Advanced Primary Care for the Older Adult II Exam with Rationales, Exams of Nursing

Download Advanced Primary Care for the Older Adult II Exam with Rationales and more Exams Nursing in PDF only on Docsity! NGR6650 Advanced Primary Care for the Older Adult II LATEST EXAM w/ RATIONALES 2024 1. Which of the following statements best describes the concept of advanced primary care for older adults? a) It focuses on specialized care for older adults with chronic illnesses. b) It emphasizes preventive care to promote healthy aging in older adults. c) It involves providing palliative care for older adults in end-of-life situations. d) It focuses on care coordination between primary care providers and specialists. Answer: b) It emphasizes preventive care to promote healthy aging in older adults. Rationale: Advanced primary care for older adults aims to prevent illness and promote wellness by focusing on proactive measures, such as regular screenings, immunizations, and lifestyle modifications. This approach helps older adults maintain their independence and quality of life. 2. What is the primary goal of the geriatric assessment in advanced primary care for older adults? a) To identify chronic illnesses and provide disease management. b) To assess cognitive function and mental health. adults. b) To provide specialized care for older adults with multiple chronic conditions. c) To offer end-of-life care services for terminally ill older adults. d) To manage acute illnesses and hospital admissions. Answer: a) To address the physical and psychosocial needs of older adults. Rationale: Comprehensive care plans in advanced primary care for older adults aim to address the holistic needs of older adults, including physical, mental, and social aspects. These plans usually involve interdisciplinary care teams and consider the preferences and goals of the older adult and their family. 6. Which of the following is an example of a community- based support service that promotes healthy aging in older adults? a) Providing comprehensive geriatric assessments at home. b) Offering meal delivery programs for frail older adults. c) Conducting medication reconciliation during hospital admission. d) Providing palliative care services in a hospice facility. Answer: b) Offering meal delivery programs for frail older adults. Rationale: Community-based support services, such as meal delivery programs, are designed to support healthy aging and independence in older adults. These programs ensure access to nutritious meals, particularly for frail older adults who may have difficulty preparing their own meals. 7. Which of the following is a key principle of the Geriatric Resource Nurse (GRN) role in advanced primary care for older adults? a) Providing specialized palliative care for older adults. b) Coordinating care transitions for older adults at end of life. c) Promoting evidence-based practice in geriatric care. d) Offering counseling and therapy services to older adults. Answer: c) Promoting evidence-based practice in geriatric care. Rationale: The Geriatric Resource Nurse (GRN) plays a vital role in advanced primary care for older adults by promoting evidence-based practice in geriatric care. They provide education and support to healthcare providers, ensuring the use of the best available evidence in managing older adults' health and well-being. 8. Which of the following is a common screening tool used to assess cognitive function in older adults during advanced primary care? a) Mini-Mental State Examination (MMSE) b) Glomerular Filtration Rate (GFR) c) Berg Balance Scale (BBS) d) Activities of Daily Living (ADL) scale Answer: a) Mini-Mental State Examination (MMSE) Rationale: The Mini-Mental State Examination (MMSE) is a widely used screening tool to assess cognitive function in older adults. It evaluates multiple cognitive domains, including orientation, memory, attention, and language. The MMSE helps identify cognitive impairments and guide further assessment and interventions. 9. In advanced primary care for older adults, what is the role of the primary care provider in end-of-life care? a) Providing specialized palliative care services. b) Coordinating hospice care in nursing homes. c) Initiating discussions on advance care planning. d) Conducting routine medication reviews. Answer: c) Initiating discussions on advance care planning. Rationale: The primary care provider plays a crucial role in initiating discussions about advance care planning with older adults and their families. This involves exploring their preferences for end-of-life care, completing advance directives, and ensuring their goals and wishes are respected. advanced primary care for older adults? a) Prescribing medications and managing chronic diseases. b) Conducting comprehensive geriatric assessments. c) Providing rehabilitative services and improving mobility. d) Coordinating care transitions and discharge planning. Answer: c) Providing rehabilitative services and improving mobility. Rationale: Physical therapists play a key role in advanced primary care for older adults by providing rehabilitative services, improving mobility, and promoting independence. They design exercise programs, assess and treat musculoskeletal conditions, and facilitate functional recovery following illness or injury. 14. Which of the following is a common geriatric syndrome that is often addressed in advanced primary care for older adults? a) Congestive heart failure b) Type 2 diabetes mellitus c) Urinary tract infections d) Delirium Answer: d) Delirium Rationale: Delirium is a common geriatric syndrome characterized by acute confusion and a rapid change in mental status. Advanced primary care for older adults involves recognizing and managing delirium promptly to prevent complications, identify underlying causes, and provide appropriate interventions for a positive outcome. 15. What is the role of the nurse in a home healthcare setting within advanced primary care for older adults? a) Coordinating hospice care for terminally ill older adults. b) Administering medications and monitoring vital signs. c) Providing nutritional counseling and meal planning. d) Conducting comprehensive geriatric assessments at home. Answer: b) Administering medications and monitoring vital signs B: 1. A 75-year-old patient with hypertension, diabetes, and chronic kidney disease presents to the primary care clinic with fatigue, dyspnea, and edema. The nurse practitioner suspects heart failure and orders a B-type natriuretic peptide (BNP) test. What is the rationale for ordering this test? A) BNP is a hormone that is released by the heart when it is under stress and indicates the severity of heart failure. B) BNP is a marker of inflammation that is elevated in patients with heart failure and other cardiac conditions. C) BNP is a protein that is produced by the kidneys and reflects the renal function of patients with heart failure. D) BNP is a peptide that is secreted by the liver and regulates the fluid balance of patients with heart failure. Answer: A Rationale: BNP is a hormone that is released by the ventricles of the heart when they are stretched or overloaded, which occurs in heart failure. BNP levels correlate with the severity of heart failure and can help guide diagnosis and treatment. 2. A 68-year-old patient with osteoarthritis and obesity visits the primary care clinic for a routine check-up. The nurse practitioner reviews the patient's medication list and notes that the patient is taking acetaminophen 1000 mg four times a day for pain relief. What is the most appropriate action for the nurse practitioner to take? A) Advise the patient to reduce the dose of acetaminophen to 650 mg four times a day to avoid liver toxicity. B) Prescribe a nonsteroidal anti-inflammatory drug (NSAID) instead of acetaminophen to provide better pain relief and anti-inflammatory effects. C) Educate the patient about the risks of acetaminophen overdose and monitor the patient's liver function tests regularly. D) Refer the patient to a physical therapist and a 5. A 66-year-old patient with chronic obstructive pulmonary disease (COPD) and smoking history visits the primary care clinic for a follow-up. The nurse practitioner reviews the patient's spirometry results and notes that the patient has a forced expiratory volume in one second (FEV1) of 60% of predicted and a FEV1/forced vital capacity (FVC) ratio of 65%. How would the nurse practitioner classify the severity of the patient's COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria? A) GOLD 1 (mild) B) GOLD 2 (moderate) C) GOLD 3 (severe) D) GOLD 4 (very severe) Answer: B Rationale: The GOLD criteria are used to assess the severity of COPD based on spirometry results and clinical symptoms. The FEV1 is a measure of the volume of air that can be exhaled in one second, and the FVC is a measure of the total volume of air that can be exhaled. The FEV1/FVC ratio reflects the degree of airflow obstruction in COPD. The GOLD criteria classify COPD into four stages based on the FEV1 as a percentage of predicted: GOLD 1 (mild): FEV1 ≥ 80%, GOLD 2 (moderate): FEV1 50-79%, GOLD 3 (severe): FEV1 30-49%, and GOLD 4 (very severe): FEV1 < 30%. The patient in this case has a moderate COPD with an FEV1 of 60% and an FEV1/FVC ratio of 65%. 6. A 70-year-old patient with Parkinson's disease and depression visits the primary care clinic for a medication review. The nurse practitioner notes that the patient is taking levodopa/carbidopa, pramipexole, and sertraline. What is the most important drug interaction that the nurse practitioner should monitor for in this patient? A) Serotonin syndrome B) Neuroleptic malignant syndrome C) Dopamine dysregulation syndrome D) Orthostatic hypotension Answer: A Rationale: Serotonin syndrome is a potentially life- threatening condition caused by excessive serotonin activity in the central nervous system. It can occur when two or more drugs that increase serotonin levels are combined, such as selective serotonin reuptake inhibitors (SSRIs) like sertraline and dopamine agonists like pramipexole. Serotonin syndrome can manifest with symptoms such as agitation, confusion, tremor, hyperthermia, tachycardia, hypertension, diarrhea, and muscle rigidity. The nurse practitioner should monitor the patient for signs of serotonin syndrome and adjust the doses or discontinue the drugs if necessary. 7. A 69-year-old patient with type 2 diabetes mellitus and peripheral neuropathy visits the primary care clinic for a foot examination. The nurse practitioner inspects the patient's feet and observes that the patient has dry, cracked skin, calluses, and ulcers on the plantar surface of both feet. The nurse practitioner also performs a monofilament test and finds that the patient has reduced sensation on both feet. What is the most appropriate diagnosis for this condition? A) Diabetic foot syndrome B) Charcot foot C) Plantar fasciitis D) Tarsal tunnel syndrome Answer: A Rationale: Diabetic foot syndrome is a term that encompasses various foot complications that can occur in patients with diabetes mellitus due to chronic hyperglycemia, peripheral neuropathy, and peripheral vascular disease. Diabetic foot syndrome can present with skin changes, calluses, ulcers, infections, deformities, and osteomyelitis. The monofilament test is a simple screening tool that assesses the sensation of light touch on the feet using a thin nylon fiber. Reduced sensation on the monofilament test indicates peripheral neuropathy and increased risk of foot ulcers. 8. A 76-year-old patient with atrial fibrillation and hypertension visits the primary care clinic for a follow-up. The nurse practitioner reviews the patient's medication list and notes that the patient is taking warfarin, metoprolol, lisinopril, and hydrochlorothiazide. The nurse practitioner also checks the patient's international normalized ratio (INR) and finds that it is 3.5. What is the most appropriate action for the nurse practitioner to take? A) Increase the dose of warfarin to achieve a target INR of 4-5.