Exam NR 601 Advanced Practice Nursing in the Care ofOlder Adults / Edition 2 TESTBANK, Exams of Nursing

Download Exam NR 601 Advanced Practice Nursing in the Care ofOlder Adults / Edition 2 TESTBANK and more Exams Nursing in PDF only on Docsity! 1 Advanced Practice Nursing in the Care of Older Adults / Edition 2 TESTBANK Chapter 1. Changes With Aging Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The major impact of the physiological changes that occur with aging is: A. Reduced physiological reserve B. Reduced homeostatic mechanisms C. Impaired immunological response D. All of the above 2. The strongest evidence regarding normal physiological aging is available through: A. Randomized controlled clinical trials B. Cross-sectional studies C. Longitudinal studies D. Case-control studies 3. All of the following statements are true about laboratory values in older adults except: A. Reference ranges are preferable B. Abnormal findings are often due to physiological aging C. Normal ranges may not be applicable for older adults D. Reference values are not necessarily acceptable values 4. Biochemical individuality is best described as: A. Each individual’s variation is often much greater than that of a larger group B. The unique biochemical profile of a selected population C. The truly “normal” individual—falling within average range D. Each individual’s variation is often much smaller than that of a larger group 5. Polypharmacy is best described as taking: A. More than nine medications per day B. More than five medications per day C. Even a single medication if there is not a clear indication for its use D. When a drug is given to treat the side effect of another drug 6. Pharmacokinetic changes with aging are reflective of: A. What the drug does to the body B. What the body does to the drug C. The effect at the site of action and the time and intensity of the drug D. D. The side effects commonly associated with the drug 7. All the following statements are false about drug absorption except: 2 A. Antacids increase the bioavailability of digitalis B. Gastric acidity decreases with age 5 8. ANS: A PTS: 1 9. ANS: C PTS: 1 10. ANS: C PTS: 1 11. ANS: A PTS: 1 12. ANS: C PTS: 1 13. ANS: B PTS: 1 Chapter 2. Health Promotion Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The leading cause of death in elderly travelers worldwide is: A.Cardiovascular disease B.Infections C.Accidents D.Malaria 2. Which of the following should be avoided in countries where food and water precautions are to be observed? A.Hot coffee B.Bottled water C.Salad buffet D.Unpeeled bananas 3. What insect precautions are not necessary to prevent insect-borne diseases in the tropics? A. Using 100% DEET on the skin to prevent bites B. Treating clothes with permethrin C. Covering up exposed skin to lessen biting surface D. Taking malaria pills as directed for areas at risk for malaria 4. An example of secondary prevention you could recommend/order for older adults would be to: A. Check for fecal occult blood B. Wear seat belts in the car C. Provide foot care for a diabetic patient D. Administer a tetanus shot 5. Ali is a 72-year-old man who recently came to the U.S. from Nigeria. He reports having BCG (bacille Calmette-Guerin) vaccination as a child. Which of the following is correct regarding a tuberculin skin test? A. It should not be done at all. B. It should be read as smaller than it really is. C. Vaccination history is irrelevant; read as usual. D. It should be read as larger than it really is. 6 6. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? A. Pulmonary edema B. Heart failure C. Pulmonary embolism 7 D. Pneumonia 7. Ivan W. is a 65-year-old man who is new to your practice. He has a history of COPD, CAD, hypertension, and type 2 diabetes mellitus. He has had no immunizations since his discharge from the military at age 25. Childhood diseases included chickenpox, measles, mumps, and “German measles.” He presents for a disease management visit. Which of the following immunizations would you recommend for Ivan? A. MMR, influenza, pneumococcal, Zostavax B. Influenza, pneumococcal, PPD, Hepatitis B C. Tdap, pneumococcal, influenza, Zostavax D. Hepatitis B, influenza, pneumococcal, Hepatitis A 8. Leo L. is a 62-year-old African American male who comes for an initial visit to your practice. Personal health history includes smoking 1 pack/day since age 11, consuming a case of beer (24 bottles) every weekend, and working as an assembler (sedentary job) for the past 10 years. Family history in first-degree relatives includes hypertension, high cholesterol, heart attack, and type 2 diabetes mellitus. Leo’s BMI is 32; BP today is 130/86. You order a fasting glucose, lipid profile, and return visit for BP check. This is an example of: A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Health profiling 9. A local chapter of a nurse practitioner organization has begun planning a community-based screening for hypertension at a local congregate living facility. This population was selected on the basis of: A. A predicted decreased incidence of high blood pressure in this population B. A recognized element of high risk within this group C. Readily available treatment measures D. Achieving an administrative goal for the congregate living facility 10. Performing range of motion exercises on a client who has had a stroke is an example of which level of prevention? A. Primary prevention B. Tertiary prevention C. Secondary prevention D. Rehabilitation prevention 11. The nurse practitioner demonstrates an understanding of primary prevention of falling among the elderly through which management plan? 10 1.ANS: C PTS: 1 5.ANS: C PTS: 1 2.ANS: C PTS: 1 6.ANS: C PTS: 1 3.ANS: A PTS: 1 7.ANS: C PTS: 1 4.ANS: A PTS: 1 8.ANS: B PTS: 1 11 9.ANS: B PTS: 1 13.ANS: C PTS: 1 10.ANS: B PTS: 1 14.ANS: A PTS: 1 11.ANS: D PTS: 1 15.ANS: C PTS: 1 12.ANS: C PTS: 1 16.ANS: B PTS: 1 Chapter 3. Exercise in Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Exercise recommended for older adults should include activities that: A. Conserve energy B. Restrict flexibility C. Strengthen muscles D. Are anaerobic in nature 2. Preferred amount of exercise for older adults is: A. 10 minutes of physical activity each morning B. 30 minutes per day of aerobic activity five times a week C. Any increase in physical activity over a sedentary lifestyle D. 60 minutes per day that includes 30 minutes of aerobic activity and 30 minutes of weight training five times a week 3. Which of the following medical conditions is not considered restrictive for engaging in physical activity? A. A.Unstable angina B. Dehydration C. Depression D. Uncontrolled tachycardia 4. The best recommendation for a patient who states they have no equipment to exercise would be: A. Sign a contract for a year’s membership to a local gym B. Borrow free weights from grandchildren C. Have a personal trainer come to the home three times a week D. Improvise with recommended objects at home that can be used 5. When the nurse practitioner recommends exercise for a sedentary older adult, which of the following pieces of advice should be considered for all types of exercise? A. Only use equipment recommended by physical trainers 12 B. Start low and go slow C. Only group exercise is beneficial to someone who has not been active in a long A. time D. Focus only on one type of exercise for the first few months 15 B. Mammography screening C. Hearing screening D. Dementia screening 7. Assessment of vital signs in the elderly reflect: A. Errors in blood pressure measurement are rare with automated recording devices B. Shortness of breath in the elderly is rare in the older, deconditioned, and immobile patient C. Older adults prefer a 0-10 pain rating scale D. Older adults could be septic with a temperature within normal limits 8. What statement is true about nutrition intake in the elderly? A. Deficiencies in protein intake are common with aging. B. Malnutrition is the most common nutritional disorder among the elderly living in the community. C. Increased caloric consumption is needed as one ages. D. The serum albumin is a good reflection of protein stores. 9. What is reflective of functional decline in older adults? A. Functional decline is synonymous with advanced age. B. Some individuals die of “old age” but have maintained an active and healthy lifestyle. C. Instrumental activities of daily living are preserved longer than activities of daily living. D. It is always possible to prevent functional deterioration. 10. The leading cause of traumatic death in the elderly is due to: A. Motor vehicle accidents B. Pedestrian injuries C. Falls D. Burns 11. Timing of the get-and-go test enhances its sensitivity. The process should take less than: A. Thirty seconds B. Sixteen seconds C. Sixty seconds D. Ten seconds 12. A validated tool for assessing cognitive function specific to dementia is: A. Mini-cog B. Confusion assessment method C. Yesavage GDS scale D. NuDesc 13. The medical outcome study short form 36 remains the gold standard of quality of life instruments. It measures: A. Mental and social domains 16 B. Social domain 17 C. Physical, mental, and social domains D. Physical domain MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: C PTS: 1 3. ANS: B PTS: 1 4. ANS: B PTS: 1 5. ANS: A PTS: 1 6. ANS: C PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: B PTS: 1 10. ANS: C PTS: 1 11. ANS: B PTS: 1 12. ANS: A PTS: 1 13. ANS: C PTS: 1 Chapter 5. Symptoms and Syndromes Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The term “geriatric syndrome” is best described as: A. A condition that has multiple underlying factors and involves multiple systems B. A condition that has a discreet etiology that is difficult to pinpoint C. Significant progress has been made in understanding geriatric syndromes, especially falls and delirium D. Therapeutic management of a geriatric syndrome can be accomplished once a specific diagnosis is made 2. The anal wink reflex is used to test: A. Rectal prolapse B. Sensation and pudental nerve function C. Baseline and squeeze sphincter tone D. Fissures and fistulas 3. Atypical presentation of acute coronary syndrome is: 20 B. The Confusion Assessment is negative C. Rapid change and fluctuating course of cognitive function D. The presence of behavioral symptoms with cognitive impairment 11. Presbystasis is best described as: A. Impairment in vestibular apparatus that causes dizziness B. Age-related disequilibrium of unknown pathology characterized by a gradual onset of difficulty walking C. The loss of high frequency tones with aging that can impair sensation D. A disorder of the inner ear characterized by vertigo 12. If dizziness has a predictable pattern associated with it, the clinician should first consider: A. Hypoglycemia B. Psychogenic etiology C. Cardiovascular cause D. Neurogenic cause 13. All of the following are considered as contributors to dysphagia except: A. Anticholinergics B. Drugs that increase reflux symptoms C. Inadequate intake of fluids with medications and meals D. Smooth muscle relaxants 14. Evidence shows that the most important predictor of a fall is: A. Prior history of a fall B. Cognitive impairment C. Gait and balance disturbance D. Proximal muscle weakness 15. The most cost-effective interventions used to prevent falls are: A. Use of sitters B. Use of alarms (bed, chair, monitors) C. Tai Chi exercises D. Home modifications and vitamin D supplements 16. Chronic fatigue syndrome is best described as: A. Fatigue that is constant, lasting more than three months B. Fatigue lasting longer than six months and not relieved by rest C. Fatigue that waxes and wanes over a period of three months D. Total exhaustion with inability to get out of bed 17. Which form of headache is bilateral? 21 A. Cluster B. Tension 22 C. Migraine D. Acute angle closure glaucoma 18. Microscopic hematuria is defined as: A. Twenty or more RBCs on a urine sample B. Three or more RBCs on a urine sample C. Twenty or more RBCs on three or more samples of urine D. Three or more RBCs on three or more samples of urine 19. Risk factors associated with the finding of a malignancy in a patient with hemoptysis include all of the following except: A. Male sex B. Smoking history C. Over age 40 D. Childhood asthma 20. Recent weight loss is defined as: A. loss of >10 pounds over the past 3-6 months B. loss of >2 pounds a week C. 5% weight loss in three months D. 10% weight loss in one year 21. The most common cause of disability in the elderly is due to: A. Diabetes B. Arthritis C. Heart disease D. Chronic obstructive pulmonary disease 22. Lipedema is best described as: A. Bilateral accumulation of interstitial fluid B. Bilateral distribution of fat in the lower extremities C. Fluid retention caused by a compromised lymphatic system D. Lipid molecules that break down and cause fluid retention 23. Drug-induced pruritus is distinguished because it: 25 13. ANS: D PTS: 1 27. ANS: B PTS: 1 14. ANS: A PTS: 1 26 Chapter 6. Skin and Lymphatic Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which of the following dermatological conditions results from reactivation of the dormant varicella virus? A. Tinea versicolor B. Seborrheic keratosis C. Verruca D. Herpes zoster 2. An older adult male presents with pain in his right chest wall for the past 48 hours. Upon examination, the nurse practitioner notices a vesicular eruption along the dermatome and identifies this as herpes zoster. The NP informs the gentleman that: A. All symptoms should disappear within three days B. Oral medications can dramatically reduce the duration and intensity of his symptoms C. He has chickenpox and can be contagious to his grandchildren D. He has a sexually transmitted disease 3. A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot rule out other lesions. What recommendation would you give him? A. Ignore the lesion, as it is associated with aging. B. Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion. C. Perform a biopsy or refer to a dermatologist. D. Advise him to use a dandruff shampoo and return in one month if the lesion has not gone away. 4. The immunofluorescent antibody (IFA) is a laboratory test used to diagnose which of the following disorders? A. Tinea versicolor B. Herpes zoster C. Squamous cell carcinoma D. Human papilloma virus 5. A wound with drainage and foul odor should be cleansed with: A. Normal saline 27 B. Hydrogen peroxide C. 20% acetic acid D. Betadine 30 is called: 31 A. Hard corn B. Tinea pedis C. Soft corn D. Plantar warts (verrucae) 19. A 64-year-old male presents with an exacerbation of psoriasis. His social history includes 50- year two packs a day of cigarettes and a six-pack a week of beer. He states he had a recent sore throat, which he attributes to minding his young grandson. He reports that until recently the pruritis was only minimal. His BMI is 37. Which of the following factors most likely contributed to the acute presentation of psoriasis? A. Alcohol abuse B. Smoking C. Streptococcal infection D. Obesity 20. Treatment of complicated cellulitis of the lower extremity resulting from an anaerobe requires all of the following except: A. Extended antibiotic medication lasting at least 7-10 days B. Topical antifungal medication C. Inquiry when last tetanus toxoid booster was given D. Elevation of limb and consideration of compression bandaging MULTIPLE CHOICE 1. ANS: D PTS: 1 11. ANS: B PTS: 1 2. ANS: B PTS: 1 12. ANS: B PTS: 1 3. ANS: C PTS: 1 13. ANS: A PTS: 1 4. ANS: B PTS: 1 14. ANS: D PTS: 1 5. ANS: A PTS: 1 15. ANS: D PTS: 1 6. ANS: B PTS: 1 16. ANS: A PTS: 1 7. ANS: C PTS: 1 17. ANS: B PTS: 1 8. ANS: A PTS: 1 18. ANS: C PTS: 1 9. ANS: B PTS: 1 19. ANS: C PTS: 1 10. ANS: D PTS: 1 20. ANS: B PTS: 1 32 Chapter 7. Head, Neck, and Face Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 35 B. Microaneursyms 36 C. Deep hemorrhages D. Neovascularization 14. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? A. Fictional keratosis B. Keratoacanthoma C. Lichen planus D. Leukoplakia 15. A gross screening for hearing is the whisper tests. Which cranial nerve is being tested when the nurse practitioner conducts this test? A. Cranial nerve V B. Cranial nerve VII C. Cranial nerve VIII D. Cranial nerve IV MULTIPLE CHOICE 1. ANS: B PTS: 1 9. ANS: B PTS: 1 2. ANS: C PTS: 1 10. ANS: B PTS: 1 3. ANS: C PTS: 1 11. ANS: C PTS: 1 4. ANS: A PTS: 1 12. ANS: C PTS: 1 5. ANS: B PTS: 1 13. ANS: B PTS: 1 6. ANS: B PTS: 1 14. ANS: D PTS: 1 7. ANS: A PTS: 1 15. ANS: C PTS: 1 8. ANS: D PTS: 1 Chapter 8. Chest Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. In mitral stenosis, p waves may suggest: A. Left atrial enlargement 37 B. Right atrial enlargement C. Left ventricle enlargement D. Right ventricle enlargement 2. Aortic regurgitation requires medical treatment for early signs of CHF with: 40 as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, 41 definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? A. Musculoskeletal chest wall syndrome with radiation B. Esophageal motor disorder with radiation C. Acute cholecystitis with cholelithiasis D. Coronary artery disease with angina pectoris 16. Jose M. is a 68-year-old man who presents to your primary care practice for a physical. Jose has had type 2 diabetes mellitus for 5 years, diet controlled. His BMI is 32. Smoker, pack per day for 25 years. He denies other medical problems. Family history includes CAD, CABG x4 for father, now deceased; CHF, type 2 diabetes mellitus, HT for mother. According to the AHA/ACC guidelines, what stage is Jose? A. Stage A B. Stage B C. Stage C D. Stage D 17. Susan P., a 60-year-old woman with a 30 pack-year history, presents to your primary care practice for evaluation of persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? A. Seasonal allergies B. Acute bronchitis C. Bronchial asthma D. Chronic bronchitis 18. The best way to diagnose structural heart disease/dysfunction non-invasively is: A. Chest x-ray B. EKG C. Echocardiogram D. Heart catheterization 19. A common auscultatory finding in advanced CHF is: A. Systolic ejection murmur B. S3 gallop rhythm C. Friction rub D. Bradycardia 20. The organism most commonly responsible for community-acquired pneumonia in older adults is: 42 A. Pseudomonas aeruginosa B. Staphylococcus aureus 45 D. All of the above 3. A thorough vascular exam includes all of the following except: A. Cardiac exam B. Reproductive organ exam C. Peripheral vascular exam D. Cranial nerve exam 4. The majority of abdominal aortic aneurysms are due to: A. Trauma B. Infection C. Inflammation D. Atherosclerosis 5. The best initial screening test for abdominal aortic aneurysm is: A. Angiography B. CT scan with IV contrast C. Abdominal ultrasound D. MRI 6. The initial treatment for symptomatic abdominal aortic aneurysm involves: A. Emergency surgery B. Aggressive blood pressure control C. watch-and-wait approach D. Cardiology consult 7. The major cause of death after an abdominal aortic aneurysm repair is: A. AAA rupture B. Hemorrhage C. Renal failure D. Myocardial infarction 8. An early symptom of peripheral artery disease is: A. Painful cramping of muscles during walking B. Pain is worse when the legs are dependent below the level of the heart C. Pain intensifies after vigorous walking is stopped D. Ulceration or gangrene occurs at the sight of minor injury 9. The hallmark of venous stasis ulcers include all of the following except: A. Lower extremity edema B. Hyperpigmentation of the lower extremities C. Ulcers on the medial or lateral malleolus 46 D. Copious draining ulcers 10. Exercise is an essential element of peripheral arterial disease management primarily because: 47 A. It encourages weight loss, as being overweight is a contributing factor to PAD B. Evidence shows exercise reduces smoking C. Collateral vessels are strengthened D. It improves aerobic capacity 11. Home exercise programs for peripheral arterial disease focus on: A. Walk until pain develops then stop B. Walk through the pain then stop C. Begin at a slow speed with 10 minutes a day and build up to 30 minutes D. Walk through the pain, rest until it goes away, then resume walking 12. When should surgical options for peripheral arterial disease be considered? A. Immediately after the diagnosis since the prognosis without revascularization is poor B. After two weeks of pentoxifylline (Trental) therapy C. Pain is not relieved with rest D. Pain limits the patient’s lifestyle or ulceration occurs 13. All of the following are classic signs of venous insufficiency except: A. Pain B. Dependent edema C. Hemosiderosis D. Dermatitis 14. Lower leg edema associated with pain is characteristic of: A. Venous insufficiency B. Heart failure C. Deep venous thrombosis D. Diabetes 15. The most common cause of secondary lymphedema is: A. Surgery B. Cancer treatment C. Infection D. Trauma 16. The imaging gold standard for lymphedema is: A. Lymphosonogram B. Lymphoscintigraphy C. Lymphoangiogram D. CT scan 17. Known risk factors for lymphedema include all of the following except: A. Osteoarthritis B. Rheumatoid arthritis C. Obesity 50 D. Midepigastric pain that is not reproducible with palpation 51 3. The nurse practitioner is examining a 62-year-old female who has been complaining of lower abdominal pain. Upon auscultation, bowel sounds are high pitched and tinkling. Which of the following terms describes this finding? A. Succession splash B. Borborygmi C. Tenesmus D. Puddle sign 4. In teaching an older adult female client with end-stage renal disease her medication regimen, the nurse practitioner must include which of the following pieces of information in the treatment plan? A. Report any changes in the color of her stool B. Take iron supplement and elemental calcium with each meal C. Take iron supplement before meals and the calcium after meals D. Take calcium with a high phosphorus meal 5. A 62-year-old client presents with a complaint of fever, pain, and burning on urination. Difficulty urinating with dribbling has been increasing in the past few days. He has a feeling of pressure in his groin. On examination, his prostate is tender, boggy, and warm. A stat urinalysis reveals the presence of leukocytes and bacteria. He is allergic to sulfa drugs. His weight is 70 kg and his last serum creatinine was 1.0. While awaiting the culture and sensitivity, the nurse practitioner begins empiric treatment with which of the following? A. Trimethoprim/sulfamethoxazole DS bid x 2 weeks B. Ampicillin 250 mg PO q day for 10 days C. Nitrofurantoin 100 mg Q 12 hours for 7 days D. Ciprofloxacin 500 mg Q 12 hours for 14 days 6. A 62-year-old woman presents with a recurrent urinary tract infection. She now has a fever of 104°F and severe costovertebral tenderness with pyuria. What is the appropriate diagnosis and intervention for this patient? A. Septic arthritis and oral prednisolone is indicated B. Pyelonephritis and hospitalization is required C. Recurrent cystitis and 10 days of antibiotics are needed D. Pelvic inflammatory disease and 7 days of antibiotics are indicated 7. Which of the following drugs would be useful for the nurse practitioner to prescribe for an older adult to prevent gastric ulcers when a nonsteroidal anti-inflammatory drug is used for chronic pain management? A. Misoprostol (Cytotec) B. Cimetidine (Tagamet) C. Metronidazole (Flagyl) D. Bismuth subsalicylate (Pepto bismol) 52 8. A 68-year-old male reports painless rectal bleeding occasionally noted with thin pencil-like stools, but no pain with defection. He has a history of colon polyp removal 10 years ago but was lost to follow-up. The nurse practitioner’s appropriate intervention is: A. A digital rectal exam and send home with 3 hemoccult to return B. Immediate referral to gastroenterologist and colonoscopy C. Order a screening sigmoidoscopy D. Order a colonoscopy and barium enema and refer based on results 9. Asymptomatic 1+ bacteruria is found in a nursing home resident with an indwelling catheter. The nurse practitioner’s initial intervention includes: A. Assessing resident’s cognitive status and last change of the catheter/bag B. Prescribing prophylactic Bactrim 1 tablet at bedtime C. Ordering a urine culture and sensitivity and prescribing empiric treatment until results obtained D. Ordering an x-ray of the kidney, urine, and bladder 10. When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti- diarrheal and Kaopectate, the nurse practitioner advises patients to: A. Use all the medication B. Do not use for possible infectious diarrhea C. Use should exceed one week for effectiveness D. These drugs provide exactly the same pharmaceutical effects 11. When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? A. Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins B. Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime C. Sit up for an hour after taking any medication and restrict fluid intake D. Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal 12. A clinical clue for suspected renal artery stenosis would be: A. Decreased urine output B. Development of resistant hypertension in a previously well-controlled patient C. Retroperitoneal pain on the affected side D. Rising BUN level with normal creatinine level 55 A. Pain occurs on an empty stomach B. Diffuse epigastric pain 56 C. Rarely associated with non-steroidal use D. Occurs in patients under 40 years of age 19. A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis? A. C-reactive protein level of 3 mg B. White blood cell count of 11,000 C. Direct serum bilirubin level of 0.3 mg/dL D. Serum amylase level of 145 U/L 20. Which of the following is not a contributing factor to the development of esophagitis in older adults? A. Increased gastric emptying time B. Regular ingestion of NSAIDs C. Decreased salivation D. Fungal infections such as Candida MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: D PTS: 1 3. ANS: B PTS: 1 4. ANS: C PTS: 1 5. ANS: D PTS: 1 6. ANS: B PTS: 1 7. ANS: A PTS: 1 8. ANS: B PTS: 1 9. ANS: A PTS: 1 10. ANS: B PTS: 1 11. ANS: D PTS: 1 12. ANS: B PTS: 1 13. ANS: C PTS: 1 14. ANS: C PTS: 1 15. ANS: B PTS: 1 16. ANS: B PTS: 1 17. ANS: B PTS: 1 18. ANS: B PTS: 1 19. ANS: D PTS: 1 20. ANS: A PTS: 1 Chapter 11. Urological and Gynecologic Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which ethnic group has the highest incidence of prostate cancer? A. Asians B. Hispanics 57 C. African Americans 60 A. Increased estrogen production’s influence on the bladder and ureter B. Decline in bladder outlet function C. Decline in ureteral resistance pressure D. Laxity of the pelvic muscle 9. Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the past week. He has never had a surgical procedure in his life and seeks clarification on the availability of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is NOT a potential side effect of this procedure? A. Urinary incontinence B. Impotence C. Dribbling urine D. Selected low back pain 10. The nurse practitioner is evaluating a patient’s pelvic muscle strength by digital examination. This is performed when: A. A male patient complains of nocturia and dribbling B. The nurse practitioner needs to confirm a cystocele or stress incontinence C. The patient reports sudden loss of large amounts of urine or urge incontinence D. The nurse practitioner suspects overflow incontinence 11. A pelvic mass in a postmenopausal woman: A. is most commonly due to uterine fibroids. B. is always symptomatic. C. is highly suspicious for ovarian cancer. D. should be monitored over a period of time. 12. A 79-year-old man is being evaluated for frequent urinary dribbling without burning. Physical examination reveals a smooth but slightly enlarged prostate gland. His PSA level is 3.3 ng/mL. The patient undergoes formal urodynamic studies, and findings are as follows: a decreased bladder capacity of 370 mL; a few involuntary detrusor contractions at a low bladder volume of 246 mL; an increased postvoid residual urine volume of 225 mL; and a slightly decreased urinary flow rate. Which of the following is not consistent with a normal age-associated change? A. PSA level of 3.3 ng/mL B. Decreased bladder capacity C. Involuntary detrusor contradictions D. Increased postvoid residual urine volume 13. Mrs. Smith, a 65-year-old woman presents to clinic for the first time and complains of urinary incontinence and dyspareunia. She went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 82 years of 61 age. The patient’s most recent mammogram was 5 years ago and no known family history of breast cancer. She is not taking any medications. Her physical examination is unremarkable except for findings 62 consistent with atrophic vaginitis. You decide to begin topical hormone replacement therapy. Which of the following evaluations would be necessary prior to initiating hormone replacement therapy? A. Mammogram B. Endometrial biopsy C. Bone mineral density measurement D. Papanicolaou smear 14. Mrs. L. Billings is a 77-year-old Caucasian female who has a history of breast cancer. She has been in remission for 6 years. As her primary care provider, you are seeing her for follow-up of her recent complaint of intermittent abdominal pain of a 3-month duration and some general malaise. Given the brief history above, what will you direct your assessment at during physical examination? A. Examination of her thyroid to rule out thyroid nodules that may contribute to her feeling fatigued. B. Auscultation of her abdomen for abnormal bowel sounds to rule out peritonitis. C. Thorough abdominal and gynecological exam to rule out masses and identify any tenderness. D. A rectal examination to rule out colon cancer as a secondary site for breast cancer. 15. A 78-year-old female comes to the office because she has pain when she urinates. She has been seen three times for this problem in the last 3 months. Each time she was told she had a UTI and was given antibiotics. She carefully followed the instructions but has had no relief of symptoms. Last UA: WBCs: 2-3/high-power field RBCs: 0-2/high-power field Epithelial cells: Few Nitrite: Negative Leuckocyte esterase: Negative Which of the following should be done next? A. Obtain a clean catch urine for UA and urine for C&S B. Perform a pelvic examination C. Reassure the patient that she has asymptomatic bacteriuria and does not need A. antibiotics D. Order a pelvic ultrasound MULTIPLE CHOICE 1. ANS: C PTS: 1 2. ANS: C PTS: 1 3. ANS: B PTS: 1 4. ANS: B PTS: 1 5. ANS: D PTS: 1 6. ANS: C PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: D PTS: 1 10. ANS: B PTS: 1 11. ANS: C PTS: 1 12. ANS: D PTS: 1 13. ANS: A PTS: 1 14. ANS: C PTS: 1 15. ANS: B PTS: 1 Chapter 12. Musculoskeletal Disorders Multiple Choice 65 D. Scalp tenderness and aching in shoulder and pelvic girdle 66 8. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include: A. Recommending she increase her dietary intake of Calcium and Vitamin D B. Ordering once a year bisphosphonate and a proton pump inhibitor C. Participate in a fall prevention program D. Dual-energy x-ray (DEXA) scan and updating immunizations 9. Which of the following differential diagnosis for patients presenting with polymyalgia rheumatica (PMR) can be ruled out with a muscle biopsy? A. Parkinson’s disease B. Polymyositis C. Late-onset rheumatoid arthritis D. Giant Cell Arteritis 10. In reviewing laboratory results for patients suspected with polymyalgia rheumatica (PMR), you realize that there is no definitive test to diagnosis PRM, rather clinical response to treatment. Results you would expect to see include: A. Elevated erythrocyte sedimentation rate (ESR) greater than 50mm per hour B. Elevated rheumatoid factor and anti-citrullinated protein antibodies (RF and ACPA) C. Decreased C-reactive protein level (CR-P) D. Elevated thyroid stimulating hormone (TSH) 11. Which of the following is the most appropriate laboratory test for monitoring gout therapy over the long-term? A. Erythrocyte sedimentation rate (ESR) B. Completer blood count (CBC) C. Serum urate level D. Serum albumin 12. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items: A. Green leafy vegetables B. Beer, sausage, fried seafood C. Sugar D. Gluten and bread items 13. The best method of verifying a diagnosis of gout in a joint is which of the following: A. Radiographic examination of the joint with two views B. Ultrasound C. Palpation D. Joint aspiration and polarized-light microscopy 67 14. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk): A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days B. Doxycycline 100 mg BID for 5 days C. Prednisolone 35 mg QD for 5 days D. Ice therapy 15. The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be: A. Symmetric joint space narrowing B. Soft tissue swelling C. Subluxations of the joints D. Joint erosions 16. The nurse practitioner is examining the hands of a 55-year-old woman with rheumatoid arthritis and notes bilateral spindle shaped deformities on the middle interphalangeal joints. These are known as: A. Haygarth’s nodes B. Heberden’s nodes C. Bouchard’s nodes D. Benediction hands 17. A 72-year-old female patient has been diagnosed with gout. She also has a long history of chronic congestive heart failure. The most likely contributing factor to the development of gout in this older female is: A. Lead intoxication B. Illegal whiskey C. Binge-eating D. Thiazide diuretics 18. Which of the following statements about osteoarthritis is true? A. It affects primarily weight-bearing joints B. It is a systemic inflammatory illness C. The metacarpal phalangeal joints are commonly involved D. Prolonged morning stiffness is common 19. In considering the specificity of laboratory data, the most reliable diagnostic test listed below would be: A. Elevated erythrocyte sedimentation rate (ESR) to rule out inflammation B. CBC to rule out infection 70 A. Bilateral vision disturbance and/or diplopia B. Dysarthria and speech difficulties C. Disorders in behavior and in cognition D. Motor and sensory problems on both sides of the body 71 2. When assessing a patient who complains of a tremor, the nurse practitioner must differentiate essential tremor from the tremor of Parkinson’s disease. Which of the following findings are consistent with essential tremor? A. The handwriting is not affected by the tremor B. The tremor occurs with purposeful movements C. The tremor occurs at rest D. The tremor gets worse with alcohol ingestion 3. Which of the following assessments are commonly noted in a client with Parkinson’s disease? A. Macrographia and bradycardia B. Micrographia and bradykinesia C. Exaggeration of rapid successive movements D. Increased arm swing 4. An older adult client with a history of a seizure disorder comes into the clinic for a routine check- up. Although seizure-free, the client continues on long-term phenytoin treatment. The nurse practitioner would assess for which of the following long-term effects? A. Lid lag and nystagmus B. Gingival hyperplasia and nystagmus C. Nystagmus and microcytic anemia D. Gingival hyperplasia and iron deficiency anemia 5. An elderly nursing home resident is maintained on phenytoin therapy for a history of a seizure disorder. In addition to periodic serum drug concentrations, which of the following are needed for annual evaluation? A. Complete blood count, liver function tests, and renal function tests B. Complete blood count, liver function tests, and platelet count C. Renal function and calculated creatinine clearance D. Serum albumin, liver function tests, and renal function tests 6. A 78-year-old female presents with a seizure that occurred over the weekend. In selecting the most important diagnostics for this presentation, it is important to know that the least common site of seizures in the elderly is: A. Cerebellum B. Frontal lobe C. Temporal lobe D. Parietal lobe 7. An elderly patient has had a CVA in the anterior cerebral circulatory system (frontal lobe). What symptoms are most likely expressed? A. Neglect of body and difficulty organizing space B. Wernicke’s aphasia (difficulty understanding speech) 72 C. Disorders of behavior and cognition 75 slight delayed elicitation. You assess that he has only mild dysphagia. You recommend which of the following as the next step in his care? A. Consult gastroenterologist for g-tube decision B. Consult speech pathologist for video fluoroscopy C. Provide a trial of foods of differing consistency D. Require that he is fed all his meals 15. Which of the following assessment findings is commonly noted in a client with advanced Parkinson’s disease? A. Macrographia B. Micrographia C. Ataxic gait D. Increased arm swing 16. A middle-aged patient has been diagnosed with Parkinson’s disease. What influences the nurse practitioner’s decision to begin pharmacological treatment for this patient? A. Intentional tremors B. Gait instability requiring use of a cane C. Symptoms interfering with functional ability D. Medications initiated at first sign of unilateral involvement 17. An older male presents with incontinence, has a wide-based and irregular gait, and progressive dementia. Which of the following presents with these cardinal signs? A. Parkinson’s disease B. Normal-pressure hydrocephalus C. Basilar artery CVA D. Progressive supranuclear palsy 18. In review of a nursing home patient’s chart, the nurse practitioner discovers that the neurology consult identified that the client has homonymous hemianopsia. Which of the following statements accurately describes these findings? A. Partial loss of visual acuity in the ipsilateral peripheral fields B. Diplopia in the eye contralateral to the cerebral lesion C. Loss of vision in either the right or left halves of the visual fields D. Nystagmus in both eyes with asymmetrical movement 19. 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. The patient will be asked to repeat five words immediately following the directions by the practitioner. B. The patient is asked to draw the hour and minute hands on a picture of an analog clock. C. A score of 0-2 is a positive screen for dementia. D. The patient is asked to recall five images from picture cards following the drawing of the clock hands. 76 MULTIPLE CHOICE 77 1. ANS: C PTS: 1 2. ANS: B PTS: 1 3. ANS: B PTS: 1 4. ANS: B PTS: 1 5. ANS: B PTS: 1 6. ANS: C PTS: 1 7. ANS: C PTS: 1 8. ANS: C PTS: 1 9. ANS: B PTS: 1 10. ANS: B PTS: 1 11. ANS: B PTS: 1 12. ANS: D PTS: 1 13. ANS: C PTS: 1 14. ANS: C PTS: 1 15. ANS: B PTS: 1 16. ANS: C PTS: 1 17. ANS: B PTS: 1 18. ANS: C PTS: 1 19. ANS: C PTS: 1 Chapter 14. Endocrine, Metabolic, and Nutritional Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. An elderly client presents with a new onset of feeling her heart race and fatigue. An EKG reveals atrial fibrillation with rate >110. The patient also has a new fine tremor of both hands. Which of the following would the nurse practitioner suspect? A. Hypothyroidism B. Hyperthyroidism C. Congestive heart failure D. Type 2 diabetes mellitus 2. A 62-year-old female complains of fatigue and lack of energy. Constipation has increased and the patient has gained ten pounds in the past 3 months. Depression is denied although the patient reports a lack of interest in usual hobbies. Vital signs are within normal limits and the patient’s skin is dry and cool. Which of the following must be included in the differential? A. Hyperthyroidism B. Hypothyroidism C. Hyperparathyroidism D. Grave’s disease 3. Mrs. Black, an 87-year-old patient, has been taking 100 mcg of Synthroid for 10 years. She comes to your office for a routine follow-up, feeling well. Her heart rate is 90. Your first response is to: A. Increase the Synthroid B. Order TSH C. Start a beta-blocker D. Order thyroid scan 4. Which patient is most likely to have osteoporosis? A. An 80-year-old underweight male who smokes and has been on steroids for psoriasis B. A 90-year-old female with no family history of osteoporosis who is on hormone replacement therapy 80 10. A patient has been prescribed metformin (Glucophage). One week later he returns with lowered blood sugars but complains of some loose stools during the week. How should the nurse practitioner respond? 81 A. Discontinue the medication immediately B. Reassure the patient that this is an anticipated side effect C. Double the dosage of medication and have patient return in 1 week D. Order a chem. 7 to check for lactic acidosis 11. Which of the following signs of hyperthyroidism commonly manifest in younger populations, but is notably lacking in the elderly? A. Weight gain B. Constipation C. Bradycardia D. Exophthalmos 12. A 60-year-old obese male client has type 2 diabetes mellitus and a lipid panel of TC = 250, HDL = 32, LDL = 165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include: A. Advancing age, diabetes, hyperlipidemia, and male gender B. Diabetes, obesity, and hyperlipidemia C. Hyperlipidemia, smoking, and family history of heart disease D. Male with age > 45, diabetes mellitus, and hyperlipidemia 13. A diabetic patient presents with the complaint of right foot pain but denies any recent known injury. He states it has gotten progressively worse over the past few months. On exam, vibratory sense, as well as sensation tested with a monofilament, was abnormal. The patient’s foot is warm, edematous, and misshapen. The nurse practitioner suspects Charcot foot. What intervention is indicated? A. Warm soaks and return for follow-up in 1 week B. Referral to a pain management clinic C. Referral to an orthopedist D. Referral to a cardiologist for evaluation of peripheral vascular disease 14. What is a sign of insulin resistance that can present in African American patients? A. Acanthosis Nigricans B. Psoriasis Nigricans C. Seborrheic Nigricans D. Bullemic Nigricans 15. During a routine physical examination of a 62-year-old female patient, the nurse practitioner identifies xanthelasma around both his eyes. What is the significance of this finding? A. High potential for future blindness and requires immediate referral B. None, normal variant of aging process C. Abnormal lipid metabolism requiring medical management 82 D. Hereditary variant that is of no consequence but requires watchful waiting 85 4. Despite adherence to oral iron therapy of 2 weeks, your elderly patient with IDA demonstrates a drop in his hemoglobin from 8.4 to 7.4. He is complaining of fatigue, dyspnea, and heart racing. You would change his therapy by which of the following: 86 A. Schedule patient for outpatient parenteral iron infusion B. Switch to a different form of oral therapy C. Schedule patient for outpatient blood transfusion D. Make no changes until evaluated by GI specialist 5. You are prescribing oral iron therapy for a patient with IDA. In teaching your patient about iron therapy, all of the following instructions should be reviewed except: A. Iron is best taken on an empty stomach one hour before meals B. Meat, fish, poultry, beans, and green leafy vegetables are good dietary sources of iron C. Adding vitamin D daily enhances absorption of iron D. Common GI side effects of iron therapy include constipation, nausea, and black stools 6. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): A. Hemoglobin <12 g/dl, Mean Corpuscular Volume (MCV) decreased, Mean Corpuscular Hemoglobin (MCH) decreased B. Hemoglobin >12 g/dl, Mean Corpuscular Volume (MCV) increased, Mean Corpuscular Hemoglobin (MCH) increased C. Hemoglobin <12 g/dl, Mean Corpuscular Volume (MCV) normal, Mean Corpuscular Hemoglobin (MCH) normal D. Hemoglobin >12 g/dl, Mean Corpuscular Volume (MCV) decreased, Mean Corpuscular Hemoglobin (MCH) increased 7. The pathophysiological hallmark of ACD is: A. Depleted iron stores B. Impaired ability to use iron stores C. Chronic uncorrectable bleeding D. Reduced intestinal absorption of iron 8. The main focus of treatment of patients with ACD is: A. Replenishing iron stores B. Providing for adequate nutrition high in iron C. Management of the underlying disorder D. Administration of monthly vitamin B12 injections 9. In addition to the CBC with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? A. Serum iron B. Total iron binding capacity C. Transferrin saturation D. Serum ferritin 10. Education of patient and family regarding ACD includes discussion of all of the following except: A. Early prevention of chronic conditions through healthy lifestyle measures B. Importance of adherence to the treatment plan for management of chronic conditions C. Explaining the ACD is mainly attributed to the aging process 87 D. Importance of regular follow-up to monitor responses to treatments 11. Symptoms in the initial HIV infection include all of the following except: A. Sore throat B. Fever C. Weight loss D. Headache 12. The primary mode of HIV transmission in the U.S. is: A. Blood transfusion B. Men having sex with men C. Heterosexual contact D. Needle sharing 13. In the older adult, which group comprises the highest rate of HIV/AIDS? A. African American women B. African American men C. Hispanic women D. Hispanic men 14. Contributing factors in HIV development in the older adult include all of the following except: A. Older adults are less likely to be tested B. Healthcare providers do not routinely ask older adults about HIV risks C. Older adults are less likely to use condoms D. Older adults are at low risk to contract HIV 15. Immune system changes that render older adults more susceptible to contracting HIV include all of the following except: A. Hyper-responsive T cells B. Age-related thymic involution C. Depletion of naïve CD4 cells D. Decline in B cell function MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: C PTS: 1 3. ANS: D PTS: 1 4. ANS: C PTS: 1 5. ANS: C PTS: 1 6. ANS: C PTS: 1 7. ANS: B PTS: 1 90 B. Confusion Assessment Method C. Folstein’s Mini-Mental Status Examination D. Montreal Cognitive Assessment 91 7. The proposed mechanism by which diphenhydramine causes delirium is: A. Serotinergic effects B. Dopaminergic effects C. Gabanergic effects D. Anticholinergic effects 8. The elderly are at high risk for delirium because of: A. Multisensory declines B. Polypharmacy C. Multiple medical problems D. All of the above 9. A consistent finding in delirium, regardless of cause, is: A. Dopamine deficiency B. Serotinergic toxicity C. Acetylcholine deficiency D. Reduction in regional cerebral perfusion 10. Older adults with dementia sometimes suffer from agnosia, which is defined as the inability to: A. Use language B. Understand language C. Recognize objects D. Remember events and places 11. In late stages of dementia, a phenomenon called “sun downing” occurs, in which cognitive disturbances tend to: A. Improve as the day goes on B. Become worse toward the evening C. Fluctuate during the course of the day D. Peak mid-day 12. Of the following, which one is the most useful clinical evaluation tool to assist in the diagnosis of dementia? A. Folstein’s Mini-Mental Status Exam (MMSE) B. St. Louis University Mental Status Exam (SLUMS) C. Montreal Cognitive Assessment (MoCA) D. Geriatric Depression Scale (GDS) 13. The cornerstone of pharmacotherapy in treating Alzheimer’s disease is: A. Cholinesterase inhibitors B. NMDA receptor antagonist C. Psychotropic medications D. Anxiolytics 14. The comorbid psychiatric problem with the highest frequency in dementia is: 92 A. Anxiety B. Depression 95 2. The nurse is aware that increased may affect the absorption of medications. A. a.gastric motility B. b.alkaline gastric secretion C. c.intestinal emptying time D. d.peristalsis ANS: B An increase in alkaline gastric secretions may affect the absorption of medications, because gastric motility, gastric emptying time, and peristalsis are all decreased with increased alkaline gastric secretions. 3. The older adult client is prescribed a drug that is excreted through the urine. The nurse anticipates that which laboratory test will be prescribed to evaluate renal function before administration of themedication? A. a.Blood urea nitrogen B. b.Serum albumin C. c.Serum electrolytes D. d.White blood cell count ANS: A Drug dosages are adjusted according to the older adults weight, adipose tissue, laboratory results (e.g., serum protein, electrolytes, liver enzymes, blood urea nitrogen, creatinine), and current health problems. 4. The nurse recognizes that polypharmacy is more likely to occur in an older adult client because the older client: a. has difficulty maintaining a list of current medications. b. experiences changes in visual capability. c. experiences alterations in mental capacity. d. may obtain prescribed drugs from various providers. ANS: D Polypharmacy is the prescription and administration of many drugs during the same period. This is more likely with the older client, who may see various healthcare providers to manage the health concerns that may accompany aging. 5. The diuretic hydrochlorothiazide (HCTZ; HydroDIURIL) is usually prescribed for the older adult in a lower dose. The nurse recognizes that this is an attempt to prevent the older adult from experiencing a(n): a. increase in potassium loss. b. Decrease in sodium loss. 96 c. Decrease in blood sugar levels. 97 d. Increase in red and white blood cell count. ANS: A 6. The nurse notes that Cimetidine has been prescribed for an older adult client. The nurses highest priority would be to call: a. the physician. b. The pharmacist. c. The nursing supervisor. d. Poison Control. ANS: A Cimetidine is not recommended for older adults because of its side effects and multiple potential drug interactions. Famotidine, nizatidine, and ranitidine may be prescribed for the geriatric client instead of cimetidine. 7. An older adult client says that he has difficulty removing the cap from his medication bottle. He says That's why I don't always take my medication. The nurse should suggest that he: a. ask a neighbor to help him remove the bottle cap. b. Ask the pharmacist to put the drug in a non childproof container. c. Have a family member visit daily to prepare his medications. d. Ask the healthcare provider not to prescribe drugs that come in childproof bottles. ANS: B Childproof caps may be difficult to remove for older adults with arthritis or decreased strength or motor function. 8. A client is demonstrating signs and symptoms of disorientation. Which question by the nurse would be appropriate related to the clients medication use? a. Are you taking any new medications? b. Do you take medications with a full glass of water? c. Do your medications make you constipated? d. Have you been diagnosed with dementia? ANS: A A new medication may be associated with changes in sensorium or other behavioral characteristics. This should be evaluated. 9. The nurse is caring for an older adult client and a middle-aged adult client. The nurse anticipates that the medication doses for the older adult will be those for the middle-aged adult. a. the same as b. less than c. slightly more than d. twice as much as