Caring for Older Adults: Addressing Common Health Concerns, Exams of Nursing

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NURS 601 APPB Assessment Review Exam with

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There are well described racial and socioeconomic disparities in diagnosis, the following populations have the higher incidence and lower survival - Correct Answer black and hispanic older adults in general A 72 yo female has residual effects from a stroke that includes memory loss and apathy. Which intervention can best improve the brain's functional reserve? - Correct Answer decrease overstimulating the patient to avoid agitation Which of the following considerations is necessary for the NP who is evaluating the effectiveness of a prescribed opioid for an elderly patient with chronic, debilitating pain? - Correct Answer All of the above The NP is providing chronic management for a 74-year-old male with longstanding COPD. He presents to the primary care office with increased shortness of breath to the point that he is unable to walk to the mailbox or send a flight of stairs in his home. He reports that he still smokes 1/4 pack of cigarettes per day. He tells the NP I guess I'm just getting too old to do normal things anymore. The NP recognizes that the decline in the patient's physical function is due to: - Correct Answer disease- related disability The physiologic eye changes that occur in adults between the ages of 42 to 50 years of age that indicate the new reading glasses are due to - Correct Answer reduced lens elasticity -year-old male reports to the primary care office with a complaint of feeling down since the death of his spouse eight months ago. He has suppressed his depression through the use of alcohol. His medical history includes gerd, atrial fibrillation, and chronic back pain. His medications include: Cyclobenzaprine 10 milligrams as needed for pain, warfarin 5 milligrams daily, pantoprazole 40 milligrams daily, lisinopril 10 milligrams daily, Flomax 0.4 milligrams daily, multivitamin daily, vitamin C 500 milligrams daily, and vitamin D 1000 IU daily. The MP decides to perform the cage assessment to determine the patient's extent of alcohol dependency and obtains a score of three which signifies alcohol use disorder. The NP also performs a medication review and identifies that some of his medications metabolic effects are altered by alcohol. Which of the medications should be of concern for the NP? - Correct Answer Cyclobenzaprine (Amrix), Warfarin, and Pantoprazole (Protonix) A 68-year-old female presents to the primary care office as a new patient who recently located from Florida. The patient reports a past medical history of vitamin B12 deficiency, hypertension, hyperlipidemia, and gerd. The patient reports that one

year ago she was seen by gastroenterologist for gerd symptoms where she was prescribed omeprazole 40 milligrams daily. She reports that after being on the omeprazole for two months she stopped having guard symptoms. Therefore an endoscopy was not indicated. Despite having no symptoms she continued to take omeprazole because she did not want her symptoms to return. She also reports that diet modification has also helped him reduce and gerd symptoms. The MP determines that omeprazole should be prescribed. The best prescribing method for this patient is - Correct Answer Reducing the omeprazole from 40 mg to 20 mg To ensure the older adults correct use of prescribed metered dose inhalers that NP should - Correct Answer Recommend a spacer device A 64 year old homeless female reports to the primary care clinic with shortness of breath. Approximately one week the patient presented to the emergency room with mild sternal chest pain. A cardiac workup revealed no abnormalities And the patient was released. Today the patient reports that her breathlessness is worse. The pmh includes hypertension, hyperlipidemia, atherosclerotic heart disease. The patient is also pack year smoker. Other than seeking medical care at the ER last week the patient has not seen a health care provider in five years period based on the patient's age and condition what immunizations are most important for the MP to administer today? - Correct Answer Influenza, Prevnar- A 65 year old male patient is a 36 pack year smoker who is seeing the MP today for smoking cessation intervention. The MPP plans to use the 5 A's in planning interventions for this patient. In addition to prescribing a nicotine patch the patient has also agreed to participate in intensive cessation counseling covered by Medicare. When the NP scheduled future follow up visit for the patient which 5A is being utilized? - Correct Answer Arrange The NP has diagnosed a 62-year-old female with Graves' disease. What lab value below was used to diagnose? - Correct Answer Decreased TSH level The NP is reviewing a 68-year-old males 2 fasting plasma glucose levels completed on separate occasions. Diagnosing type 2 diabetes both plasma glucose levels must be greater than - Correct Answer 126 mg/dL An older adult with type 2 diabetes presents to the primary care clinic with a report of polyurea, polydipsia, and loss. Which of the following lab results requires immediate intervention by the NP? - Correct Answer Serum glucose of 65 mg/dL Mr. Gonzalez a 65-year-old patient with type 2 diabetes reported to the primary care office with complaints of weakness, fatigue, and diaphoresis. A review of the patient's blood sugars over the last seven days demonstrates 2 sugars of 58 mg/DL and 56 MG/ DL respectively period to narrow the differential diagnosis what should the NP do first? - Correct Answer Determine if the hypoglycemia is related to alcohol

Clinical findings in a patient with hypothyroidism includes: - Correct Answer facial and eyelid edema When prescribing oral medications for an overweight patient with type 2 diabetes who also has a voracious appetite, the MP is likely to prescribe which medication to encourage weight loss? - Correct Answer Exenatide (Byetta) Glargine (Lantus) is an insulin analog that essentially has no peak and is usually administered: - Correct Answer once daily Patient started on metformin (glucophage) need to be monitored closely for which potential side effect? - Correct Answer Lactic acidosis The NP is seeing a 64-year-old obese female for a follow up visit. She was diagnosed with type 2 diabetes three months ago and started on a regimen of diet and exercise. Today her fasting plasma glucose is 200 MG/ DL and A1C is 10%. She has lost two pounds. She reports that her home glucose monitoring has ranged from 180-300 MG/ DL. The rest of the chemistry profile is within normal limits. What is the best treatment choice for this patient? - Correct Answer initiate treatment with metformin (glucophage) An older adult male has recently been started on insulin. His regiment is two daily injections with two daily insulin in the morning and 1/3 in the evening. He is using the 70/30 make sure intermediate insulin in both injections. He presents for a follow up visit with his fasting blood sugar log. The NP recorded glucose level before the evening meal has been 6070 MG/dL. Other checks during the day MG/dl. What adjustments need to be made? - Correct Answer Regular insulin: change 70/ combo to self mix and reduce AM regular dose A patient is diagnosed with hypothyroidism and is placed on levothyroxine 100 MCG daily. What should the NP's approach to follow up? - Correct Answer The patient should return to the clinic withinn 4-6 wks for TSH measurement and determination of any improvements in the symptoms In caring for older adults with respiratory disease, the NP recognizes that there are age-related changes in pulmonary function. When older adults present with chronic rhino sinus drainage and post nasal drip the NP relates this to which of the following physiologic change in the respiratory system? - Correct Answer Narrowed decreased collagen A 60-year-old male patient presents with severe comorbidities that include history of MI, hypertension, type 2 diabetes, and obesity. He reports feeling like his heart is skipping beats. He is also experiencing dyspnea at rest and on exertion that is associated with fatigue. He also reports two falls over the last month period on exam

the NP notes and irregular rhythm. Which of the following conditions should be included as a differential diagnosis? - Correct Answer Atrial fibrillation A 69 year old male presents to the primary care clinic for follow up for the treatment of afib. As the NP plans to prescribe an anticoagulant at today's visit she is aware that the patient has a history of moderate mitral valve stenosis. Which anticoagulant is recommended for this patient? - Correct Answer Warfarin (Coumadin) In older adults hypertension may be linked to functional issues that impact their quality of life. What may impact the quality of life of an older hypertensive individual?

- Correct Answer All choices are correct Which of the following is not true regarding the low rates of successful treatment for hypertension in older adults? - Correct Answer Among persons greater than or equal to 60 years of age, at least 70% will have their blood pressure under control As people age, what abnormal parameter is the best predictor of heart disease? - Correct Answer widening pulse pressure According to ACC/AHRA guidelines for maintaining hypertension when should treatment be initiated for adults greater than or equal to 65 years of age? - Correct Answer When the average SBP is greater than 130 mmHg A 62-year-old male patient is diagnosed with uncomplicated hypertension. According to JNC-8 guidelines what classifications are recommended for first line treatment in this age group? - Correct Answer Calcium channel blocker and diuretic The NP is performing a medication review on a new patient who presents with hypertension. The patient is taking the following medications Aleve, Suphedrine, methylphenidate. Which one should be eliminated based on its blood pressure rising effects? - Correct Answer All choices ar correct DM. Because of relocating to a new town he has been without his antihypertensive medication for six months and reports that up to now he was not aware that he had diabetes and therefore has never taken treatment for it. Based on his age his hypertension and new diagnosis of T2DM the MP should choose antihypertensive medications from which of the following classifications? - Correct Answer All of the above A 70-year-old female with atrial fibrillation has an associated rapid ventricular response (AF RVR). The NP recognizes that the long-term management of heart rate can prevent morbidity from afib RVR. What medication should the NP prescribe for a long-term management of heart rate in afib RVR? - Correct Answer Diltiazem

The NP is performing a cardiac exam on an 80-year-old patient with heart failure and here's an S4 gallop. The MP recognizes that this heart sound may be common in older adults with heart failure due to: - Correct Answer stiffness of the left ventricle The NP identifies an elevated NT-proBNP and a 78-year-old female patient. Before making a diagnosis of heart failure what important factors should be considered as a reason for the elevated value? - Correct Answer The value may be elevated in older patients who have renal disease After a trial of lifestyle modification, a 72 year old male has a blood pressure of 150/

90. What do you do next? - Correct Answer Prescribe the patient an antihypertensive drug in addition to lifestyle modifications A 65-year-old male is a new patient that presents to the primary care office with increasing dyspnea and a productive cough that started four days ago. The cough has been on and off for the last six months. He reports smoking one pack of cigarettes per day since age of 25, but recently cut back to 1/2 pack per day. One assessment the MP observes the patients increased effort to breathe. On exam and P notes the presence of wheezing and rock eye. Due to the patient's increased breathing effort smoking history and chronic cough the emphasis effect COPD. To confirm the diagnosis what should the NP order first? - Correct Answer Spirometry to classify airway obstruction Which of the following spirometry classifications indicate a moderate airflow obstruction according to the GC guidelines? - Correct Answer 50% _< FEVI < 80% predicted The treatment of COPD is based on the patient's clinical symptoms and the number of recent exacerbations that may or may not lead to hospitalization. According to the gold guidelines, the recommended treatment for a patient who has had zero or one moderate exacerbations requiring no hospitalization and an MRC 0-1, CAT <10 is? - Correct Answer A bronchodilator The treatment of COPD is guided by: - Correct Answer All the above The FeV1/FVC ratio for a patient with a restrictive lung disorder indicates: - Correct Answer Asthma A 60-year-old male presents with dyspnea, nonproductive cough, inspiratory rails and clubbing interstitial lung disease. Which of the following diagnostic findings would support a diagnosis? - Correct Answer High resolution CT scan shows honeycombing The benefit of the six-minute walk test is that it can help the NP determine: - Correct Answer The patient's supplemental oxygen needs on exertion

There are well described racial and socioeconomic disparities in diagnosing lung cancer, treatment of the following populations has the higher incidence and lower survival rates of lung cancer? - Correct Answer Black and Hispanic older adults in general For older adults with early-stage non-small cell lung cancer what is the appropriate treatment for those who are strong candidates? - Correct Answer Lung resection They knew Beutler and Warren criteria provides hemoglobin thresholds to define anemia in adults aged 60 and above as: - Correct Answer All of the above The NP has determined that a 72-year-old female patient that she has been following for the last four years for anemia evaluation. Which clinical data below guided the NP's decision? - Correct Answer A 1 g/dL decrease in Hgb in less than 5 years The NP has diagnosed iron deficiency anemia in her 66-year-old male patient. To establish the ideology of the ID a comma what is the next action by the NP? - Correct Answer Order fecal guaiac tests and endoscopy The NP is challenged to determine if her 70 year old patients anemia is due to iron deficiency anemia or anemia of chronic inflammation. Because the patient has advanced cancer and a ferritin level of less than 30 to 50 ng it is reasonable for the NP to: - Correct Answer Treat the patient for iron deficiency anemia The NP identifies thrombocytopenia, neutropenia, and abnormal peripheral blood smear that is unexplained. What is the NP's next action? - Correct Answer Refer the patient to a hematologist/oncologist for bone marrow examination Chemotherapy related toxicity may occur in older adults. Nearly all antineoplastics cause: - Correct Answer Anemia and fatigue Which of the following patients will benefit most from a geriatric assessment as part of determining the best treatment of cancer? - Correct Answer A 72 year old female with lung cancer Which of the following are exam findings for osteoporosis? - Correct Answer All the above When performing an assessment, the NP recognizes that the metacarpophalangeal Joints are frequently involved with? - Correct Answer Rheumatoid arthritis (RA) The NP is examining a 64-year-old patient who is complaining of pain in her hips and knees. She has a history of osteoarthritis. On exam the joints are painful to movement and are warm to touch. The best immediate therapy for this patient is? - Correct Answer Physical therapy for range of motion of affected areas

Which of the following patients is most at risk for developing osteoporosis and bone fracture? - Correct Answer All of the above Which of the following is an interesting factor that alters skin integrity? - Correct Answer Diabetes The national pressure ulcer advisory panel recognizes that in older adults some pressure injuries are unavoidable while other pressure injuries may be due to illness. What differential diagnosis does the panel recommend for those patients who have an illness that has caused poor tissue perfusion resulting in low tissue tolerance to any pressure? - Correct Answer Arterial insufficiency A patient with COPD smokes one pack of cigarettes daily. In approaching the patient about smoking cessation, the NP recognizes that: - Correct Answer Smoking cessation counseling should be done at every clinic visit A 73-year-old patient has hearing loss. Which strategy would be most appropriate for the NP to implement during a health promotion session? - Correct Answer Speak in a tone that does not include shouting The NP is managing a 68-year-old woman who is complaining of Constipation. What concern does the NP recognize regarding her nutritional status? - Correct Answer Absorption of nutrients may be impaired A patient with severe COPD says he experiences fatigue and dyspnea with activity. In determining his activity, the NP understands that: - Correct Answer Pulmonary rehabilitation has been shown to improve functional exercise capacity and quality of life The NP is taking the history of a healthy 70-year-old man and determines the patient is an avid gardener and spends much of his time enjoying outdoor activities. A health maintenance recommendation for this patient is to obtain a: - Correct Answer Pneumococcal vaccine At which patient's age should the NP recommend an older adult obtain the pneumococcal vaccination? - Correct Answer 65 years of age or older The dietitian has recommended a textured modified diet for an 87-year-old patient who is having pain upon chewing. What will this type of diet include? - Correct Answer All of the above The NP is discussing making lifestyle changes that will decrease the older adults risk for cardiovascular disease. Which of the following is most important to include in this discussion? - Correct Answer Control HTN, stop smoking, maintain normal weight, and exercise regularly

The NP is reviewing a 72-year-old patient's history in the clinical setting. Which finding requires a priority action of health promotion and maintenance? - Correct Answer Patient is not current for flu vaccine An effective treatment that produces less side effects for Constipation associated fecal incontinence for older adults who reside in long term care facilities is: - Correct Answer Dietary modification It is important for the NP to consider mealtime and environmental issues that may be present in the older adult who has dementia what important teaching should be provided to family members who are caring for the patient with dementia? - Correct Answer Check for pocketing of foods during mealtime Conservative treatment is often recommended for older adults with fecal incontinence. Which of the following are considered to be a conservative treatment?

- Correct Answer All of the above What would be the best bulking agent to prescribe for treating Constipation in the older adult? - Correct Answer Psyllium (metamucil) A 94-year-old male nursing home resident exhibits fecal incontinence. He now wears adult diapers 24 hours a day, he is bedridden, and cannot use a bedside commode or ambulate to the bathroom even with assistance. Which of the following is the most common type of fecal incontinence in this patient? - Correct Answer Overflow incontinence Which of the following medications may prevent cancer of the upper airways in smokers? - Correct Answer Retinoids For men who are 70 years of age and older with a 2 what would be a reasonable approach at this time?????? - Correct Answer Close observation Which of the following symptom is excluded from the definition of fecal incontinence by the international continent society? - Correct Answer Flatal incontinence Older adults are likely to experience severe bone marrow suppression during chemotherapy. What does the NCCN and SIOG guidelines recommend for routine prevention of neutropenia? - Correct Answer Pegfilgrastim