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

Download NR 601 Advanced Practice Nursing in the Care ofOlder Adults / Edition 2 TESTBANK and more Exams Nursing in PDF only on Docsity! 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: A. Antacids increase the bioavailability of digitalis B. Gastric acidity decreases with age C. Anticholinergics increase colonic motility D. Underlying chronic disease has little impact on drug absorption ____ 8. All of the following statements are true about drug distribution in the elderly except: A. Drugs distributed in water have lower concentration B. Drugs distributed in fat have less intense, more prolonged effect C. Drugs highly protein bound have greater potential to cause an adverse drug reaction D. The fastest way to deliver a drug to the action site is by inhalation ____ 9. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: A. Less obesity rates than women B. Prostate enlargement C. Testosterone D. Less estrogen than women ____ 10. The cytochrome p system involves enzymes that are generally: A. Inhibited by drugs B. Induced by drugs C. Inhibited or induced by drugs D. Associated with decreased liver perfusion ____ 11. A statement not shown to be true about pharmacodynamics changes with aging is: A. Decreased sensitivity to oral anticoagulants B. Enhanced sensitivity to central nervous system drugs C. Drug responsiveness can be influenced by patient activity level D. There is a decreased sensitivity to beta blockers ____ 12. Atypical presentation of disease in the elderly is reflected by all the following except: A. Infection without fever B. Depression without dysphoric mood C. Myocardial infarction with chest pain and diaphoresis D. Cardiac manifestations of thyroid disease ____ 13. Functional abilities are best assessed by: A. Self-report of function B. Observed assessment of function C. A comprehensive head-to-toe examination D. Family report of function MULTIPLE CHOICE 1.ANS: D PTS: 1 2.ANS: C PTS: 1 3.ANS: B PTS: 1 4.ANS: D PTS: 1 5.ANS: C PTS: 1 6.ANS: B PTS: 1 7.ANS: D PTS: 1 C. Reinforce the need to use prescribed eyeglasses to prevent further injury from falls. D. Provide information about medications, side effects, and interactions. ____ 12. An example of an active strategy of health promotion for an individual to accomplish would be: A. Maintaining clean water in the local environment B. Introducing fluoride into the water C. Beginning a stress management program D. Maintaining a sanitary sewage system ____ 13. You are working with an older male adult with a long history of alcohol abuse and a 30-year history of smoking. In recommending an intervention for this client, your responsibility is to: A. Make the individual abandon his own health practices and follow your recommendations B. Register the patient for a local intervention program and secure payments C. Promote positive change in lifestyle choices D. Identify the barriers that the client will encounter ____ 14. The four main domains of clinical preventive services that the practitioner will provide are: A. Counseling interventions, screening tests, immunizations, and chemoprophylaxis B. Counseling intervention, screening tests, immunizations, and education C. Counseling interventions, transportation, screening tests, and immunizations D. Screening tests, brief psychotherapy, immunizations, and chemoprophylaxis ____ 15. Which organism that can be prevented by immunization is most often responsible for an infectious “outbreak” in the nursing home setting? A. Haemophilus influenza B. Streptococcus C. Influenza A D. Mycobacterium tuberculosis ____ 16. What is the appropriate method for tuberculosis screening of an older adult entering a nursing home? A. 5 tuberculin units intramuscular PPD injection and if negative repeat with same dose one week later B. 5 tuberculin units intradermal PPD injection and if negative repeat with same dose one week later C. Chest x-ray at the same time of PPD testing D. 5 tuberculin units intradermal PPD injection and if positive repeat same dose in one week MULTIPLE CHOICE 1.ANS: C PTS: 1 2.ANS: C PTS: 1 3.ANS: A PTS: 1 4.ANS: A PTS: 1 5.ANS: C PTS: 1 6.ANS: C PTS: 1 7.ANS: C PTS: 1 8.ANS: B PTS: 1 9.ANS: B PTS: 1 10.ANS: B PTS: 1 11.ANS: D PTS: 1 12.ANS: C PTS: 1 13.ANS: C PTS: 1 14.ANS: A PTS: 1 15.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 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 1. ANS: C PTS: 1 2. ANS: D PTS: 1 3. ANS: C PTS: 1 4. ANS: D PTS: 1 5. ANS: B PTS: 1 Chapter 4. Comprehensive Geriatric Assessment Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The evidence reflects that comprehensive geriatric assessment should be conducted: A. On all individuals 65 and older B. On all individuals 75 and older C. By an inter-disciplinary team of professionals D. Targeting the vulnerable and frail elderly ____ 2. Evidence-based geriatric assessment instruments available to the clinician: A. Are largely screening instruments to detect a condition B. Largely do not exist and if they do they have limited clinical utility C. Include screening, evaluation, and measurement instruments in multiple domains D. Have applicability in the outpatient but not the inpatient setting ____ 3. When interviewing the older adult with a suspected dementia, it is most important that: A. Mental status be evaluated first in order to determine if the patient is a reliable historian B. The examiner use short simple questions and recognize non-verbal signs of discomfort C. Postpone the mental status evaluation for the following visit and establish a rapport first D. The clinician get in contact with a family member to obtain the history ____ 4. Which is not considered a dimension of symptomatology? A. Onset B. Physical signs C. Location D. Absence of associated symptoms ____ 5. The best approach to taking the health history is to: A. Start with an open-ended question B. Start with the review of systems C. Focus on the chief complaint D. Complete the history before conducting the examination ____ 6. A review of the evidence relative to screening of the elderly reveals the highest evidence rating for: A. Vision screening A. Most common in Hispanic females B. More common in men C. Most common in African American men D. More common in females ____ 4. What disease can mimic and often co-exists with myocardial infarctions in elders with coronary artery disease? A. Hypertension B. Esophageal disease C. Diabetic gastroparesis D. Vascular disease ____ 5. Thoracic aortic dissection presents typically as: A. Sharp stabbing pain in the mid thorax B. Pleuretic chest pain and dyspnea C. Severe retrosternal chest pain that radiates to the back and both arms D. Unilateral pleuretic chest pain and dyspnea ____ 6. Medications known to contribute to constipation include all of the following except: A. Stimulant laxatives B. Anticholinergic drugs C. Broad-spectrum antibiotics D. Iron ____ 7. Bordetella pertussis is best characterized by: A. Sub-acute cough lasting greater than two weeks B. Acute cough associated with a coryzal symptom C. Chronic cough with post-nasal drip D. Non-productive acute cough ____ 8. The routine testing of tuberculosis should occur in all of the following vulnerable populations except: A. Nursing home residents B. Prison inmates C. Hospitalized elderly D. Immune-compromised patients ____ 9. Which of the following statements about fluid balance in the elderly is false? A. Total body water decreases with age. B. Thirst response decreases as a person ages. C. African Americans have higher rates of dehydration than white Americans. D. Assessment of skin turgor at the sternum is a reliable indicator of dehydration in the elderly. ____ 10. Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the differential is: A. Performance on the Mini Mental Status Exam 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? A. Cluster B. Tension 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: A. Occurs soon after a new drug is taken B. Usually is a generalized rash C. May occur right after the drug is taken or months later D. Usually involves localized circumscribed lesions ____ 6. A full-thickness pressure ulcer is partially covered with eschar and the surrounding tissue is reddened. Which of the following is the most appropriate treatment for this condition? A. Apply an occlusive dressing B. Debride mechanically or chemically C. Saline moistened gauze dressings D. Vacuum-assisted wound closure ____ 7. In examining the skin of your nursing home patient, you note a “stained glass” brownish mark on the face. Which of the following lesions best describes a stained glass brownish mark? A. Actinic keratosis B. Seborrhea keratosis C. Lentigo maligna D. Superficial spreading malignant melanoma ____ 8. Patients who have an underlying tinea infection to the cellulitis should also be treated with which one of the following? A. An anti-fungal medication B. Topical steroids C. Oral steroids D. Zinc oxide ____ 9. Identify the type of malignant melanoma that is associated with the Hutchinson’s sign of the cuticle of the finger. A. Lentigo maligna B. Acral lentiginous C. Nodular D. Superficial spreading malignant melanoma ____ 10. A smooth round nodule with a pearly gray border and central induration best describe which skin lesion? A. Seborrheic keratosis B. Malignant melanoma C. Herpes zoster D. Basal cell carcinoma ____ 11. Cellulitis is a deep skin infection involving the dermis and subcutaneous tissues. The nurse practitioner suspects cellulitis in a 70-year-old Asian diabetic male presenting with reddened edematous skin around his nares. Which statement below will the nurse practitioner use in her decision-making process for the differential diagnosis pertaining to reddened edematous skin? A. Cellulitis is two times more common in women B. Facial cellulitis is more common in people >55 C. There is low incidence of cellulitis in patients with diabetes D. Cellulitis is only a disease of the lower extremities of patients with known arterial insufficiency ____ 12. An 82-year-old female has a “pimple” on his nose that occasionally bleeds and may have increased in size in the past year. The lesion is a 0.7-cm, dome-shaped, umbilicated papule with pearly translucence. There is also a hemorrhagic crust covering the central portion. Which of the following is the most likely diagnosis? A. Squamous cell carcinoma B. Basal cell carcinoma C. Keratoacanthoma D. Sebaceous hyperplasia ____ 13. Which of the following is generally not a first-line treatment for post herpetic neuralgia? A. Intrathecal methylprednisolone B. Gabapentin C. 5% lidocaine patch D. Topical capsaicin ____ 14. A nursing home resident with a Stage 4 pressure ulcer that extends to the muscle layer and has significant undermining with heavy exudate should be treated with: A. Dry gauze dressings B. Duoderm C. Chemical debridement D. Calcium alginate dressings ____ 15. Which of the following descriptions accurately documents cellulitis? A. Cool, erythematous, shiny hairless extremity with decreased pulse B. Scattered, erythematous ring-like lesions with clear centers C. Clearly demarcated, raised erythematous area of face D. Diffusely inflamed skin that is warm and tender to palpation ____ 16. Asymmetrical bi-color lesion with irregular border measuring 8 mm is found on the right lower arm of an adult patient. This assessment finding is consistent with: A. Melanoma B. Basal cell carcinoma C. Leukoplakia D. Senile lentigines ____ 17. Which of the following descriptions best illustrates assessment findings consistent with tinea capitis? A. Circular erythematous patches with papular, scaly annular borders and clear centers B. Inflamed scaly dry patches with broken hairs C. Web lesions with erythema and scaling borders D. Scaly pruritic erythematous lesions on inguinal creases ____ 18. A hyperkeratotic nodule formed as the result of exposure of the foot to moisture from perspiration is called: 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 2. ANS: B PTS: 1 3. ANS: C PTS: 1 4. ANS: B PTS: 1 5. ANS: A PTS: 1 6. ANS: B PTS: 1 7. ANS: C PTS: 1 8. ANS: A PTS: 1 9. ANS: B PTS: 1 10. ANS: D PTS: 1 11. ANS: B PTS: 1 12. ANS: B PTS: 1 13. ANS: A PTS: 1 14. ANS: D PTS: 1 15. ANS: D PTS: 1 16. ANS: A PTS: 1 17. ANS: B PTS: 1 18. ANS: C PTS: 1 19. ANS: C PTS: 1 20. ANS: B PTS: 1 Chapter 7. Head, Neck, and Face Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 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 2. ANS: C PTS: 1 3. ANS: C PTS: 1 4. ANS: A PTS: 1 5. ANS: B PTS: 1 6. ANS: B PTS: 1 7. ANS: A PTS: 1 8. ANS: D PTS: 1 9. ANS: B PTS: 1 10. ANS: B PTS: 1 11. ANS: C PTS: 1 12. ANS: C PTS: 1 13. ANS: B PTS: 1 14. ANS: D PTS: 1 15. ANS: C 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 B. Right atrial enlargement C. Left ventricle enlargement D. Right ventricle enlargement ____ 2. Aortic regurgitation requires medical treatment for early signs of CHF with: A. Beta blockers B. ACE inhibitors C. Surgery D. Hospitalization ____ 3. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: A. Women with ischemic heart disease many times do not present with chest pain B. Some patients may have no symptoms or atypical symptoms. Diagnosis may only be made at the time of an actual myocardial infarction C. Elderly patients have the most severe symptoms D. A & B only ____ 4. The best evidence rating drugs to consider in a post myocardial infarction patient include: A. ASA, ACE/ARB, beta-blocker, aldosterone blockade B. Ace, ARB, Calcium channel blocker, ASA C. Long-acting nitrates, warfarin, ACE, and ARB D. ASA, clopidogrel, nitrates ____ 5. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST-segment abnormalities. Your plan may include: A. Echocardiogram B. Exercise stress test C. Cardiac catheterization D. Myocardial perfusion imaging ____ 6. Preceding a stress test, the following lab work might include: A. CBC and differential to differentiate ischemic heart disease from anemia B. Liver enzymes to rule out underlying gall bladder disease C. Thyroid studies to rule out hyperthyroidism D. A & C only ____ 7. Which test is the clinical standard for the assessment of aortic stenosis? A. Cardiac catheterization B. Stress test C. Chest x-ray D. Echocardiography ____ 8. What is the most common valvular heart disease in an older adult? A. Aortic regurgitation B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis ____ 9. On examination, what type of murmur can be auscultated with aortic regurgitation? A. Austin flint B. Systolic ejection C. Soft S1 and a Loud S2 D. Loud S1 ____ 10. Ischemic heart disease is: A. Defined as imbalance between oxygen supply and demand. B. Frequently is manifested as angina. C. Leading cause of death in the elderly. D. All of the above. ____ 11. Which test is the clinical standard for the assessment of aortic stenosis? A. Cardiac catheterization B. Stress test C. Chest x-ray D. Echocardiography ____ 12. The aging process causes what normal physiological changes in the heart? A. The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis B. Cardiology occurs along with prolapse of the mitral valve and regurgitation C. Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves D. Hypertrophy of the right ventricle ____ 13. An older adult may present with atypical clinical signs of pneumonia. The nurse practitioner needs to be aware that the clustering of all of the following signs and symptoms may be indicative of pneumonia in an older person except: A. Bradycardia B. Malaise C. Anorexia D. Confusion ____ 14. Which of the following statements is true concerning anti-arrhythmic drugs? A. Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile. B. Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality. C. Most antiarrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic. D. Anti-arrhythmic therapy should be initiated in the hospital for all patients. ____ 15. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized 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, 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 D. Copious draining ulcers ____ 10. Exercise is an essential element of peripheral arterial disease management primarily because: 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 D. Venous ulcer disease ____ 18. Complete decongestive physiotherapy (CDP) works by: A. Stimulating the lymph vessels B. Breaking up subcutaneous fibrous tissue C. Redirecting lymph flow D. All of the above MULTIPLE CHOICE 1. ANS: A PTS: 1 2. ANS: D PTS: 1 3. ANS: B PTS: 1 4. ANS: D PTS: 1 5. ANS: C PTS: 1 6. ANS: B PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: C PTS: 1 10. ANS: C PTS: 1 11. ANS: D PTS: 1 12. ANS: D PTS: 1 13. ANS: A PTS: 1 14. ANS: C PTS: 1 15. ANS: B PTS: 1 16. ANS: B PTS: 1 17. ANS: A PTS: 1 18. ANS: D PTS: 1 Chapter 10. Abdominal Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Your 70-year-old patient has gastroesophageal reflux disease (GERD). After a trial of lifestyle modifications and antacids, the patient continues to have occasional mild heartburn after occasional meals and at night. The most appropriate next action is: A. Prokinetic agents B. H2 antagonists C. Proton pump inhibitors D. Sucralfate ____ 2. An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? A. Identification of a fluid wave B. Positive Murphy’s sign C. Palpable spleen D. Midepigastric pain that is not reproducible with palpation A. It is highly contagious and a mask should be worn at home. B. The treatment regimen is multiple lifetime medications. C. The treatment regimen is multiple medications taken daily for a few weeks. D. The treatment regimen is complicated and is not indicated unless the patient is symptomatic. ____ 14. An obese middle-aged client presents with a month of nonproductive irritating cough without fever. He also reports occasional morning hoarseness. What should the differential include? A. Atypical pneumonia B. Peptic ulcer disease C. Gastroesophageal reflux D. Mononucleosis (Epstein-Barr) ____ 15. Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease? A. Cases of dyspepsia with constipation B. Symptoms persisting after 6-8 weeks of therapy C. All clients with dyspepsia who smoke and drink alcohol D. When a therapeutic response to empiric treatment is obtained ____ 16. A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she also experiences bouts of constipation. She has no known allergies and experienced no unintentional weight loss. What is the most likely condition? A. Inflammatory bowel disease B. Irritable bowel syndrome C. Giardiasis D. Lactose intolerance ____ 17. The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal reflux. What are the nonpharmacological management interventions that should be included? A. Weight reduction and rest 30 minutes after each meal in the supine position B. Elevation of head of the bed 4-6 inches on blocks and weight reduction C. Encouraged to wear restrictive clothing to add support for diaphragmatic breathing D. Using oral mints to relieve gastric distress ____ 18. In differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer can present with distinct signs and symptoms. Which of the following pieces of information from the patient’s history is the least useful for you to determine that the patient has a duodenal ulcer? A. Pain occurs on an empty stomach B. Diffuse epigastric pain 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 C. African Americans D. American Indians ____ 2. Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what intervals? A. Every 6 months B. Yearly C. Every 2 years D. Every 2 to 4 years ____ 3. All of the following may be reasons associated with an elevated PSA besides prostate cancer except: A. Prostatitis B. Urinary tract infection C. Perineal trauma D. Digital rectal exam ____ 4. In the diagnosis of acute bacterial prostatitis, a midstream urine culture is of benefit. To be diagnostic, the specimen should reveal how many white blood cells per high-power field? A. Five B. Ten C. Fifteen D. Twenty ____ 5. In chronic bacterial prostatitis, what is the organism most commonly associated with the disease? A. Klebsiella B. Proteus C. Pseudomonas D. Escherichia coli ____ 6. In acute prostatitis, an exam of the prostate may find the gland to be: A. Nodular B. Cool and pliable C. Swollen and tender D. Asymmetrical ____ 7. All of the following antimicrobials may be indicated in chronic bacterial prostatitis except: A. Ciprofloxacin B. Levofloxacin C. Trimethoprim D. Azithromycin ____ 8. Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: ____ 1. Osteoarthritis of the cervical and lumbar spine causes pain that is related to all of the following except: A. Bone spur formation B. Pressure of the ligaments C. Reactive muscle spasm D. Crystal deposition ____ 2. In differentiating osteoarthritis from chronic gout, pseudogout, or septic arthritis, the most valuable the diagnostic study would be: A. Erythrocyte sedimentation rate (ESR) B. Synovial fluid analysis C. C-reactive protein analysis D. Complete blood cell count ____ 3. Patients with osteoarthritis of the hip and knee often have a distinguishable gait described as: A. Ataxic B. Festinating C. Antalgic D. Steppage ____ 4. Which of the following best describes the pain associated with osteoarthritis? A. Constant, burning, and throbbing with an acute onset? B. Dull and primarily affected by exposure to cold and barometric pressure C. Begins upon arising and after prolonged weight-bearing and/or use of the joint D. Begins in the morning but decreases with activity ____ 5. Joint effusions typically occur later in the course of OA, especially in the: A. Knee B. Elbow C. DIP joints D. Hips ____ 6. You have ordered a CBC for your patient you suspect has polymyalgia rheumatica (PMR). Which two clinical findings are common in patients with PMR? A. Neutropenia and hypochromic, normocytic anemia B. Normochromic, normocytic anemia and thrombocytosis C. Microcytic, hypochromic anemia and reticulocytopenia D. Macrocytic, hyperchromic anemia and leukocytopenia ____ 7. You suspect that your patient has polymyalgia rheumatica and now are concerned that the patient may also have Giant Cell Arteritis (GCA). Which of the following two symptoms are most indicative of GCA and PMR? A. Jaw pain and heart murmur B. Joint swelling and sudden loss of central vision bilaterally C. Hoarseness and the total inability to grasp small objects D. Scalp tenderness and aching in shoulder and pelvic girdle ____ 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 ____ 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 C. Antinuclear Antibody (ANA) test to rule out a collagen disease D. Bilateral motor and sensory problem ____ 8. The most common neurological cause of seizures in an older adult is: A. Alzheimer’s disease B. Multiple sclerosis C. Stroke D. Peripheral neuropathy ____ 9. You are evaluating an elderly patient’s complaint of a new onset of “hand shaking” when he drinks from a cup. The patient is euthyroid and does not drink alcohol. Which of the following signs indicate that this tremor is most likely an essential tremor rather than a Parkinson’s tremor? A. It is characteristic of “pill rolling” and occurs at rest B. It is a moderate amplitude tremor that occurs only with movement/activity C. The tremor is also associated with slowed movements D. The tremor is accompanied by dyskinesia ____ 10. Mr. Andrews experienced a brief onset of right-sided weakness, slurred speech, and confusion yesterday. The symptoms have resolved. What should the nurse practitioner do? A. Assure the patient that he will not experience the symptoms again B. Identify modifiable cardiovascular risk factors C. Do a thorough medication review and a CT scan D. Order a stat EEG and administer O2 by mask ____ 11. An older male patient is experiencing acute onset of right-sided weakness, slurred speech, and confusion. What should the nurse practitioner do promptly? A. Administer an aspirin by mouth B. Evaluate for stroke and arrange transport to the hospital right away C. Do a thorough medication review and stat blood sugar D. Order an EKG and administer O2 by cannula immediately ____ 12. An older adult female patient had a stroke. What symptoms are not usually expressed by patients who have had a vertebrobasilar stroke? A. Vertigo B. Ataxia C. Dysarthria D. Monocular blindness ____ 13. When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinson’s disease? A. Any presence of tremor B. Symptoms of slowed movement, unstable angina, and tremor C. Resting tremor, slow unsteady gait, and cogwheel resistance D. Cogwheel rigidity, bradykinesia, and amnesia ____ 14. A 78-year-old man with Parkinson’s disease is being cared for in a nursing home. The nurses observe that he coughs at mealtime; he has the ability to still feed himself with adaptive equipment. He has had no aspirations. Oral exam is normal, except during his swallowing assessment you note there is 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. MULTIPLE CHOICE 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 C. A 68-year-old overweight female who drinks 1-2 drinks alcohol/day ____ 16. Mr. White is 62 years old and has chronic kidney disease that has been relatively stable. He also has a history of hyperlipidemia, osteoarthritis, and hypertension. He is compliant with his medications, and his BP has been well controlled on a calcium channel blocker. His last lipid panel showed: TC = 201, HDL = 40, TG = 180, LDL = 98. He currently takes Crestor 20 mg daily. In the office today, his BP is 188/90, and his urine dip now shows significant proteinuria. He denies any changes in his dietary habits or medication regimen. What would be the best medication change for Mr. White at this point? A. No change—have him return in 4 weeks for a re-check of his blood pressure and urine B. Increase the dose of the calcium channel blocker for his hypertension C. Change the calcium channel blocker to an ACE-I D. Increase the dose of his Crestor and have him return in 3 months for a re-check of his BP ____ 17. You are working as a nurse practitioner in the Fast Track of the emergency room. A 76-year-old male presents with left upper quadrant abdominal pain. There can be many conditions that present as left upper quadrant pain, but which of the following is least likely to cause pain in the left upper quadrant? A. Splenic abscess B. Left pyelonephritis C. Splenic rupture D. Acute pancreatitis ____ 18. Which is a “cardinal feature” of failure to thrive? A. Decline in toileting ability B. Gait disturbance C. Poor nutritional status D. Spiritual distress ____ 19. Feeding gastrostomy tubes at end-of-life Alzheimer’s disease patients have been associated with: A. Prolongation of life B. Aspirational pneumonia C. Increase in skin infections D. Reversal of any clinical signs of failure to thrive ____ 20. Which of the following nutritional indicators is not an indication of poor nutritional status in an older person? A. Albumin of < 3.5 g/dl B. Body mass index of 25 C. Total cholesterol < 150 mg/dl D. Loss of 10% body weight in 180 days MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: B PTS: 1 3. ANS: B PTS: 1 4. ANS: A PTS: 1 5. ANS: B PTS: 1 6. ANS: B PTS: 1 7. ANS: A PTS: 1 8. ANS: B PTS: 1 9. ANS: B PTS: 1 10. ANS: B PTS: 1 11. ANS: D PTS: 1 12. ANS: B PTS: 1 13. ANS: C PTS: 1 14. ANS: A PTS: 1 15. ANS: C PTS: 1 16. ANS: C PTS: 1 17. ANS: D PTS: 1 18. ANS: C PTS: 1 19. ANS: B PTS: 1 20. ANS: B PTS: 1 Chapter 15. Hematologic and Immune System Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? A. Hemoglobin and hematocrit B. Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) C. Serum ferritin and serum iron D. Total iron binding capacity and transferrin saturation ____ 2. Initial therapy for patients with IDA is: A. Blood transfusion B. Increasing dietary intake of green leafy vegetables C. Ferrous sulfate 325 mg orally bid-tid D. Parenteral administration of Venofe ____ 3. Mrs. G, a 70-year-old patient, presents to you with a hemoglobin of 9.4 and a decreased MCV/MCV. You diagnose her with IDA and start her on ferrous sulfate 325 mg PO tid. The next step in your work-up would be: A. Send Mrs. G for a GI consult B. Obtain hemoglobin one week after oral therapy C. Schedule Mrs. G for an upper GI series D. Obtain stool for occult blood ____ 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: 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 ____ 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: A. Anxiety B. Depression C. Agitation and aggression D. Psychosis ____ 15. When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed? A. Fluoxetine B. Desipramine C. Amitriptyline D. Mirtazapine MULTIPLE CHOICE 1. ANS: C PTS: 1 2. ANS: D PTS: 1 3. ANS: D PTS: 1 4. ANS: B PTS: 1 5. ANS: A PTS: 1 6. ANS: B PTS: 1 7. ANS: D PTS: 1 8. ANS: D PTS: 1 9. ANS: D PTS: 1 10. ANS: C PTS: 1 11. ANS: B PTS: 1 12. ANS: B PTS: 1 13. ANS: A PTS: 1 14. ANS: A PTS: 1 15. ANS: C PTS: 1 Chapter 17. Polypharmacy MULTIPLE CHOICE ____1. The nurse plans to closely monitor an older adult client who is receiving multiple drugs for evidence of adequate excretion of the medications. Which two major organs affecting drug clearance from the body should be monitored when an older adult client is receiving multiple drugs? i. Kidneys and lungs ii. Kidneys and pancreas iii. Liver and pancreas iv. Liver and kidneys ANS: D The older adult client may experience a decrease in hepatic enzyme production, hepatic blood flow, and total liver function. These decreases cause a reduction in drug metabolism. A decrease in renal blood flow and decrease in glomerular filtration rate of 40% to 50% can also occur. ____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. c. Decrease in blood sugar levels. d. Provide time for questions; reinforce with written information. ANS: C The nurse should help the client develop a chart indicating times to take drugs. Space should be provided to mark each drug taken. An organizer or calendar can be used to mark days and weeks. ____14. The physician is recommending a benzodiazepine medication for an older adult client who has previously been treated with Valium. The nurse recognizes that which medication would be most appropriate for this client? a. Librium b. Dalmane c. Ativan d. Equanil ANS: C A short-acting benzodiazepine, such as Ativan, would be preferable to any of the other drugs to avoid prolonged sedation and addiction. ____15. Which older adult client is most likely to experience digoxin toxicity? a. 72-year-old man who is also experiencing hyperkalemia b. 74-year-old woman who is also experiencing hypokalemia c. 66-year-old woman who is also experiencing hypercalcemia d. 62-year-old woman who is also experiencing hypocalcemia ANS: B Hypokalemia enhances the effect of digoxin, thus increasing the possibility of toxicity. Chapter 18. Chronic Illness and the Advanced Practice Registered Nurse (APRN) Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. All of the following statements are true about chronic disease/illness except: A. Chronic disease is defined as a condition that requires both modification by the patient along with interaction with the provider B. The meaning of chronic illness includes the experience of the patient and family and provider C. Chronic illness is reversible if diagnosed and treated early D. Chronic conditions are those that last a year or longer ____ 2. The highest number of people with multiple chronic conditions are those that are: A. Over age 85 B. Diagnosed with type 2 diabetes C. African American women over age 65 D. Diagnosed with COPD ____ 3. Long durations of a chronic illness that are most commonly associated in both women and men are: A. Heart disease and obesity B. Diabetes and COPD C. Arthritis and dementia D. Dyslipidemia and eye disease ____ 4. The percentage of non-institutionalized elderly over age 75 with limitations in activity due to a chronic condition is: A. 25% B. Nearly 50% C. Over 75% D. Less than 15% ____ 5. Which of the following statements are true? A. Most Medicare participants have a single care provider B. Chronic kidney disease patients have better outcomes due to the dialysis benefit C. Nearly half of Medicare participants have five or more chronic diseases D. Nearly half of Medicare participants have three or more chronic diseases ____ 6. Which statement about chronic mental disorders is false? A. The numbers are projected to increase in the next decade B. Individuals with mental health problems actually have a decreased risk of medical problems C. The number of older adults with addiction problems is projected to increase in the next decade D. Nearly half of individuals with dementia are not diagnosed prior to hospitalization ____ 7. All of the following criteria define frailty except: A. Unintentional weight loss >10 pounds in the past year B. Slow walking speed C. Stooped posture D. Self-reported exhaustion ____ 8. All of the following are health consequences of obesity except: A. Mortality of aging B. Hypertension C. Coronary artery disease D. Sleep apnea ____ 9. Evidence-based clinical practice guidelines may have limited applicability in the older population because: A. They often are disease specific B. They often have complex comorbid conditions C. Both A and B D. None of the above evidence-based clinical practice guidelines are always the standard ____ 10. Inter-professional care is distinguished from other models of team-based care in that: A. Independent providers share information B. Expert advice is shared from one provider to another C. Different disciplines work under one leader D. Shared leadership and accountability is a primary focus ____ 11. All of the following statements about the Chronic Care Model are true except: A. It was developed with Robert Wood Johnson Foundation funding B. It focuses exclusively on a self-management model C. It is an evidence-based policy response designed to meet the needs of the chronically ill D. It directs quality improvement and system change for patients with chronic disease ____ 12. The legislation signed in March 2010 with provisions for addressing chronic disease was: A. Accountable Care Organization Act B. Independence at Home Act C. Patient Protection and Affordable Care Act D. Patient Centered Medical Home Act ____ 13. Reported outcome measures for the Patient Centered Medical Home include all of the following except: A. Emergency room use B. Hospitalizations C. Patient/family satisfaction D. Number of primary care visits A. In a nursing home B. In the hospital C. In an inpatient hospice facility D. At home ____ 11. A drug that can be used to treat two very common symptoms in a dying patient (pain and dyspnea) is: A. Morphine B. Methadone C. Gabapentin D. Lorazepam ____ 12. The tasks of grieving include all of the following except: A. Acknowledge the reality of death B. Work through the pain of grief C. Begin to disengage D. Restructure relationships ____ 13. The best description of complicated grief is: A. Chronic, delayed, exaggerated, masked, or disenfranchised B. Experience of shock during notification of the death C. When grief is actually experienced before the death of a loved one D. A physical illness develops soon after death of a loved one ____ 14. All of the following statements are true about interventions in working with the bereaved except: A. Allow the active expression of grief B. There is strong evidence behind recommended interventions C. Staff attending memorial services support the family D. Provide both emotional and spiritual support ____ 15. The highest level of evidence to support interventions at the end of life is with: A. Opioids for pain control B. Hyocsyamine for respiratory secretions C. Stimulant laxatives for treating constipation D. Opioids for dyspnea ____ 16. The highest level of evidence with the use of adjuvant analgesics is with: A. Tricyclic antidepressants avoided due to high adverse events B. Therapeutic trials before discontinuing drugs C. Patient with fibromyalgia are candidates for adjuvant analgesics D. Neuropathic pain patients are candidates for adjuvant analgesia MULTIPLE CHOICE 1.ANS: B PTS: 1 2.ANS: D PTS: 1 3.ANS: A PTS: 1 4.ANS: B PTS: 1 5.ANS: A PTS: 1 6.ANS: D PTS: 1 7.ANS: C PTS: 1 8.ANS: B PTS: 1 9.ANS: B PTS: 1 10.ANS: D PTS: 1 11.ANS: A PTS: 1 12.ANS: C PTS: 1 13.ANS: A PTS: 1 14.ANS: B PTS: 1 15.ANS: D PTS: 1 16.ANS: D PTS: 1