NR 601 Final Exam Questions with Complete Solutions 2024, Exams of Nursing

Download NR 601 Final Exam Questions with Complete Solutions 2024 and more Exams Nursing in PDF only on Docsity! 1 NR 601 Final Exam Questions with Complete Solutions 2024 _________ is an acute onset of memory deficit, disorientation, attention issues with fluctuation in status based on situation and IS reversible - Correct Answer-delirium __________ is insidious in onset with progressive decline in cognition - Correct Answer- dementia What is the Mini-Cog? - Correct Answer-a routine screening tool that test pt's executive function, ability to plan, manage time, organize activities, manage working memory what are the parts of the mini cog - Correct Answer-3 word recall and draw a clock what are the total points of the mini cog test and what does the score mean - Correct Answer-out of 5 ; less than 4 - screen further, les than 3 - suspicious for dementia symptoms in delirium (11) - Correct Answer-acute mental change fluctuating attention issue memory issue orientation issue perceptual issues though issue sleep issue consciousness issue speech issue psychomotor issue potential contributing factors to delirium development - Correct Answer-medications, alcohol, infxn, hypoxia, surgery, sleep disturbances what particular medication class is strongly associated with delirium in older adults - Correct Answer-anticholinergics why are antihistamines like benadryl and hydroxyzine not recommended for older adults - Correct Answer-anticholinergic activity - promotes delirium labs that should be checked in patient with delirium (7) - Correct Answer-UA Creatinine sodium potassium calcium glucose CBC 2 sedative agent considered okay to use in patient with delirium while being treated - Correct Answer-haloperidol (or ativan if alcohol related) opiates to avoid in older adults due to delirium concerns - Correct Answer-tramadol meperidine / demerol codeine sleep aid safe for older adults (less concern for delirium) - Correct Answer-trazadone what are the biomarkers associated with neurocognitive disorder (5) - Correct Answer- amyloid beta 42 phosphorylated / total tau APOE4 Brain derived neurotrophic factor ubiquitin what tool is used to detect delirium reliably in under 5 minutes ? - Correct Answer-CAM / confusion assessment model What is the Confusion Assessment Method (CAM)? - Correct Answer--Standardized assessment tool used to quickly identify delirium in a hospitalized patient what is on the CAM - Correct Answer-squeeze hand when letter A is said, disorganized thinking questions, hold up fingers what is mild cognitive impairment - Correct Answer-patient or family may report decline in memory or other cognition but function is preserved. types of MCI - Correct Answer-amnestic and dysexecutive what is amnestic MCI - Correct Answer-primarily relating to memory what is dysexecutive cognitive impairment - Correct Answer-emotional, motivational, behavioral symptoms type of MCI that more often progresses to alzheimers / dementiaa - Correct Answer- amnestic what is the clinical dementia rating CDR scale / what do scores mean - Correct Answer- rating device that rates based on memory, orientation, judgement, problem solving, etc. score is 0 to 3, 0 being no dementia 3 being severe impairment what is the mini mental state exam MMSE - Correct Answer-a screening tool used to monitor changes in cognition 5 medication that may help with BPSD in dementia - Correct Answer-memantine may help spinning of the room is _________ - Correct Answer-vertigo lightheadedness is also called - Correct Answer-presyncope Disequilibrium or unsteadiness on feet most represents - Correct Answer-dizziness what is a common cause of dizziness in older adults - Correct Answer-visual vestibular decline --- normal change (decreased vision and vestibular fxn) chronic, constant dizziness is most likely to be ________ in origin - Correct Answer- mixed or psychiatric dizziness that happens while lying down is NOT likely ____________ - Correct Answer- presyncope dizziness + full ear or hearing loss = - Correct Answer-menieres, labyrinthitis, acoustic neuroma, otitis media dizziness with weakness or diplopia consider - Correct Answer-TIA, ischemia, migraine dizziness or vertigo worse with rolling over in bed or bending over consider - Correct Answer-BPPV or inner ear cause chronic dizziness is more than - Correct Answer-2 months duration dizziness from many causes is called - Correct Answer-multisensory dizziness most common cause of dizziness in older adult - Correct Answer-BPPV medications that cause dizziness (6) - Correct Answer-seizure meds anxiety meds antidepressants NSAID heart meds antihistamines nystagmus usually means a ________ cause of dizziness, unless in acute vestibular issues - Correct Answer-central what maneuver is used to assess nystagmus in dizziness - Correct Answer-Dix hallpike what questionnaire is used to assess dizziness and what do scores mean - Correct Answer-dizziness handicap index ; over 10 is compelling for further workup 6 treatment and labs for dizziness - Correct Answer-largely dependent on suspected origin cardiovascular: CBC, CMP, ekg, orthostatics neuro: consider imaging hearing loss: ENT follow can treat with meclizine, steroids, antiemetics stroke types - Correct Answer-Ischemic, hemorrhagic, transient ischemic attacks (TIAs), subarachnoid hemorrhage most stroke types in US - Correct Answer-ischemic what is the most widely used classification for ischemic stroke - Correct Answer-TOAST (characterizes by location primarily) risk of stroke doubles for each _________ - Correct Answer-decade after 55 ________ is the most important modifiable risk factor in stroke - Correct Answer-HTN modifiable risk factors for stroke (8) - Correct Answer-HTN DM Hld Afib OSA Smoking alcohol sedentary _______ circulation is most common place for a stroke - Correct Answer-anterior circulation anterior circulation of the brain - Correct Answer-supplied by internal carotid arteries and circulates to the frontal, parietal, lateral temporal lobes posterior circulation of brain - Correct Answer-supplied by the vertebral arteries and circulates to the stem, cerebellum, occipital, thalamus vessels in the posterior circulation of brain - Correct Answer-posterior cerebral artery basilar artery vertebral arteries 7 What is a lacunar stroke? - Correct Answer-caused by a SMALL vessel disease deep in cerebral white matter (penetrating artery disease) what is different about a lacunar stroke - Correct Answer-can be asymptomatic and are in non cortical areas cutoff for alteplase in ischemic stroke - Correct Answer-3 to 4.5 hours since last known well contraindications for alteplase - Correct Answer-stroke or trauma or brain surgery within 3 months, HX hemorrhage, low platelet, INR > 1.7, if on anticoags, imaging for a stroke should be done within ________ minutes of ER arrival - Correct Answer-20 min agents used to control BP in acute ischemic stroke - Correct Answer-beta blockers (labetalol) ca channel blockers (nicardipine) typical duration of TIA symptoms - Correct Answer-20 min medications used for spasm in post stroke patient - Correct Answer-dantrolene gabapentin tizanidine baclofen (first line) benzos warfarin indications - Correct Answer-Valvular AFib, Mechanical heart valve direct oral anticoagulants indications - Correct Answer-nonvalvular afib depression is common in post stroke patients and treatment with __________ is appropriate - Correct Answer-SSRI first thing to be done in suspected stroke - Correct Answer-noncontrast CT characteristics of Parkinsons / PD - Correct Answer-rigid tremor bradykinesia usually asymmetric PD is more common in - Correct Answer-men pathophysiology of PD - Correct Answer-degeneration of dopamine producing neurons in the substancia nigra 10 treatment for irregular sleep wake disorder - Correct Answer-meds not recommended, alter light and dark therapy as appropriate most common sleep disturbance in older adults - Correct Answer-OSA gold standard test for OSA - Correct Answer-polysomnogram hypnotic medications for sleep are recommended for no more than ___________ - Correct Answer-1 week labs to check in major depression - Correct Answer-thyroid b12 vita D folate UA anemia neuroimaging related to depression - Correct Answer-only if need to rule out cancer, hematoma, hydrocephalus or if resistant to TX first line drug classes for depression in older adult - Correct Answer-SSRI SNRI SSRI common side effects - Correct Answer-GI upset jittery hyponatremia ** watch esp if on diuretics extrapyramidal drug interactions (CYP450 inhibitor) antidepressant without sexual side effect - Correct Answer-bupropion concerning side effects with TCAs in older adults - Correct Answer-pulse increase hypotension conduction issues anticholinergic screenings for anxiety - Correct Answer-GAD 7 Hamilton anxiety scale scoring for the GAD 7 - Correct Answer-5-9 mild 10-14 moderate 15+ severe Hamilton Anxiety Rating Scale - Correct Answer-a. 14 items scored on a scale of 0 (not present) to 4 (severe) b. total score range 0-56 11 c. Mild severity- <17 d. mild-mod 18-24 e. mod -severe 25-30 lab testing for anxiety - Correct Answer-thyroid CMP tox screen insomnia requires what in terms of symptoms - Correct Answer-at least 3 nights per week for 3 months or more Narcolepsy - Correct Answer-A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times. narcolepsy diagnostics - Correct Answer-polysnomnography, multiple sleep latency test symptoms of OSA - Correct Answer-daytime sleepiness trouble concentrating mood change dry mouth / sore throat headaches gasping / choking snoring STOP-BANG questionnaire - Correct Answer-screen for sleep apnea dysfunctional beliefs and attitudes about sleep questionnaire - Correct Answer-to determine if room for CBTI Morningness-Eveningness Questionnaire - Correct Answer-Assesses one's circadian rhythms -- for sleep wake disorders HP 2020 goals for flu vaccine rates in older adults - Correct Answer-goal is 90% of adults over 65 recommended vaccines for older adults - Correct Answer-flu annually Tdap 1 TDAP over 65 then Td every 10 yrs pneumonia on separate card hep A and B if at high risk at least one dose shingrex 2 dose 2-5 mo apart pna vaccine adult - Correct Answer-1 dose PCV15 then PPSV23 1 year later PCV 20 is single dose 12 smoking cessation is most effective if - Correct Answer-combined medication with behavioral / counseling questionairre used to assess alcohol abuse and scores - Correct Answer-CAGE (2 or more yes answers is POS for alcoholism) physiologic changes in aging make the older adult prone to what issue with hydration - Correct Answer-dehydration screening for breast cancer - Correct Answer-50 to 74, every 2 years screening for colon cancer - Correct Answer-50 to 74 every 5 -10 years screening for cervical cancer - Correct Answer-PAP every 1-3 years from 21 to 65 prostate cancer screening - Correct Answer-55 to 64 dexa screening - Correct Answer-over 65 , every 2-5 years , women HP 2030 goal related to older adults - Correct Answer-improve health and well being of older adults diseases addressed in HP 2030 for older adults (4) - Correct Answer-DM dementia osteoporosis respiratory disease HP 2030 goal for older adults related to physical activity - Correct Answer-increase adults with disease who get exercise HP 2030 goal for older adults related to injury prevention (3) - Correct Answer-reduce fall deaths reduce inappropriate medications reduce ER visits due to falls HP 2030 goal for older adults related to oral conditions (3) - Correct Answer-reduce number of people with untreated root decay reduce people over 45 who have lost all teeth reduce adults over 45 with moderate and severe periodontitis daily alcohol intake limit for older adults - Correct Answer-1 daily for women 2 daily for men 15 Dribbling - Correct Answer-Leakage of small amounts of urine after voiding Nocturia - Correct Answer-Waking in the middle of the night to void Overactive bladder includes what - Correct Answer-urgency, frequency, and nocturia Pharmacological treatment and dose for OAB - Correct Answer-Ditropan (oxybutinin)5- 10mg once daily Mirabegron (myrbetriq) 25-50mg once daily What is it important to do for a patient with urinary incontinence - Correct Answer-create a plan with the patient and family to assist with bladder incontinence and education and assisted living to reduce stress and improve outcomes UTI symptoms - Correct Answer-frequency, dysuria, urgency, hematuria Postmenopausal women complaints of UTI - Correct Answer-incontinence nacturia low back pain constipation Older adult UTI symptoms - Correct Answer-change in cognition should treatment for UTI in older adults be based on symptoms - Correct Answer-no because common symptoms may mimic other disease processes Diagnostics for UTI - Correct Answer-urine dip stick to evaluate for leukocyte and nitrates If urine dipstick is positive for leukocytes and nitrates present then what - Correct Answer-symptomatic treatment until microbiology is back with direct targeted antibiotic Why should you make sure dipstick is positive before treating symptomatically - Correct Answer-to reduce antibiotic resistance Should you treat asymptomatic UTIs in long term care and why - Correct Answer-no because asymptomatic bacteriuria is common and if treated will increase antibiotic resistance, drug side effects, cost, and have no improvement in morbidity/mortality does pyuria indicate the difference between symptomatic and asymptomatic UTI - Correct Answer-no because you can have pyuria in bacteriuria and without bacteriuria so no pyuria can rule out UTI but presence of pyuria cannot confirm UTI common long term care residents UTI symptoms - Correct Answer-chronic symptoms like nocturia, hematuria, change in function 16 Common drugs for UTI treatment - Correct Answer-cipro bactrim macrobid and keflex BPH is a _____________ disease involving ....... - Correct Answer-multifactorial disease involving smooth muscle hyperplasia The prostate is under what type of influence for growth - Correct Answer-neurohormonal what receptors control the smooth muscle of the prostate and help maintain urethral tone and pressure - Correct Answer-alpha-1 adrenergic receptors What is testosterone converted into in the prostatic stromal cells - Correct Answer-its converted into dihydrotestosterone by the 5-alpha-reductase in the prostatic stromal cells What stimulates growth of the prostate gland - Correct Answer-androgen stimulation of tissue by dihydrotestosterone(DHT) during growth spurts which can lead to BPH When is the last growth spurt a man undergoes and what should we look for - Correct Answer-in his 50's...thats why this is usually when BPH shows up What else may increase the effect of dihydrotestosterone in older men - Correct Answer-the increase in circulating testosterone Static component of BPH - Correct Answer-relates to anatomical enlargement of prostate impingingg on urethra and bladder outlet Dynamic component of BPH - Correct Answer-increased prostatic smooth muscle tone which promotes obstruction of urine flow which medications help the static component of BPH - Correct Answer-5-alpha reductase inhibitors Which medications help the dynamic component of BPH - Correct Answer-Alpha-1 adrenergic blockers LUTS means - Correct Answer-lower urinary tract symptoms LUTS is caused by what in men - Correct Answer-BPH Is LUTS only caused by BPH - Correct Answer-no can be a variety of conditions only describes patient complaints without cause 17 LUTS symptom categories - Correct Answer-storage voiding postmicturation symptoms LUTS- storage symptoms - Correct Answer-(irritative) frequency nocturia urgency incontinence bladder sensation LUTS- voiding symptoms - Correct Answer-(obstructive) slow stream splitting/spraying intermittent stream hesitancy straining dribbling LUTS - Post Micturition Symptoms - Correct Answer-feeling of incomplete emptying dribble Diagnostics for BPH - Correct Answer-Digital Rectal Exam (DRE) lower abdominal palpation urinalysis PSA PVR what is the 2nd most common form of cancer in the united states and what is the most common risk factor - Correct Answer-prostate cancer age Lifestyle modifications for BPH - Correct Answer-reduce night time fluids eliminate dietary diuretics bladder retraining Alpha-1 adrenergic blockers examples - Correct Answer-- osin terazosin doxazosin tamsulosin Alpha-1 adrenergic blockers work by - Correct Answer-relaxing smooth muscle of prostate (i.e. dynamic component) 5-alpha reductase inhibitors examples - Correct Answer--teride 20 first line therapy for Genitourinary syndrome of menopause symptoms - Correct Answer-vaginal moisturizers second line therapy for Genitourinary syndrome of menopause - Correct Answer-topical estrogen therapy which hormone therapy is indicated for women who have not had a hysterectomy and why - Correct Answer-estrogen plus progestin to help prevent uterine cancer how can hormonal therapy be given - Correct Answer-systemically (pills, patches, injections) or locally (creams, or vaginal rings) what dose should be used for hormonal therapy - Correct Answer-lowest effective dose risks of hormonal therapy - Correct Answer-stroke blood clots breast cancer alternative treatment of hormonal therapy for women with history of breast cancer - Correct Answer-selective estrogen receptor modulators which block or activate estrogen receptors in certain areas of the body postmenopausal bleeding - Correct Answer-genital tract bleeding in a woman not on hormonal therapy or is non-cyclical bleeding in women on hormonal therapy most common cause of postmenopausal bleeding - Correct Answer-benign vaginal atrophy Other causes of postmenopausal bleeding - Correct Answer-vaginal atrophy endometrial atrophy endometrial polyps uterine fibroids endometrial hyperplasia cancers (endometrial, ovarian, cervical, vaginal) how is vaginal atrophy seen on exam - Correct Answer-thin pale vaginal epithelium narrowing of the Introitus subjective complaints of vaginal atrophy - Correct Answer-dysparenurria post-coitla bleeding vaginal atrophy treatment - Correct Answer-local or systemic estrogen endometrial atrophy treatment - Correct Answer-short course of systemic estrogen 21 endometrial polyps treatment - Correct Answer-surgical removal uterine fibroids treatment - Correct Answer-surgical removal cancers (endometrial, ovarian, cervical, vaginal) tx - Correct Answer-total hysterectomy radiation endometrial hyperplasia treatment - Correct Answer-systemic progesterones or hormonal IUD ageism and sexuality - Correct Answer-the belief the older adults are sexless satisfying sex lives in the older adults are associated with... - Correct Answer-better cardiovascular health greater self-esteem sense of comfort and security what is the most common cause of erectile dysfunction in older men - Correct Answer- atherosclerosis A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide, chlorthalidone, and acetaminophen. What would be your first step in therapy? - Correct Answer-stop chlorthalidone A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of her problem? - Correct Answer-high-tone pelvic floor dysfunction what is a growing epidemic in the u.s. older adult population - Correct Answer-sti's treatment for chlamydia and doses - Correct Answer-doxycycline 100mg BID x 7 days or azithromycin 1g orally in one dose or levofloxacin 500mg once daily x7 days treatment for gonorrhea - Correct Answer-Ceftriaxone 250 mg IM in a single dose PLUS treatment for chlamydia (azithromycin 1 g PO single dose or doxycycline 100 mg PO BID for 7 days) if a patient has an STI what education is recommended - Correct Answer-abstain from sexual intercourse for 7 days after single dose abx or until completion of 7 day course if you can't abstain use condoms 22 all sexual partners within last 60 days should be tested how to prevent STIs return in 3 months for a test of cure sexuality and intimacy assessment tools - Correct Answer-personal assessment of intimacy in relationships (PAIR) PLISSIT personal assessment of intimacy in relationships (PAIR) - Correct Answer-MEASURE INTIMACY SELF ADMINISTERED 36 items measured on 1-5 scale how it is and how you would like it to be PLISSIT model of sex therapy - Correct Answer-method of introducing sex into clinical conversation P - Permission LI - Limited Information SS - Specific Suggestions IT - Intensive Therapy PLISSIT: Permission - Correct Answer-give patients permission to raise sexual issues PLISSIT: limited info - Correct Answer-giving patients limited information about sexual side effects of tx's PLISSIT: Specific Suggestions - Correct Answer-make specific suggestions based on full evaluation of presenting problems PLISSIT: Intensive Therapy - Correct Answer-Referral to intensive therapy (includes psychological interventions, sex therapy, and biomedical approaches) Is all hospice care considered palliative - Correct Answer-yes is all palliative care considered hospice care - Correct Answer-no What is palliative care - Correct Answer-specialized medical care for people with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. What is the goal of palliative care - Correct Answer-The goal is to improve quality of life for both the patient and the family 25 generally documented through an advanced directive What are the components of a advanced directive - Correct Answer-living will durable power of attorney for health care DNRCC or DNRCC-Arrest what is a living will - Correct Answer-a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. directed at healthcare providers durable power of attorney for health care - Correct Answer-legal document that designates a health care proxy, who is authorized make health care decisions for a client who is unable DNRCC - Correct Answer-Do not resuscitate comfort care no CPR, airway, resuscitative drugs, etc DNRCC-Arrest - Correct Answer-activities DNR order when cardiac or respiratory arrest occurs resuscitative therapies can be used BEFORE an arrest but not during POLST (Physician Orders for Life-Sustaining Treatment) - Correct Answer-dentify the patient's overall goals of treatment as either aggressive, limited, or comfort-focused identify actions regarding CPR, hospitalizations, abx, hydration, and nutrition What is the surprise question regarding when a POLST should be filled out - Correct Answer-"Would the provider be surprised if the patient died within 2 years? an affirmative answer is used to identify patients who would most benefit from a document of this kind SPIKES - Correct Answer-6 step protocol for effectively communicating sensitive information about advanced care planning while focusing on the patients emotions SPIKES Six steps are - Correct Answer-Setting Perception (what patient knows) Invitation (clarify information preferences) Knowledge (Give the information) 26 Empathy (Respond to emotion) Summary (next steps and follow up plan) Kübler-Ross' Stages of Dying and grief or loss in other contexts - Correct Answer-denial anger bargaining depression acceptance are Kübler-Ross stages linear - Correct Answer-no they can be experienced out of order, with stages missing, or multiple times Grief - Correct Answer-universal yet personal psychological or emotional response to a loss an experience of emotions not just one Types of grief - Correct Answer-Normal, anticipatory, complicated, disenfranchised normal grief - Correct Answer-common, universal reaction characterized by sadness, guilt, crying, loneliness, changes in sleep Anticipatory grief - Correct Answer-occurs before actual death or loss disenfranchised grief - Correct Answer-a loss cannot be socially acknowledged, mourned or supported minimized and not understood by others prolonged grief - Correct Answer-grief where symptoms limit day to day functioning and are disabling may include difficulty accepting the loss, self-destructive behavior, suicidal thoughts what type of grief is more common but less recognized in older adults - Correct Answer- prolonged grief bereavement - Correct Answer-state of sorrow over the death or departure of a loved one normal period of grief and mourning Hospice bereavement services - Correct Answer-grief assessment and education bereavement counseling 27 support groups commemorative activities referrals to therapeutic or community resources community bereavement support