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Geriatric Health Management: Comprehensive Approach to Older Adult Care, Exams of Nursing

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

2024/2025

Available from 09/27/2024

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NR 601 Midterm Questions with Answers Perfect Updates

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

  1. A 55 yo Caucasian male follows up after referral to cardiologist. He thinks his med is causing a cough and sometimes he has difficulty breathing. Which med was most likely prescribed?: Lisinopril
  2. MJ presents with h/o structural damage with current s/s of HF. Treatment will be based on his stage of HF which is: Stage C
  3. 65 yo Caucasian presents with mitral valve stenosis, physical exam is unremarkable. you know her stage of HF is: Stage B 6.The best way to diagnose structural heart disease/dysfunction noninvasive- ly is: Echocardiogram
  4. Chronic pain can have major impact on patients ability to function and have profound impact on overall QOL. Ongoing pain may be linked to: Depression, sleep disturbance, decreased socialization
  5. The Beers criteria are appropriate for use in evaluating use of certain

meds in patients: >65 y/o

  1. All of the following statements are true about lab values in older adults except: Abnormal findings are often due to physiological aging 10. According to the 2017 ACC HTN guidelines, the recommended BP goal for a 65y/o African American woman with a h/o HTN and DM and no h/o CKD is: <140/ 11.THe pathophysiology of HF is due to: Inadequate cardiac output to meet the metabolic and O2 demands of the body 12.The volume of air a patient to exhale for total duration of the test during maximal effort is: FVC 13.According it the 2017 ACC HTN guidelines, normal BP is: <120/ 14.Functional abilities are best assessed by: Observed assessment of function 15.LB is a 77 yo with chronic poorly controlled HTN. You know that goals include prevention of target organ damage. During your eval you will assess for evidence of: Left ventricular hypertrophy 16. Aortic regurgitation requires medical treatment for early signs of HF with- : ACEi

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

  1. 60 y/o obese male has T2DM and lipid panel of TC= 250 HDL=32, LDL=165. You teach him about his modifiable cardiac risk factors which include: DM, obesity, hyperlipidemia

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

  1. When you recommend exercise for the elderly which of the following pieces of advice should be considered for all types of exercise: Start low and go slow
  1. Biochemical individuality is best described as: Each individual's variation is often much smaller than that of a larger group 102. All of the following statements about drug absorption are false except: - Underlying chronic disease has little impact on drug absorption
  2. The cytochrome p system involves enzymes that are generally:: Inhibited or induced by drugs
  3. A statement not shown to be true about pharmacodynamic changes with aging is: Decreased sensitivity to oral anticoagulants
  4. The major impact of the physiological changes that occur w/aging is:: Re- duced physiological reserve, reduced homeostatic mechanisms, impaired immuno- logical respons
  5. The strongest evidence regarding normal physiological aging is available through: Longitudinal studies
  6. Pharmacokinetic changes with aging is reflective of: What the body does to the drug
  7. All of the following statements are true about drug distribution in the elderly except: Drugs distributed in water have a lower concentration
  1. Men have faster and more efficient biotransformation of drugs and this is thought to be due to:: Testosterone
  2. Atypical presentation of disease in elderly is reflected by all of the follow- ing exept: MI with CP and diaphoresis
  3. Polypharmacy is best described as: Even a single med if there is not a clear indication for its use 112. What is the major difference between varicose veins and atherosclerosis- : Vessels that are affected
  4. Patient has poorly controlled HTN for >10 years. Indicate the most likely position of his PMI: 5th ICS left of MCL
  5. 43 year old Hispanic male has audible diastolic murmur best hard at the mitral point. No audible click. He has been monitored for 2 years. What is the most likely murmur: Mitral Stenosis
  6. The following are true statements about bipolar disorders in older adults except: Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults.
  7. The caregiver for an older adult with cognitive impairment is concerned about the individuals seeming disinterest in eating. Which

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.

  1. An older man has a hx of medication therapy for hypertension. Which intervention does the nurse practitioner implement when the client reports that, I've fallen twice in 5 weeks.: Orthostatic blood pressures
  2. In the elderly population, the fastest growing group is the age range: 85 years or older
  3. Which statement correctly describes normal changes of aging: Individual variations are enormous at every age and in every part of the body
  4. Compared with acute pain, persistent chronic pain requires in the nurse practitioner to: Educate the patient to the benefit of specific lifestyle changes
  5. When considering Erikson's developmental stages, the task for later life is referred to as: Ego integrity
  6. What is the method of action of anticholinergics: Block the effect of acetyl- choline on muscarinic type 3 receptors resulting in bronchodilation
  1. What is the method of action of beta agonists: Stimulates beta- adrenergic receptors, increasing cyclic AMP, resulting in relaxing airways
  2. What is tuberculosis: Chronic, necrotizing infection caused by slow-growing acid fast bacillus (mycobacterium tuberculosis). Most common cause of death related to infectious disease worldwise
  3. What is aortic regurgitation?: Retrograde blood flow through an incompetent aortic valve into left ventricle during ventricular diastole
  4. What is aortic stenosis: abnormal narrowing of the aortic valve
  5. What is mitral stenosis: Abnormal narrowing of the mitral valve orifice
  6. What is mitral regurgitation: Retrograde blood flow during systole from the left ventricle into the left atrium through incompetent mitral valve
  7. What is mitral valve prolapse?: Mitral regurgitation associated with bulging of one or both mitral valve leaflets into the left atrium during ventricular systole
  8. What happens in valvular regurgitation: Portion of the ejected blood leaks back into the upstream cardiac chamber
  1. What happens in valvular stenosis: Usually results in elevated pressures in the chamber upstream from the stenosis
  2. What is the purpose of functional assessment of the elderly: Discovers the ability to care for themselves on a daily basis
  3. How should HTN be managed: Stage 2 and up should be given consideration for pharm treatment. Others can wait for lifestyle modification.
  4. What is first line meds for non-black HTNpopulation including those with DM: Thiazide, CCB, ACEi or ARM either alone or in combo
  5. What is the med guideline for ASCVD for those </= 75 y/o: High intensity statin, atorvastatin-Lipitor 40-80, rosuvastatin/Crestor 20mg
  6. What is the med guideline for ASCVD for those >75 y/o: Moderate statin (atorvastatin 10mg, rosuvastatin 5mg, simvastatin 20-40mg, pravastatin 40mg, lo- vastatin 40mg, fluvastatin 40mg)
  7. What is the guideline for meds for LDL>=190: High intensity statin (atorvas- tatin 40-80mg, rosuvastatin 20mg)
  8. What is the bed guideline for ASCVD for 40-75 y/o with DM: Their 10 year risk is >7.5% so high intensity statin
  9. What is the med guideline for LDL 79-189: Their 10 year risk is

,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

  1. When is Zostavax recommended: Anyone over 60, given as a single dose
  2. What is primary prevention: Activities to prevent occurrence of disease or adverse health condition, including mental health.
  3. What is secondary prevention: Activities aimed at detection of disease or adverse health condition in asymptomatic patient who has risk factors but no detectable disease
  4. What is teritiary prevention: Management of existing conditions to prevent disability and minimize complications, striving for optimal function and QOL
  5. The symptoms of depression may encompass what 4 domains: Af- fect/mood, cognition, physiological, behavioral
  6. What is transient insomnia: Lasts a few night, related to emotional issues, usually resolved without meds when elderly adapts to or removes change
  1. What is short-term insomnia: Lasts <1 month, related to acute medical/psy- chological condition or to persistent situational stress
  2. What is chronic insomnia: Lasts >1 month, results from age related changes in sleep or chronic stressors.
  3. What are some symptoms of polymyalgia rheumatica: New onset stiff- ness/aching in neck, shoulders, pelvic girdle, unable to get out of bed in the morning without extreme difficulty, difficulty lifting arms above head
  4. What are common lab findings in PMR: Elevated ESR and CRP, nor- mochromic normocytic anemia, thrombocytosis
  5. What is the treatment for PMR: If s.s are only of PMR and not of GCA as well, start low dose prednisone 10-20mg daily and taper dose
  6. What is osteoporosis: Skeletal disorder characterized by impaired bone strength that predispose to increased risk of fracture
  7. Primary osteoporosis: Due to aging, increased bone resorption reduced new bone formation
  8. Secondary osteoporosis: Consequence of underlying medical condition/drug
  9. What is a T-score of -2.5 indicative of: Osteoporosis
  1. What is a T-score of -1.0 to -2.5 indicative of: Osteopenia
  2. What is a T-score of -1.0 or higher indicative of: Normal bone density
  3. What is a Z-score of <-1.5 indicative of: Secondary cause of osteporosis
  4. What is nocieceptive pain: Pain from nociceptive fibers in the periphery triggered by actual or potential tissue damage. Pain is well-localized, stabbing, throbbing, achy
  5. What is neuropathic pain: Direct neuronal injury, burning, tingling, lancinating. Often occurs in a dermatomal pattern
  6. Treatment goals for stage A HF are: Heart healthy lifestyle
  7. The Beer's criteria are appropriate for use in evaluating use of certain meds in patients: >65 y/o
  8. The pathophysiology of heart failure is due to: Inadequate cardiac output to meet the metabolic and O2 demands of the body
  9. Which of the following nutritional indicators is not an indication of poor nutritional status in the elderly: BMI 25
  10. You examine the hands of a 55 year old woman and note bilateral spindle shaped deformities on middle interphalangeal joints. These are

known as: - Haygarth's nodes

  1. The comorbid psych problem with the highest frequency in dementia is: Anxiety
  2. When treating depression associated with dementia, which of the follow- ing would be a poor choice and should not be prescribed: Amitriptyline
  3. You demonstrate an understanding of primary prevention of falling among the elderly through which management plan?: Provide info about meds, SE and interactions
  4. An example of an active strategy of health promotion for an individual to accomplish would be: Beginning stress management progrma
  5. You are working with an older adult male with a long history of alcohol abuse and a 30 year history of smoking. In recommending an intervention, your responsibility: Promote positive change in lifestyle choices
  6. Which organism that can be prevented by immunization is most often responsible for an infectious "outbreak" in the nursing home setting: Influenza A
  1. What disease can mimic and often co-exists with MI in elderly with CAD: Esophageal Disease