DNP701 Advanced Practice Nursing in the Care of Older Adults Latest Update Exam 100% pass, Exams of Nursing

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DNP701 Advanced Practice Nursing in the Care of Older Adults Latest

Update Exam 100% pass 2024-

Mrs. Smith, 75 years old, complains of weakness, dysuria, and dehydration. Though afebrile, the nurse performs an in-depth physical exam including urinalysis and CBC. The total assessment must be performed because:

1. All systems of the body are interrelated and symptoms may lead to multiple differential diagnoses.
2. The symptoms are nonspecific and could be manifestations of aging.
3. There may be other better indications or symptoms of illness
4. Mrs. Smith may not be telling all the salient information.

• Answer Answer: 1 Page: 2

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The clinician needs to remember that all the systems are inter-related and, in that interaction can result in heightened susceptibility to disease/illness for the older adult

The nurse should not attribute symptoms exclusively to the aging process.

There may be associated co-morbidities along with this condition.

Assumptions of not reporting properly may not be true.

The blood work is drawn on a patient with renal disease, and the lab results indicate that the serum creatinine is elevated. The nurse practitioner must know which of the following laboratory values before ordering medications?

1. CBC
2. Culture and sensitivity of the urine
3. Creatinine clearance
4. Uric acid levels - Answer Answer: 3 Page: 3

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A CBC will not evaluate kidney function for a patient with renal disease.

A culture and sensitivity test indicates the presence of an infection and the antibiotic to which the organism is sensitive.

Creatinine clearance is calculated, which indicates an approximation of renal function.

A uric acid level is high in the presence of gout.

Which of the following statements is correct regarding a diagnostic test?

1. A test is ordered for a specific purpose.
2. A test is the most invasive available.
3. Results don't necessarily need to be disclosed to the patient.
4. If a test has the potential to be helpful, it should be ordered without consideration to any potential risk to the patient - Answer Answer: 1 Page: 3

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Before ordering a specific test, the nurse practitioner should have an idea regarding how he or she will utilize the value of each test result obtained.

As one contemplates which laboratory tests to order, consider the doctrine primum no nnocere- first, do no harm.

Once laboratory tests results are available to be reviewed, the tests results are to be discussed with the patient. Abnormal test results are to be interpreted for the aging individual and become addressed with the patient and the caregivers.

The risks, if any associated with laboratory testing is to be considered in relation to the patient's clinical condition and must be weighed against what benefit the test can provide.

. Janey age 25 years may have arthritis quite differently than Mrs. Johnson age 65 years because :

1. Physiological changes in the body are associated with aging.
2. A healthy body remains more or less the same as one age.
3. The systemic symptom such as malaise and weight loss is not felt by the patient in old age.
4. Though the same joints are usually involved, age seems to make it feel different. - Answer Answer: 1 Page: 5

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1. End. Knowledge of the bimodality of the age of onset of the certain disease conditions will

help the advanced practice nurse to avoid misdiagnosis or delay in diagnosis due to lack of recognition.

The symptoms of rheumatoid arthritis can be at variance depending on the age of the patient.

The constitutional symptoms such as fever, malaise, weight loss and depression may not occur in the younger patients.

In late-onset rheumatoid arthritis, the joint involvement is more often the larger joints.

The nurse practitioner is examining an 85-year-old male patient who is experiencing abdominal pain, weakness, and loss of appetite. Which of the following diseases or conditions is most likely to be tested for and ruled out?

1. Neoplasms and carcinomas
2. Partial seizure
3. Sarcopenia
4. Hirschsprung's disease. - Answer Answer: 1 Page: 4

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Neoplasms and carcinomas are among the diseases found more in older individuals, and epidemiological knowledge is paramount in interpretation.

Partial seizure is more common in early old age.

Sarcopenia is more common in early old age.

Hirschsprung's disease is most common in infancy. . For those > 65 years, the most common morbidities are related to: 1 Heart disease, arthritis 2 Respiratory problems, cancer 3 Diabetes, stroke 4 All are common morbidities - Answer Answer: 4 Page: 5

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Heart disease is one of the common morbidities.

Cancer is common within the general population; however, certain types are more prevalent in the older patient.

Diabetes is common above 40 years of age.

Heart disease, cancer, and diabetes put together are the most common morbidities among older patients. A gerontological patient is being examined for a report of pain in the shoulder. The nurse practitioner completes a thorough systemic examination because:

1. One morbidity older patient as a rule, does not express the difficulties in general.
2. Arthritis of the shoulder accompanied by other neurological symptoms.
3. Lower extremities pain often present in case of arthritis in older patient
4. The patient may not give significant signs and symptoms-Answer Answer: 1 Page: 5. Late-onset rheumatoid arthritis in older patients has joint involvement in larger joints more frequently than the shoulder, and also usually includes systemic symptoms consisting of fever, malaise, weight loss, and depression.

Symptoms can be expressed on other physical systems in the older patient.

Arthritis in smaller joints occurs more frequently. 4 Objective signs will be observed upon examination.

A patient presents with the complaint of diarrhea and pain in the upper left quadrant of the abdomen. The nurse practitioner conducts a systemic examination. Lateral thinking will lead to one of the following diagnoses:

1. Hirschsprung's disease
2. Pancreatitis
3. Appendicitis
4. GIBD - Answer Answer: 4 Page: 5

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Hirschsprung's disease is an obstruction of the colon in infancy.

Diarrhea is not associated with pancreatitis.

Appendicitis is more common in younger patients than in older patients.

GIBD manifests itself in a bimodal pattern.

A 70-year-old male is seen by the nurse practitioner with chief complaints of weakness and dizziness. The nurse practitioner is discussing a care plan with the client and can inform him of which of the following? Select all that apply.

1. I would like to order a test for your heart to evaluate its functioning.
2. I will perform an examination of your functional abilities.
3. I am going to order a blood sugar test to rule out diabetes.
4. This is how many older adults feel. It's normal.
5. I will have to check you for other diseases. - Answer Answer: 1, 2, 3, 5 Page: 2, 3

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A complete examination will differentiate between symptoms of aging versus disease.

All systems are interconnected and may have an effect on a current disease.

An underlying disease will be uncovered to avoid undertreatment.

Attributing symptoms to aging can contribute to depression in an older person.

There are changes in the sympathetic response which contribute to the orthostasis and falls, as well as lack of hypoglycemic response. The nurse practitioner is leading a class of seniors over age 65 years and is teaching about nutritional needs. One of the men asks why, even though he eats correctly according to the standards presented, he still feels weaker than he did 10 years ago. He also wonders why he gets more infections than he used to. Which of the following are helpful answers? Choose all that apply.

1. I recommend that you exercise a little more than you are currently doing.
2. Others have reduced reserve energy
3. Some experience a compromised immune system
4. Viruses are passed on more within the population
5. I advise you to seek out your primary caregiver for further testing. - Response Response: 2, 3, 5 Page: 2, 3

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Nutrition of the elderly is not necessarily what is affecting the changes in health.

There may be other factors affecting elders' health; for example, lifestyle or medications being taken.

Many factors affect elders health, among them are changes in the immune system.

Viruses and other infections are not only considerations for infections.

Biochemical individuality is an important factor in the detection of asymptomatic abnormalities in older adults. Significant homeostatic disturbances in the same individual may be detected through serial laboratory tests, even though all individual test results may lie within normal limits of the reference interval for the entire group.

An elderly woman presents to the ambulatory clinic for a routine checkup. The patient asks about her blood work results compared to last year's. How is it best for the clinician to respond? Choose all that apply.

1. They are likely to be the same if you have had no diseases since then.
2. Blood work results may be different just because of your aging process.
3. Your results might be different since the body changes due to diseases and the usage of medications
4. Blood work is not a reliable indicator of health as there are various things that can affect one's health and do not necessarily show in the results of your blood work
5. There probably isn't much difference as your body stays stable concerning its operations. - Answer Answer: 2, 3 Page: 4, 5

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It is further observed that the biochemical individuality variation is often much smaller

than that in the larger group. 2 The process of aging, decline in organ function may affect elders health. 3 Disease, nutrition, and medications affect elders' health. 4 Abnormal laboratory findings are often blamed on old age, but rarely are they true aging changes.

Interpretation of laboratory values for the elderly can be influenced by many factors that include the physiological changes with aging, the prevalence of chronic disease, changes in nutritional and fluid intake, lifestyle (including activity), and the medications that are taken.

An elderly couple discusses health concerns with the nurse practitioner. The couple is frustrated that each of their individual blood studies shows different results. One set of test results shows a significant decrease in blood sugar; however, the test results of the partner does not show an equal decrease. Their physician does not appear to be concerned, and the couple is wondering why. How is it best for the nurse practitioner to respond? Select all that apply.

1. Research indicates that the pattern of chemical make-up of each person differs.
2. One person's range of blood results is no different from that of any other person.
3. The chemical make-up for every person is the same as others of the same gender and age group.
4. The chemical make-up of a person is influenced by many factors.
5. Ranges of the values provided by the laboratory are correct for any ag - Answer Answer: 1, 4 Page: 2, 3

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Individuals have narrower variations of laboratory work than from the others in the same age group.

There is a wider variation of laboratory results within a group of older people.

Laboratory values are determined by more than age and gender.

Laboratory values may vary as a result of nutrition, activity, and emotional status.

Because of biochemical individuality, the reference values represented for the older adult population are not specifically applicable to the patient.

Adam, 70 years of age, is a 340-pound male who was admitted for possible myasthenia gravis (MG).The nurse practitioner knows that the most common presentation of MG is in women between 20 and 40 years of age. Adam presents, however, with ocular presentation of MG with dysphonia and without thymus abnormalities. Adam wonders why the nurse is looking for MG since he is older and this is a "young person's disease." Choose the best responses. Select all that apply. 1. We need to test for everything, just in case. 2. Some diseases present in two unrelated age and gender groups.

3. Older adults have weakness, but we have to rule out other causes.
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. - Answer Answer: 2, 3 Page: 5 Feedback

Doing more tests than necessary breaks the principle of "Do no harm."

MG is bimodal and can occur in younger women as well as in both men and women.

Knowledge of the bimodality of age onset of certain disease conditions will help the nurse practitioner avoid misdiagnosis or delay in diagnosis due to lack of recognition.

There should be an indication for ordering a test and value attributed to the results.

The manifestations of illness and disease in the elderly can be very different, even if the underlying pathological process is the same as in younger individuals. Explanation: Mrs. Smith is 75 years old and has had type 2 diabetes for 30 years, seeing her nurse practitioner quite regularly. Mrs. Smith asks the nurse practitioner why her treatment has not been changed out of her laboratory values are seemingly out of normal range. Which of the following answers are best? Select all that apply.

1. A pattern of change must be the basis for a decision and not one set of laboratory results.
2. The normal range charts are based on patients younger than 75 years.
3. It is presently too costly to alter your treatment.
4. Comparing new results with your prior results gives a more accurate picture.
5. Normal values for laboratory tests differ as one gets older - Answer Answer: 1, 4, 5 Page: 3 Comments

Blood studies are more useful when looking at an increase or decrease in values.

Age should not be used as an excuse for possible abnormal results.

If a change in treatment is indicated, the less costly alternative should be pursued.

Acious disturbances can be uncovered in the same client with serial laboratory tests.

The clinician needs to identify whether a value obtained represents a normal aging change, disease, or potential for disease. Mr. Adams is 90 years old. Over the past several months he appears unable to comply with the health-care plan established by the nurse practitioner. The nurse practitioner considers which of the following reasons for noncompliance when updating his home care plan? Select all that apply.

1. Polypharmacy
2. Treatment burden
3. Having to attend several appointments
4. Having to afford complicated drug regimens
5. Cognitive ability only - Answer Answer: 1, 2, 3, 4 Page: 5 Feedback

With increasing age of a patient, this is associated with more medications having been prescribed.

There are patients with multimorbidity who are known to have a treatment burden in understanding and self-care managing their conditions.

There are patients with multimorbidity who are known to have a treatment burden in understanding and self-care managing their conditions.

This burden includes being able to afford complicated drug therapies.

While cognitive ability can play a role, much more is involved when noncompliance is a factor.