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NR 601 Midterm Exam Study Guide
Weeks 1-4 content uide Week Topics 1 Developmental changes o Review Kennedy and Dunphy readings for age related changes o Physiological the major impact that occurs with physiological changes are – all of the above the strongest evidence regarding normal physiological ageing is availiable through longitudinal studies 5-5 Beginning at about age 55, most people can expect which of the following changes? A. A 1- to 2-in. decline in height B. Stable body weight C. Sharper vision and hearing D. Increased strength 5 - 31 Which of these musculoskeletal changes accompany older adulthood? A. Change in stature B. Increased stride length 5-35 Which one of the following is a normal physiological change of aging? A. A decrease in strength and speed of muscle contraction in the extremities B. Degenerative arthritis C. Rheumatoid arthritis D. Bulging intervertebral disks 5-37 Evaluating an older adult client according to the successful aging paradigm involves assessment of A. cognition, problem-solving, physical skills, and memory. B. health, social engagement, mental activity, and life satisfaction. C. vision, hearing, balance, and strength. D. coping, social support, fi nancial resources, and living arrangement. 5-49 The benefi ts of exercise during middle adulthood include which of the following? A. Less need for an increase in dietary calcium B. Slower decli ne in central nervous system processing
5-50 When completing the health history and review of systems for a healthy 88-year-old woman, you would expect which age-related change to be reported? A. Mildly blurry vision B. Chronically dry and itchy eyes and eyelids C. Increasing presbyopia 5-61 Which cognitive change is expected in healthy older adults aged 65 and older? A. Decrease in IQ B. Slower information processing C. Low capacity for learning D. Decreased attentional focus 5-57 Sleep in older adults is characterized by which pattern? A. Increased time spent in REM sleep B. Increased overall sleep time C. Increased sleep latency D. Increased proportion of deep sleep 5- 67 Risks for automobile accidents are increased in older adult drivers due to which normal changes associated with aging? A. Decreased ability to understand driving-related dangers B. Lack of recognition of their own physical challenges C. Magnifi ed physiological response to stressful situations D. Increased reaction time 5-85 Older adults face greater risks for fl uid imbalance than young adults and middle adults due to which age-related factor? A. Increased amounts of intracellular fl uid and total body water B. Higher proportion of fat to muscle cells C. Faster speed of metabolism D. Increased intestinal motility 5-86 Which strategy for care of older adults is inconsistent with an approach supportive of aging in place? A. Make changes to the home environment that can accommodate an individual’s changing needs. B. Refer for home care and adult day-care services. C. Hire assistants to help with activities of daily living. D. Emphasize the individual’s limitations and likely need for long-term care placement. 5- 96 Which theory of aging focuses on older adults’ development of specifi c strategies to manage losses of function over time? A. Disengagement theory B. Activity/developmental task theory C. Person- environment fi t theory D. Selective optimization with compensation theory 5- 107 Why is Alzheimer’s disease (AD) considered a specifi c disease, distinct from the normal. changes of aging? A. There are types of AD that are inherited and present before age 60. B. There are changes in biological processes that occur with normal aging. C. There is a notable decline in cognitive functioning as people age. D. There are multiple changes in organ functioning, especially in the brain. 5-115 Physiological changes of aging can affect functional mobility. Screening for functional mobility of older adults involves which screening tool? A. Katz Index B. Get Up and Go Test C. Functional Independence Measure D. Mini Mental State Exam 5-112 Your 66-year-old patient is able to correctly interpret the meaning of the proverb “A penny saved is a penny earned.” This helps to establish the patient’s expected ability to A. access long-term memory. B. engage in abstract reasoning. C. execute concrete operations. D. follow complex instructions. 13-68 In the older adult, which physiological change affects pharmacokinetics? A. Decreased creatinine clearance B. Increased lean muscle mass C. Decreased total body fat D. Increased serum albumin level 18- 98 Physiological changes in the immune system of older adults include A. an increase in immunoglobulin A and G antibodies. B. a high rate of T-lymphocyte proliferation. C. an increase in the number of cytotoxic T cells. D. an increase in CD8, which affects regulation of the immune system.
Total serum protein 6.0–8.4 g/100 mL No change Decreases may indicate malnutrition
Blood urea nitrogen Men: 10–25 mg/
mL
Women: 8–20 mg/
mL
Increases significantly
up to 69 mg/100 mL
Decline in glomerular filtration rate;
Creatinine 0.6–1.5 mg/100 mL Increases to 1.
mg/100 mL seen
Related to lean body mass decrease
Creatinine clearance 104–124 mL/min Decreases 10%/decade
after age 40 years
Used for prescribing medications for
Glucose tolerance 62–110 mg/dL after
fasting; >120 mg/dL
after 2 hours
postprandial
Slight increase of 10
mg/dL/decade after 30
years of age
Diabetes increasingly prevalent; dru
Alkaline phosphatase 13–39 IU/L Increase by 8–10 IU/L Elevations >20% usually due to dise
bone abnormalities, drugs (e.g., narc
all of the following are true about lab results except : abnormal findings are usually due to physiological aging. o Atypical disease presentations
- Acute abdomen Absence of symptoms or vague symptoms, acute confusion, mild discomfort and constipation, some tachypnea and possibly vague respiratory symptoms, appendicitis pain may begin in right lower quadrant and become diffuse
- Depression Anorexia, vague abdominal complaints, new onset of constipation, insomnia hyperactivity, lack of sadness
- Hyperthyroidism Hyperthyroidism presenting as “apathetic thyrotoxicosis,” i.e., fatigue and weakness; weight loss may result instead of weight gain; patients report palpitations, tachycardia, new onset of atrial fibrillation, and heart failure may occur with undiagnosed hyperthyroidism
- Hypothyroidism Hypothyroidism often presents with confusion and agitation; new onset of anorexia, weight loss, and arthralgias may occur
- Malignancy
New or worsening back pain secondary to metastases from slow growing breast masses Silent masses of the bowel
- Myocardial Absence of chest pain infarction (MI), vague symptoms of fatigue, nausea, and a decrease in functional and cognitive status; classic presentations: dyspnea, epigastric discomfort, weakness, vomiting; history of previous cardiac failure, higher prevalence in females versus males Non-Q- wave MI
- Overall infectious diseases process Absence of fever or low-grade fever, malaise
- Sepsis Without usual leukocytosis and fever, falls, anorexia, new onset of confusion and/or alteration in change in mental status, decrease in usual functional status
- Peptic ulcer disease Absence of abdominal pain, dyspepsia, early satiety, painless, bloodless, new onset of confusion, unexplained, tachycardia, and/or hypotension
- Pneumonia Absence of fever; mild coughing without copious sputum, especially in dehydrated patients; tachycardia and tachypnea; anorexia and malaise are common; alteration in cognition.
- Pulmonary edema Lack of paroxysmal nocturnal dyspnea or coughing; insidious onset with changes in function, food or fluid intake, or confusion
- Tuberculosis (TB) Atypical signs of TB in older adults include hepatosplenomegaly, abnormalities in liver function tests, and anemia
- Urinary tract infection Absence of fever, worsening mental or functional status, dizziness, anorexia, fatigue, weakness 17-11 An elderly client with hyperthyroidism may present with atypical symptoms. Which of the following manifestations are commonly seen in the elderly with hyperthyroidism? A. Adrenergic fi ndings
ecommendations have been made to divide patients into three groups based on age: 65 to 74 years (young-old); 75 to 84 years (middle-old); and over 85 years (old-old). Exercise in older adults (Kennedy) B Tertiary prevention C Exercise in older adults should contain activities that strengthen muscles Preferred amount of exercise is : D 60 mins, 30 mins of aerobic activity and 30 minutes of weight training 5 times a week The best recommendation for a patient who states they have no equipment at home to exercise with would be: D improvise with recommended objects at home The NP recommends exercise for a sedentary adult: B start low and go slow
C Depression o Recommended exercises for sleep and flexibil;ty To maintain the flexibility necessary for regular physical activity and daily life, older adults should perform activities that maintain or increase flexibility on at least 2 days each week for at least 10 min each day.
sleep disorders Tai chi, walking, aquatherapy, biking
Exercise recommendations for specific diagnoses (Kennedy) HEALTH CONDITION: CONSIDER COMORBIDITIES FOR ALL
RECOMMENDED ACTIVITIES: START
LOW INTENSITY, GO SLOW COMMENTS: CONSIDER COMORBIDITIES FOR ALL
Osteoarthritis Walking, aquatic activities, tai chi, resistance exercises, cycling Vary type and intensity to avoid overstressing joints; heated pool Coronary artery disease Walking, treadmill walking, cycle ergometry Supervised program with BP and heart rate monitoring Congestive heart failure Walking, treadmill walking, cycle ergometry Individualize to client; supervised program Type 2 diabetes mellitus Resistive, aerobic, aquatic, recreational activities Proper shoe fit; may need insulin reduction if insulin dependent
exercises
that encourage lumbar fl exion and fl attening of the lumbar lordotic curve. C. refrain from exercising. D. see a surgeon because surgery is the best treatment option. 6-94 Sidney, age 58, has diabetes and asks you why exercise is so essential for him. You tell him that A. all persons with diabetes are overweight, and exercise is the one tried-and-true method for weight loss. B. going for a walk or exercising takes the mind off food, so he will not eat as much. C. after exercising, people tend to be less hungry and thus do not consume as much. D. exercising lowers blood sugar and helps the body make better use of its food supply. 16-95 What pathophysiology associated with transient pain after exercising usually begins a few hours after exercise with soreness and may last up to a week? A. Increased lactic acid production, muscle breakdown, and minor infl ammation B. Mild musculotendinous infl ammation C. Major musculotendinous infl ammation, periostitis, and bone microtrauma D. Breakdown in soft tissue and stress fracture o Recommended testing prior to exercise initiation Healthy adult men over 45 years old and healthy women over 55 years old who are considering a vigorous exercise program need health-care provider screening and routine stress testing. Sedentary older adults and all adults with cardiac disease or strong risk factors should undergo screening and stress test if they are undertaking a vigorous exercise program ( o Barriers, facilitators and contraindications to exercise
Patient Barriers
■ Lack of time
■ Perceived need for equipment
■ Perceived barrier to beginning exercise/physical activity
■ Disability or functional limitation
■ Unsafe neighborhood or weather conditions
■ No parks or walking trails
■ Depression
■ High body mass index (BMI)
■ Lack of motivation
■ Interpersonal loss or significant life event
■ Ignorance of what to do
Patient Facilitators
■ Social support
■ Positive self-efficacy
■ Motivation to engage in physical activity
■ Good health, no functional limitations
■ Frequent contact with prescriber
■ Regular schedule, planned program
■ Satisfaction with program
■ Insurance incentive
■ Improvement in mobility or health condition
65 year old man with German measles needs: C the TDAP, pneumococcal, influenza, and zostavax A C 3-76 Gerald, a 67-year-old retired maintenance worker, comes to your offi ce for a physical. On reviewing Gerald’s history, you discover that he has had pneumonia twice in the past 5 years. When you question Gerald about his immunization history, he reveals that his last tetanus and diphtheria (Td) immunization was 6 years ago, and his last fl u shot was 8 months ago, during the last fl u season. He denies ever having had a pneumonia vaccination. Which immunizations should you offer to Gerald today? A. Td B. Pneumococcal vaccine C. Infl uenza D. Td and pneumococcal vaccine 49 Immunizations in adults age 65 and older should include A. diphtheria, tetanus, and pertussis every 5 years and pneumococcal vaccine every 6 years starting at age 65. B. pneumococcal vaccine at age 65 and tetanus and diphtheria every 10 years. C. diphtheria, tetanus, and acellular pertussis every 10 years and pneumococcal vaccine at age 65. D. infl uenza immunization every fall; tetanus, diphtheria, and acellular pertussis every 10 years; and pneumococcal vaccine at age 65. o Recommended health screenings- age ranges and frequency (Kennedy p.9-11)
C hearing 19-C 2-C 8-B 2-C 14-A Travel (Kennedy)
2-C
13-C gold stands measures the: physical, mental, and social domains o Screening tools associated with each domain FUNCTIONAL HEALTH Two well-established tools used to evaluate function in older adults are the Katz Activities of Daily Living Scale (Katz et al., 1963) and the Lawton and Brody Scale for Instrumental Activities of Daily Living PSYCHOLOGICAL HEALTH Mini cog- dementia PHQ9- depression CAM- delirium PHYSICAL HEALTH SOCIOENVIRONMENTAL SUPPORTS Lubben Social Network Scale—6-item version (Lubben et al., 2006). This validated scale can be an important contribution to the assessment of family and friendship relationships, and identifies patients at risk for social isolation who can benefit from intervention. Beers Criteria (article) o Purpose Polypharmacy (Kennedy)
MAI (Medication Appropriateness Index)
ARMOR (Assess, Review, Minimize, Optimize, Reassess)
B and 2 below!!!
Two of the most well-known and frequently used are STOPP/START and the BEERS criteria. 19-C dementia = mini cog delirium: cam The USPSTF recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 years who have ever smoked. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. The USPSTF recommends screening for osteoporosis in women aged 65 years and older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. The USPSTF recommends screening for colorectal cancer (CRC) starting at age 50 years and continuing until age 75 years (A recommendation). 6-23 Mary is caring for her 83-year-old father at home. He has dementia and is unsteady on his feet. You recommend that Mary A. put her father in a nursing home so that she can have a life of her own. B. take in another elderly person so that her father can have company. C. get information on home safety and community resources. D. lock her father’s bedroom door at night so that he will not wander into the street. 6-69 Mr. Green is a vigorous 70-year-old who comes for early assessment of dementia. He wants to “work” to keep up his mental capacities. You counsel that he should A. make sure he gets enough rest because cells need time to regenerate as a result of the stress of the aging process. B. begin taking a calcium supplement. C. consider a hobby that challenges his mental capacity, like building model ships or airplanes. D. play bridge (or any group card game) several times a week. 6-70 Gary, a gay male client, age 45, arrives in your offi ce with facial bruises. He states that he injured himself opening a door, but he seems nervous. What do you suspect? A. He is manifesting early signs of dementia. B. His injuries are a result of a hate crime or domestic violence. C. He engaged in self- mutilation. D. He injured himself as stated.
2 COPD (Dunphy and Kennedy) 3B o Signs and symptoms may be asymptomatic for 10 to 20 years except for frequent colds, persistent morning cough, and upper respiratory infections. 6-68 Tim, age 66, has chronic obstructive pulmonary disease (COPD). He comes in for counseling regarding a fl u shot. He states that he thinks he needs one but has heard some horror stories about the shot being related to Guillain-Barré syndrome. What do you tell him? A. “You have to weigh the advantages against the disadvantages.” B. “Your chances of getting the fl u are 10 to 1, and your chances of getting Guillain-Barré are 1,000,000 to 1.” C. “If you are worried, you shouldn’t receive the fl u shot.” D. “There is no relationship between the fl u shot and neurological complications.” 10-4 When you teach clients about using steroid inhalers for asthma or COPD, what information is essential? A. Keep the inhaler in the refrigerator. B. Do not use another inhaler for 10 minutes after the steroid inhaler. C. Rinse your mouth after using the inhaler. D. Be careful not to shake the container before using. 10-12 To ease their breathing, clients with COPD often position themselves in A. an erect sitting position. B. a tripod position. C. a supine position. D. a prone position. 10-17 Evidence-based practice has shown that clients with COPD will benefi t the most from which of the following single modalities? A. Nutritional supplementation B. Routine use of inspiratory muscle training C. Pulmonary rehabilitation D. Psychosocial interventions 10- 21 Which of the following underlying lung diseases is the most common cause of a secondary spontaneous pneumothorax? A. COPD B. Lung abscess C. Cystic fi brosis D. Tuberculosis 10-47 What do you include in your teaching about tiotropium (Spiriva) when you initially prescribe it for your client with COPD? A. Use it every time you use your beta-2 agonist. B. Stop taking all your other COPD medications. C. Use this once per day. D. Stop taking Spiriva if you develop the adverse effect of dry mouth. 10- 51 When asthma does not respond to traditional therapy, it may be due to another syndrome that mimics asthma, such as A. lower airway obstruction. B. upper airway obstruction. C. COPD. D. bronchitis. 10- 82 Other than smoking cessation, which of the following most slows the progression of COPD in smokers? A. Making sure the environment is free of all pollutants B. Eliminating all pets from the environment C. Engaging in moderate to high levels of physical activity D. Remaining indoors with air conditioning as much as possible
