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Common Medical Conditions and Presentations in Older Adults, Exams of Nursing

A wide range of medical conditions and presentations commonly seen in older adult patients. It addresses topics such as noninfectious epididymitis, prostate-specific antigen (psa) levels, breast masses, inguinal hernias, hypertension, heart murmurs, dementia, parkinson's disease, osteoporosis, osteoarthritis, eating disorders, alcohol abuse, sexual maturation, congenital heart disease, otitis media, neurofibromatosis, club foot, scarlet fever, sickle cell anemia, hypertension in adolescents, diabetes management in older adults, fall risk assessment, copd, cataracts, and elder abuse. Information on symptoms, diagnostic tests, and management strategies for these conditions, making it a valuable resource for healthcare professionals working with older adult patients.

Typology: Exams

2024/2025

Available from 09/21/2024

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Download Common Medical Conditions and Presentations in Older Adults and more Exams Nursing in PDF only on Docsity! APEA PREDICTOR EXAM ACTUAL EXAM QUESTIONS AND DETAILED CORRECT ANSWERS | A+ GRADE 2025 NEWEST A patient has a TSH value of 13.1. Today the NP has decided to initiate replacement with levothyroxine 88mcg daily. When should the NP recheck the patient's TSH level? a. Two weeks b. 4 weeks c. Six weeks d. 8 weeks Correct Answer C A 30-year old female patient who complains of fatigue undergoes a screening TSH. Her TSH 8 M LU/L. What should be done next? a. Begin thyroid supplementation b. Repeat the TSH and add T4 c. Begin supplementation and repeat the TSH in 4-6 weeks d. Measure the T4 and consider repeating the test in a month Correct Answer B A 65-year old person with diabetes has been on oral antihyperglycemic agents and is still having poor glycemic control. His AM fasting glucose range from 140 to 160. You decide to add insulin. He weighs 127kg. What should the NP order as an initial starting dose. a. 10 units of long acting insulin at bedtime b. 30 units of long-acting insulin before breakfast c. 5 units of intermediate insulin at bedtime d. 20 units of short-acting insulin at breakfast Correct Answer A The most appropriate time to begin screening for renal nephropathy in a patient with type 1 diabetes is: a. At diagnosis b. Once annually after diagnosis, two to three years after diagnosis c. Two to three years after diagnosis d. Five years after diagnosis Correct Answer D A 52-year old person presents with thirst and frequent urination today. His glucose is 352. How should this be managed today? a. Have him return tomorrow to recheck his blood glucose b. Start metformin c. Start insulin d. Start metformin plus pioglitazone Correct Answer B A nurse practitioner identifies filamentous structures and many uniform oval shaped structures during a microscopic exam of vaginal discharge. These are probably: a. Bacteria b. Sperm c. Hyphae d. Candida albicans Correct Answer C Noninfectious epididymitis is common in: c. MRI d. clinical breast exam Correct Answer B Which of the following medications should be avoided in a 65-year old male with BPH? a. Diphenhydramine b. Doxazosin c. Ciprofloxacin d. Propranolol Correct Answer A A 54-year old female presents with small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. What diagnosis is least likely? a. Endometrial cancer b. Ovarian cancer c. Endometrial hyperplasia d. Uterine polyps Correct Answer B A common presentation of an inguinal hernia is: a. Groin or abdominal pain with a scrotal mass b. Abdominal mass without pain c. Scrotal and abdominal masses d. Abdominal pain and scrotal erythema Correct Answer A What choice below has no precautions for oral contraceptive pill use? a. gallbladder disease b. five months postpartum and lactating c. blood pressure 160/100 d. varicose veins Correct Answer D A 25year old male patient is training for a marathon. He reports an acute onset of scrotal pain after a 10-mile run. He has nausea and is found to have an asymmetric high riding testis on the right side. What should be suspected? a. Sports hernia b. Epididymitis c. Testicular torsion d. Prostatitis Correct Answer C A 72-year old patient with a history of polymyalgia rheumatica complains of new onset unilateral headache and visual changes. Her sedimentation rate is elevated. Her neurologic exam is otherwise normal. What is the most likely reason for her symptoms? a. Transient ischemic attack b. Temporal arteritis c. Meningitis d. CVA Correct Answer B A patient complains of right leg numbness and tingling following a back injury. He has a diminished right patellar reflex and his symptoms are progressing to both legs. What test should be performed? a. Lumbar X-rays b. Lumbar CT scan c. Lumbar MRI d. Lumbar MRI with contrast Correct Answer C A 70-year old male patient is diagnosed with vertigo. Which choice below indicates that the vertigo is more likely to be of central etiology a. Brief duration b. Nystagmus present c. Nausea and vomiting d. Persistent symptoms Correct Answer D A patient is examined and found to have a positive Kernig's and positive Brudzinski signs. What is the most likely diagnosis? a. Parkinson's disease b. Encephalitis c. Meningitis d. Pneumonitis Correct Answer C A 75-year old is diagnosed with essential tremor. What is the most commonly used medication to treat this? a. Carbidopa b. Long-acting propranolol c. Phenobarbital d. Gabapentin Correct Answer B A patient is diagnosed with carpal tunnel syndrome. Which finger is not affected by carpal tunnel syndrome? a. thumb b. second finger c. 4th finger d. 5th finger Correct Answer D d. Order an EEG Correct Answer C A patient has had poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse a. 5th intercostal space mid clavicular line b. 8th intercostal space mid clavicular line c. 5th intercostal space left of MCL d. 5th intercostal space right of MCL Correct Answer B A 43-year old Hispanic male has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past two years. This murmur is probably what? a. Mitral valve prolapse b. Acute mitral regurgitation c. Chronic mitral stenosis d. Mitral Stenosis Correct Answer D A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as sloughing of the skin and hospitalization. Which medication is contraindicated in this patient? a. Lisinopril b. Metoprolol c. Hydrochlorothiazide d. Verapamil Correct Answer C A 75-year old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. The nurse practitioner replies: a. Palpitations and weakness b. Ventricular arrhythmias c. Shortness of breath and syncope d. Fatigue and exercise intolerance Correct Answer C A 74-year old patient has peripheral artery disease. Which term listed below is an important non-modifiable risk factor for PAD? a. Cigarette smoking b. Hyperlipidemia c. Diabetes d. Alcohol consumption Correct Answer C Lisinopril should be discontinued immediately if: a. Dry cough develops b. Pregnancy occurs c. Potassium levels decrease d. Gout develops Correct Answer B The valve most commonly involved in chronic rheumatic heart disease is the: a. Aortic b. Mitral c. Pulmonic d. Tricuspid Correct Answer B A patient taking an ACE inhibitor should avoid what: a. strenuous exercise b. potassium supplements c. protein rich meals d. grapefruit juice Correct Answer B A 28-year old has a grade 3 murmur. Which characteristic indicates a need for referral? a. A fixed split b. An increase in splitting with inspiration c. A split S2 with inspiration d. Changes in intensity with position change Correct Answer A Mr. Smith is a 72-year old patient who takes warfarin for chronic atrial fibrillation. His INR today is 4.0. The nurse practitioner should: a. Stop the warfarin for the next four days and repeat the INR on day 5 b. admit to the hospital immediately c. Administer Vitamin K and repeat INR in two hours d. Stop the Warfarin today and repeat the INR tomorrow Correct Answer D According to the National Heart Lung and Blood Institute, which characteristic listed below is a coronary heart disease risk equivalent that is which risk factor places the patient at AC CHD risk similar to a history of CHD? a. Hypertension b. Cigarette smoking c. Males over the age of 45 d. Diabetes Correct Answer D A patient diagnosed is with mild heart failure. What drug listed below would be a good choice for reducing morbidity and mortality long-term? a. Verapamil a. AM fasting b. Two-hour postprandial c. Preprandial d. Bedtime Correct Answer A A 60-year old patient has anosmnia. Which cranial nerve must be assessed? a. I b. II c. V d. X Correct Answer A A patient with migraine headaches and hypertension should receive which medication class with caution? a. beta blockers b. triptans c. pain medications d. ACE inhibitors Correct Answer B All of the following characteristics may be found in an older adult with dementia. Which one is common in a patient with Alzheimer's disease but is uncommon in a patient with another type of dementia? a. visual hallucinations b. personality changes c. abrupt onset d. indifference Correct Answer D Which symptom below is a true characteristic of cluster headaches but not migraine headaches? a. It is more common in females b. the length of the headache duration is about 30 to 90 minutes c. the most common characteristic is family history d. sunlight is a common trigger Correct Answer B A 70-year old patient exhibits a unilateral resting tremor. This likely indicates what? a. intention tremor b. alcohol withdrawal c. Parkinson's disease d. benign essential tremor Correct Answer C A 52-year old patient presents with an acute drooping upper right eyelid. She states that the right side of her face feels numb. Stroke has been ruled out. Based on the most likely etiology how should she be managed? a. steroids plus an antiviral agent b. immediate referral to the ED c. antiviral agent only d. steroids only Correct Answer D A patient who is 60 years old complains of low back pain bilaterally for the past five to six weeks. She states that the severity is about 4/10 and that she gets no relief from sitting, standing, or lying. The nurse practitioner should consider? a. Sciatica b. Ankylosing spondylitis c. Disc disease d. Systemic illness Correct Answer D What does a positive anterior drawer test demonstrate in a patient who has an injured knee? a. injury to the lateral meniscus b. instability of the anterior cruciate ligament c. stability of the posterior cruciate ligament d. stability of the lateral knee Correct Answer B A patient reports that her knee locks sometimes and feels like it will give out on her. She denies injury. She has no complaint about her other knee. What is her likely problem? a. Torn anterior cruciate ligament b. Knee effusion c. Osteoarthritis d. Meniscus tear Correct Answer D A 50-year old patient reports acute pain in his lower back that started two weeks ago after working in his yard. The pain radiates into his right leg intermittently. He has been managing his pain with ibuprofen. There are no red flags in his history or on his examination. When should consideration be given to ordering imaging studies? a. Now b. At 4 weeks c. At 8 weeks d. There is no need Correct Answer B Which patient below should be screened for osteoporosis? a. A 60-year old with rheumatoid arthritis b. A 50-year old Caucasian female c. A 65-year old male who is otherwise healthy Which joints are least commonly involved in osteoarthritis? a. Fingers b. Wrists c. Hips d. Knees Correct Answer B An older adult with a complaint of shoulder pain has a positive drop arm test. What is his likely diagnosis? a. Peripheral neuropathy b. Shingles c. Frozen shoulder d. Torn rotator cuff Correct Answer D A patient presents with right shoulder pain after an acute shoulder injury yesterday. He fell against a brick wall while working at his home. He reports pain that radiates into his upper arm. How should this be managed? a. Immobilize the right shoulder for 3 days b. Rest, Ice, and Naproxen for one week c. Order an X-ray of the right shoulder d. Prescribe physical therapy for the patient Correct Answer C A long-distance runner is diagnosed with a tibial stress fracture. Which statement is true about this injury? a. the pain worsens with rest b. the patient should be casted for six weeks c. plain X-rays will confirm the diagnosis d. rest and an alternative activity are recommended Correct Answer D A 75-year old female who knits daily has a positive Finklestein test. What is her likely diagnosis? a. gamekeepers thumb b. DeQuervain's tenosynovitis c. Osteoarthritis of the thumb d. Trigger thumb Correct Answer B Which findings are most commonly associated with rheumatoid arthritis? a. Morning stiffness, positive rheumatoid antigen, and antinuclear antibody b. fever, symmetrical joint involvement, normal sedimentation rate c. Asymmetrical joint involvement, male gender pain, d. Nodular lesion on the elbow, negative sedimentation rate, positive antinuclear antibody Correct Answer A Which of the following tests if positive is part of the criteria for systemic lupus erythematosus? a. antinuclear antibody b. rheumatoid factor c. elevated liver function studies d. elevated sedimentation rate Correct Answer A Which statement about attention deficit disorder is correct? a. This is more common in girls younger than 9 b. Family history does not play a role in this disorder c. Hyperactivity must be present for this diagnosis d. DSM V is used to diagnose a child with ADD Correct Answer D A patient with an eating disorder might also exhibit evidence of: a. thyroid disease b. sleep disorders c. anxiety disorders d. sexual abuse Correct Answer C A patient presents to your clinic numerous times with vague complaints. She seems to respond poorly to medical treatment that is given to her. What should be considered when obtaining a history from her? a. physical abuse or depression b. depression or HIV c. hepatitis or HIV d. Anemia or depression Correct Answer A Serotonin syndrome may result from taking an SSRI and: a. Dextromethorphan b. Loratadine c. Pravastatin d. Niacin Correct Answer A What is the usual age of onset of symptoms for patients with bipolar disorder? a. childhood b. third decade c. between 15 and 30 years d. adolescence Correct Answer C Pharmacologic treatment for children who have hypertension should be initiated for: a. those who are obese b. stage one hypertension c. diabetics with hypertension d. asymptomatic stage one or stage 2 hypertension Correct Answer C A six-day old has bilateral mucopurulent eye discharge. Which historical finding explains the etiology of the discharge? a. Infant is hepatitis B positive b. Infant received silver nitrate drops c. Mother has chlamydia d. Delivery was by C-section Correct Answer C A nurse practitioner is assessing the head of a three-day old infant. What would be a normal observation in a healthy three-day old infant who is crying? a. there are pounding pulsations over the anterior fontanelle b. there are palpable pulsations over the anterior fontanelle c. there is a palpable nodule near the posterior fontanelle d. the fontanelle is depressed Correct Answer B A 2-month old is diagnosed with thrush. An exam of this patinet's saliva demonstrates all except what? a. Hyphae b. Yeast c. Spores d. a positive KOH Correct Answer C Which choice below is a risk factor for sudden infant death syndrome? a. maternal age greater than 40 years old b. SIDS in a second degree relative c. low birth weight d. female gender Correct Answer C A child's resting heart rate is expected to be between 60 and 100 beats per minute once he reaches what age? a. 4 years of age b. Six years of age c. 10 years of age d. 12 years of age Correct Answer C Cranial nerve II could be evaluated in a young infant by assessing what? a. Squinting response to bright light b. a blink reflex c. a pupillary response d. rapid eye movement Correct Answer A Which infant feeding behavior is least likely related to congenital heart disease? a. limited intake of volume of milk b. feedings that take a long time to complete c. feedings that are interrupted by sleeping d. infants that burp frequently when feeding Correct Answer D An otherwise healthy 6-year old male has been diagnosed with otitis media. His mother reports that he has not had an ear infection since he was three years old. How long should he be treated with an antibiotic? a. 5 days b. 5-7 days c. 10 days d. until the erythema has resolved Correct Answer B Which reflexes might a one-month old infant be expected to exhibit? a. Morrow, stepping, rooting b. Stepping, rooting, tonic neck c. Morrow, Babinski only d. Fencing, stepping, rooting Correct Answer A A mother reports that her child is not allergic to chicken but is allergic to duck and duck feathers. The child is four years old today. Which immunizations should he receive? a. Avoid flu, but all others OK b. Avoid Hepatitis B c. MMR and tetanus are contraindicated d. None are contraindicated Correct Answer D At what age should initial blood pressure screening take place? a. 3 years b. 4-6 years c. 6 years d. 6-10 years Correct Answer A An NP has successfully reduced a nusemaid's elbow. How can the NP know it was successful? a. Xray confirmation b. Child moves the affected arm at the elbow c. A click is heard d. The deformity has resolved Correct Answer B A 4-year old has been dx with measles. The NP identifies Koplik's spots. These are: a. spots on the skin that are pathognomonic for measles b. Red rings found on the tongue with white centers c. Found on the inside cheek and are granular d. Blanchable areas on the trunk and extremities Correct Answer C Which of the following is true about metatarsus adductus? a. This is another term for clubfoot b. Mild flexible metatarsus usually spontaneously corrects c. X-rays are usually necessary to diagnose this d. Infants frequently require casting to correct this Correct Answer B Club foot: a. always requires a neural surgical referral b. involves the foot and lower extremity c. involves the foot only d. can be corrected with shoes and exercises Correct Answer B A 2-month old infant has an asymmetric Morrow reflex. Which statement is true? a. This is normal. It develops bilaterally later b. This indicates a side of dominance c. The infant could have a hearing problem d. The infant could have a birth injury Correct Answer D The term caput succadenum refers to: a. cradle cap b. atopic dermatitis c. scalp edema d. asymmetric head shape Correct Answer C A mother of a four-week old infant visits your office. She states that her baby is vomiting after feeding and then cries as if he is hungry again. What should the NP assess? a. His abdomen for an olive shaped mass b. His rectum for patency c. His swallowing ability d. The position his mother uses when she feeds him Correct Answer A Age-appropriate anticipatory guidance for the parent of a 9-month old infant? a. keep syrup of ipeac in case of accidental poisoning b. stranger anxiety will develop by one year of age c. your baby should be able to say 10 words by age 1 d. discuss weaning from a botle Correct Answer ___ Which reflex may be present at nine months of age during sleep? a. Moro reflex b. Rooting c. Stepping d. Tonic neck Correct Answer B A 6-year old patient has sore throat, coryza, hoarseness and diarrhea. What is the likely etiology? a. Group A streptococcus b. H. Para influenza c. Viral ideology d. Mycoplasma Correct Answer C Newly diagnosed pregnant teenager has suspected depression. Before a diagnosis is made, she should have a CBC, TSH, renal and liver functions and a. sedimentation rate b. quantitative beta HCG level c. Hemoglobin A1c d. Urine toxicology screen Correct Answer D Hand foot and mouth disease and herpangina: a. Both produce pustules on oral mucous membranes b. potentially can cause orchitis in infected males c. are viral infections caused by coxsackie virus d. will only occur in the spring and summer Correct Answer C The initial step in the management of encopresis is: a. Client and family teaching b. Bowel cleansing c. Dietary changes d. Psychosocial evaluation Correct Answer A An adolescent male has suspected varicocele. He has dull scrotal pain that is relieved by: a. Standing b. Recumbent c. Having a bowel movement d. Elevation of the testicle Correct Answer B A patient has suspected scarlet fever. He likely has a sandpaper rash and: a. negative throat swab b. a positive rapid strep test c. diarrhea with abdominal cramps d. petechiae on the trunk Correct Answer B A healthy appearing 3-year old female presents with non- blanchable redness over both knees and elbows. During the exam she is found to have normal growth and development and she interacts appropriately with the NP. She had an upper respiratory infection about four weeks ago that cleared without incident. Her CBC demonstrated a platelet count of 50. The rest of her CC is normal. Her urinalysis demonstrated hematuria. The most likely diagnosis is: a. septic arthritis b. acute lymphocytic leukemia c. von Willebrand's disease d. Idiopathic thrombocytopenia purpura Correct Answer D Which of the following increases the risk of cryptorchidism? a. Family history of hearing problems b. Premature birth c. Maternal iron deficiency d. Constipation Correct Answer B What is the earliest age that an average child would be able to copy a triangle, know his colors, and count on his fingers? a. 3 years b. 4 years c. 5 years d. 6 years Correct Answer C A 9-year old boy has been diagnosed with chickenpox. A drug that should be avoided in him is: a. penicillin b. aspirin c. ibuprofen d. sulfa Correct Answer B What Tanner stage corresponds to an average 8-year old male? a. Stage 0 b. Stage 1 c. Stage 2 d. Stage 3 Correct Answer B Which suggestion below is the standard for treating iron deficiency anemia in infants and children? a. Iron supplementation in divided doses between meals with orange juice b. Iron supplementation once daily with the largest meal c. Greater than five servings of meat per week with citrus juice d. Iron supplementation with orange juice 5x weekly Correct Answer A A 2-year old with sickle cell anemia should receive which immunizations? a. All routine childhood immunizations at an accelerated rate b. All routine childhood immunizations at a decelerated rate c. All routine childhood immunizations at the usual rate d. Immunizations should be limited in this group Correct Answer C The average age of pubertal growth spurt in North American boys is: a. 9.5-11.5 years b. 10-12 years c. 12-14 years d. 14-16 years Correct Answer C The NP sees a child who reports fatigue and presents with purpura on his lower extremities. His temperature is normal. The differential includes: a. anemia b. abuse c. acute leukemia d. Kawasaki syndrome Correct Answer C b. An oral antiviral agent and ibuprofen c. An oral antiviral agent and pain medication d. An oral antiviral agent, pain medication, and oral steroids Correct Answer C A 91-year old female with a long standing history of chronic heart failure has renal and liver studies that have slowly worsened over the past year. This probably indicates: a. final stage of heart failure b. target organ damage secondary to heart failure c. poor nutrition intake and need for nutrition assessment d. new disease processes involving the liver and kidneys Correct Answer B Symptoms of uncomplicated reflux disease in older adults should be treated: a. by referring for upper GI testing b. with empiric treatment c. ambulatory pH testing d. referral to gastroenterology Correct Answer B Metformin is a good choice for many older adults with type 2 diabetes. Whatever, while on metformin, the NP should carefully monitor for: a. hypoglycemia b. fluid retention c. lactic alkalosis d. renal dysfunction Correct Answer D A 75-year old male patient has been in poor health for a decade. Which type of anemia is least likely in this patient? a. Sideroblastic anemia b. pernicious anemia c. anemia of chronic disease d. folic acid deficiency anemia Correct Answer A In older adults, the three most common ailments are: a. hearing loss, vision loss, hypertension b. hearing loss, hypertension, arthritis c. depression, vision loss, hypertension d. arthritis, hearing loss, depression Correct Answer B A patient who wrote a living will has changed his mind about the initiation of life sustaining measures. Which statement is true about this? a. He cannot change his mind regarding the content of the living will b. He can only change the content if he is of sound mind c. A health care provider is exempt from liability if they provide care outside of the living will d. An attorney must be consulted if the living will is changed at any time Correct Answer B What is the AM fasting glucose goal for 75-year old patient who has diabetes? a. 80 to 100 b. 100 to 120 c. 80 to 130 d. 120 to 140 Correct Answer C To the American Cancer Society, what recommendation should be made to a 70-year old female regarding mammograms if she is considered at low risk? a. she no longer needs mammograms b. she should have them annually until age 75 c. she should have them every three years d. she should have them every one to two years as long as she has a reasonable life expectancy Correct Answer D Older adults have a unique blood pressure pattern. Which blood pressure reading below reflects this pattern? a. 100/50 b. 140/100 c. 160/60 d. 160/100 Correct Answer C A 70-year old presents to the NP office for a well exam today. What medication probably has no effect on screening for occult blood in the stool? a. aspirin b. clopidogrel c. acetaminophen d. ibuprofen Correct Answer C A 66-year old African American female has multiple risk factors for osteoporosis. Which choice listed below is not a risk factor for osteoporosis? a. her age b. her race c. glucocorticoid intake A common complaint of older patients who have cataracts is: a. sensitivity to light b. poor peripheral vision c. increased incidence of falls d. eye pain in the affected eye Correct Answer A An older adult patient with organic brain syndrome is at increased risk of abuse because she: a. lives in a nursing home b. has multiple caregivers c. is incontinent of stool and urine d. has declining cognitive function Correct Answer C Two common causes of weight loss in older adults are: a. anorexia and depression b. depression and malignancy c. malignancy and social isolation d. financial limitations and hyperthyroidism Correct Answer B A patient is 86 years old and functions independently. He has hypertension, hyperlipidemia, BPH, and flare ups of gout. His last colonoscopy was at age 76. What should he be advised about having a colonoscopy now? a. Colonoscopy is not the preferred method for screening in older adults b. Colonoscopy is ill advised in older adults c. It is not advised in this patient at this time d. Screening is not necessary after age 80 Correct Answer C Which older adult is at the highest risk for suicide? a. 86-year old male patient with chronic pain and depression b. 75-year old female with history of depression c. 65-year old female with a terminal illnesss d. 81-year old male with active alcohol abuse Correct Answer A