Geriatric Care and Health Promotion for Older Adults, Exams of Nursing

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1. Mrs. Smith, 75 years old, reports that she is weak, has difficulty urinating, and is dehydrated. Although she is afebrile, the nurse conducts a thorough physical examination, including urinalysis and complete blood count (CBC). The total assessment is necessary because:
2. All body systems interact, and symptoms could indicate a variety of diagnoses.
3. The symptoms are vague and may be signs of aging.
4. There may be other signs or symptoms more indicative of the condition.
5. Mrs. Smith may not be reporting all significant information. - ANSWER 1.
6. A patient with renal disease has blood work drawn, and the results show an increase in serum creatinine. The nurse practitioner needs to know which of the following laboratory values before ordering medications?
7. CBC
8. Culture and sensitivity of the urine
9. Creatinine clearance
10. Uric acid levels - ANSWER 3.

Which of the following statements is true regarding diagnostic testing?

1. A test is ordered for a specific purpose.
2. A test is the most invasive available.
3. There is no need to discuss results with the patient.
4. If a test is needed, it should be ordered regardless of risk to the patient. - ANSWER 1. Janey, 25 years old, may experience arthritis differently than 65 - year-old Mrs. Johnson because:
5. The body undergoes physiological changes with aging.
6. A healthy body does not experience significant changes as one gets older.
7. Older patients do not feel any systemic symptoms, such as malaise and weight loss.
8. Even though the same joints are usually affected, age makes it feel different.

• ANSWER 1. The nurse practitioner is examining an 85-year-old man with reports of abdominal pain, weakness, and loss of appetite. Which is the most likely condition to be tested for and ruled out?

1. Neoplasms and carcinomas
2. Partial seizure
3. Sarcopenia

4. Hirschsprung's disease - ANSWER 1. For individuals over 65 years old, the most common morbidities are related to:
5. Heart disease, arthritis
6. Respiratory problems, cancer
7. Diabetes, stroke
8. All of these are common morbidities. - ANSWER 4 A gerontological patient is being examined for a report of pain in the shoulder. The nurse practitioner completes a thorough systemic examination because:
9. Older patients with one morbidity often express difficulties in general.
10. Arthritis of the shoulder is accompanied by other neurological symptoms.
11. Older patients with arthritis often experience pain in lower extremities.
12. The patient may not report significant signs and symptoms. - ANSWER 1. The nurse practitioner performs a thorough systemic examination of a patient who reports diarrhea and pain in the upper left quadrant of the abdomen. One possible diagnosis would be:
13. Hirschsprung's disease
14. Pancreatitis
15. Appendicitis
16. Gastrointestinal inflammatory bowel disease (GIBD) - ANSWER 4.

9. A 70-year-old man is seeing a nurse practitioner because he is feeling weak and dizzy. The nurse practitioner is discussing a care plan with him and makes which of the following statements? Select all that apply.
10. I want to order a test for your heart to evaluate its function.
11. I will perform a thorough examination of your functional abilities.
12. I will order a blood sugar test to check for diabetes.
13. Many older people feel this way. It is to be expected.
14. I will assess you for the presence of other conditions. - ANSWER 1, 2, 3, 5 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? Select all that apply.
15. I suggest that you exercise a little more than you are currently doing.
16. Some people experience a decrease in reserve energy.
17. For some people, the immune system weakens.
18. More viruses are being spread throughout the community.

5. I suggest that you see your primary caregiver for extensive testing. - ANSWER 2, 3, 5 An older woman is seen in the ambulatory clinic for a routine checkup. The patient asks about results of her blood work compared to last year's results. How is it best for the clinician to respond? Select all that apply.
6. They are likely to be the same if you have had no diseases since then.
7. Blood work results may be different just because of your aging process.
8. Your results may be different because the body changes with disease and medications you are taking.
9. Blood work is not a reliable indicator of health because many things can affect your health that may not show up in the results of your blood work.
10. There is likely no significant difference as your body remains stable in its functioning. - ANSWER 2, 3
11. An elderly couple is discussing health concerns with the nurse practitioner. The couple is concerned that each of their individual blood studies show different results. One set of test results shows a significant decrease in blood sugar, but the test results of the partner does not show an equal decrease. Their physician does not seem concerned, and the couple is

wondering why. How is it best for the nurse practitioner to respond? Select all that apply.

1. Studies show that each person's pattern of chemical make-up is different.
2. There is no difference between one person's range of blood results and that of any other person.
3. Each person's chemical make-up is the same as that of others of the same gender and age group.
4. Many factors affect an individual's chemical make-up.
5. Ranges of the values provided by the laboratory are correct for any age. - ANSWER 1, 4 Adam, 70 years old, is admitted for possible myasthenia gravis (MG). The nurse practitioner knows that MG is commonly seen in women between 20 and 40 years old. Adam, however, is experiencing an ocular form of MG, has dysphonia, and does not have any thymus abnormalities. Adam asks why the nurse is concerned about MG since he is older and this is a "young person's disease." Which of the following are the best answers? Select all that apply.
6. We need to assess for anything, just in case.
7. Some diseases show up in two different age and gender groups.
8. Older people often experience weakness, and we must rule out other conditions.

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 2,
6. Mrs. Smith is 75 years old and has had type 2 diabetes for 30 years. She sees her nurse practitioner on a regular basis. Mrs. Smith asks the nurse practitioner why her treatment has not been changed, even though her laboratory values are seemingly out of normal range. Which of the following answers are best? Select all that apply.
7. A decision to make changes must be based on a pattern and not on one set of laboratory results.
8. The normal range charts are based on patients younger than 75 years.
9. Currently, it is too expensive to change your treatment.
10. Comparing new results with your prior results gives a more accurate picture.
11. Normal values for laboratory tests differ as one gets older. - ANSWER 1, 4, 5
12. Mr. Adams is 90 years old. In the last few months he appears unable to comply with the health-care plan developed 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.
13. Polypharmacy
14. Treatment burden
15. Attending multiple appointments

4. Affording complex drug regimens
5. Cognitive ability only - ANSWER 1, 2, 3, 4
6. A patient asks the nurse practitioner what is meant by health promotion. Which of the following is the nurse practitioner's best response? Health promotion:
7. Includes activities that an individual performs proactively to increase health and well-being.
8. Is a process of keeping track of immunizations.
9. Includes a set of programs that help people cope with the disease.
10. Includes strategies that prolong life. - ANSWER 1.
11. The nurse practitioner knows that health promotion is accomplished on a broader scale by:
12. Maintaining current health services.
13. Maintaining federal legislation regarding health care at the current level.
14. Encouraging healthy lifestyle and healthy public policy formulation.
15. Encouraging the advancement of alternative health therapies. - ANSWER 3.
16. Mr. Thomas comes in for a health examination appointment with his nurse practitioner. He asks why nurse practitioners are qualified to conduct these evaluations. Which of the following is the nurse practitioner's best response? The nurse practitioner:

1. Is concerned about health and not disease.
2. Saves the physician time in the office.
3. Can assess for minor conditions and refer to the doctor for other conditions.
4. Is prepared to assess health holistically. - ANSWER 4.
5. Mrs. Williams, 80 years old, asks her nurse practitioner to order a new alternative therapy for her. Mrs. Williams believes that this botanical supplement will provide pain relief for her fibromyalgia. The nurse practitioner explains that this therapy is likely not covered by Medicare because:
6. The botanical is expensive and not approved for use.
7. Medicare only covers treatments that are approved according to the stringent guidelines of the U.S. Preventive Services Task Force (USPSTF).
8. There is no reason to use these botanicals when opioids are proven effective.
9. This botanical is not on the Medicare list of approved medications. - ANSWER 2.
10. When a patient is seen by a nurse practitioner, the care plan is developed keeping which of the following objectives in mind?
11. Increasing the use of the emergency department for injuries from falls.
12. Maintaining the patient living in his or her home.
13. Increasing safety checks in the home.

4. Increasing use of the Welcome to Medicare visit. - ANSWER 4.
5. The focus of advanced nurse practitioners is primary care. This is defined as activities that focus on:
6. Preventing the occurrence of a disease or condition.
7. Treating an illness after symptoms appear.
8. Enabling the patient to recover and convalesce.
9. Enriching the patient's appreciation of life. - ANSWER 1.
10. A health promotion topic included in the nurse practitioner visit is physical activity. Which of the following would be a good recommendation for the 75 - year-old male? Select all that apply.
11. Skydiving
12. Horseback riding
13. Swimming
14. Dancing
15. Whatever the patient is willing and able to do - ANSWER 3, 4, 5
16. Understanding that the current life expectancy is 79 years, the nurse practitioner plans a patient's health promotion while considering which of the following? Select all that apply.
17. Patient's health beliefs and goals.

2. Present levels of function.
3. Benefit of treatment.
4. Patient's involvement in a religious community.
5. Primary disease or condition affecting the patient. - ANSWER 1, 2, 3
6. As the nurse practitioner is teaching about the need for more exercise, the patient says that it takes away too much energy needed for other activities. The nurse practitioner explains that the benefits of exercise include which of the following? Select all that apply.
7. Increased flexibility.
8. Increased muscle mass.
9. Maintenance of optimal weight.
10. Lower blood pressure.
11. Decreased urinary output. - ANSWER 1, 2, 3, 4
12. While counseling a patient about physical activity, the nurse practitioner considers which of the following? Select all that apply.
13. A physical activity prescription that is individualized to the patient.
14. Active hobbies that the patient enjoys.
15. Alternative activities such as yoga or tai chi.
16. Armchair activities for the frail older adult.
17. Patient's ability to pay for involvement in activities. - ANSWER 1, 2, 3, 4

11. Nutrition counseling is part of health promotion. The nurse practitioner considers a teaching plan that includes which of the following information? Select all that apply.
12. Level of involvement in community activities.
13. Baseline information on current dietary intake.
14. Current activity patterns.
15. Current height and weight.
16. Health status information. - ANSWER 2, 3, 4, 5
17. A major concern for older adults is safety. The nurse practitioner addresses safety issues when assessing the following. Select all that apply.
18. Presence of a gun in the home.
19. Fear of falling.
20. Strength of the patient.
21. Presence of rugs and other hazards in the home.
22. Urinary incontinence. - ANSWER 1, 2, 3, 4, 5
23. Albert is 72 years old and complains of burning upon urination. He has recently returned from a vacation to another country. The nurse practitioner conducts a physical examination and observes that there is a white discharge from his penis. What does the nurse practitioner include in the treatment plan? Select all that apply.

1. Teaching on safe sex practices.
2. Teaching about the incidence of contracting sexually transmitted infections (STIs), even at an older age.
3. Teaching that frequent testing and screening is needed if he continues to be sexually active.
4. Assuring the patient that while traveling there are limited opportunities for sexual encounters.
5. There is no need to assess an older patienet's sexual preferences and practices. - ANSWER 1, 2, 3
6. Mary, 72 years old, goes to the pharmacy to pick up her prescriptions. The pharmacist asks if she has had her immunizations. Mary replies, "I had all my childhood shots, so I do not need any now." What should the nurse practitioner teach her about senior immunizations? Select all that apply.
7. Because the immune system may be weakened in older persons, immunizations are suggested.
8. Persons over the age of 50 years should have a yearly influenza vaccine.
9. The new Shingrix vaccine will help protect her from shingles.
10. The side effects of immunizations outweigh the benefits of immunizations.
11. The pneumococcal vaccine is given as a one-time dose. - ANSWER 1, 2, 3
12. Mr. and Mrs. Jones are preparing to take a trip to Europe. The nurse practitioner includes the following teaching about taking care of their health while gone. Select all that apply.

1. Shorter airplane flights provide more chance to ambulate and relieve pressure on the back and legs.
2. Generally speaking, the air in Europe is cleaner than the air in the United States, so you should have no problems with your respiratory conditions.
3. Plan to fill your prescriptions when you are in a larger city.
4. Depending on the specific areas you will visit, certain immunizations may be needed.
5. You will most likely function as well when traveling as when at home. - ANSWER 1, 4
6. Mrs. Keating is a 70-year-old woman suffering from arthritis. She is seeing the nurse practitioner for her regular checkup. For a person with chronic degenerative conditions, which of the following should the nurse suggest for health promotion?
7. Take herbal supplements.
8. Increase physical activity.
9. Take Aleve.
10. Get a massage. - ANSWER 2
11. Many adults find reasons or barriers for not being able to exercise. Which of the following is an example of a patient barrier?

1. Good health, no functional limitations.
2. Insurance incentive.
3. High body mass index (BMI).
4. Frequent contact with prescriber. - ANSWER 3
5. Mr. Osorio is a 65-year-old male who recently retired because of a medical condition. He has good family support and is very motivated to start a wellness program to prevent worsening of his condition. These factors are an example of:
6. Barriers
7. Incentives
8. Positive self-efficacy
9. Facilitators - ANSWER 4
10. The American College of Sports Medicine (ACSM) has designed programs to incorporate exercise into every patient encounter. Which of the following is the correct phrase for this program?
11. Back to Exercise
12. Health and Wellness
13. Exercise is Medicine

4. Exercise is Wellness - ANSWER 3
5. Which of the following should nurse practitioners suggest to counter common patient excuses for not exercising?
6. Join a gym.
7. Find an exercise "buddy."
8. Take a 10 - minute walk every day.
9. Go to the YMCA. - ANSWER 3
10. Older adults who have chronic conditions and are considering an increase in their physical activity should:
11. Start slowly, using lower weights with high repetitions.
12. Consult with a personal trainer.
13. Consult a health-care provider to help set physical activity goals that are realistic and safe.
14. Start with low repetitions but heavier weights. - ANSWER 3
15. Challenges to increasing physical activity are different for everyone. For instance, some patients may be experiencing depression or loss, some may have had significant life changes, and others may be dealing with functional limitations. As relates to increasing physical activity,

these are examples of what?

1. Patient excuses
2. Patient facilitators
3. Patient ignorance regarding what to do
4. Patient barriers - ANSWER 4
5. Which of the following is the focus of additional studies about the relationship between physical activities and cognitive changes?
6. Diet and supplements
7. Provider and patients
8. Social support and patients
9. Medical conditions and medications - ANSWER 1
10. With the recognition that baby boomers will increase the over 65 population exponentially, guidelines for increasing physical activity in older adults have been issued. Which of the following programs is dedicated to health promotion in older adults? Select all that apply.
11. The Healthy People 2020 initiative

2. The Center for Medicare and Medicaid
3. The American Medical Association
4. The National Institute on Aging
5. The American Heart Association (AHA) - ANSWER 1, 2, 4
6. Mr. Fekjar is diagnosed with unstable angina. Which of the following is a contraindication for exercise therapy and prevents patients from joining an exercise program? Select all that apply.
7. Uncontrolled hypertension
8. Fibromyalgia
9. Unstable aortic aneurysm
10. Chondromalacia
11. Hypoxemia - ANSWER 1, 3
12. Which of the following may be included in the healthy lifestyle counseling during the initial Welcome to Medicare visit? Select all that apply.
13. Level of physical activity assessment.
14. Physical therapy consultation.
15. Referral to an herbalist.
16. Referral to a health coach.

5. Referral to an acupuncturist. - ANSWER 1, 2, 4
6. Incorporating exercise into patients' lifestyles can be effectively achieved by including which of the following in your discussions with patients? Select all that apply.
7. Talking about the importance of exercise.
8. Encouraging goal setting and self-monitoring by the patient.
9. Recommending the purchase of exercise equipment to use at home.
10. Informing the patient about resources that are available in the communityfor group exercise.
11. Giving an illustration of the exercises. - ANSWER 2, 4
12. The goal of increasing physical activity is to promote a healthy lifestyle. Which of the following options help reduce the risk of injuries? Select all that apply.
13. Choosing physical activities that are appropriate for their current fitness level and health goals.
14. Remaining under the care of a health-care provider if they have chronic conditions or symptoms.
15. Choosing to do physical activities their friends are doing.
16. Enlisting spousal supervision and support.
17. Hiring a personal trainer. - ANSWER 1, 2

14. The AHA Council on Nutrition, Physical Activity, and Metabolism identified patient facilitators to increasing physical activity in older adults. Which of the following is an example of patient facilitators? Select all that apply.
15. Frequent contact with prescriber.
16. Planned program.
17. Making time.
18. Purchasing new equipment.
19. Ignorance of exercise. - ANSWER 1, 2
20. To perform physical activity safely and reduce the risk of injuries and other adverse events, which of the following are advisable? Select all that apply.
21. Start fast to get acclimated to the activities.
22. Use their instincts.
23. Use appropriate protective gear.
24. Follow rules and policies.
25. Have an exercise "buddy." - ANSWER 3, 4
26. Mr. and Mrs. Smith are both 75 years old and are seeing their nurse practitioner for their annual checkups. Mrs. Smith wonders why they each have trouble digesting different foods. It is inconvenient for her to fix different meals that they both can tolerate. The nurse practitioner explains that:

1. Men have more difficulty digesting vegetables.
2. Women have more difficulty digesting dairy products.
3. Men and women have different enzymes in their gastrointestinal tracts.
4. Organ systems progress differently for each person regardless of age. - ANSWER 4
5. The nurse practitioner conducts a comprehensive geriatric assessment of the older individual because:
6. Health of older people is affected by several factors.
7. A focused assessment will provide depth of specific information.
8. A comprehensive assessment will provide more subjective information.
9. A comprehensive assessment will result in a list of current and prior medications taken. - ANSWER 1
10. The nurse practitioner knows that conducting a comprehensive geriatric assessment (CGA) is more beneficial for which of the following groups?
11. People between 60 and 70 years old.
12. People over 70 years old.
13. People classified as vulnerable older adults.
14. People over 55 years old. - ANSWER 3

4. A family member comes into the clinician's office with her older mother, the patient. In the process of the examination, the nurse practitioner identifies the patient as "frail older adult." The family member asks what that means. The nurse practitioner explains that this refers to:
5. Someone who is prone to pathological fractures.
6. An older person already exhibiting signs of decline.
7. An older person who has lost height and is under 5 feet tall.
8. An older person being susceptible to infections. - ANSWER 2
9. Jane, 83 years old, comes to the clinic with her daughter for a geriatric assessment. The daughter asks about the necessity of this comprehensive assessment. The clinician explains that a CGA is a multidimensional process to:
10. Identify care needs and plans of care for older people.
11. Acquire information about past medical conditions.
12. Determine which diagnostic tests are necessary.
13. Satisfy requirements of Medicare. - ANSWER 1
14. Mary Jane is seeing a nurse practitioner for a CGA and asks which parts of her life will be examined. The nurse practitioner says the domains of the CGA include:
15. Internal organ health.
16. Social habits.

3. Physical and psychological health, as well as other facets of life.
4. History of family illness. - ANSWER 3
5. In conducting a CGA, the nurse practitioner looks for any impairments in communication with the patient. The assessment includes:
6. Interviewing prior to the physical examination.
7. Asking questions of the accompanying family member.
8. Reading the history forms provided by the patient after the examination.
9. Observing physical impairments. - ANSWER 1
10. When an assessment is conducted, which of the following needs to be recorded when a new concern is identified? Select all that apply.
11. Location and radiation.
12. Quantity and quality.
13. Aggravating and alleviating.
14. Signs and symptoms.
15. Effect on financial status. - ANSWER 1, 2, 3, 4
16. After examining Adam, who is 79 years old, the nurse practitioner uses which of the following criteria to adjust Adam's medications? Select all that apply.

1. The Beers Criteria published in 1991
2. Medication Appropriateness Index
3. STOPP/START Criteria
4. HHS Guide to Geriatric Medications
5. Hospital formulary - ANSWER 2, 3
6. While examining John, who is 80 years old, the nurse practitioner observes that as he rises from the chair he pauses and holds on to the rail. Asking John if this happens often, he replies, "Yes, I get lightheaded and feel like I will fall." The nurse practitioner decides to conduct testing for orthostatic hypotension. This test includes which of the following? Select all that apply.
7. Having the patient lie down for 5 minutes, then measuring blood pressure and pulse.
8. Having the patient stand and wait a minute, then measuring blood pressure and pulse.
9. Having the patient jump in place for 2 minutes and then lie down.
10. Having the patient breathe deeply five times and then stand up.
11. Having the patient get up from his chair without using his arms, walk two to three steps, then back up to his chair and sit down. - ANSWER 1, 2
12. In conducting a physical assessment of an older person, the nurse practioner assesses which of the following? Select all that apply.
13. Pulse oximetry
14. Weight

3. Color of hair
4. Functional assessment
5. Presence of pain - ANSWER 1, 2, 4, 5
6. Mrs. Parsons is 75 years old and is anticipating renewing her driver's license. The nurse practitioner conducts an eye examination and is concerned to find which of the following? Select all that apply.
7. Visual acuity better than 20/20.
8. Visual acuity worse than 20/40.
9. Abnormality in the six cardinal fields of gaze.
10. Ability to gaze downward.
11. Absence of nystagmus. - ANSWER 2, 3, 5
12. Bertha is an 85-year-old grandmother who has multiple morbidities. Family members report that Bertha is not eating much and does not seem as active as usual. They want the nurse practitioner to order tests to identify what is happening to her. The nurse practitioner considers which of the following before ordering any tests? Select all that apply.
13. Will the test results alter any of the diagnoses that she is currently addressing?
14. Will the results alter management of her health regimen?
15. What is the cost/benefits ratio?
16. Is the test the least invasive?