CHAMBERLAIN COLLEGE OF NURSING NR 601 FINAL EXAM –2 VERSIONS QUESTION WITH ANSWERS (LATEST, Exams of Nursing

Download CHAMBERLAIN COLLEGE OF NURSING NR 601 FINAL EXAM –2 VERSIONS QUESTION WITH ANSWERS (LATEST and more Exams Nursing in PDF only on Docsity! P a g e 1 | 22 1 CHAMBERLAIN COLLEGE OF NURSING NR 601 FINAL EXAM –2 VERSIONS QUESTION WITH ANSWERS (LATEST, GRADED A) Version 1 1. Which of the following statements is NOT true about palliative care teams? • A: Provide weekly home visits 2. A 55-year-old women has type 2 DM she had three UTIs in the last 9 months and she is concerned about her kidneys. She has no report of dysuria, frequency or urgency at this time. Which of the following is the best action to follow? • A: Recheck UA dipstick today 3. According to the sexuality presentation, atrophic vaginitis (AV) • A: Is a contributing factor for frequent UTIs 4. Ms. L 55-year-old women with BMI of 28, has 20-year hx of primary HTN and has been on hydrochlorothiazide 25 mg daily for years with excellent response. During follow up visit Mrs L reports that for the last 6 months she has felt thirsty all of the time even though she drinks at least 10 glasses of water a day. Upon chart review the N notes that the last two fasting blood glucose levels have been 136 mg/dl and 165 mg/dl. The NP checks a random blood glucose, which is 210 mg/dl. What is the next appropriate test? • A: Prescribe Metformin 500 mg PO BID 5. A patient has been prescribed Metformin (Glucophage). One week later he returns with lowered blood sugars but complaints of some loose stools during the week. How should the NP respond? • A: Reassure the patient that this is an anticipated side effect 6. A 60-year-old obese male client has type 2 DM and a lipid panel of TC= 250, HDL = 32, LDL= 165. The NP teaches the patient about his modifiable cardiac risk factors which include: • A: Diabetes, obesity, and hyperlipidemia 7. Lifestyle approaches to postmenopausal symptom management include • A: avoiding sugar, coffee, chocolate and alcohol P a g e 2 | 22 2 8. When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed? • A: Amitriptyline 9. How does women’s anatomy make them more susceptible to UTIs? • A: the urethra is shorter P a g e 5 | 22 5 • A: The tremor occurs with purposeful movement 32. Which characteristic of delirium helps to distinguish it from dementia? • A: abrupt or Acute onset 33. According to the sexuality presentation, the biggest barrier to appropriate sexual evaluation in the older patient: • A: Ageist attitudes 34. Mrs. Smith a 65-year-old women presents to the clinic for the first time and c/o UI and dyspareunia, she went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for fibroid. Her mother had a hip fracture at 82, pt had mammogram 5 years ago and no known fam hx of breast cancer……you decide to begin topical hormone replacement therapy. Which of the following evaluations would be necessary prior initiating hormone replacement therapy? • A: Mammogram 35. Mr. A experienced a brief onset of right-sided weakness, slurred speech and confusion yesterday. The symptom has resolved. What should the NP do? • A: identify modifiable cardiovascular risk factors 36. Any women with a complicated cystitis or symptoms of upper tract disease needs a urine culture and • A: sensitivity test 37. All of the following patients have a risk of adverse reaction from Metformin except: • A: patients with BMI >30 38. A middle-aged patient has been diagnosed with Parkinson’s disease. What influences the NP’s decision to begin pharmacological treatment for this patient? • A: symptom interfering with functional ability 39. Which of the following medications can blunt the signs of hypoglycemia in diabetes? • A: beta blockers 40. The Mini-cog is a short screening tool used to assess cognition. Which of the following statements pertaining to the test is a true statement? • A: A score of 0-2 is a positive screen for dementia 41. What is a sign of insulin resistance that can present in African American patients? • A: Acanthosis Nigricans P a g e 6 | 22 6 42. Age related changes in bladder, urethra and ureters include all of the following in older women except: • A: increased estrogen production’s influence on the bladder and ureter 43. The majority of patients enrolled in hospice care die: • A: at home 44. Diabetes is the leading cause of: • A: kidney failure 45. A male pt with a BMI of 30 presents to the office for an annual exam. You ordered a CMP as part of routine labs. The fasting glucose was 130. Your next action is: • A: repeat the fasting glucose 46. A pelvic mass in a postmenopausal woman: • A: highly suspicious of ovarian cancer 47. A 65-year-old Hispanic woman presents to the office for routine follow up for her DM2. Her routine UA results are as follows: few epithelial cells, negative leukocytes, negative nitrates, negative protein, no ketones. Which test would you order next? • A: 24-hour urine for albumin 48. Hospice services and palliative services are underutilized due to: • A: All of the above (Services not well understood, confusion remains over when it is appropriate to consult palliative care, denial of impending death) 49. Which of the following would be an appropriate treatment for a patient with mild BPH? • A: reevaluate symptoms in 1-3 months 50. The most common neurological cause of seizures in an older adult is: • A: stroke 51. A 68-year-old women presents with a c/o urine leakage whenever she sneezes, laughs, or strains for the past 4 months. She denies dysuria, frequency and nocturia. US dipsticks is negative for RBCs, leukocytes esterase, nitrites, ketones and urobilinogen. What is the diagnosis? • A: stress incontinence 52. The tasks of grieving include all of the following EXCEPT: • A: begin to disengage P a g e 7 | 22 7 53. Acanthosis nigrans is associated with all of the following conditions except: • A: tinea versicolor 54. Which of the following statements is true regarding pain? • A: pain is subjective experience related to actual or potential tissue damage 55. A 51-year-old male pt screened for diabetes has a fasting plasma glucose level of 98 mg/dl. The NP plan includes: • A: repeat fasting plasma glucose in 3 years 56. Increased risk factors for erectile dysfunction include all EXCEPT: • A: dominant personality 57. When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinson’s disease? • A: Resting tremor, slow unsteady gait, and cogwheel resistance 58. Which of the following is the most appropriate screening tool for delirium? • A: Confusion Assessment Method 59. An 82-year-old man is seen in the primary care office with complaints of dribbling urine, difficulty starting his stream. Which of the following should be included in the list of differential diagnosis? • A: all of the above (BPH, Parkinson’s disease, prostate cancer) 60. The patient with BPH is seen for follow up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of the side effects? • A: Erectile dysfunction 61. Hospice care differs from palliative care in that: • A: supports patients and families through both the dying and the bereavement process 62. According to the genitourinary presentation, the number 1 risk factor for urinary incontinence is: • A: AGING 63. The firs step in treating delirium is to: • A: identify the cause 64. Which of the listed conditions is most likely to cause delirium? • A: Acute infection P a g e 10 | 22 10 84. The NP is reviewing a patient chart prior to the start of the encounter. The NP notes that the patient is using topical CAPSAICIN. The NP knows that topical capsaicin id often used for treatment of: • A: Diabetic neuropathy 85. Which of the following statements about OA is true? • A: It affects primarily weight bearing joints 86. MJ presents to the clinic with the following hx and presentation: hx of structural damage with current s/s of HF. Treatment will be based on MJs stage of HF which is: • A: Stage C 87. Dietary supplements such as Omega 3 (fish oils) are often taken for cardioprotective benefit. The NP knows regarding Omega 3 consumption: • A: randomized control trials have found no reduction in morbidity or mortality 88. A 55-year-old Caucasian male pt follows up with you after referral to a cardiologist. The pt reports he thinks the medication is causing cough and sometimes he has difficulty breathing, which of the following medication was most likely prescribed? • A: Lisinopril 89. The prevalence of depression in nursing home residents is greater than adults living in the community: • A: 3-4 times 90. The NP orders bilateral wrist Xrays on a 69-year-old gentleman c/o of pain in both wrists for the past 6 weeks not related to any known trauma. The NP suspects elderly onset RA. The initial radiographic finding in a patient with elderly onset RA would be: • A: soft tissue swelling 91. The NP knows that the goal of treatment for anxiety should: • A: reduce symptoms and improve function 92. All of the following statements are true regarding anxiety EXCEPT: • A: is a normal part of aging 93. Which of the following best describes the pain associated with OA? • A: Begins upon arising and after prolonged weight bearing and/or use of the joint 94. Which organism that can be prevented by immunization is most often responsible for infectious outbreak in the nursing home setting? P a g e 1 | 22 • A: Influenza A 95. JK 60 year old women comes to the office today for evaluation of mgmt. plan of her c/o insomnia….. she wakes up after about 4 hrs and cannot return to sleep. The next step in treatment of insomnia is: • A: Zolpidem 5 mg by mouth at hs#7 with no refills 96. You have ordered a CBC for your patient you suspect has PMR. Which two clinical findings are common in pt with PMR? • A: Normochromic, Normocytic anemia and thrombocytosis 97. PG is a 58-year-old Caucasian man with stable mental health diagnosis of schizophrenia who presents for a yearly physical. PG is prescribed aripiprazole for treatment of his schizophrenia. The NP knows the following labs should be ordered to assess for cardiometabolic changes related to his medication EXCEPT: • A: AST/ALT CHAMBERLAIN COLLEGE OF NURSING NR 601 FINAL EXAM 2 – QUESTION WITH ANSWERS (LATEST, GRADED A) 1. A 77-year-old Hispanic Catholic Nun (retired) who immigrated to the United States 15 years ago lives alone but in an apartment complex where her sister lives as well. She is being discharged home after a hospitalization for congestive heart failure with prescriptions for 8 different medications. She is considered at risk for noncompliance due to the following contributing factors except: • Ethnic background 2. A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress. In order to best address the client and family, you should: • Educate the family that this is normal behavior in this situation 3. A 79-year-old female client resides independently in the community. The client’s daughter is concerned because her mother insists on wearing a sweater and keeps all of the windows closed even though it is 90 degrees Fahrenheit outside. The nurse practitioner initially recognizes that this behavior may be related to: P a g e 2 | 22 • age-related neurosensory changes that diminish awareness of temperature changes 4. An 88-year-old, being admitted to rule out lung cancer, is assessed using the short form of the Geriatric Depression Scale tool. When it is determines that the earned score is 9, the nurse practitioner initially: • asks if they have any thoughts of committing suicide 5. The area in which nurse practitioners have the greatest effect on the safe, effective medication therapy of an older client is: • educating the client to all aspects of the medication. 6. The Beers list is an effective tool for healthcare professionals prescribing and/or managing the medication therapy of older adults since it identifies medications that for this population: • have a higher than usual risk for injury 7. A client who reported, “a problem sleeping” shows an understanding of good sleep hygiene when: • limiting the afternoon nap to just 30 minutes 8. Common causes of dyspnea in the older adult may include which of the following? P a g e 5 | 22 • fire mortality is highest in adults older than 65 years of age 27. The nurse practitioner is providing care for an older client who is experiencing mild cognitive impairment. Which communication technique is most likely to bring about a negative outcome? • Asking the family to answer interview questions 28. The nurse practitioner makes the greatest impact on the safe management of an 81- year-old client’s medication administration when included in education is: • a pillbox with compartments for each day and each of the doses 29. The nurse practitioner’s first response when told by a client during an assessment interview that they “can’t take furosemide (Lasix)” is to ask: • "Can you describe what happened when you took Lasix?" 30. The nurse practitioner suspects that a client is experiencing tardive dyskinesia when observing: • the client's facial muscles are twisting involuntarily 31. The nurse suspects that an older adult client is experiencing symptomology seen in herpes zoster when the client • rates the pain as an 8 out of a possible 10 develops clusters of fluid-filled vesicles reports symptoms focused on one side of the body 32. A nurse suspects that her next-door neighbor, an older woman, is a victim of elder abuse by her daughter. What is the appropriate action for the nurse to do in this situation? • Complete a confidential report with the adult protective services in the area. 33. Of the following agents, which is least likely to cause a chronic or recurrent cough? • Gabapentin 34. Of the following risk factors, which is not 35. An older adult client will require extensive rehabilitative therapy after a fall that resulted in several fractures and reconstructive surgeries. Which intervention will have the greatest impact on the individual’s relocation to a rehabilitation facility? • Actively seeking the individual's input regarding the decisions relating to the move 36. An older adult has recently experienced a number of stressful life events. The client comes to the ambulatory clinic and tells the nurse practitioner that, “On top of all I’ve had to endure; now I’ve got this flu!” In rendering care for this client, the nurse practitioner recognizes that: P a g e 6 | 22 • crisis and stressful situations may produce emotions that erode the health of the older people. 37. An older adult is concerned that if her spouse, who recently suffered a stroke, is placed in a nursing home, “they will take everything in order to pay for his care.” What response will the nurse practitioner make? • "A spouse is allowed to keep a percentage of the family income and cash as well as the family home, car, and personal property." 38. An older adult patient with a history of osteoporosis is hospitalized for wrist surgery. Which medication that is currently being prescribed would be most likely to interfere with bone integrity? • heparin 39. An older client diagnosed with dementia resides with his daughter. When the home care nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, “I don’t know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him.” How will the nurse respond to the client’s daughter? • "Let's try to figure out what your father was trying to say with his behavior." 40. An older client prescribed a transdermal morphine patch for severe chronic pain is being educated on the appropriate administration of the medication. The nurse shows an understanding of essential information regarding this route of drug administration when stating: • “Since you have problems with digestion, this is a good way to take your medication." 41. The original intent of Social Security was to: • minimize the dependency of older members on younger members of society. 42. The primary risk for injury experienced by a client diagnosed with asthma is: • infections of the lower respiratory tract 43. Research has shown that long-term care (LTC) facility nursing • is comparable to the complexity and demand of intensive care nursing is a nursing intensive environment crosses the continuum of care 44. Snoring is a symptom of which of the following disorders: • Sleep apnea 45. State Death with Dignity Laws require that the terminally ill client be • educated regarding treatment alternatives. 46. Weight loss is frequently caused by ingestion of the following drugs. P a g e 7 | 22 • Antibiotics Digoxin Nonsteroidal anti-inflammatory drugs (NSAIDs) Theophylline 47. What factor is an important contribution to polypharmacy in older adults? • Inadequate communication among medical care providers 48. What research finding is the basis for care planning of the client receiving palliative care? • Pain management is inadequately addressed among the terminally ill population. 49. When a chronically ill 80-year-old client is admitted to your acute care facility in an unconscious state, the nurse practitioner’s priority is to determine: • who is the client's durable power of attorney for health care (DPAHC). 50. When acting as a fictive kin, in which activity will a paid caregiver engage? • organizing the client's birthday celebration 51. When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse practitioner is confident that client education on the condition’s contributing factors has been effective when the client states: • "I've cut way back on my caffeinated coffee, teas and sodas." 52. When answering an older client’s questions about diet, exercise, and bone integrity, which exercise would the nurse practitioner identify as ineffective at meeting the need for moderately intense aerobic activity? • Yoga for 45 minutes twice a week 53. When assessing an older client for indications of depression, the nurse practitioner bases the intervention on the knowledge that: • The older client's symptoms may be atypical for the disorder 54. When assessing the intellectual abilities of an older adult, the nurse practitioner demonstrates an understanding of a major barrier to reliable testing of this population when: • stating, "Just take your time and try to relax; there are no wrong answers to this test." 55. When caring for an ill adult client, the nurse is particularly concerned that the client communicates well since: • Assessment, planning of care and even the therapeutic relationship is based on effective communication? P a g e 10 | 22 76. Which intervention demonstrates effective care for an individual who has expressed a wish to “retire sometime soon”? • Asking about when they plan to retire Assessing their ability to handle the stresses of retirement Engaging them in a conversation about their interests Inquiring about the existence of any chronic illnesses 77. Which intervention to manage wandering in clients in a long-term care facility should not be implemented? • Using physical restraints to prevent wandering to maintain safety 78. Which is the most likely reason that Type 2 diabetes mellitus is often difficult to diagnose in older adults? • The classic symptoms may not be present in older adults. 79. Which nursing intervention will have the greatest impact on minimizing an older adult’s risk for re-hospitalization within 30 days of discharge? • Evaluation of a cardiac client's comprehension of their prescribed medication therapy 80. Which of the following commonly causes insomnia: • Alcohol consumption Caffeine ingestion Sleep apnea Depression 81. Which of the following does not demonstrate an understanding of the factors affecting physical wellness of the older adult client when: • Asking each client if "they come from a healthy family" 82. Which of the following is the best advice a nurse practitioner can give an older client who is about to move to a new apartment and needs to feel safe about living alone for the first time? • Arrange with the local police to have a home security assessment done and then follow through with their suggestions. 83. Which older adult client has the greatest risk for readmission into the acute care health system and so is the focus of extensive nursing follow-up post discharge? • The client recovering from an exacerbation of congestive heart failure 84. Which older adult meets the criteria for foster care housing? • A cognitively impaired homeless individual diagnosed with congestive heart failure 85. Which option is an example of which type of elder exploitation? P a g e 11 | 22 • A home bound client can only get groceries by agreeing to pay for her neighbor's groceries, too. 86. Which pharmacokinetic/pharmacodynamic parameter is least affected by the aging process? • Absorption 87. Which question will best assess the ability of the LGBT older couple to successfully adjust to the challenges of aging ? • "Have you experienced prejudice and discrimination in your life?" 88. Which reaction to the loss of a spouse or long-term partner is a unique example of older adult male bereavement? • Remarrying within months of the loss 89. Which statement correctly describes normal changes of aging? • Individual variations are enormous at every age and in every part of the body. 90. Which statement made by a nurse regarding a resident of a long-term care facility requires follow up by the nurse manager? • "If he doesn't take his medication, he'll get no dessert tonight." 91. Which statement made by the resident of a long-term care facility is evidence that the facility is providing care in accordance with the Long-Term Care Residents’ Bill of Rights? • "I was told that if I didn't want to change rooms, I didn't have to." 92. Which statement reflects a need for further education on elder abuse? • "Abuse does not happen in people of financial means." 93. Which statements made by a couple who have recently retired support the nurse’s evaluation that the transition to retirement has been a successful one? • "I'm afraid we can't make it that weekend; we'll be visiting the grandchildren." 94. Which truism will the nurse practitioner base spousal grief counseling upon? • Women are generally more likely to outlive their spouses. 95. While the older African-American is at the highest risk for developing Alzheimer’s disease, the nurse practitioner demonstrates an understanding of this disease process’s risk factors when assessing this population’s: • Blood pressure and glucose serum ln 96. A widowed grandmother is about to assume the role of custodial parent for her 6- year-old grandchild. Which intervention has priority • Teaching stress management and relaxation techniques P a g e 12 | 22 97. Your client is cared for at home by his son and daughter-in-law, who are also responsible for the care of their four preschool-aged children. What is true of this “sandwich” generation? • The conflicts that arise from caring for both older adults and children can be very stressful. 98. You suspect that the spouse of a terminally ill client is experiencing anticipatory grief when they: • Dramatically reduce the time they spend attending to the client 99. Of the following risk factors, which is not associated with Alzheimer's disease (AD)? • history of respiratory infections 100 Which diagnosis is associated with the symptom of early morning awakening and poor quality of sleep: • Depression