Advanced Practice Nursing in the Care of Older Adults Ch.1 - 11 3rd Edition Malone Kennedy, Exams of Nursing

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Advanced Practice Nursing in the Care

of Older Adults Ch. 1 - 11 3rd Edition

Malone Kennedy 2024-2025. Questions &

Correct Answers. Graded A

A 59 y/o female was admitted to the hospital for malaise, headache, fever, & flu-like Sxs. She has a decreased appetite & is having trouble sleeping. After a couple of days, she complains to the NP of itching, burning, & tingling pain around her waist. The NP advises the nursing staff to observe for vesicles for a few days. The pt asks why she is so sick. What would be the NP's best response? Select all that apply.

1. We are not certain at this point, however, these symptoms often occur before a break-out of herpes zoster.
2. You have some very general systemic symptoms, so we are waiting for more specific symptoms to appear.
3. Because you had chicken pox as a child, and you now have a depressed immune system, the chance of developing herpes zoster is high.
4. These symptoms are probably a strong case of influenza.
5. Herpes zoster is more common in people 55 years old and older. - ANSAnswer: 1, 3 Feedback

Patients usually experience itching, burning, or tingling pain at the site 4 to 5 days before the eruption appears.

Although there are general systemic symptoms, there is also itching, burning, and pain in the waist, which is leading to a herpes zoster diagnosis.

The patient has initial contact with VZV in the form of chicken pox. Individuals who are immunosuppressed are more likely to develop herpes zoster.

Herpes zoster is characterized by pain along the dermatomes and vesicles, which is not symptomatic of influenza.

This infection is most common in adults over 55 years old. The risk of herpes zoster increases with age. 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 - ANSAnswer: 3 Feedback

First-degree burns involving the epidermis are erythematous and painful but do not blister.

Second-degree burns involve the dermis and are characterized by blisters.

The patient presents with erythematous skin, painful with blisters, which indicates both first- and second-degree burn areas.

In third-degree burns there is no sensation when the wound is pinpricked. A 65-year-old patient is just becoming eligible for Medicare. Which Medicare plan will offer the patient dental care and eyeglasses if they have a premium payment deducted from their social security check?

1. A
2. B
3. C
4. D - ANSAnswer: 3

Medicare A is coverage for hospitalizations and provided to everyone 65 years and older without additional premiums.

Medicare B, medical coverage, is offered as an option and requires an additional premium. Medicare B covers such items as doctor's office visits, medical equipment, laboratory tests, and home health care.

Medicare C, Advantage plans, provide options through private insurance companies and require additional premium payments. Advantage plans cover such items as dental care, eyeglasses, hearing aids, and gym memberships.

Medicare D is the prescription drug plan. It will pay a portion of the patient's prescription drug costs. A 70-year-old man is seeing an APRN because he is feeling weak and dizzy. The APRN is discussing a care plan with him and should make 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. I want to wait to order further tests. Many older adults feel this way, but it may resolve.
5. I will assess you for the presence of other conditions. - ANSAnswer: 1, 2, 3, 5

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 adult. Furthermore, failing to take action at this time risks undertreating the client.
5. There are changes in the sympathetic response that contribute to the orthostasis and falls as well as lack of hypoglycemic response. A 77-year-old is in the acute care hospital setting with exacerbation of chronic obstructive pulmonary disease (COPD) and debility from illness. He is getting ready for discharge to subacute care. Prior to hospitalization he was living alone in his own home without difficulty. The APRN wants him to gain strength before he can return to his own home. Which subacute care setting would be most appropriate for this patient?
6. Home health agency that provides therapy
7. Outpatient rehabilitation
8. Short-term rehabilitation in a skilled nursing facility
9. Nursing home - ANSAnswer: 3

Returning home with therapy is not the best option because the patient is debilitated and lives alone.

The patient is debilitated after an acute illness and hospital stay. Outpatient therapy requires transportation to and from a facility and is not the best option.

Recovery, strengthening, and therapy in a skilled nursing rehabilitation facility is the best option because the patient lives alone and will need to care for himself when he returns home. The ultimate goal is for continuity and a return to the baseline function and living situation.

The patient does not need custodial care in a skilled nursing facility. A family member comes into the clinician's office with her mother, who is of an advanced age. In the process of the examination, the APRN identifies the patient as "frail." The family member asks what that means. The APRN 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 susceptible to infections - ANSAnswer: 2

Frailty is not defined by only one symptom.

Frailty, or signs of declining health, can occur at any age.

Frailty is not related to the size of the patient.

Infections can be treated at any age. A gerontological patient is being examined for a report of pain in the shoulder. The APRN completes a thorough systemic examination because:

1. Older adults with one morbidity often express difficulties in general.
2. Arthritis of the shoulders can be accompanied by other neurological symptoms.
3. Older adults with arthritis often experience pain in the lower extremities.
4. The older adult may not report significant signs and symptoms. - ANS1. Older adults with one morbidity often express difficulties in general.
5. Older patients with late-onset RA 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.
6. Older adults may express symptoms in any other physical systems.
7. Patients more often experience arthritis in smaller joints.
8. A thorough examination will detect objective indicators. A health promotion topic that should be included in the APRN visit is physical activity. Which of the following would be a good recommendation for the 75-year-old male?
9. Team sports

2. Horseback riding
3. Walking
4. Aerobics - ANS3. Walking

Team sports could be risky for an older person who may be more susceptible to falls or orthopedic issues.

Horseback riding could be risky for an older person who may have neurological or orthopedic issues.

Walking is a good option for the older adult to perform When recommending physical activity, the person's functional abilities and desires need to be considered.

Aerobics may be too aggressive of an exercise for an older person. A major concern for older adults is safety. The APRN addresses safety issues for the older adult when assessing which of the following? Select all that apply.

1. Presence of a gun in the home
2. Falling
3. Strength of the patient
4. Food intake
5. Urinary incontinence - ANSAnswer: 1, 2, 3, 5

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.

Falls are the second cause of unintended injury deaths, but older adults can be embarrassed by falling. To combat this, the APRN needs to be proactive in asking about falls.

Potential recommendations include exercise programs to build strength.

Food intake has to do with nutritional status rather than safety.

Urinary incontinence, day or night, can cause the person to rush to the bathroom and increases the risk of falling. A patient asks the advanced practice registered nurse (APRN) what is meant by health promotion. The best answer regarding health promotion is:

1. It includes activities that an individual performs proactively to increase health and well-being.
2. It is a process of keeping track of immunizations.
3. It includes a set of programs that help people cope with the disease.
4. It includes strategies that prolong life. - ANS1. It includes activities that an individual performs proactively to increase health and well-being.

*Health promotion includes not only preventive and health-protective measures but also taking control of one's health. A patient comes into the emergency department complaining of itchy, burning, scaling, and redness to their eyes. Symptoms have been going on for some time and are affecting vision. The APRN diagnoses blepharitis. Which of the following should the patient be educated on regarding treatment? Select all that apply.

1. Use Visine eye drops for redness.
2. Cleanse the eyelids once per day with diluted baby shampoo.
3. Apply a warm compress to the eye once a day.
4. Long-term application of topical ophthalmic antibacterial is recommended.
5. Oral tetracycline should be taken as ordered. - ANSAnswer: 2, 3, 5 Feedback

Artificial tears can be used for dry eye, but because Visine contains preservatives, it can only be used up to four times a day.

Treatment of blepharitis includes washing the eyelid with diluted baby shampoo once a day.

Treatment of blepharitis includes applying a warm compress once a day.

Topical antibiotics are recommended for intermittent use to avoid microbial resistance. 5, Oral tetracycline may be prescribed. A patient comes to the health-care provider office for a check-up. The advanced practice registered nurse (APRN) notes that the patient is 67 years old and is presenting with symptoms of dizziness, orthopnea, and edema. The APRN begins a focused assessment of the:

1. Cardiovascular system
2. Respiratory system
3. Neurological system
4. Reproductive system - ANSAnswer: 1 Feedback

Key symptoms of cardiovascular assessment include dizziness, syncope, orthopnea, angina, palpitations, edema, and shortness of breath.

Edema is not commonly found in respiratory conditions.

Dizziness is a symptom in various conditions besides neurological conditions.

Dizziness, orthopnea, and edema have no direct connection with the reproductive system. 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 - ANSAnswer: 3 Feedback

Lice may cause itching in the scalp but is generally localized.

Scabies may cause itching of the skin but is generally localized.

Pruritus is an unpleasant, irritating, or itching sensation on the surface of the skin that may lead to a desire to scratch. Inflammation results from activation of the immune response.

Lichenification is the result of continued scratching and causes thickening of the skin.

A patient is admitted to the intensive care unit (ICU) setting after a stroke. The patient subsequently has left-sided hemiparesis and has failed a cookie swallow. It is clear that enteral nutrition will be started. Which of the following are true statements regarding enteral nutrition for this patient? Select all that apply.

1. Enteral nutrition is used as a long-term supplementation even if the patient can begin to meet nutritional needs orally.
2. Enteral nutrition should be given through a nasogastric tube.
3. Enteral nutrition should be provided when it is unsafe to take in nutrition orally.
4. Enteral nutrition should be started within 24 to 48 hours after a patient is deemed a risk for nutritional deficit.
5. Enteral nutrition should be given via a PEG tube if parenteral nutrition is needed for less than 4 weeks. - ANSAnswers 3, 4

Enteral nutrition is not used as a supplement when the patient can eat orally. It is used when a patient cannot meet nutritional needs orally.

Long-term enteral nutrition is given via PEG tube. A nasogastric tube can be used for 4 weeks then, if a patient cannot take in nutrients orally, a PEG tube is placed for long-term use.

The patient failed the cookie swallow, so it is unsafe to take in oral nutrition. A PEG tube should be placed.

Enteral nutrition should be initiated within 24 to 48 hours in patients who are unable to maintain nutrition themselves.

Long-term enteral nutrition is given via PEG tube. A nasogastric tube can be used for 4 weeks then, if a patient cannot take in nutrients orally, a PEG tube is placed. A patient presents to the advanced practice registered nurse (APRN) with complaints of not seeing well at night due to an extreme glare. The patient is worried there is something very wrong. The APRN refers the patient to an ophthalmologist who states the patient has intraocular inflammation. Which of the following is a contributing factor for the symptoms and for intraocular pressure?

1. Diabetes mellitus
2. Cardiovascular disease
3. Use of NSAIDs
4. Wearing sunglasses - ANSAnswer: 2 Feedback

Diabetes is not a contributing factor for macular degeneration.

Cardiovascular disease, family history, smoking, exposure to sunlight, nutritional deficits, and hyperlipidemia are contributing factors to macular degeneration.

Use of NSAIDs is not a contributing factor.

Wearing sunglasses is protective to the eyes and is not a contributing factor. A patient presents to the office feeling tired and hopeless. Their BMI is 30. What other diagnostic tests related to obesity would be appropriate for this patient?

1. Thyroid-stimulating hormone (TSH)
2. CBC
3. 24-hour urine collection
4. Alanine transaminase (ALT) - ANSAnswer: 1

A TSH level should be drawn to rule out hypothyroidism in the obese patient. A fasting blood sugar and a lipid panel can also detect metabolic syndrome.

A CBC would not differentiate a cause of overnutrition.

A 24-hour urine would not differentiate a cause of overnutrition.

ALT shows liver function and would not differentiate a cause for overnutrition. A patient with renal disease has blood work drawn, and the results show an increase in serum creatinine. Which of the following laboratory values does the advanced practice registered nurse (APRN) need to know before ordering medications?

1. Complete blood count
2. Culture and sensitivity of the urine
3. Creatinine clearance
4. Uric acid levels - ANS3. Creatinine clearance *The calculation of creatinine clearance provides an estimation of renal function. Adam, 70 years old, is admitted for possible myasthenia gravis (MG). The APRN 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, as he is older and this is a "young person's disease." Which responses from the APRN are best? Select all that apply.
5. We need to assess for anything, just in case.

2. Some diseases show up in two different age and gender groups.
3. Depending on your age, MG may present with different symptoms.
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. - ANSAnswer: 2, 3
6. Ordering more tests than needed violates the principle of "Do no harm."
7. Myasthenia gravis (MG) is bimodal and can be found in younger women as well as in older men and women.
8. Knowledge of the bimodality of age of onset of certain disease conditions as well as the differences in presentations of disease will aid the APRN in avoiding misdiagnosis or delay in diagnosis due to lack of recognition.
9. There should be a need for ordering a test and value attributed to the results.
10. The manifestations of illness and disease in the older adult can be very different even if the underlying pathological process is the same as in younger individuals. After examining Adam, 79 years old, the APRN uses which of the following criteria to adjust Adam's medications? Select all that apply.
11. Beers Criteria
12. Medication Appropriateness Index
13. STOPP/START criteria

4. U.S. Department of Health and Human Services (HHS) Guide to Geriatric Medications
5. Hospital formulary - ANSAnswer: 1, 2, 3

The Beers Criteria was revised in 2015. Other criteria were also developed to address weaknesses found in the original Beers Criteria.

The Medications Appropriateness Index was developed to address some of the weak areas of the Beers Criteria.

The STOPP/START criteria was developed to determine when medications should be added and when another might be discontinued for an older patient.

The HHS does not guide in medication prescribing.

The hospital formulary provides a list of medications carried within that hospital. Albert is 72 years old and complains of burning upon urination. He has recently returned from a vacation to another country. The APRN conducts a physical examination and observes that there is a white discharge from his penis. What does the APRN 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
3. Assuring the patient that while traveling there are limited opportunities for sexual encounters
4. Explaining possible medication side effects to the patient - ANSAnswer: 1, 2, 3

Safe sex education is important because older adults are less likely to practice safe sex and use condoms.

Older people may be at increased danger from sexually transmitted infections because of the decreased perception of risk.

Current sexual history may determine the need for continued screening for STIs, human papillomavirus (HPV), and cervical cancer.

Traveling does not limit potential sexual encounters with fellow travelers, locals, or commercial sex workers.

While medication education is important, this patient's symptoms and circumstances indicate teaching on sexual health is required.

An 80-year-old female has an appointment at the clinic. She reports that she sometimes has trouble swallowing. There are no abnormalities found on a physical examination, however, the patient reports she takes Benadryl at night to sleep. The advanced practice registered nurse (APRN) understands that anticholinergics coupled with what age-related physiological change can cause dysphagia?

1. Decreased taste
2. Decreased hydrochloric acid
3. Decreased amount and function of teeth
4. Decreased saliva - ANSAnswer: 4

Decreased taste and smell are normal physiological changes of aging. They can cause loss of appetite that could lead to malnutrition.

Decreased hydrochloric acid is a normal physiological change with aging. It can affect the ability to absorb micronutrients.

Older adults' teeth lose enamel and become decayed and loose. This affects the ability to chew foods.

Loss of saliva production coupled with anticholinergics can make formation of a food bolus difficult and increase the risk of dysphasia.

An 89-year-old female presents to the emergency department with epigastric pain that has been ongoing for about 2 hours and fatigue. The patient states she is not becoming dyspneic and the pain is radiating to her arms and neck. The APRN suspects ischemic heart disease and angina. Which of the following would be recommended treatments for this patient to prevent a myocardial infarction (MI)? Select all that apply.

1. Avoidance of exercise
2. Aspirin therapy of 75 to 162 mg daily
3. Calcium channel blocker therapy to prevent angina
4. Dipyridamole therapy
5. Antihypertensive therapy to keep blood pressure less than 140/90 mm Hg - ANSAnswer: 2, 3, 5 Feedback

Physical activity is recommended at 30 to 60 minutes 5 days a week at moderate-intensity aerobic type. Other lifestyle modifications such as diet, smoking cessation, and weight management are also recommended to prevent an MI.

Antiplatelet therapy with aspirin at 75 to 162 mg is recommended to prevent an MI.

Anti-ischemic medications are recommended such as calcium channel blockers or sublingual nitroglycerin.

Dipyridamole is not recommended.

Blood pressure management is recommended to prevent MI after an anginal event. Blood pressure should be maintained under 140/90 mm Hg. An APRN is seeing a patient who lives in an independent living facility. The patient requires assistance with her complicated medication regimen. Recently, the patient has had some weakness and a few falls. The APRN wants the patient to have therapy to regain strength and improve safety. Which care services and setting would be appropriate for this patient?

1. Short-term rehabilitation with a home health agency
2. Assisted living
3. Long-term care in a nursing home
4. Short-term rehabilitation in a skilled using facility - ANSAnswer: 1

The best choice for therapy for this patient is short-term rehabilitation by a home care agency in the patient's independent living facility. This will provide continuity and build strength and safety. If care needs change, then a different level of care may be needed.

There is no need for the patient to move to assisted living for therapy. Therapy can be done in her independent living facility to help with strength and safety.

There is no indication that the patient cannot live alone and would require skilled care for therapy in a long-term care facility.

The patient would not qualify for rehabilitation in a skilled nursing facility because she did not have an injury and her needs do not warrant hospitalization or a change in level of care. An APRN is working as an acute care provider in a hospital setting. An older adult arrives who has multiple chronic conditions and is a new patient for the APRN. What is necessary to provide in the care of this acute patient to improve outcomes?

1. Refer to the physician because the patient has multiple conditions.
2. Provide a shortened assessment for timely treatment.
3. Communicate with a family member only because dementia is more prevalent in older adults.
4. Understand atypical presentations for accurate diagnosis and treatments. - ANSAnswer: 4

The APRN can make referrals to specialists.

Chronic conditions often have baseline symptomology and require providers to spend more time on assessment.

It cannot be assumed that every older adult has dementia, and the APRN should always communicate with the patient and involve family when necessary.

Older adults may present with problems in uncommon ways. Providers should know atypical presentations of common conditions in older adults. An older adult couple is discussing health concerns with the APRN. The couple is concerned that each of their individual blood studies show different results. One set of test results shows a significant decrease in blood sugar, but the test results of the partner do not show an equal decrease. Their physician does not seem concerned, and the couple is wondering why. How is it best for the APRN 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.

• ANSAnswer: 1, 4

1. Reference ranges are used in laboratory value interpretation, so some individuals may experience smaller variations in lab work than others in the same age group.
2. There are wider variations of laboratory results within a group of older adults.
3. Lab values are determined by more than age and gender.
4. Lab values may vary as a result of physiological changes with aging, prevalence of chronic disease, changes in nutritional and fluid intake, lifestyle, and current medications.
5. The reference values presented for the older adult cohort are not necessarily correct for the individual due to biochemical individuality. An older adult patient presents with a systolic blood pressure of 150 mm Hg and diastolic blood pressure of 80 mm Hg. Which statement is correct regarding the blood pressure reading?
6. It is normal for the patient's age.
7. Isolated hypertension is usually identified by a systolic blood pressure higher than 160 mm Hg.
8. When evaluating blood pressure, a higher diastolic blood pressure is risky.
9. There is a risk of a cardiovascular event with a systolic blood pressure of 150 mm Hg. - ANSAnswer: 2 Feedback