NR 601 MIDTERM EXAM ACTUAL EXAM 2024 -2025 QUESTIONS AND DETAILED CORRECT ANSWERS | A+ GRA, Exams of Nursing

Download NR 601 MIDTERM EXAM ACTUAL EXAM 2024 -2025 QUESTIONS AND DETAILED CORRECT ANSWERS | A+ GRA and more Exams Nursing in PDF only on Docsity! NR 601 MIDTERM EXAM ACTUAL EXAM 2024 -2025 QUESTIONS AND DETAILED CORRECT ANSWERS | A+ GRADE You suspect your patient has PMR and now are concerned that they may have Giant Cell Arteritis too. Which of the following 2 symptoms are most indicative of GCA and PMR Correct Answer Scalp tenderness and aching in shoulder and pelvic girdle 63 yo Caucasian patient with PMR will begin tx corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical exam and any labs or diagnostic tests as she relocated and had not yet ID'd a provider. In prioritizing your management plan your first orders should include Correct Answer Duel energy X-ray scan and updating immunizations Which of the following DD for patients presenting with PMR can be ruled out with a muscle biopsy Correct Answer Polymyositis In reviewing lab results for patients with suspected PMR, you realize there is no definitive test to diagnose PMR, rather clinical response to treatment. Results you would expect to see include: Correct Answer ESR >50 Which of the following is the most appropriate lab test for monitoring gout therapy over the long-term Correct Answer Serum urate level In providing health teaching related to dietary restrictions, you should advise a patient with gout to avoid which of the following dietary items Correct Answer Beer, sausage, fried seafood The best method of verifying gout diagnosis in a joint is which of the following Correct Answer Joint aspiration and polarized light microscopy The most appropriate first line treatment for acute gout flare, assuming no kidney disease or elevated bleeding risk Correct Answer Indomethacin 50mg TID x2 days, then 25mg TID x3 days You order bilateral wrist XR on 69 yo man with c/o both wrists x6 weeks, not related to any known trauma. You suspect early RA. The initial XR finding in apatien with elderly onset RA would be Correct Answer Soft tissue swelling A 72 female has been diagnosed with gout. She also has chronic HF. The most likely contributing factor to development of gout in this older female is Correct Answer Thiazide diuretics Which of the following statements about OA is true Correct Answer It affects primarily weight bearing joints WHen treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed Correct Answer Amitriptyline Which of the following should be avoided in countries where food and water precautions are to be observed Correct Answer Salad buffet What insect precautions are not necessary to prevent insect borne diseases in the Tropics Correct Answer Using 100% DEET on skin to prevent bites An example of secondary prevention you could recommend/order for older adults would be to Correct Answer Check for fecal occult blood Ali is a 72 year old male who recent came to the US from Nigeria. He reports having BCG vax as a child. Which of the following is correct regarding a TB skin test Correct Answer Vax hx is irrelevant, read as usual A local chapter on NP organization has begun planning a community based screening for HTN at a local congregate living facility. The organization was select3d on the basis of Correct Answer A regcognized element of high risk within this group Performing ROM exercises on a patient who has had a CVA is an example of which level of prevention Correct Answer Tertiary You demonstrate an understanding of primary prevention of falling among the elderly through which management plan Correct Answer Provide info about meds, SE and interactions An example of an active strategy of health promotion for an individual to accomplish would be Correct Answer Beginning stress management program The 4 main domains of clinical preventive services that you will provide are Correct Answer Counseling interventions, screening tests, immunizations, chemoprophylaxis What is the appropriate method for TB screening of an older adult entering a nursing home Correct Answer 5 TBU intradermal PPD injection and if negative, repeat with same dose one week later The term "geriatric syndrome" is best described Correct Answer Condition that has multiple underlying factors and involves multiple systems Atypical presentation of acute coronary syndrome is Correct Answer More common in females What disease can mimic and often co-exists with MI in elderly with CAD Correct Answer Esophageal disease Thoracic aortic dissection presents typically as Correct Answer Severe retrosternal CP that radiates to the back and both arms Bordetella pertussis is best characterized Correct Answer Sub-acute cough lasting >2 weeks Routine testing of TB should occur in all of the following vulnerable populations except Correct Answer hospitalized elderly Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the DD is Correct Answer Rapid change and fluctuating course of cognitive function Evidence shows that the most important predictor of a fall is Correct Answer Prior history of a fall The most cost-effective interventions used to prevent falls are Correct Answer Home modifications and vitamin D supplements Chronic fatigue syndrome is best described as Correct Answer Fatigue lasting longer than 6 months and not relieved by rest Risk factors associated with the finding of a malignancy in a patient with hemoptysis include all of the following except Correct Answer Childhood asthma The most common organism responsible for CAP in the elderly is Correct Answer Strep pneumoniae 72 year old woman and her husband are driving cross country. After a long day of driving, they stop to eat. Midway through the meal, the woman because very SOB with CP and a sense of panic. Which problem is most likely Correct Answer Pulmonary embolism Exercise recommended for elderly should include activities that Correct Answer Strengthen muscles Preferred amount of exercise for elderly is Correct Answer 30 min of aerobic activity a day 5 days a week. The percentage of the FVC expired in one second is Correct Answer FEV1/FVC ratio The aging process causes what normal physiological changes in the heart Correct Answer The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis A 55 yo Caucasian male follows up after referral to cardiologist. He thinks his med is causing a cough and sometimes he has difficulty breathing. Which med was most likely prescribed? Correct Answer Lisinopril MJ presents with h/o structural damage with current s/s of HF. Treatment will be based on his stage of HF which is Correct Answer Stage C 65 yo Caucasian presents with mitral valve stenosis, physical exam is unremarkable. you know her stage of HF is Correct Answer Stage B The best way to diagnose structural heart disease/dysfunction noninvasively is Correct Answer Echocardiogram Chronic pain can have major impact on patients ability to function and have profound impact on overall QOL. Ongoing pain may be linked to Correct Answer Depression, sleep disturbance, decreased socialization The Beers criteria are appropriate for use in evaluating use of certain meds in patients Correct Answer >65 y/o All of the following statements are true about lab values in older adults except Correct Answer Abnormal findings are often due to physiological aging According to the 2017 ACC HTN guidelines, the recommended BP goal for a 65y/o African American woman with a h/o HTN and DM and no h/o CKD is Correct Answer <140/80 THe pathophysiology of HF is due to Correct Answer Inadequate cardiac output to meet the metabolic and O2 demands of the body The volume of air a patient to exhale for total duration of the test during maximal effort is Correct Answer FVC According it the 2017 ACC HTN guidelines, normal BP is Correct Answer <120/80 Functional abilities are best assessed by Correct Answer Observed assessment of function LB is a 77 yo with chronic poorly controlled HTN. You know that goals include prevention of target organ damage. During your eval you will assess for evidence of Correct Answer Left ventricular hypertrophy Aortic regurgitation requires medical treatment for early signs of HF with Correct Answer ACEi The volume of air in the lungs at max inflation is Correct Answer TLC (total lung capacity) Preferred amount of exercise for older adults is Correct Answer 30min/day of aerobic exercise 5 days a week You know the following statements regarding th pain of acute coronary syndrome are true except Correct Answer Present atypically more often in men than women Elderly patient presents with new onset of feeling heart race, fatigue. EKG reveals Afib with rate >100. Patient also has a new tremor in both hands. Which of the The cytochrome p system involves enzymes that are generally: Correct Answer Inhibited or induced by drugs A statement not shown to be true about pharmacodynamic changes with aging is Correct Answer Decreased sensitivity to oral anticoagulants The major impact of the physiological changes that occur w/aging is: Correct Answer Reduced physiological reserve, reduced homeostatic mechanisms, impaired immunological respons The strongest evidence regarding normal physiological aging is available through Correct Answer Longitudinal studies Pharmacokinetic changes with aging is reflective of Correct Answer What the body does to the drug All of the following statements are true about drug distribution in the elderly except Correct Answer Drugs distributed in water have a lower concentration Men have faster and more efficient biotransformation of drugs and this is thought to be due to: Correct Answer Testosterone Atypical presentation of disease in elderly is reflected by all of the following exept Correct Answer MI with CP and diaphoresis Polypharmacy is best described as Correct Answer Even a single med if there is not a clear indication for its use What is the major difference between varicose veins and atherosclerosis Correct Answer Vessels that are affected Patient has poorly controlled HTN for >10 years. Indicate the most likely position of his PMI Correct Answer 5th ICS left of MCL 43 year old Hispanic male has audible diastolic murmur best hard at the mitral point. No audible click. He has been monitored for 2 years. What is the most likely murmur Correct Answer Mitral Stenosis The following are true statements about bipolar disorders in older adults except Correct Answer Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults. The caregiver for an older adult with cognitive impairment is concerned about the individuals seeming disinterest in eating. Which suggestion does the NP offer based upon a known effect of dementia on a clients nutrition Correct Answer Establish a routine of when and where the individual will have their meals. An older man has a hx of medication therapy for hypertension. Which intervention does the nurse practitioner implement when the client reports that, I've fallen twice in 5 weeks. Correct Answer Orthostatic blood pressures In the elderly population, the fastest growing group is the age range Correct Answer 85 years or older Which statement correctly describes normal changes of aging Correct Answer Individual variations are enormous at every age and in every part of the body Compared with acute pain, persistent chronic pain requires in the nurse practitioner to Correct Answer Educate the patient to the benefit of specific lifestyle changes When considering Erikson's developmental stages, the task for later life is referred to as Correct Answer Ego integrity What is the method of action of anticholinergics Correct Answer Block the effect of acetylcholine on muscarinic type 3 receptors resulting in bronchodilation What is the method of action of beta agonists Correct Answer Stimulates beta-2 adrenergic receptors, increasing cyclic AMP, resulting in relaxing airways What is tuberculosis Correct Answer Chronic, necrotizing infection caused by slow-growing acid fast bacillus (mycobacterium tuberculosis). Most common cause of death related to infectious disease worldwise When is Zostavax recommended Correct Answer Anyone over 60, given as a single dose What is primary prevention Correct Answer Activities to prevent occurrence of disease or adverse health condition, including mental health. What is secondary prevention Correct Answer Activities aimed at detection of disease or adverse health condition in asymptomatic patient who has risk factors but no detectable disease What is teritiary prevention Correct Answer Management of existing conditions to prevent disability and minimize complications, striving for optimal function and QOL The symptoms of depression may encompass what 4 domains Correct Answer Affect/mood, cognition, physiological, behavioral What is transient insomnia Correct Answer Lasts a few night, related to emotional issues, usually resolved without meds when elderly adapts to or removes change What is short-term insomnia Correct Answer Lasts <1 month, related to acute medical/psychological condition or to persistent situational stress What is chronic insomnia Correct Answer Lasts >1 month, results from age related changes in sleep or chronic stressors. What are some symptoms of polymyalgia rheumatica Correct Answer New onset stiffness/aching in neck, shoulders, pelvic girdle, unable to get out of bed in the morning without extreme difficulty, difficulty lifting arms above head What are common lab findings in PMR Correct Answer Elevated ESR and CRP, normochromic normocytic anemia, thrombocytosis What is the treatment for PMR Correct Answer If s.s are only of PMR and not of GCA as well, start low dose prednisone 10-20mg daily and taper dose What is osteoporosis Correct Answer Skeletal disorder characterized by impaired bone strength that predispose to increased risk of fracture Primary osteoporosis Correct Answer Due to aging, increased bone resorption reduced new bone formation Secondary osteoporosis Correct Answer Consequence of underlying medical condition/drug What is a T-score of -2.5 indicative of Correct Answer Osteoporosis What is a T-score of -1.0 to -2.5 indicative of Correct Answer Osteopenia What is a T-score of -1.0 or higher indicative of Correct Answer Normal bone density What is a Z-score of <-1.5 indicative of Correct Answer Secondary cause of osteporosis What is nocieceptive pain Correct Answer Pain from nociceptive fibers in the periphery triggered by actual or potential tissue damage. Pain is well-localized, stabbing, throbbing, achy What is neuropathic pain Correct Answer Direct neuronal injury, burning, tingling, lancinating. Often occurs in a dermatomal pattern Treatment goals for stage A HF are Correct Answer Heart healthy lifestyle The Beer's criteria are appropriate for use in evaluating use of certain meds in patients Correct Answer >65 y/o The pathophysiology of heart failure is due to Correct Answer Inadequate cardiac output to meet the metabolic and O2 demands of the body Which of the following nutritional indicators is not an indication of poor nutritional status in the elderly Correct Answer BMI 25