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NR 601 midterm study guide A client is newly diagnosed with type 2 diabetes mellitus. Which diagnostic test will best evaluate the management plan prescribed for this client? Quarterly hemoglobin A1C After first managing the pain being experienced by the client with gout, the treatment focuses on: Preventing systemic involvement by altering the client's diet The abrupt onset of symptoms of stress or urge incontinence is most often due to a urinary tract infection True A 60-year-old woman presents with a chief complaint of uncomfortable breathing on exertion. She has had a minimally productive cough for several years that does not bother her. On further questioning, she states that her breathing gets much worse when she lies down. The most likely cause of her dyspnea is: Cardiac Which of the following drugs do not trigger or aggravate a cough? Hydrochlorothiazide Based on current demographic data, which statement identifies a predictive trend regarding the health care needs of society? More nursing services will be required to serve the needs of the population 85 years of age and older. Which diagnostic laboratory test would the nurse practitioner typically not order for the purpose of evaluating an individual's acute, unexplained weight loss? Serum Potassium

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It has been projected that the cultural group presenting the greatest growth rate among the older adult population will be the: Hispanic Americans Which statement made by a client recently diagnosed with diverticular disease would indicate that she needs additional teaching regarding dietary considerations? "I'll have to give up eating right before I go to bed." Ethnocentrism is defined as: a belief that one's ethnic group is superior to that of another true When diagnosed with diverticulosis, a client asks how this problem occurred. Which assessment data identifies a risk factor for diverticulosis? Maintains a diet low in fiber.

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A 77-year-old client being treated for glaucoma asks the nurse practitioner what causes glaucoma. The nurse bases the response on the knowledge that the increase in intraocular pressure is a result of: a breakdown in the absorption process Weight loss is frequently caused by ingestion of one or more of the following drugs. Antibiotics Digoxin Nonsteroidal anti-inflammatory drugs (NSAIDs) Theophylline A, B, and C All of the above Answer: All of the above Which of the following culturally diverse male clients will most benefit from educational material related to "Staying Healthy into your 80s" Japanese The following are true statements about bipolar disorders in older adults except "Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults." Which assessment data would not be of particular concern when attempting to manage an older adult's risk for dehydration? Chronic constipation When educating the older adult population about the risks to physical health that chronic alcohol abuse presents, the nurse practitioner is especially careful to include the: Identification of the signs and symptoms of gastrointestinal bleeding Which of the following drugs does not typically cause constipation? Magnesium-containing antacid

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An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging? Assessing the client for both depression and anxiety The greatest risk for injury for a client with progressed Parkinson's disease is: Falls An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that aging may cause this change due to the: Slower ability of the pupil to adjust to changes in lighting.

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The nurse practitioner educates that client that Healthy People 2010: offers direction for the achievement of improved quality of life across the life span Which of the following is not a common cause of constipation? hypercalcemia The nurse is teaching a health promotion class at a senior center. Which of the following statements demonstrate that the participant does not understand the topic: "We need to use caustic soaps and scrub aggressively with a wash cloth bathing to minimize bacteria on the skin." The nurse practitioner shows an understanding of appropriate influenza vaccination guidelines for a client over the age of 65 when stating: "Regardless of your physical health you really should get a yearly flu shot." The nurse shows understanding of the need to promote healthy skin in the older adult when encouraging the client to all of the following except : clean the skin with a moisturizing soap

. A 78-year-old man is being evaluated in the geriatric clinic. His daughter reports that he has been very forgetful lately, and she is concerned that he might be "senile." The advanced practice nurse administers the clock drawing test and the patient draws a distorted circular shape and places the numbers all on one side of the shape. Based on his performance, the nurse concludes that the patient: needs further evaluation Tinnitus is defined as: a buzzing, clicking, or ringing in the ear Which intervention is not therapeutic when facilitating communication with

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a cognitively impaired older client? Use non-verbal as well as verbal cues to help get your message across to the client When best promoting a sense of well-being, the role of the nurse practitioner caring for a terminally ill client is to: help empower the client to achieve his/her potential for wellness A 68-year-old male presents with a chief complaint of episodes of lightheadedness or dizziness. He states that sweating, tachycardia, and some hand trembling are often associated with these episodes. Which one of the following questions should you ask to help confirm the diagnosis? Are these symptoms related to eating? The caregiver for an older adult with cognitive impairment is concerned about the individual's seeming disinterest in eating. Which suggestion does the nurse practitioner offer based upon a known effect of dementia on a client's nutrition?

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Establish a routine of when and where the individual will have their meals. A 68-year-old male presents with a chief complaint of episodic dizziness. Although not dizzy at present, he states that he has noted onset of dizzy episodes when he rolls over in bed and occasionally when he turns his head rapidly. Episodes last about 3 minutes. The most likely diagnosis is: Benign positional vertigo What information will be included in client education for an older adult who needs to manage their calcium levels? Take your 1200-1500 mgs of daily calcium spread out between your meals and snacks The nurse practitioner is developing a class on stroke prevention for a local senior citizens center. What would be an important focus when teaching stroke prevention directed at modifiable risk factors? Smoking cessation The nurse practitioner provides a client with education regarding the use of My Pyramid. What is the primary advantage of the United States Department of Agriculture's (USDA) My Pyramid to the older adult client? It's an easy method for identifying and correcting nutritional deficiencies in one's diet. An older adult recently diagnosed with depression asks, "How long will it take for the antidepressant medication to make me feel better?" The nurse practitioner correctly responds: "It can take up to 3 months for the full effects of the medication to be felt." An older man has a history of medication therapy for hypertension. Which intervention does the nurse practitioner implement when the client reports that, "I've fallen twice in 5 weeks"? Orthostatic blood pressures

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The nurse practitioner is caring for a client with a newly diagnosed chronic illness. In answering the client's questions, the nurse practitioner most accurately responds when basing the response on the fact that: chronic illness is lifelong, and coping can be influenced by perceived uncertainty. true In the elderly population, the fastest growing group is the age range: 85 years or older Which statement correctly describes normal changes of aging? Individual variations are enormous at every age and in every part of the body. Compared with acute pain, persistent chronic pain requires the nurse practitioner to: Educate the patient to the benefit of specific lifestyle changes

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An older adult is admitted to the hospital during the night after a serious fall. When you round on the patient, you note that the patient has been prescribed meperidine (Demerol) for muscle pain. The nurse practitioner: Changes this medication order as Demerol is contraindicated in older adults Of the following clients, all of whom are 65 years of age or older, the nurse practitioner anticipates that the one who will rate himself or herself as has having excellent health will be: a white female who lives independently in a senior citizen community A 75-year old resident in the nursing home has end stage dementia and experiences a 10-pound weight loss over the course of 2 months. The resident has become increasingly difficult to feed and often spits out food, pockets food, and frequently drools. The family is concerned about the resident's nutritional status. What is the initial action of the nurse practitioner? order a swallow evaluation The FANCAPES assessment tool focuses on the older adult's: ability to meet personal needs to identify the amount of assistance needed Which of the following causes of chest pain are often relieved by sublingual nitroglycerin? Esophagitis When considering Erikson's developmental stages, the task for later life is referred to as: ego integrity An older adult is currently prescribed both aspirin (81 mg) and ibuprofen daily. What instructions are most important for the nurse practitioner to provide to assure the expected outcomes for this client? Take ibuprofen 30 minutes after the aspirin so as to not interfere with its

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effectiveness Which assessment data does not support the medical diagnosis of coronary heart disease? Client reported an unexplained gain of 10 pounds in last 6 months. What are the 3 primary physiological changes of aging?

1. Reduced physiological reserve of most body systems, esp. cardiac, resp, renal.
2. Reduced homeostatic mechanisms that fail to adjust regulatory systems (i.e. temp control, fluid/lyte balance, etc.).

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3. Impaired immunological function (infection risk is greater, autoimmune dz's more prevalent) What is the preferred amount of exercise for elderly? 30min/day 5 days/wk of moderate exercise. If trying to lose wt: 60min/day. What are PFTs? Group of tests that provide quantifiable measurement of lung function, used to dx resp abnormalities or assess progression/resolution of lung dz. What is FEV1? Forced Expiratory Volume in 1 second (80-120%) What is FVC? Forced Vital Capacity (80-120%) What is normal FEV1/FVC ratio? <0.7 (70%) What is GOLD 1 criteria? Mild FEV1 >/= 80% predicted What is GOLD 2 criteria? Moderate FEV1 50-79% predicted What is GOLD 3 criteria? Severe

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FEV1 30-49% predicted What is GOLD 4 criteria? Very severe FEV1 <30% predicted What are the signal symptoms of COPD? Dyspnea Chronic cough w/sputum Decreased activity tolerance Wheezing What are characteristics of COPD? Common, preventable, treatable.

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Characterized by persistent airflow limitation. Usually progressive, associated with enhanced chronic inflammatory response in airways and lungs to noxious particles/gases Airway fibrosis, luminal plugs, airway inflammation, increased airway resistance, small airway dz. Decreased elastic recoil of alveoli. What are risk factors for COPD? Smoking (increasing w/number of pack years) Second hand smoke Environmental pollution (endotoxins, coal dust, mineral dust) What is seen on phys exam in COPD? May be normal in early states As severity progresses: lung hyperinflation, decreased breath sounds, wheezes at bases, distant heart tones (b/c of hyperinflation, so S1/S sounds off in distance), accessory muscle use, pursed lip breathing, increased expiratory phase, neck vein distention. How is COPD diagnosed? Spirometry is gold standard (pre and post bronchodilator). Irreversible airflow limitation is hallmark. How is COPD treated? Bronchodilators: beta agonists (long/short), anticholinergics (long/short), or

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combo. What is the MOA of beta agonists? Stimulates beta-2-adrenergic receptors, increasing cyclic AMP, resulting in relaxing airways. What is the MOA of anticholinergics? Block the effect of acetylcholine on muscarinic type 3 receptors, resulting in bronchodilation. Why are long-acting beta agonists prescribed for COPD? They are for moderate airflow limitation. They relieve symptoms, increase exercise tolerance, reduce number of exacerbations, improve QOL. What are some non pulmonary diagnoses that result in COPD-type symptoms? CHF

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What are some Hyperventilation syndrome Panic attacks Vocal cord dysfunction Obstructive sleep apnea Aspergillosis Chronic fatigue syndrome What are signal symptoms of asthma? Wheezing Shortness of breath Cough (esp at night) Chest tightness What is chronic bronchitis? Daily chronic cough w/increased sputum for at least 3 consecutive months in at least 2 consecutive years. Usually worse on wakening. May or may not be associated with COPD. What is emphysema? Characterized by obstruction to airflow caused by abnormal airspace enlargement distal to terminal bronchioles. Chronic inflammation/remodeling, trapping air, hindering effective O2/CO exchange (all due to inflammatory mediators infiltrating airways). What are signal symptoms of ischemic heart dz? Chest pain Chest

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tightness Chest discomfort What is ischemic heart dz? Imbalance between supply and demand for blood flow to myocardium What are signal symptoms of lung CA? Cough Dyspnea Wt loss Anorexia Hemoptys is What is lung CA? Malignant neoplasm originating in parenchyma of lung/airways

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What are signal symptoms of MI? Prolonged CP (>20min duration) SOB Confusion Weakness Worsening HF What is an MI? Necrosis of heart tissue caused by lack of blood and O2 supply to the heart What are signal symptoms of pneumonia? Fever Chills Hypotherm ia New cough w/or w/out sputum Chest discomfort or dyspnea Fatigue HA Some older adults will be asymptomatic but may experience falls/confusion What is community acquired pneumonia? Acute lower resp tract infection of lung parenchyma. Can be bacterial or viral. Bacterial is most common in older adults. What are signal symptoms of a PE? Dyspnea CP on inspiration Anxiety Presentation is variable Symptoms

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nonspecific Some asymptomatic What is PE description? Occlusion of one or more pulmonary vessels by traveling thrombus originating from distant site. What are signal symptoms of tuberculosis? Initially asymptomatic Later: productive, prolonged cough Fatigue Low-grade fever Night sweats Poor appetite Hemoptysis Wt loss

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Fever/sweats are less common in elderly Symptoms in elderly are often attributed to other comorbidities What is tuberculosis? Chronic, necrotizing infection caused by slow-growing acid-fast bacillus (Mycobacterium tuberculosis). Most common cause of death related to infectious dz worldwide. What are signal symptoms of valvular heart dz? Asymptomatic in early stages Fatigue Exertional dyspnea What is valvular heart dz? Damage to valve(s) of the heart, causing cardiac dysfunction. Most prevalent types in elderly: calcific and degenerative aortic valve dz What is aortic stenosis? Abnormal narrowing of aortic valve orifice What is aortic regurgitation? Retrograde blood flow through incompetent aortic valve into L ventricle during ventricular diastole What is mitral stenosis? Abnormal narrowing of mitral valve orifice What is mitral regurgitation? Retrograde blood flow during systole from L ventricle into L atrium through incompetent mitral valve

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What is mitral valve prolapse? Mitral regurgitation associated with bulging of one or both mitral valve leaflets into L atrium during ventricular systole What are most common causes of VHD in elderly? Age-related degenerative calcifications Myxomatous degeneration Papillary muscle dysfunction Infective endocarditis Rheumatic dz What happens in valvular regurgitation? Portion of the ejected blood leaks back into the upstream cardiac chamber

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What happens in valvular stenosis? Usually results in elevated pressures in the chamber upstream from the stenosis What are signal symptoms of URI? Nasal congestion Rhinorrhea/mucopurulent discharge Sore throat Coug h HA Malaise What is a URI? Most frequently called the common cold Usually caused by virus Results in nasal passage inflammation Most are self-limiting, accompanied by minor complaints Included in URI dx: acute laryngitis, acute rhinosinusitis, acute pharyngitis What are signal symptoms of restrictive lung dz? Rapid, shallow respirations Dyspnea Decreased activity tolerance Easily fatigued Nonproductive, irritating cough provoked by deep breathing/exertion What is restrictive lung dz? Heterogenous group of disorders that share common abnormal ventilatory function. Characterized by small tidal volume, rapid rate. Hallmark restrictive pattern is decreased lung volm, esp. total lung capacity and vital capacity.

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What is the purpose of functional assessment of the elderly? Discovers the ability to care for themselves on a daily bases What can ongoing pain be linked to in the elderly? Depression Decreased socialization Sleep disturbance Impaired cognitive function Is chronic pain a normal sign of aging? No What is polypharmacy?

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Broad definition, but basically too many medications for what is going on with the patient, the use of multiple pharmacies/providers. What is Stage A of HF? At high risk for heart failure but w/out structural changes/symptoms What is Stage B HF? Structural heart dz but w/out s/s of HF (still "at risk" for HF) What is Stage C HF? Structural heart dz w/prior or current s/s of HF (actually have HF) What is Stage D HF? Refractory heart failure including specialized interventions (actually have HF, need surgery, PM, etc.) What are treatment goals for Stage A HF? Heart-healthy lifestyle Prevent vascular, coronary dz Prevent LV structural abnormalities What are drugs used in Stage A HF? ACEi or ARB in appropriate pt's for vascular dz or DM Statins as appropriate What are treatment goals for Stage B HF? Prevent HF symptoms Prevent further cardiac remodeling What are drugs used in Stage B HF? ACEi or ARB as appropriate Beta blockers as appropriate

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In selected pt's: ICD Revascularization/valvular surgery as appropriate What are goals of Stage C HFpEF? Control symptoms Improve HRQOL Prevent hospitalization Prevent mortality ID comorbidities What is treatment for Stage C HFpEF?

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Diuresis to relieve s/s congestion Follow guideline-driven indications for comorbidities (HTN, AF, CAD, DM, etc.) What are treatment goals for Stage C HFrEF? Control symptoms Pt education Prevent hospitalization Prevent mortality What are drugs used in Stage C HFrEF? Diuretics for fluid retention ACEi or ARB BB Aldosterone antagonists Drugs in selected pts: Hydralazine/isosorbide dinitrate ACEi and ARB Digitalis Procedures in selected pts: CRT ICD Revascularization/valvular surgery as appropriate What are treatment goals in Stage D HF? Control symptoms Improve HRQOL Reduce hospital readmissions Establish pt's end-of-life goals

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