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 Feedba 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 ordering medications? 1. CBC 2. Culture and sensitivity of the urine 3.Creatinine clearance 4.Uric acid levels - 2. Selected answer: 3Page: 2 3 5 2. Symptoms of rheumatoid arthritis may be different depending on the age of the patient. 6 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 Feedba 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 Feedba ck 1. Heart disease is one of the common morbidities. 2. Cancer is common in the general population; however, specific types are more 7 common in the older patient. 10 Appendicitis is more common in younger patients than in older patients. 4. GIBD is manifested differently in a bimodal pattern. 11 NRNP 6540 Advanced Practice Care Of Older Adults NEW 2023 APPROVED EXAM 9. A 70-year-old man is seeing a nurse practitioner because he is feeling weak and dizzy. The nurse practitioner is discussing a care plan with him and makes which of the following statements? Select all that apply. 1.I want to order a test for your heart to evaluate its function. 2.I will perform a thorough examination of your functional abilities. 3.I will order a blood sugar test to check for diabetes. 4.Many older people feel this way. It is to be expected. 5.I will assess you for the presence of other conditions. - 9. Selected answer: 1, 2, 3, 5Page: 2, 3 Feedba ck 1. A complete assessment will help differentiate signs of aging from disease. 2. All systems interact and can affect an existing condition. 3. Identifying underlying conditions will avoid undertreatment. 4. Attributing symptoms to aging can contribute to depression in an older person. 5. There are changes in the sympathetic response which contribute to the orthostasis and falls, as well as lack of hypoglycemic response. 10. The nurse practitioner is leading a class of seniors over age 65 years and is teaching about nutritional needs. One of the men asks why, even though he eats correctly according to the standards presented, he still feels weaker than he did 10 years ago. He also wonders why he gets more infections than he used to. Which of the following are helpful answers? Select all that apply. 1.I suggest that you exercise a little more than you are currently doing. 2.Some people experience a decrease in reserve energy. 3. For some people, the immune system weakens. 4. More viruses are being spread throughout the community. 5. I suggest that you see your primary caregiver for extensive testing. - 10. Selected answer: 2, 3,5 Page: 2, 3 Feedba ck 1. Improved nutrition may not be the factor affecting health of elders. 2. 12 NRNP 6540 Advanced Practice Care Of Older Adults NEW 2023 APPROVED EXAM Many factors can influence the health of elders, including lifestyle and medications. 15 decrease. Their physician does not seem concerned, and the couple is wondering why. How is it best for the nurse practitioner to respond? Select all that apply. 1. Studies show that each person's pattern of chemical make-up is different. 2.There is no difference between one person's range of blood results and that of any other person. 3. Each person's chemical make-up is the same as that of others of the same gender and age group. 4. Many factors affect an individual's chemical make-up. 5. Ranges of the values provided by the laboratory are correct for any age. - 12. Selected answer: 1, 4Page: 2, 3 Feedba ck 1. Individuals experience smaller variations in laboratory work than from the others in the same age group. 2. There are wider variations of laboratory results within a group of older people. 3. Laboratory values are determined by more than age and gender. 4. Laboratory values may vary as a result of nutrition, activity, and emotional status. 5. The reference values presented for the older adult cohort are not necessarily correct for the individual due to biochemical individuality. 13. Adam, 70 years old, is admitted for possible myasthenia gravis (MG). The nurse practitioner knows that MG is commonly seen in women between 20 and 40 years old. Adam, however, is experiencing an ocular form of MG, has dysphonia, and does not have any thymus abnormalities. Adam asks why the nurse is concerned about MG since he is older and this is a "young person's disease." Which of the following are the best answers? Select all that apply. 1. We need to assess for anything, just in case. 2. Some diseases show up in two different age and gender groups. 3. Older people often experience weakness, and we must rule out other conditions. 4.Your insurance will cover this, and we want to rule out as much as possible. 5.Signs and symptoms of illness are the same for each disease regardless of age. - 13. Selected answer: 2, 3Page: 5 Feedba ck 1. 16 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. 17 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 Feedba 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 reasons for noncompliance when updating his home care plan? Select all that apply. 20 2. Maintaining federal legislation regarding health care at the current level. 3.Encouraging healthy lifestyle and healthy public policy formulation. 21 4.Encouraging the advancement of alternative health therapies. - 2. Selected answer: 3Page: 6 Feedba ck 1. Current health policies are ever-changing to improve services for citizens. 2. Federal legislation is being proposed to increase health services. 3. The World Health Organization has determined that healthy lifestyle promotion works best when coupled with supportive environments, community action, and healthy public policy formation. 4. This does not include preventive and health-protective measures, nor actualization of one's health potential. 3. Mr. Thomas comes in for a health examination appointment with his nurse practitioner. He asks why nurse practitioners are qualified to conduct these evaluations. Which of the following is the nurse practitioner's best response? The nurse practitioner: 1. Is concerned about health and not disease. 2.Saves the physician time in the office. 3. Can assess for minor conditions and refer to the doctor for other conditions. 4. Is prepared to assess health holistically. - 3. Selected answer: 4Page: 6 Feedba ck 1. The nurse practitioner is concerned about health promotion, disease prevention, and early diagnosis. 2. The nurse practitioner may spend more time with the patient than the doctor is able to. 3. The nurse practitioner is prepared to diagnose and plan treatment for many conditions. 4. The nurse practitioner brings a holistic orientation to health and wellness development and possesses knowledge of developmental tasks and the wellness-illness continuum. 4. Mrs. Williams, 80 years old, asks her nurse practitioner to order a new alternative therapy for her. Mrs. Williams believes that this botanical supplement will provide pain relief for her fibromyalgia. The nurse practitioner explains that this therapy is likely not covered by Medicare because: 22 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). 25 4. Enriching the patient's appreciation of life. - 6. Selected answer: 1Page: 7 Feedba ck 1. Primary preventive strategies focus on immunization, well-checks, and other health maintenance activities. 2. Secondary preventive strategies focus on prevention and treatment of illness. 3. Tertiary preventive strategies focus on rehabilitation. 4. Nurse practitioners focus on the wellness-illness continuum. 7. A health promotion topic included in the nurse practitioner visit is physical activity. Which of the following would be a good recommendation for the 75- year-old male? Select all that apply. 1. Skydiving 2.Horseback riding 3.Swimming 4.Dancing 5.Whatever the patient is willing and able to do - 7. Selected answer: 3, 4, 5Page: 7 Feedba ck 1. Skydiving is risky for older patients who may have cardiovascular issues. 2. Horseback riding could be risky for an older person who may have neurological or orthopedic issues. 3. Swimming is a good option if the patient is willing. 4. Dancing is a good option if the person is able. 5. When recommending physical activity, the person's functional abilities and desires need to be considered. 8. Understanding that the current life expectancy is 79 years, the nurse practitioner plans a patient's health promotion while considering which of the following? Select all that apply. 1. Patient's health beliefs and goals. 2.Present levels of function. 26 3. Benefit of treatment. 4. Patient's involvement in a religious community. 27 5. Primary disease or condition affecting the patient. - 8. Selected answer: 1, 2, 3Page: 6 Feedba 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 Feedba 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. Exercise strengthens the cardiac muscle and thereby lowers blood pressure. 5. Exercise does not affect urinary output. 30 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 Feedba 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. Teaching on safe sex practices. 2. Teaching about the incidence of contracting sexually transmitted infections (STIs), even at an older age. 3. Teaching that frequent testing and screening is needed if he continues to be sexually active. 31 4. Assuring the patient that while traveling there are limited opportunities for sexual encounters. 5. There is no need to assess an older patient's sexual preferences and practices. - 13. Selected answer: 1, 2, 3Page: 8 32 Feedba 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 Feedba 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. 4. Side effects are most often mild and localized. Viruses can cause serious or even lethal conditions. 5. 35 Feedba 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. 36 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 Feedba 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 4.Facilitators - 3. Selected answer: 4Page: 20 37 Feedba ck 1. 40 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 Feedba 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, these are examples of what? 1. Patient excuses 2.Patient facilitators 3. Patient ignorance regarding what to do 41 4. Patient barriers - 7. Selected answer: 4Page: 20 42 Feedba 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 Feedba 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. The Healthy People 2020 initiative 2.The Center for Medicare and Medicaid 3.The American Medical Association 4.The National Institute on Aging 45 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 Feedba 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 group exercise. 5.Giving an illustration of the exercises. - 12. Selected answer: 2, 4Page: 21 46 Feedba ck 1. Handing a program or exercise prescription to the patient is more effective than just talking about it. 2. 47 Goal setting and self-monitoring by the patient is very effective in persuading the patient to adopt a healthy lifestyle. 3. Recommending the purchase of exercise equipment to use at home may not be the best approach for different reasons, such as financial ability. 4. Informing patients about the resources that are available in the community for group exercise is a valuable adjunct to counseling. 5. Though not listed as something that could promote exercise, giving the patient illustrations for the exercise could be helpful when it is demonstrated and explained. 13. The goal of increasing physical activity is to promote a healthy lifestyle. Which of the following options help reduce the risk of injuries? Select all that apply. 1. Choosing physical activities that are appropriate for their current fitness level and health goals. 2. Remaining under the care of a health-care provider if they have chronic conditions or symptoms. 3. Choosing to do physical activities their friends are doing. 4.Enlisting spousal supervision and support. 5.Hiring a personal trainer. - 13. Selected answer: 1, 2Page: 22 Feedba ck 1. Choosing to do types of physical activities that are appropriate for a patient's current fitness level and health goals helps reduce the risk of injuries. 2. Being under the care of a health-care provider if a patient has chronic conditions or symptoms helps reduce the risk of injuries. 3. Choosing to do types of physical activities one's friends are doing is not the best option in reducing risk for injuries because of differences in physical ability or medical conditions. 4. Being under the supervision of one's spouse for support is a good facilitator, but it is not the best option in reducing the risk for injures because a spouse may not understand the impact of physical activity on physical and medical conditions. 5. 50 5. 51 Having an exercise "buddy" may make the activity fun but will not necessarily reduce risk of injuries, especially if the buddy does not understand the concepts of exercises and physical activity physiology. 1. Mr. and Mrs. Smith are both 75 years old and are seeing their nurse practitioner for their annual checkups. Mrs. Smith wonders why they each have trouble digesting different foods. It is inconvenient for her to fix different meals that they both can tolerate. The nurse practitioner explains that: 1. Men have more difficulty digesting vegetables. 2.Women have more difficulty digesting dairy products. 3.Men and women have different enzymes in their gastrointestinal tracts. 4.Organ systems progress differently for each person regardless of age. - 1. Selected answer: 4Page: 26 Feedba ck 1. There are no gender differences in types of food digested. 2. People of either gender may have an intolerance to dairy. 3. People of either gender have the same types of enzymes in their digestive systems. 4. People age at different rates, and within each person organ systems age at different rates. 2. The nurse practitioner conducts a comprehensive geriatric assessment of the older individual because: 1. Health of older people is affected by several factors. 2.A focused assessment will provide depth of specific information. 3.A comprehensive assessment will provide more subjective information. 4.A comprehensive assessment will result in a list of current and prior medications taken. - 2. Selected answer: 1 Page: 26 Feedba 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. 52 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. 55 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 Feedba 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 Feedba ck 1. The CGA includes more than internal health. 2. Learning about social habits is not the only component 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. 56 Although family health history provides information about genetics, the CGA is complete and includes current health status in several domains. 57 7. In conducting a CGA, the nurse practitioner looks for any impairments in communication with the patient. The assessment includes: 1. Interviewing prior to the physical examination. 2.Asking questions of the accompanying family member. 3.Reading the history forms provided by the patient after the examination. 4.Observing physical impairments. - 7. Selected answer: 1Page:26 Feedba ck 1. Interviewing begins before the physical examination and continues throughout the examination. 2. Permission from the patient must be obtained before discussing anything with the family member. 3. When forms about the history of the patient are brought in, the nurse practitioner should review them before the examination. 4. Observation alone will not provide adequate information about communication impairments. 8. When an assessment is conducted, which of the following needs to be recorded when a new concern is identified? Select all that apply. 1. Location and radiation. 2.Quantity and quality. 3.Aggravating and alleviating. 4.Signs and symptoms. 5.Effect on financial status. - 8. Selected answer: 1, 2, 3, 4Page:27 Feedba ck 1. A comprehensive assessment includes the location and radiation of the symptom. 2. A comprehensive assessment includes the quantity and quality of the symptom. 3. A comprehensive assessment includes aggravating and alleviating factors. 4. Associated signs and symptoms are included in a comprehensive assessment. 5. Financial concerns are considered after the findings of the assessment are understood. 60 Measuring the blood pressure after John gets up will show a drop if he experiences hypostatic hypotension. 3. Jumping in place is not a normal activity and is risky for older people. 4. Breathing deeply does not affect blood pressure significantly. 5. Mobility can be screened with the Timed Get Up and Go Test. This test involves observing for unsteadiness as the patient gets up from a chair without using the arms, walks 10 feet, turns around, walks back, and resumes a seated position. 11. In conducting a physical assessment of an older person, the nurse practioner assesses which of the following? Select all that apply. 1. Pulse oximetry 2.Weight 3.Color of hair 4. Functional assessment 5. Presence of pain - 11. Selected answer: 1, 2, 4, 5Page: 27, 28 Feedba ck 1. Pulse oximetry provides a reading of oxygen saturation for the end tissues. 2. Measuring weight provides information about nutrition and fluid status. 3. Hair color is not directly associated with health status. 4. The ability to function for ADLs is crucial to the health of an older person. 5. Pain is the fifth vital sign and provides information about underlying conditions. 12. Mrs. Parsons is 75 years old and is anticipating renewing her driver's license. The nurse practitioner conducts an eye examination and is concerned to find which of the following? Select all that apply. 1. Visual acuity better than 20/20. 2.Visual acuity worse than 20/40. 3.Abnormality in the six cardinal fields of gaze. 4.Ability to gaze downward. 61 5.Absence of nystagmus. - 12. Selected answer: 2, 3,5 Page: 28 62 Feedba 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 Feedba 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 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. 65 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 Feedba 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 Feedba 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. 66 CFM syndrome is not the correct term, although conditions may have cognitive, functional, and mobility impairments. 4. 67 Geriatric syndrome is the term that refers to the conditions that have multiple underlying factors that may involve multiple organs. 3. Mrs. Rizzo is an 80-year-old Caucasian female who is presenting symptoms of chest pain, weakness, and lightheadedness. Which of the following may be a possible differential diagnosis of her symptoms? 1. Ischemic colitis 2. Spinal cord compression 3.Diabetic neuropathy 4.Costochondritis - 3. Selected answer: 4Page: 38, 39 Feedba ck 1. Ischemic colitis is a possible differential diagnosis for fecal incontinence. 2. Spinal cord compression is a possible differential diagnosis for fecal incontinence. 3. Diabetic neuropathy is a possible differential diagnosis for fecal incontinence. 4. Costochondritis is the possible differential diagnosis for her symptoms of chest pain, weakness, and lightheadedness. 4. Steven is a 65-year-old male diagnosed with Parkinson's disease. He is taking anti- Parkinson's drugs, calcium supplements, and NSAIDs for his joint pain. Which of the following conditions could be caused by his medications? 1. Constipation 2.Hematuria 3.Headache 4.Chest pain - 4. Selected answer: 1Page: 41 Feedba ck 1. Anti-Parkinson's drugs, calcium supplements, and NSAIDs are all known to cause constipation. 2. 70 fever as high as 105°F, along with profuse sweating, bluish lips and nails, and confusion. 2. Antibiotics should not be used with acute bronchitis because it is viral. 3. 71 Chronic bronchitis is a condition that presents with symptoms of coughing, shortness of breath, and purulent sputum, and is often treated with antibiotics, use of a nebulizer, and oral steroids. 4. GERD is a gastrointestinal condition that may be associated with coughing but is treated with an antihistamine and decongestant. 7. Reduction of pain is the main goal for patients suffering from acute joint pain. The mnemonic PRICE is a helpful reminder of the treatment when this occurs. What does the "E" in PRICE stand for? 1. Elevation 2.Emergency 3.Elastic 4.Electrical - 7. Selected answer: 1Page: 73 Feedba ck 1. Elevating the joint above heart level may help reduce pain and swelling. 2. This is not part of the mnemonic. 3. This is not part of the mnemonic, although the "P" does stand for protection with a brace or wrap. 4. This is not part of the mnemonic. 8. A patient complains of dry, irritated, and itchy skin that has not been relieved with over-the-counter medications. On examination, the patient is also found to present cholestasis and jaundice. From which of the following conditions may the patient be suffering? 1. Lice 2.Scabies 3.Pruritus 4.Lichenification - 8. Selected answer: 3 Page: 77 Feedba ck 1. 72 Lice may cause itching in the scalp but is generally localized. 2. Scabies may cause itching of the skin but is generally localized. 3. 75 Feedba ck 1. Use of medications should be considered in formulating diagnostic possibilities. 2. Precipitating factors should be included in the assessment process as main descriptors to guide the diagnosis. 3. Character of symptoms are necessary descriptors to guide the diagnosis. 4. Family history, although helpful, is a secondary factor in the assessment process. 5. Social history would not provide helpful information for this physical condition. 11. When a patient is suffering from constipation, the clinician evaluates the etiology and contributing factors. Which of the following diagnoses are being ruled out in these evaluations? Select all that apply. 1. DVT 2. Fecal impaction 3.IBS 4. Botulism toxin 5. Bowel incontinence - 11. Selected answer: 2, 3Page: 35, 37 Feedba ck 1. DVT is a condition that produces unilateral lower extremity swelling and tenderness. 2. Fecal impaction is a differential diagnosis, so it needs to be ruled out. 3. IBS is a differential diagnosis that is being ruled out. 4. Botulism toxin is sometimes used for treatment of conditions arising from symptoms of chest pain, such as esophageal spasms. 5. Fecal or bowel incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. 12. Dizziness is an imprecise word used by patients to describe various subjective conditions. Care must be taken to establish what the patient means by dizziness in order to determine a diagnosis. Which of the following etiologies could be the cause of dizziness? Select all that apply. 76 1. Medications 2.Otolaryngologic conditions 3.Exercise 4.Psychiatric conditions 5.Hypothyroidism - 12. Selected answer: 1, 2, 4Page: 51 Feedba ck 1. Some medications can cause dizziness. 2. Otolaryngologic conditions can result in symptoms of dizziness. 3. Exercise does not usually result in dizziness unless it is associated with other pathologies. 4. Psychiatric conditions can produce symptoms of dizziness. 5. Hypothyroidism (underactive thyroid) is a condition in which the thyroid gland doesn't produce enough of certain important hormones. Signs and symptoms of this condition may include fatigue, increased sensitivity to cold, constipation, dry skin, and weight gain, but not dizziness. 13. Joint pain is a condition that is caused by joint damage or injury that can interfere with movement. From which of the following etiologies may joint pain arise? Select all that apply. 1. Bursitis 2.Muscle spasm 3.Gout 4.Fractured humerus 5.Muscle strain - 13. Selected answer: 1, 3Page: 72 Feedba ck 1. Bursitis is an inflammation of the fluid-field pads called bursa within the joint that can cause joint pain. 2. Muscle spasm is a condition that affects the muscles due to injury and does not necessarily cause joint pain. 77 3. Gout is a form of arthritis that causes joint pain. 4. 80 Feedba ck 1. Pneumonia is a lung infection that can make an individual very sick but does not cause wandering. It often clears up in 2 to 3 weeks. 2. Delirium is a condition that causes extreme confusion and changes in cognition, which can cause wandering. 3. Mood disorder is a mental disorder but does not cause wandering. 4. Dementia is a condition that causes individuals to experience looseness of thought and confusion, which can cause wandering. 5. Vertigo is a sensation of whirling and loss of balance, associated particularly with looking down from a great height, or caused by disease affecting the inner ear or the vestibular nerve. Vertigo does not cause wandering. 1. Mrs. Williams is 76 years old and comes in to have a wound checked on her right leg. She fell a month ago and the wound has not healed. She is concerned that something is wrong. The nurse practitioner examines the wound and sees that it has been cleaned properly and has no signs of infection. The edges are approximated, but the skin around the wound is red and tender to touch. The best response regarding Mrs. Williams' concern is: 1. Wound healing for older people may take up to four times longer than it does for younger people. 2. Let us talk about what you are eating. 3. Had you come in earlier, I would have ordered medicine that would have healed that right up. 4. I will order an antibiotic to prevent infection. - 1. Selected answer: 1 Page: 96 Feedba ck 1. Skin renewal turnover time increases to approximately 87 days in older adults, compared with 20 days during youth. 2. The perceived extended healing time is not related to diet. 3. This is false hope, as there is no medication that will heal this wound quickly. 4. Prophylactic antibiotics are not appropriate when there are no signs or symptoms of infection. 81 2. The nurse practitioner is conducting patient rounds in a long-term care facility. As she talks with Mrs. Jones, she notices that her arms and elbows are excoriated and the skin is shearing. The nurse 82 practitioner explains to the staff that Mrs. Jones needs frequent assessment of her skin and protection provided to prevent skin breakdown because: 1. Her lack of activity causes the skin to tear. 2. Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such as the face, hands, and sacrum. This can result in injury. 3. She has lost weight and is in jeopardy of falling. 4.She picks at herself and causes skin breakdown. - 2. Selected answer: 2Page: 96 Feedba ck 1. Lack of activity alone does not cause skin breakdown. 2. Fat is redistributed to the abdomen and thighs, leaving bony surfaces, such as the face, hands, and sacrum, exposed to potential injury, especially skin tears from shearing, friction forces and pressure ulcer development. 3. Although losing weight may be a risk factor for falling, it is not directly related to skin breakdown. 4. There is no evidence that she is picking at herself, as there is nothing reported anywhere else on her arms. 3. Mr. James is 91 years old. His daughter notices that he has bruises and lacerations on his arms and reports this to the nurse practitioner, who tells her that older people bruise easily due to their fragile blood vessels. The skin lacerations happen because he has thin skin. Even so, the nurse practitioner assures the daughter that she will investigate further to ensure that he is getting proper care. She says this because she understands that: 1. These markings on the patient's skin are part of aging skin. 2.Bruises and lacerations can indicate inadequate care. 3. The daughter needs assurance that her father is okay. 4.The patient is being abused. - 3. Selected answer: 2Page: 97 Feedba ck 1. Markings on the skin may be signs of aging, a disease, or maltreatment. 2. Poorly healing wounds or chronic pressure ulcers may signal a problem not only with the patient but with the caregiver's ability to provide adequate care. Welts, 85 Lesions that warrant biopsy are those that have changed, bleed, or are painful. 4. 86 The ability to put on her ring is not the problem. 6. A 60-year-old male enters the burn center for triage and treatment due to a burn he received at a campfire. His left arm has an area that is erythematous and painful, and another area has a blister. What does the nurse practitioner record as the degree of burn? 1. First degree 2.Second degree 3. First and second degree 4. Second and third degree - 6. Selected answer: 3 Page: 98 Feedba ck 1. First-degree burns involving the epidermis are erythematous and painful but do not blister. 2. Second-degree burns involve the dermis and are characterized by blisters. 3. The patient presents with erythematous skin, painful with blisters, which indicates both first- and second-degree burn areas. 4. In third-degree burns there is no sensation when the wound is pinpricked. 7. The nurse practitioner is concerned with primary prevention strategies. How can the nurse practitioner implement primary prevention strategies for an 80- year-old male patient who smokes? 1. Review home fire safety protocols, including the proper use of smoke alarms, and discuss smoking cessation. 2. Inform him that if he does not stop smoking, the nurse practitioner cannot see him again. 3. Have a conference with his family about his smoking. 4. Plan a family meeting with the patient to discuss benefits of his smoking cessation. - 7. Selected answer: 1Page: 115, 116 Feedba ck 1. Primary prevention includes educational programs designed to educate the public on safety. For example, the individual smoking in bed would hopefully benefit from smoking cessation programs in the community, as well as instruction in safety precautions. 2. 87 Threatening refusal of care is not ethical. 3. The patient is at risk, not the family. 4. 90 Deep dermal burns extend further into the dermis; third-degree burns involve the full dermis, extending into the subcutaneous tissue. 2. In these burns there is pain from exposed nerve endings, but by the second day, pain is often described more as pressure. 3. The first step in treatment is to stop the burn. 4. Destroyed nerves do not register pain. 5. Superficial dermal burns involve the dermis and are characterized by blisters. The underlying tissue is pink, moist, and hypersensitive to touch. 10. Mrs. Thomas is 82 years old and burned her hand while cooking. The nurse practitioner assesses second- and third-degree burns over approximately half of the back of her hand. The nurse practitioner chooses which of the following for initial treatment? Select all that apply. 1. Administer appropriate pain medication. 2.Rinse with cool tap water. 3. Clean with a strong detergent. 4. Remove any loose tissue but allow the blisters to remain. 5.Diagnose as first- and third-degree burns. - 10. Selected answer: 1, 2, 4Page: 100 Feedba ck 1. After administration of appropriate pain medication, wound management can begin. 2. Burn wounds should be immediately doused in cool tap water to disperse any remaining heat in the tissue. 3. Detergents and antibacterial soaps are not indicated. Burn wounds should be cleaned with mild soap and rinsed. 4. For small surface area burns, it is good to remove any loose tissue during cleansing and allow intact blisters to remain. 5. First-degree burns do not exhibit blisters, and third-degree burns do not exhibit pain. 11. Mr. Watson,75 years old, comes to the urgent care center with complaints of fever, fast heartbeat, a swollen gland under his right arm, and redness in his 91 upper left arm that has hurt for 2 to 3 days. The patient says that he has had the redness in his arm for months without any difficulty. The nurse practitioner suspects which of the following? Select all that apply. 92 1. Influenza 2. Upper respiratory infection 3.Cellulitis of upper left arm 4.Necrotizing fasciitis 5.Lymphangitis - 11. Selected answer: 3Page: 103 Feedba ck 1. Influenza is systemic and not localized in any one area. 2. The patient has no respiratory symptoms. 3. Signs of cellulitis include worsening of erythema, edema, tenderness, and pain that has occurred for a few days. Symptoms are usually sudden. Systemic symptoms which indicate serious toxicity include fever, hypotension, and tachycardia. 4. Necrotizing fasciitis exhibits diffuse swelling of an arm or leg with bullae. 5. Systemic symptoms that indicate serious toxicity include fever, hypotension, tachycardia, leucocytosis, lymphadenopathy, and lymphangitis. 12. The treatment for cellulitis includes which of the following? Select all that apply. 1.Patients with mild cellulitis may be given oral antibiotics. 2.One drug of choice is dicloxacillin, 500 mg four times a day. 3.Treatment is dependent on the culture of the cells affected. 4.The drug of choice is given for a minimum of 3 days. 5.Administration of a tetanus booster injection. - 12. Selected answer: 1, 2Page: 103 Feedba ck 1. Oral antibiotics are sufficient for mild cellulitis and IV antibiotics for organisms such as MRSA. 2. There are several drugs effective with cellulitis; dicloxacillin is one of them. 3. 95 but has recently grown. The area around the growth appears inflamed. Why would the nurse practitioner suggest a biopsy? Select all that apply. 1. The growth is elevated and increasing in size. 2.The ear has high exposure to the sun. 3. There is inflammation around the growth. 96 4. The patient is 82 years old and reports having lived in the south of the United States for many years. 5. There is no concern about familial tendencies. - 14. Selected answer: 1, 2, 3, 4Page: 118 Feedba ck 1. Signs of malignancy include elevation; the original lesion may also have enlarged in size. 2. Common locations for skin cancers are the scalp, ears, lower lip, and dorsal side of the hands. 3. Signs of malignancy include inflammation of the lesion. 4. The incidence of all types of skin cancers increases with age and the degree and intensity of sun exposure. 5. Certain genetic predispositions can contribute to the development of skin cancer, and there is a familial tendency to develop melanoma. 15. The nurse practitioner is making patient rounds in a long-term care facility and is visiting Mr. Smith, 95 years old, who has a large amount of fungus growing from his toenails. The staff nurse asks what can be done to help alleviate this nail fungus. What does the nurse practitioner advise? Select all that apply. 1. Wash and completely dry the feet and toes daily. 2.Keep the patient's feet cool and dry. 3.Use aluminum acetate solution (Burow's solution). 4.Have the patient wear occlusive footwear. 5.Use clotrimazole (ointment, cream, or lotion). - 15. Selected answer: 1, 2, 3Page: 123 Feedba ck 1. The key to prevention of recurrence is to keep the area dry. Use a hairdryer to thoroughly dry the area after bathing. 2. The key to prevention of all types is to keep the skin cool and dry. 3. The use of aluminum acetate solution (Burow's) and the application of antifungal or absorbent powder have all been shown to prevent recurrence. 4. 97 Avoiding occlusive footwear, wearing absorbent materials, and practicing good hygiene offer the best primary prevention.