NR601 Final Exam 2024 with Actual Correct Questions and Verified Detailed Answers, Exams of Nursing

Download NR601 Final Exam 2024 with Actual Correct Questions and Verified Detailed Answers and more Exams Nursing in PDF only on Docsity! 1 | P a g e NR601 FINAL EXAM 2024 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|BRAND NEW VERSION!!|GUARANTEED PASS |LATEST UPDATE According to the American College of Cardiology 2017 Guidelines for High blood pressure in adults, hypertension stage 2 is defined as a. >150 or >90 mmHG b. >140 or >90 mmHG c. 120-129/<80 mmHg d. 130-139 or 80-89 mm HG b. >140 or >90 mmHG A 58 year old male presents to the clinic with complaints of increasing SOB. The NP suspects HF. The NP examines the CXR film. The NP knows diagnosis can be made with a high degree of accuracy if two of the following criteria are met: 1. signs of interstitial edema (Kerley Bs) 2. upper zone redistribution of pulmonary blood flow (cephalization) 3. abnormally enlarged retrosternal apace 4. flattening of the diaphragm with blunting of the costrophrenic angle on PA film a. 1 & 2 b 2 & 4 c. 1 & 3 d. 2 & 3 a. 1 & 2 Which obstructive lung disease is classified as reversible? a. Asthma b. Chronic bronchitis 2 | P a g e c. Emphysema d. COPD a. Asthma The 2017 HTN guidelines recommend the following treatment for a healthy 54 year old African American woman with a BMI of 23 and consistant BP readings of 116-120/76-78 a. none, this is a normal BP b. hypertension, stage 1 requiring tretment with an ACE inhibitor c. elevated BP requiring treatment with a thiazide. d. hypertensionn stage 1 requiring treatment with a calcium channel blocker a. none, this is a normal BP According to GOLD criteria, obstruction is defined as a reduction in the FEV1/FVC ration. A normal ratio is: a. >70% b. <70% c. 80-100% d. 50-79% a. >70% Insomnia can be caused by medications. Acording to Gorroll, the following medications and substances are associated with insomnia except: a. guaifenesin b. antihypertensive c. stimulants such as caffeine and nicotine d. corticosteroids a. guaifenesin MK a 54 year old woman has returned to the office today for evaluation of your management plan for her complaints of insomnia. You saw her two weeks ago, diagnosed primary insomnia and educated MK on sleep hygeine practices. MK reports she is avoiding caffeine and alcohol as recommended. She does not look at her phone or computer prior to bed. She is falling asleep a little easier but she is not staying asleep. She wakes up after about 4 hours and cannot return to sleep. The next step in treatement of insomnia is: a. zolpidem 5mg by mouth at hs #30 with 3 refills b. eszopiclone 1mg by mouth at hs #30 with 5 refills c. ramelteon 8mg by mouth at hs # 21 with no refills d. zolpidem 5 mg by mouth at hs #7 with no refills d. zolpidem 5 mg by mouth at hs #7 with no refills 5 | P a g e A drug that can be used to treat two very common symptoms in a dying patient (pain and dyspnea_ is: a. lorazepam b. Gabapentin c. Methadone d. Morphine d. Morphine Which of the following would you recommend annually for the elderly type 2 diabetic? a. periodic visits to a gastroenterologist b. colonoscopy c. follow up with a urologist d. eye exam with an opthlamologist d. eye exam with an opthlamologist Which characteristic of delerium helps to distinguish it from dementia? a, short term memory impairment b. personality changes c. acute onset d. impaired attention c. acute onset The majority of patients enrolled in hospice care die: a. in the hospital b. in an inpatient hospice facility c. in a nursing home d. at home d. at home A middle aged patient has been diagnosed with Parkinson's disease. What influences the nurse practitioners descision to begin pharmacological treatment for this patient? a. medications initiated at first sign of unilateral involvement b. gait instability requiring the use of a cane c. intentional tremors d. symptoms interfering with functional ability d. symptoms interfering with functional ability Which of the following is a role of the advanced practice nurse in palliative cancer care? a. detecting cancer in asymptomatic paitents or those with specific symptoms 6 | P a g e b. arranging for follow up including patiennts c. identifying and managing complications of care d. all of the above d. all of the above A 58 year old Caucasian mane with type 2 diabetes mellitus presents to the clinic as a new patient. He takes metformin 500mg twice a day. His last Hgb A1c was 7%. He is up to date on eye and foot examinations. His BP is 142/96. According to ACC 2017 guidelines for high blood pressure in adults, what is the most appropriate first line medication? a. lisinopril b. furosemide c. amlodipine d. clonidine a. lisinopril An older male patient is experiencing acute onset of right sided weakness, slurred speech and confusion. What should the nurse practitioner do promptly? a. order an EKG and administer O2 by cannula immediately b. Do a through medication review and stat blood sugar c. evaluate for a stroke and arrange transport to the hospital right away d. administer an aspirin by mouth c. evaluate for a stroke and arrange transport to the hospital right away The NP knows that medications can trigger or worsen heart failure. With this knowledge in mind, the NP will avoiding prescribing the following classes of medications a. benzodiazepines b. macrolides c. muscle relaxants d. NSAIDS d. NSAIDS MG, a 60 year old female presents with complaints of her "heart flipping in her chest" The NP wants to evaluate for arrhythmia. The nP knows that the cornerstone for arrhythmia evaluation includes: a. electrocardiogram b. physical examination c. all options are appropriate d. history c. all options are appropriate 7 | P a g e The elderly are at high risk for delerium because of: a. multiple medical problems b. multisensory deficits c. polypharmacy d. all of the above d. all of the above A 68 year old woman presents with a complaint of urine leakage whenever she sneezes, laughs or strains for the past 4 months. She denies dysuria, frequency and nocturia. US dipstick is negative for RBC's leukocyte esterase, nitrates, ketones and urobilinogen. What is the diagnosis? a. stress incontinence b. urinary incontinence c. urge incontinence d. overflow incontninence a. stress incontinence Which of the following signs or symptoms are not characteristics of delirium a. patient is coherent b. short duration c. sudden onset d. symptoms are worse in the evenings a. patient is coherent A 52 year old female patient screened for diabetes has a fasting plasma glucose level of 123 mg/dl. The nurse practitioners plan includes: a. repeat fasting glucose in 1 month b. prescribe memformin 500mg BID po c. repeat fasting plasma glucose in one year d. repeat fasting glucose in three years c. repeat fasting plasma glucose in one year According to the palliative care presentation, most elderly patients die: a. alone b. at home c. in institutions d. in pain c. in institutions 10 | P a g e A 60 year old obese male client has type 2 diabetes mellitus and a lipid panel of TC=250 HDL=32 LDL=165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include: a. diabetes, obesity and hyperlipidemia b. advancing age, diabetes, hyperlipidemia, and male gender c. hyperlipidemia, smoking and family history of heart disease d. male with age >45, diabetes mellitys and hyperlipidemia a. diabetes, obesity and hyperlipidemia When treating inflammatory pain, the NP knows treatmemnt is focused on managing the inflammation. Appropriate medications for inflammatory pain include all of the following except: a. NSAIDS b. Opioids c. Corticosteroids b. Opioids According to the New York Heart Association (NYHA) functional classification, patients who have symptoms only with marked exertion are classified as: a. Class II b. Stage 1 c. Class I d. Class IV a. Class II Which of the following assessments are commonly noted in a client with Parkinson's disease: a. exaggeration of rapid successive movements b. increased arm swing c. macrographia and bradycardia d. micrographia and bradykinesia d. micrographia and bradykinesia The most common neurological cause of seizures in an older adult is: a. multiple sclerosis b. stroke c. alzheimemrs disease d. peripheral neuropathy b. stroke 11 | P a g e Patients with osteoarthritis of the hip and knee have a distinguishable gait described as: a. antalgic b. festinating c. steppage d. ataxic a. antalgic According to the 2017 Guideline for High Blood Pressure in Adults the recommended blood pressure goal for a 55 year old man with a history of chronic kidney disease is: a. <140/80 b. <120/80 c. <130/80 d. <150/90 c. <130/80 Periods of increased activity, when the patient did not seem to need to sleep or reports being very productive not needing sleep are: a. symptoms of schizophrenia b. symptoms of worsening depression c. symtoms of unipolar depression d. symptoms of hypomania or mania d. symptoms of hypomania or mania A 56 year old man presents to the office with concerns about low energy, lack of joy in his life and decreased appetite for 2 weeks. The nurse practitioner assesses him using SIG-E CAPS, the NP knows that the E stands for a. energy (decreased) b. emotional instability c. ego dystonia d. enthusiasm (decreased) a. energy (decreased) Terazosin, an alpha blocker, is prescribed to treat the following conditions: a. benign prostatic hypertrophy and hypertension b. benign prostatic hypertrophy and hypotension c. urinary tract infection and arrhythmia d. chronic prostatitis and atrial fibrillationn a. benign prostatic hypertrophy and hypertension 12 | P a g e A 65 year old Hispanic woman who presents to the office for routine follow up of her type 2 diabetes mellitus. Her routine UA results are as follows: few epithelial cells, negative leukocytes, negative nitrates, negative protein, no ketones. Which of the following tests should also be ordered annually for diabetic patients: a. result is normal, no further testing is necessary b. urine for culture and sensitivity c. recommend a screening intravenous pyelogram (IVP) d. micoralbumin d. micoralbumin A 87 year old man tells the nurse practitioner that his grandson locks him in his bedroom when he gets out. The grandson withholds food if the patient does not give him money every week. The patient appears frail, ungroomed, and his clothes are visibly dirty and smell of urine. Which of the following is the best action for the nurse practitioner. a. advise the patient to call his son and report the grandson's behavior as soon as possible b. call the grandson from the waiting room and educate him about proper care for his grandfather c. report the grandson to your states protective services d. advise the grandson if the patient reports the concerns at the end of the next visit, the NP is obligated to report to protective services c. report the grandson to your states protective services A male patient with a BMI of 33 presents to the office with complaints of fatigue, excessive hunger and excessive thirst. You ordered a CMP and a Hgb A1C. The results are a fasting glucose 99, Hbg AIC 5.7. The nurse practitioner diagnosis is: a. type 2 diagnosis mellitus b. prediabetes c. euglycemia d. type 1 diabetes mellitus b. prediabetes All of the following patients have a risk of adverse reactions from Metformin except: a. patients with renal disease b. patients with BMI >30 c. patients with alcoholic disorder d. patients with hypoxia b. patients with BMI >30 According to the ADA guidelines, which of the following arer screening tests for type 2 diabetes mellitus? 15 | P a g e c. Cholinesterase inhibitors A 75 year old man is being treated as an outpatient for metastatic prostate cancer. Which of the following statements is true regarding the management of pain with opioids in the elderly? a. none of the options are appropriate management b. opioids with a long half life, such as methadone, are a good choice, because they stay inn the system longer and patients do not have to remember to take multiple pills a. none of the options are appropriate management 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. a score of 0-2 is a positive screen for cognitive impairment b. the patient is asked to recall five images from picture cards following the drawing of the clock hands c. the patient will be asked to repeat five eworkds immediately following the directions by the practitioner d. the patient is asked to draw the hour and minute hands on a picture of an analog clock a. a score of 0-2 is a positive screen for cognitive impairment When assessing a patient who complains of a tremor, the nurse practitioner must differentiate essential tremor from the tremor of Parkinson's disease. Which of the following findings are consistent with essential tremors? a. the tremor occurs with purposeful movement b. the handwriting is not affected by the tremor a. the tremor occurs with purposeful movement A 56 year old man is diagnosed with acute prostatitis, he is afebrile without severe pain and will be managed outpatient. He should initially be treated with antibiotics for how long? a. 6-12 weeks b. 14-21 days c. 3-6 weeks d. 10-14 days d. 10-14 days An 80 year old female widow asks her nurse practitioner about her end of life options. Her diagnosis include congestive heart failure, hypertension and type 2 diabetes mellitus. She has noticed that in the last month she has lower extremity edema and she if finding it difficult to walk to the grocery store and chrch. She does not use oxygen. She is able to maintain her home but requires more frequent rests after vacuuming. She does not wish to be admitted to the hospital again in the future but if admitted wants to maintain full code status. How should the NP address this patients concerns today? 16 | P a g e a. start her on a medication for depression b provide her with information for senior day care services c. offer the patient a palliative care referral c. offer the patient a palliative care referral Hospice services and palliative care services are underutilized due to a. denial of impending death b. confusion remains over when it is appropriate to consult palliative care c. services are not understood d. all options are appropriate d. all options are appropriate Jean, a 47 year old presents to the clinic with complaints of dysuria, frequency and strong odor of her urine for 5 days. This is the second occurrence this year. The first occurrence was 3 months ago. Today, UA reveals positive leukocyte esterase, positive nitrates, 18 WBC's, few RBC's, no protein, no casts. What is the appropriate next step for this patient a. order a urine culture and sensitivity and hold treatment until you receive results b. prescribe a 7 day course of antibiotics and order a urine culture and sensitivity c. treat the patient with a stronger antibiotic, ofloxin, for 10 days d. treat the patient with antibiotics today d. treat the patient with antibiotics today Delirium is typically characterized by all of the following except: a. altered level of consciousness b. insidious onset c. inattention b. insidious onset Not sure of the question but a. dominant personality b. obesity c. cardiovascular disease d. diabetes a. dominant personality Mrs. G has returned to your office for a follow up visit for urinary incontinence (UI). Mrs G has followed your 1st line recommendations. She has quit smoking, drinks plenty of fluids, and has eliminated caffeine and spicy foods. Despite all these changes, she still experiences UI. You decide to initiate second line treatement. You recommend: 17 | P a g e a. bladder control training b. keagels c. antimuscarinic medications d. alpha 1 adrenergic receptor antagonists c. antimuscarinic medications Which of the following diagnoses should be considered in a patient presenting with erectile dysfunction? a. diabetes mellitus b. artherosclerosis c. depression d. all options are appropriate d. all options are appropriate urinary incontinence is defined as: a. unintentional voiding, loss or leakage of urine b. urination occurs more frequently during the day c. continous loss of urine or leakage of urine d. sudden, compelling desire to pass urine that is difficult to prevent a. unintentional voiding, loss or leakage of urine A patient has been prescribed metformin (Glucophage). One week later he returns with complaints of some loose stools during the week. How should the nurse practitioner respond? a. double the dosage of medication and have patient return in one week b. order a chem. 7 to check for lactic acidosis c. discontinue the medication immediately d. reassure the patient that this is an anticipated side effect d. reassure the patient that this is an anticipated side effect An 82 year old mamn is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnosis. a. parkinson's disease b. prostate cancer c. all options are appropriate d. benign prostatic hyperplasia (BPH) c. all options are appropriate A 67 year old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis? 20 | P a g e In the late stages of dementia, a phenomenon called "sun downing" occurs, in which cognitive disturbances tend to : a. peak mid-day b. becomes worse toward the evening c. improves as the day goes on d. fluctuates during the course of the day b. becomes worse toward the evening The proposed mechanism by which diphenhydramine caused delerium is: a. anticholinergic effects b. dopaminergic effects c. gabanergic effectis d. serotinergic effects a. anticholinergic effects According to the Palliative Care Presentation, palliative care may be provided to a. only cancer patients b. anyone regardless of their life expectancy or disease progression c. those with a life expectancy > 6 months d. those with a life expectancy< 6 months b. anyone regardless of their life expectancy or disease progression The highest level of evidence with the use of adjuvant analgesics is with a. therapeutic trials before discontinuing drugs b. patients with fibromyalgia are candidates for adjuvant analgesics c. tricyclic antidepressants avoided due to high adverse affects d. neuropathic pain patients are candidates for adjuvant analgesia d. neuropathic pain patients are candidates for adjuvant analgesia According o the Sexuality presentation, the biggest barrier to appropriate sexual evaluation in the older patient a. older people dont talk about sex b. most elderly patients are not interested in sex c. ageist attitudes d. female post menopausal changes c. ageist attitudes The patient with BPH is seen for follow-up.. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects? 21 | P a g e a. headache b. urinary incontinence c. hypotensionn d. impotence d. impotence Which of the following statements is true regarding pain? a. all of the above b. if a patient complains of pain but has no physical signs, he or she is most likely exhibiting drug-seeking behavior c. pain is a subjective experience related to actual or potential tissue damage d. acute pain is more intense and severe than chronic pain c. pain is a subjective experience related to actual or potential tissue damage The highest level of evidence to support interventions at the end of life is with a. hycosamine for respiratory secretions b. stimulant laxatives for treating constipation c. opioids for pain control d. opioids for dyspnea d. opioids for dyspnea The comorbid psychiatric problem with the highest frequency in dementia is: a. depression b,, agitation and aggression c. psychosis d. anxiety a. depression According to the World Health Orginazition's analgesic ladder, which drug would be most appropriate in opiate-niave patient who presents with moderate pain a. naproxen/morphine b. asprin/fentanyl c. acetaminophen/hydrocodone d. ibuprofen/impraminen c. acetaminophen/hydrocodone K B age 54 presents to your office. her husband has just died suddenly and she states she cannot function. She is crying all the time, cant seem to focus and she has so much she needs to do to plan the funeral service and get through the next few days. YOu decide to prescribe a benzodiazepine. Please 22 | P a g e choose the correct treatment decision statements below. a. benzodiazepines are safe to prescribe long term b. benzodiazepines should not be stopped abruptly if taken for > 1 month c. benzodiazepines are first line treatment for anxiety in the elderly d. benzodiazepines should be prescribed at the highest dose tolerated for the best effect b. benzodiazepines should not be stopped abruptly if taken for > 1 month Mrs. L, a 66 year old Asian female, presented for her yearly physical last week. A review of her chart reveals she smokes 2 packs of cigarettes a day, and drinks 2 beers every evening since she retired. She stopped walkingn two years ago when she started having knee pain. As part of heallth maintenance, a DEXA was ordered. You have received the results, a T score of -2.5. The score is consistant with a. normal result b. osteoporosis b. osteoporosis A You are reviewing a pt chart before the exam. You note that the pt is using topical capsaicin. You know that topical capsaicin is often used for tx of: a. Diabetic neuropathy b. Stress reduction c. All answers are appropriate d. Depression Symptoms of depression distinct to elderly include: a. Loss of pleasure in usual activities b. Lack of emotions 25 | P a g e b. 2-hour OGTT c. HgbA1C d. All of the above D Which dx should be considered in a pt presenting with erectile dysfunction? a. HTN b. DM c. Atherosclerosis d. All of the above D Which would be an appropriate tx for pt with minimal symptoms of BPH? a. Watchful waiting b. Refer to urology for surgery c. Prescribe trial of tamsulosin d. Recommend cranberry supplements A Lifestyle approaches to postmenopausal symptom management include: a. Avoiding sugar, caffeine, chocolate, ETOH b. Sleeping more than 8hrs per night c. Decreasing levels of physical activity d. More than 1000 iu/day of Vit E A 59yo female c/o pain when she urinates. She has been seen three times for this in the last 3mo. Each time, dx'd with UTI, given abx. She carefully followed instructions, but has no relief of symptoms. Last UA: WBC: 2-3 RBC: 0-2 Epithelial cells: few Nitrite: neg Leuk: neg Which should be done next? a. Perform pelvic exam b. Reassure the pt that she has asymptomatic bacteriuria and does not need abx c. Obtain clean catch urin for UA and C&S d. Order pelvic ultrasound 26 | P a g e A Which pt should be screened for DM? a. 47yo Caucasian male w/HTN b. 45yo female on disability from back injury, unable to exercise c. Hispanic man, BMI 26 d. Overweight middle-aged African American woman w/fam h/o T2DM e. All of the above E According to the GU presentation, #1 risk factor for urinary incontinence is: a. Uncontrolled DM b. Obesity c. Aging d. Smoking and caffeine intake C Which med can blunt the signs of hypoglycemia in diabetics? a. Beta blockers b. ARBs c. CCBs d. Diuretics A What is a sign of insulin resistance that can present in African American pts? a. Seborrheic Nigricans b. Psoriasis Nigricans c. Bullemic Nigricans d. Acanthosis Nigricans D All of the following pts have a risk of adverse reaction from Metformin except: a. Pts w/alcoholic disorder b. Pts w/BMI >30 c. Pts w/hypoxia d. Pts w/renal dz B 27 | P a g e Pt presents with sudden, compelling desire to pass urine that is difficult to prevent. This type of incontinence is cause by: a. Impaired mobility b. Detrusor overactivity c. Urethral hypermobility d. Weakness of the pelvic floor muscle B 55yo woman w/BMI of 28, has 20yr h/o primary HTN, has been on HCTZ 25mg for years w/excellent response. During this follow up visit, she reports that for the last 6mo she has felt thirsty all of the time even though she drinks at least 10 glasses of water/day. Previous fasting BGL was 136. No further testing was done at that time. You check random BGL now, is 210. What is the next appropriate step? a. Order 3hr OGTT b. Order another random BGL in 2wks c. Order A1C d. Prescribe metformin XR 500mg PO D Acanthosis Nigricans is associated with all of the following except: a. Colon cancer b. Tinea versicolor c. Obesity d. DM B 66yo dx'd with acute prostatitis, afebrile w/out severe pain, deemed appropriate to be managed outpt. An appropriate initial treatment option for mild case is: a. Septra x6wks b. Cipro x10-14 days c. Bactrim x14 days d. Levaquin x3wks B 55yo Caucasian man w/T2DM presents as new pt. Take metformin 500mg BID. Labs reveal albuminuria and A1C was 7%. He's current on eye/foot exams. BP today is 136/84. According to 2017 ACC Guidelines, the most appropriate med for his current status is: a. Furosemide b. Amlodipine 30 | P a g e All of the following statements about tremor are true except: The most common tremor is the Parkinson tremor Overflow incontinence is usually associated with: Bladder outlet obstruction Wandering is best described as: Purposeful excessive ambulatory behavior Symptoms of depression distinct to the elderly include: Lack of emotions One major difference that is useful in the DD of dementia vs delirium is that: Dementia develops slowly and delirium develops quickly Which of the following is the most appropriate screening tool for delirium? Confusion Assessment Method The proposed mechanism by which diphenhydramine causes delirium is: Anticholinergic effects Elderly are at high risk for delirium because of: All of the above (multisensory declines, polypharmacy, multiple medical problems) Consistent finding in delirium, regardless of cause, is: Reduction in regional cerebral perfusion Older adults w/dementia sometimes suffer from agnosia, which is defined as the inability to: Recognize objects In late stages of dementia, a phenomenon called "sun downing" occurs, in which cognitive disturbances tend to: Become worse toward the evening Of the following, which one is most useful clinical eval tool to assist in dx of dementia? St. Louis University Mental Status Exams (SLUMS) The cornerstone of pharmacotherapy in treating Alzheimer's is: Cholinesterase inhibitor's The comorbid psych problem w/the highest frequency in dementia is: Depression 31 | P a g e When treating depression associated w/dementia, which of the following would be a poor choice and should not be prescribed? Amitriptyline A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should you teach the pt regarding taking this med? Its effectiveness is decreased by antacids, iron, or caffeine 60yo obese male has T2DM and lipid panel of TC 250, HDL 32, LDL 165. You teach the pt about his modifiable cardiac risk factors, which include? DM, obesity, hyperlipidemia Diabetic pt presents w/the c/o R foot pain but denies recent known injury. He states it has gotten progressively worse over the past few months. On exam, vibratory sense as well as sensation tested w/a monofilament was abnormal. Pt's foot is warm, edematous, misshapen. You suspect Charcot foot. What intervention is indicated? Refer to podiatry 62yo male has chronic kidney dz that has been relatively stable. He has h/o hyperlipidemia, OA, HTN. He is compliant w/meds, BP has been well-controlled on a CCB. Last lipids showed TC 201, HDL 40, TG 180, LDL 98. He currently takes Crestor 20mg daily. Today his BP is 188/90 and urine dip shows significant proteinuria. He denies any changes in dietary habits or med regimen. What would be the best med change for him at this point? Change CCB to ACEI You're working in the Fast Track of ER. 76yo male presents w/LUQ pain. There can be many conditions that present as LUQ pain, but which of the following is least likely to cause pain in LUQ? Acute pancreatitis Which is a cardinal feature of failure to thrive? Poor nutritional status Feeding gastrostomy tubes at end-of-life Alzheimer's pts have been associated with: Aspiration Pna Which of the following nutritional indicators is not an indication of poor nutritional status in elderly? BMI 25 Which ethnic group has highest incidence of prostate ca? African Americans Men w/an initial PSA <2.5 can reduce their screening frequency to what intervals? Every 2yrs 32 | P a g e All of the following may be reasons associated w/an elevated PSA besides prostate ca except: UTI In dx'ing acute bacterial prostatitis, a midstream urine cx is of benefit. To be diagnostic, the specimen should reveal how many WBCs per high-power field? 10 In chronic bacterial prostatitis, what is the organism most commonly associated with the dz? E. coli In acute prostatitis, an exam of the prostate may find it to be: Swollen and tender All of the following antimicrobials may be indicated in chronic bacterial prostatitis except: Azithromycin Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: Increased estrogen production's influence on the bladder and ureter 68yo male, retired Air Force pilot, has been dx'd w/prostate ca in the past wk. He's never had surgery and seeks clarification on availability of tx's for prostate ca. He asks you to tell him the SE of radical prostatectomy. Which of the following is NOT a potential SE of this procedure? Selected low back pain You're evaluating a pt's pelvic muscle strength by digital exam. This is performed when: You need to confirm a cystocele or stress incontinence A pelvic mass in a post-menopausal woman: Is highly suspicious for ovarian ca 79yo man is being eval'd for frequent urinary dribbling w/out burning. Physical exam reveals smooth but slightly enlarged prostate. His PSA is 3.3. He undergoes formal urodynamic studies and findings are as follows: decreased bladder capacity of 370mL, few involuntary detrusor contractions at a low bladder volume of 246mL, increased postvoid residual urine volume of 225mL, and slightly decreased urinary flow rate. Which of the following is not consistent with normal age-associated change? Increased postvoid residual urine volume 65yo female presents to the clinic for the first time and c/o urinary incontinence and dyspareunia. She went through menopause 10yrs ago w/out any hormone replacement therapy and had hysterectomy for a fibroid. Her mom had hip fx at 82. Pt's most recent mammo was 5yrs ago, no known fam h/o breast ca. She is not taking any meds. Exam is unremarkable except for findings consistent w/atrophic vaginitis. 35 | P a g e The majority of pts enrolled in hospice care die: At home A drug that can be used to treat two very common symptoms in a dying pt (pain and dyspnea) is: Morphine The tasks of grieving include all of the following except: Begin to disengage The best description of complicated grief is: Chronic, delayed, exaggerated, masked, or disenfranchized All of the following statements are true about interventions in working w/the bereaved except: There is strong evidence behind recommended interventions The highest level of evidence to support interventions at the end of life is with: Opioids for dyspnea The highest level of evidence with the use of adjuvant analgesics is with: Neuropathic pain pts are candidates for adjuvant analgesia What are some risk factors for prediabetes? >45yo Overwt/obesity Sedentary lifestyle Fam h/o T2DM What is the ADA recommendations for screening for T2DM? -Screen all adults at 45yo -Test all adults who are overwt/obese w/1 risk factor (BMI >25, >23 for Asians) -Screen at risk adults every 3yrs -Screen yearly: prediabetes, increasing hyperglycemia, multiple risk factors What are the appropriate screening tests for T2DM? FBG: least expensive, requires fasting 2hr OGTT: most sensitive, expensive, requires prep/fasting. HgbA1C: no fasting, convenient What is a normal A1C? <5.7 What is the A1C level indicative of prediabetes? 5.7-6.4 36 | P a g e What is the A1C level indicative of T2DM? >/= 6.5 What is the fasting plasma glucose level indicative of prediabetes? 100-125 What is the fasting plasma glucose level indicative of T2DM? >/= 126 What is the OGTT level indicative of prediabetes? 140-199 What is the OGTT level indicative of T2DM? >/= 200 What are complications of uncontrolled DM? -Leading cause of CV mortality/morbidity -Vision loss -Renal complications -Amputation What are the two types of hematuria and what do they mean? -Transient: occurs on one occasion -Persistent: occurs on 2 or more occasions What are some dietary substances that can cause hematuria? Caffeine Spices Tomatoes Chocolate ETOH Citrus Soy sauce Meds that contribute to hematuria. Beta-lactam abx Sulfonamides NSAIDs Cipro Allopurinol Tagamet Dilantin 37 | P a g e Anticoagulants ASA What are some diagnostic tests used to rule out hematuria causes? UA: positive blood Urine Cx & ID/sensitivities Micro UA: RBCs (if <3, hemoglobinuria? If >3, test for cause: ANA, immunoglobulins, CMP, CBC) What is gross hematuria usually associated with? Malignancy What is proteinuria usually associated with? Renal pathology, usually glomerular. Can be functional. Can be intermittent (stress, UTI, exercise). Can be from overproduction of filterable plasma protein, which can be associated with multiple myeloma. What is the best test for continuous proteinuria? 24hr urine What is an abnormal amount of protein in a 24hr urine? >160mg What amount of protein in a 24hr urine is indicative of nephrotic dz? >3.5g Name some differentials for proteinuria. Exercises Environmental conditions Fever Illness CHF Injury Nephrotic syndrome Multiple myeloma (indicated by finding of Bence Jones protein) What are some diagnostic tests used in evaluating proteinuria? 24hr urine (measure protein & creatinine) Chemistry panel Lipids Urine Cx w/sensitivity 40 | P a g e When are beta-3 adrenergic agonists contraindicated? HTN (do not use if SBP >180 or DBP >100) Severe renal/liver dz What is MOA for beta-3 adrenergic agonists? Stimulates beta-3 adrenergic receptors, which relaxes bladder smooth muscle What is 2nd line management for UI in males? Alpha-1 blockers (doxazosin, terazosin, tamsulosin, alfuzosin, silodosin) What are common SE of alpha-1 blockers? Dizziness (doxazosin, terazosin, tamsulosin, alfuzosin) Dyspnea (doxazosin) Edema (doxazosin) Fatigue (doxazosin) Somnolence (doxazosin) Postural hypotension (terazosin) Asthenia (terazosin, tamsulosin) Abnormal ejaculation (tamsulosin) Back pain (tamsulosin) Increased cough (tamsulosin) URI (alfuzosin) Retrograde ejaculation (silodosin) What is the main MOA of alpha-1 blockers? Prostatic smooth muscle relaxation What is the definition of interstitial cystitis? Chronic bladder inflammation syndrome Characterized by pelvic pain and irritative voiding symptoms Pathology unknown Related to autoimmune, allergic, or infection etiology Dx of exclusion Mostly women What is the age of onset for interstitial cystitis? 30-70 What are symptoms of interstitial cystitis? Voiding small amounts Uncomfortable constant urge to void May worsen the week of menstruation 41 | P a g e What are some diff dx's for interstitial cystitis? UTI Prostatitis Cystitis Vaginitis Endometriosis Neuropathic bladder dysfunction Neoplasm Overactive bladder What are some diagnostic tests for interstitial cystitis? UA Urine cx Potassium sensitivity test Cystoscopy What is the treatment goal for interstitial cystitis? Symptom management What should be avoided in interstitial cystitis? Acidic food Caffeine ETOH Artificial sweeteners Chocolate Cigarettes What are two lifestyle changes for interstitial cystitis? Drink plenty of water Bladder training What are meds for interstitial cystitis? Tricyclics Antihistamines NSAIDs Pyridium Ditropan Procardia Long-standing opioids What is the definition of a UTI? Inflammation and infection of the urinary bladder w/possible involvement of the urethra What is the most common organism causing UTI in women? 42 | P a g e E. coli What is the most common organism causing UTI in men? Proteus species What are some contributing factors for UTI in women? Intercourse Pregnancy DM Cath Instrumentation Retention Constipation Diaphragm use Meatal stenosis Bowel incontinence What are the most common abx for UTI? Bactrim Fluoroquinolone (no pregnant women!) What are abx alternatives for UTI in pregnancy? Sulfisoxazole Cephalosporins How long are uncomplicated female UTIs treated for? 3 days Who should receive 7-10 day abx for UTI? Men Children Elderly DM Women w/pyelo Pregnancy How is a relapsing UTI treated? Usually occurs within 3wks of first infection Treated similarly to 1st infection, but 2wks of abx When do you prescribe prophylactic abx for UTI? Women w/2 or more symptomatic UTIs w/in 6mo or 3 or more in 1yr How is urethritis in men treated? 45 | P a g e Cognitive impairment Living arrangements Social isolation, loneliness What are some physical signs of elder abuse? Physical bruises Slap marks Unexplained burns Fractures Increased home accidents What are some signs of neglect or abandonment? Lack of hygiene Failure to meet medical needs What is the provider's responsibility in elder abuse? Physical exam Diagnostic tests Reporting What is the goal of palliative care? To prevent and relieve suffering and support the best QOL, regardless of dz stage or need for other therapies and can be concurrent with other life-prolonging therapies. What are the differences between palliative care and hospice? Palliative: to relieve pain and improve quality of life. Used early in dz process. Interdisciplinary care. Provides care for entire dz process, from dx to death, including bereavement services. Hospice: for the last 6mo of life. Uses palliative care principles to support pt AND family. Includes bereavement services. Covered by Medicare/caid, most private insurances. Interdisciplinary care. Medical services/supplies. Drugs. What are the 5 leading COD in elderly? Heart dz Malignant neoplasms Chronic resp dz Cerebrovascular dz Accidents What are some obstacles to implementing palliative care for elderly? Inadequate communication among decision-makers Lack of agreement in goals of care Failure to recognize futile treatments Lack of advance directives 46 | P a g e What are some barriers that affect quality of care at the end of life? Failure to acknowledge limits of medicine Lack of healthcare provider training Poor understanding of hospice/palliative care services Denial of death Rules and regulations What are some eligibility criteria for hospice Medicare benefit? Pt's MD and hospice medical director use best clinical judgement to certify pt has 6mo or less to live. Pt chooses hospice instead of further treatment. Pt enrolls in Medicare-approved program. Who might be referred to hospice for consult? Pt's who you wouldn't be surprised would die in within 12mo. Frequent admissions w/in several mos. Difficult to control symptoms. Complex care requirements. Decline in function, feeding intolerance, unintentional wt loss. Admission from LTC. Elderly, cognitively impaired w/hip fracture Metastatic or local advanced incurable cancer. Chronic home O2 use. Out of hospital cardiac arrest. Limited social support. What are some pain assessment tools? Visual Analogue Scale Numerical Analogue Scale Wong-Baker FACES Pain Assessment in Advanced Dementia scale What are the different types of pain? Somatic Visceral Neuropathic What provides a framework for pharmacological interventions for pain? The WHO Step Ladder What is the first step on the WHO Step Ladder for pain? NSAIDs and acetaminophen for mild pain What is step 2 on the WHO Step Ladder for pain? 47 | P a g e Opioids added, usually w/APAP, for moderate-to-severe pain w/functional impairment and/or decreased QOL. What is step 3 on the WHO Step Ladder for pain? Opioid pain meds, sometimes around the clock, for severe pain. What are some common SE in opioid administration? Constipation Nausea Sedation Respiratory depression What can be added to any step of the WHO Step Ladder for pain? Adjuvant meds such as: -Tricyclic antidepressants -Nortriptyline -Desipramine -Duloxetine -Gabapentin -Pregabalin -Lidocaine 5% patch -Capsaicin cream -Corticosteroids -Calcitonin -Baclofen What are some nonpharm approaches to pain management? Relaxation Mindfulness Distraction Imagery Prayer Cognitive reframing Heat/cold application Repositioning Massage Acupuncture What are some sequelae with unrelieved pain? Functional impairment Falls Mood disorders (depression, anxiety, etc.) Sleep/appetite disturbances Decreased socialization