approach to geriatric assessment is recommended because the physical health of the older adult is inextricably related to functional ability, psychosocial health, and a safe and enabling environment. 2. 1 A focused assessment will provide a limited amount of information about the whole person. 3. A comprehensive assessment will provide both objective and subjective information. 1 4. A list of medications is only one component of a comprehensive assessment. 3.The nurse practitioner knows that conducting a comprehensive geriatric assessment (CGA) is more beneficial for which of the following groups? 1.People between 60 and 70 years old. 2.People over 70 years old. 3.People classified as vulnerable older adults. 4.People over 55 years old. - 3. Selected answer: 3Page: 26 Feedb a ck 1. People between 60 and 70 years old are likely to be healthy. 2. People over 70 years old have a variety of levels of health. 3. Vulnerable older adults and frail older adults will benefit most from a CGA because of lower physiological reserves and higher risk of iatrogenic complications. 4. People over 55 years old may not be considered the appropriate age for a CGA. 4.A family member comes into the clinician's office with her older mother, the patient. In the process of the examination, the nurse practitioner identifies the patient as "frail older adult." The family member asks what that means. The nurse practitioner explains that this refers to: 1.Someone who is prone to pathological fractures. 2.An older person already exhibiting signs of decline. 3.An older person who has lost height and is under 5 feet tall. 4.An older person being susceptible to infections. - 4. Selected answer: 2Page: 26 1 5.Jane, 83 years old, comes to the clinic with her daughter for a geriatric assessment. The daughter asks about the necessity of this comprehensive assessment. The clinician explains that a CGA is a multidimensional process to: 1.Identify care needs and plans of care for older people. 2.Acquire information about past medical conditions. 3.Determine which diagnostic tests are necessary. 4.Satisfy requirements of Medicare. - 5. Selected answer: 1Page: 26 Feedb a ck 1. The CGA is a multidimensional, interdisciplinary, and diagnostic process to identify needs and plan outcomes. 2. The CGA includes information from medical history, as well as the current assessment. 3. The CGA helps identify diagnostics, treatments, and other plan- of-care strategies. 4. The CGA is not a requirement of Medicare. 6.Mary Jane is seeing a nurse practitioner for a CGA and asks which parts of her life will be examined. The nurse practitioner says the domains of the CGA include: 1. Internal organ health. 2.Social habits. 3.Physical and psychological health, as well as other facets of life. 4.History of family illness. - 6. Selected answer: 3Page: 27 Feedb a ck 1. The CGA includes more than internal health. 2. Learning about social habits is not the only component 1 in determining health. 3. Domains of CGA include physical health, psychological health, socio- environmental supports, mobility, functional status, and a measure of the quality of life. 4. 1 Although family health history provides information about genetics, the CGA is complete and includes current health status in several domains. 1 9.After examining Adam, who is 79 years old, the nurse practitioner uses which of the following criteria to adjust Adam's medications? Select all that apply. 1.The Beers Criteria published in 1991 2.Medication Appropriateness Index 3.STOPP/START Criteria 4.HHS Guide to Geriatric Medications 5.Hospital formulary - 9. Selected answer: 2, 3Page: 27 Feedb a ck 1. The Beers Criteria, 1991, was revised in 2015. Other criteria were also developed to address weaknesses found in the original Beers Criteria. 2. The Medications Appropriateness Test was developed to address some of the weak areas of the Beers Criteria. 3. The STOPP/START Criteria were developed to determine when medications should be added and when another might be discontinued for an older patient. 4. The HHS Guide to Geriatric Medications does not guide in medication prescribing. 5. Hospital formulary provides a list of medications carried within that hospital. 10. While examining John, who is 80 years old, the nurse practitioner observes that as he rises from the chair he pauses and holds on to the rail. Asking John if this happens often, he replies, "Yes, I get lightheaded and feel like I will fall." The nurse practitioner decides to conduct testing for orthostatic hypotension. This test includes which of the following? Select all that apply. 1.Having the patient lie down for 5 minutes, then measuring blood pressure and pulse. 2.Having the patient stand and wait a minute, then measuring blood 1 pressure and pulse. 3.Having the patient jump in place for 2 minutes and then lie down. 4.Having the patient breathe deeply five times and then stand up. 5.Having the patient get up from his chair without using his arms, walk two to three steps, then back up to his chair and sit down. - 10. Selected answer: 1, 2 Page:27 1 Feedb a ck 1. Obtaining baseline blood pressures is important to assess any changes. 2. 1 5.Absence of nystagmus. - 12. Selected answer: 2, 3,5 Page: 28 1 Feedb a ck 1. An acuity of 20/20 is normal. Better than that is good. 2. Visual acuity of worse than 20/40 suggests weakness in the ability to see. 3. Abnormality in cardinal fields of gaze may indicate a neurological condition. 4. Ability to gaze downward is normal. 5. Abnormality in the six cardinal fields of gaze with nystagmus or lack of a downward gaze may reveal neurological disease. 13. Bertha is an 85-year-old grandmother who has multiple morbidities. Family members report that Bertha is not eating much and does not seem as active as usual. They want the nurse practitioner to order tests to identify what is happening to her. The nurse practitioner considers which of the following before ordering any tests? Select all that apply. 1.Will the test results alter any of the diagnoses that she is currently addressing? 2.Will the results alter management of her health regimen? 3.What is the cost/benefits ratio? 4.Is the test the least invasive? 5.Is this testing acceptable to the patient? - 13. Selected answer: 1, 2, 3, 4,5 Page:28 Feedb a ck 1. One of the considerations in ordering tests for diagnostic purposes is whether the test result will alter the diagnosis. 2. One of the considerations in ordering tests for diagnostic purposes is whether the test result will alter management of a condition. 3. The cost and benefits need to outweigh the risks. 4. Less invasive testing alleviates negative reactions to invasive procedures. 5. Evidenced-based practice includes the consideration of the patient's 1 wishes. 14. In assessing functionality, the nurse practitioner first considers activities of daily living (ADLs), which include which of the following? Select all that apply. 1 FICA (Puchalski & Romer, 2000): Faith or belief, Importance or influence, Community Address is an acceptable assessment tool. 1 1. Geriatric assessments can be challenging for the health-care provider due to delay of recognition and/or reporting of symptoms by the patient. Which of the following best describes what is used by health-care providers to address this differential? 1.Clinical decision-making tools. 2.When symptoms were noticed. 3.Change in function and impact of symptoms. 4.Symptoms from comorbidities. - 1. Selected answer: 3Page: 34 Feedb a ck 1. Using clinical decision-making tools can be complicated because of different factors, such as patient denial of symptoms and their occurrences. 2. Using the time symptoms were noticed as the basis for assessment cannot be deemed an effective tool due to inaccuracies regarding the report of when symptoms first occurred. 3. Change in function as a measure of the impact of a symptom on the patient is an effective means of sorting out the differential. 4. Comorbidities can result in a delayed or atypical presentation. 2.Which of the following terms refers to conditions that have multiple underlying factors and may involve multiple organs? 1.Multifaceted syndrome 2.Aging syndrome 3.CFM syndrome 4.Geriatric syndrome - 2. Selected answer: 4Page: 34 Feedb 1 a ck 1. Multifaceted syndrome is not the correct term, although conditions reflect the many contributing aspects to health care. 2. Aging syndrome is not the correct term, although aging may be a contributing factor to the condition. 3.