Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
A comprehensive overview of the key considerations in managing the health of older adults. It covers a wide range of topics, including the diagnosis and management of common geriatric conditions such as heart failure, osteoarthritis, polymyalgia rheumatica, depression, delirium, and dementia. The document also addresses important aspects of preventive care, including screening, immunizations, and fall prevention. Additionally, it discusses the unique pharmacokinetic and pharmacodynamic considerations in older adults, as well as the importance of addressing modifiable cardiac risk factors and promoting physical activity. A valuable resource for healthcare professionals, particularly those working with the geriatric population, as it offers insights into the nuanced and multifaceted approach required to provide high-quality, patient-centered care for older adults.
Typology: Exams
1 / 23
1.The percentage of the FVC expired in one second is: FEV1/FVC ratio
2. The aging process causes what normal physiological changes in the heart- : The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis
meds in patients: >65 y/o
17.The volume of air in the lungs at max inflation is: TLC (total lung capacity) 18.Preferred amount of exercise for older adults is: 30min/day of aerobic exer- cise 5 days a week 19.You know the following statements regarding th pain of acute coronary syndrome are true except: Present atypically more often in men than women 20.Elderly patient presents with new onset of feeling heart race, fatigue. EKG reveals Afib with rate >100. Patient also has a new tremor in both hands. Which of the following would you suspect: Hyperthyroidism 21.Which patient is more likely to have osteoporosis: 80 y/o. Underweight male who smokes and has been on steroids for psoriasis 22.Post menopausal woman with osteoporosis is taking bisphosphonate daily po. What action info statement would indicate she understood your instructions regarding this med?: Take med with full glass of water when up in the AM 30 min before other food and meds
24.OA of cervical and lumbar spine causes pain related to all of the following except: Crystal deposition 25.In differentiating OA from chronic gout, pseudo gout, or septic arthritis, the most valuable diagnostic study would be: Synovial fluid analysis 26.Patients with OA of the hip and knee often have a distinguishable gait described as: Antalgic 27.Which of the following best describes pain associated with OA: Begins upon arising and after prolonged weight bearing and or use of the joint 28.Joint effusions typically occurs later in the course of OA, especially in the: Knee 29.You ordered CBC for your patient you suspect has polymyalgia rheumatica. Which 2 clinical findings are common in patients with PMR: Normochromic, normocytic anemia and thrombocytosis 30.You suspect your patient has PMR and now are concerned that they may have Giant Cell Arteritis too. Which of the following 2 symptoms are most indicative of GCA and PMR: Scalp tenderness and aching in shoulder and pelvic girdle 31.63 yo Caucasian patient with PMR will begin tx corticosteroids until the
condition has resolved. You look over her records and it has been 2 years since her last physical exam and any labs or diagnostic tests as she relocated and had not yet ID'd a provider. In prioritizing your management plan your first orders should include: Duel energy X-ray scan and updating immunizations 32.Which of the following DD for patients presenting with PMR can be ruled out with a muscle biopsy: Polymyositis 33.In reviewing lab results for patients with suspected PMR, you realize there is no definitive test to diagnose PMR, rather clinical response to treatment. Results you would expect to see include:: ESR > 34.Which of the following is the most appropriate lab test for monitoring gout therapy over the long-term: Serum urate level 35.In providing health teaching related to dietary restrictions, you should advise a patient with gout to avoid which of the following dietary items: Beer, sausage, fried seafood 36.The best method of verifying gout diagnosis in a joint is which of the following: Joint aspiration and polarized light microscopy 37.The most appropriate first line treatment for acute gout flare, assuming no kidney disease or elevated bleeding risk: Indomethacin 50mg TID x
days, then 25mg TID x3 days 38.You order bilateral wrist XR on 69 yo man with c/o both wrists x6 weeks, not related to any known trauma. You suspect early RA. The initial XR finding in apatien with elderly onset RA would be: Soft tissue swelling 39.A 72 female has been diagnosed with gout. She also has chronic HF. The most likely contributing factor to development of gout in this older female is: Thiazide diuretics 40.Which of the following statements about OA is true: It affects primarily weight bearing joints 41.In considering the specificity of lab data, the most reliable diagnostic test listed below would be: Synovial fluid analysis to differentiate between infectious versus inflammatory infusion 42.When examining the spine of an older adult you notice a curvature with a sharp angle. This is referred to as: Gibbus
43. The prevalence of depression in nursing home residents is greater than adults living in the community: 3-4 times 44.The majority of depressed older adults remain untreated because of: Mis- diagnosis, social stigma, environmental barriers 45.Symptoms of depression distinct to the elderly include: Lack of emotions
46.The justification for ordering CBC, TSH, serum B12 for a patient you may suspect have clinical depression is: Because of overlapping symptoms with anemia, thyroid dysfunction, and nutritional deficiencies 47.One major difference that us useful in the DD of dementia versus delirium is that: Dementia develops slowly and delirium develops quickly
48. Which of the following is the most appropriate screening tool for delirium- : Confusion Assessment Method 49.The proposed mechanism by which diphenhydramine causes delirium is: Anticholinergic effects 50.The elderly are at risk for delirium because of: Multisensory declines, polypharmacy, multiple medical problems 51.A consistent finding in delirium regardless of cause i: Reduction in regional cerebral perfusion 52.Older adults with Dementia sometimes suffer from agnosia, which is de- fined as the inability to: Recognize objects 53.In late stages of dementia, a phenomenon called sun downing, in which cognitive disturbances tend to: Become worse in the evening
54.Of the following, which one is the most useful clinical eval tool to assist in the diagnosis of dementia: St. Louis Mental Status Exam SLUMS
55. The cornerstone of pharmacotherapy in treating Alzheimer's is: - Cholinesterase inhibitors 56.The comoribid psych problem with the highest frequency in dementia in: Anxiety 57.WHen treating depression associated with dementia, which of the follow- ing would be a poor choice and should not be prescribed: Amitriptyline 58.Which of the following should be avoided in countries where food and water precautions are to be observed: Salad buffet 59.What insect precautions are not necessary to prevent insect borne dis- eases in the Tropics: Using 100% DEET on skin to prevent bites 60.An example of secondary prevention you could recommend/order for older adults would be to: Check for fecal occult blood 61.Ali is a 72 year old male who recent came to the US from Nigeria. He reports having BCG vax as a child. Which of the following is correct regarding a TB skin test: Vax hx is irrelevant, read as usual 62.A local chapter on NP organization has begun planning a community
based screening for HTN at a local congregate living facility. The organization was select3d on the basis of: A regcognized element of high risk within this group 63.Performing ROM exercises on a patient who has had a CVA is an example of which level of prevention: Tertiary 64.You demonstrate an understanding of primary prevention of falling among the elderly through which management plan: Provide info about meds, SE and interactions 65.An example of an active strategy of health promotion for an individual to accomplish would be: Beginning stress management program 66.The 4 main domains of clinical preventive services that you will provide are: Counseling interventions, screening tests, immunizations, chemoprophylaxis 67.What is the appropriate method for TB screening of an older adult entering a nursing home: 5 TBU intradermal PPD injection and if negative, repeat with same dose one week later 68.The term "geriatric syndrome" is best described: Condition that has multiple underlying factors and involves multiple systems 69.Atypical presentation of acute coronary syndrome is: More common
in females
70. What disease can mimic and often co-exists with MI in elderly with CAD: - Esophageal disease 71.Thoracic aortic dissection presents typically as: Severe retrosternal CP that radiates to the back and both arms 72.Bordetella pertussis is best characterized: Sub-acute cough lasting >2 weeks 73.Routine testing of TB should occur in all of the following vulnerable popu- lations except: hospitalized elderly 74.Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the DD is: Rapid change and fluctuating course of cognitive function 75.Evidence shows that the most important predictor of a fall is: Prior history of a fall 76.The most cost-effective interventions used to prevent falls are: Home mod- ifications and vitamin D supplements 77.Chronic fatigue syndrome is best described as: Fatigue lasting longer than 6 months and not relieved by rest
78.Risk factors associated with the finding of a malignancy in a patient with hemoptysis include all of the following except: Childhood asthma 79.The most common cause of disability in the elderly is: Arthritis 80.Drug-induced pruritis is distinguished because it: May occur right after drug is taken or months later 81.A key symptom of ischemia heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: Women with ischemic heart disease many times don't present with chest pain. Some patient's may have no symptoms or atypical symptoms so diagnosis may only be made at the time of the actual MI 82.Which test is clinic standard for assessment of aortic stenosis: Echocar- diogram 83.Ischemic heart disease is: Defined as an imbalance between O supply and demand, frequently manifested as angina, leading cause of death in the elderly 84.Preceding a stress test, the following lab work might include: CBC with diff to differentiate ischemic heart disease from anemia, thyroid studies to rule out hyperthyroidism
85.On exam, what type of murmur can be auscultation with aortic regurgita- tion: Austin Flint
86. Which of the following statements is true regarding anti-arrhythmic drugs- : Most anti-arrhythmic have low toxic/therapeutic ratio and some are exceeding toxic 87.In mitral stenosis, p waves may suggest: Left atrial enlargement 88.Aortic regurgitation requires medical treatment for early signs of CHF with: ACEi 89.The best evidence rating drugs in a post MI pt include: ASA, ACEi/ARB, BB, aldosterone blockade 90.55 year old post-menopausal woman with h/o HTN c/o jaw pain on heavy exertion. No c/o CP. EKG is normal sinus rhythm without ST segment abnor- malities. Your plan may include: Exercise stress test 91.What is the most common valvular heart disease in the elderly: Aortic stenosis 92.Elderly may present with atypical signs of pneumonia. You may need to be aware that clustering of all of the following s/s may indicate pneumonia in the elderly except: Bradycardia
93.A common auscultory finding in CHF is: S 94.The most common organism responsible for CAP in the elderly is: Strep pneumoniae 95.72 year old woman and her husband are driving cross country. After a long day of driving, they stop to eat. Midway through the meal, the woman because very SOB with CP and a sense of panic. Which problem is most likely: Pulmonary embolism 96.Exercise recommended for elderly should include activities that: Strength- en muscles 97.Preferred amount of exercise for elderly is: 30 min of aerobic activity a day 5 days a week. 98.Which of the following medical conditions is not considered restrictive for engaging in physical activity: Depression 99.The best recommendation for patient who says they have no equipment to exercise is: Improvise with recommended objects at home that can be used
suggestion does the NP offer based upon a known effect of dementia on a clients nutrition: Es- tablish a routine of when and where the individual will have their meals.
,7.5% so moderate intensity statin
140. What is the ASCVD med guideline for 40-75 y/o without ASCVD or DM: - Their 10 year risk is >7.5% so moderate to high intensity statin
known as: - Haygarth's nodes