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NR601 MIDTERM CERTIFICATION TEST 2026
COMPREHENSIVE STUDY GUIDE
โ 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. Answer: Thiazide diuretics โ Which of the following statements about OA is true. Answer: It affects primarily weight bearing joints โ In considering the specificity of lab data, the most reliable diagnostic test listed below would be. Answer: Synovial fluid analysis to differentiate between infectious versus inflammatory infusion โ When examining the spine of an older adult you notice a curvature with a sharp angle. This is referred to as. Answer: Gibbus โ The prevalence of depression in nursing home residents is __________________ greater than adults living in the community. Answer: 3 - 4 times โ The majority of depressed older adults remain untreated because of. Answer: Misdiagnosis, social stigma, environmental barriers
โ Symptoms of depression distinct to the elderly include. Answer: Lack of emotions โ The justification for ordering CBC, TSH, serum B12 for a patient you may suspect have clinical depression is. Answer: Because of overlapping symptoms with anemia, thyroid dysfunction, and nutritional deficiencies โ One major difference that us useful in the DD of dementia versus delirium is that. Answer: Dementia develops slowly and delirium develops quickly โ Which of the following is the most appropriate screening tool for delirium. Answer: Confusion Assessment Method โ The proposed mechanism by which diphenhydramine causes delirium is. Answer: Anticholinergic effects โ The elderly are at risk for delirium because of. Answer: Multisensory declines, polypharmacy, multiple medical problems โ A consistent finding in delirium regardless of cause i. Answer: Reduction in regional cerebral perfusion
โ What insect precautions are not necessary to prevent insect borne diseases in the Tropics. Answer: Using 100% DEET on skin to prevent bites โ An example of secondary prevention you could recommend/order for older adults would be to. Answer: Check for fecal occult blood โ 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. Answer: Vax hx is irrelevant, read as usual โ 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. Answer: A regcognized element of high risk within this group โ Performing ROM exercises on a patient who has had a CVA is an example of which level of prevention. Answer: Tertiary โ You demonstrate an understanding of primary prevention of falling among the elderly through which management plan. Answer: Provide info about meds, SE and interactions
โ An example of an active strategy of health promotion for an individual to accomplish would be. Answer: Beginning stress management program โ The 4 main domains of clinical preventive services that you will provide are. Answer: Counseling interventions, screening tests, immunizations, chemoprophylaxis โ What is the appropriate method for TB screening of an older adult entering a nursing home. Answer: 5 TBU intradermal PPD injection and if negative, repeat with same dose one week later โ The term "geriatric syndrome" is best described. Answer: Condition that has multiple underlying factors and involves multiple systems โ Atypical presentation of acute coronary syndrome is. Answer: More common in females โ What disease can mimic and often co-exists with MI in elderly with CAD. Answer: Esophageal disease โ Thoracic aortic dissection presents typically as. Answer: Severe retrosternal CP that radiates to the back and both arms
โ The most common cause of disability in the elderly is. Answer: Arthritis โ Drug-induced pruritis is distinguished because it. Answer: May occur right after drug is taken or months later โ A key symptom of ischemia heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because. Answer: Women with ischemic heart disease many times don't present with chest pain. Some patient's may have no symptoms or atypical symptoms so diagnosis may only be made at the time of the actual MI โ Which test is clinic standard for assessment of aortic stenosis. Answer: Echocardiogram โ Ischemic heart disease is. Answer: Defined as an imbalance between O2 supply and demand, frequently manifested as angina, leading cause of death in the elderly โ Preceding a stress test, the following lab work might include. Answer: CBC with diff to differentiate ischemic heart disease from anemia, thyroid studies to rule out hyperthyroidism
โ On exam, what type of murmur can be auscultation with aortic regurgitation. Answer: Austin Flint โ Which of the following statements is true regarding anti- arrhythmic drugs. Answer: Most anti-arrhythmic have low toxic/therapeutic ratio and some are exceeding toxic โ In mitral stenosis, p waves may suggest. Answer: Left atrial enlargement โ Aortic regurgitation requires medical treatment for early signs of CHF with. Answer: ACEi โ The best evidence rating drugs in a post MI pt include. Answer: ASA, ACEi/ARB, BB, aldosterone blockade โ 55 year old post-menopausal woman with h/o HTN c/o jaw pain on heavy exertion. No c/o CP. EKG is normal sinus rhythm without ST segment abnormalities. Your plan may include. Answer: Exercise stress test โ What is the most common valvular heart disease in the elderly. Answer: Aortic stenosis
โ The best recommendation for patient who says they have no equipment to exercise is. Answer: Improvise with recommended objects at home that can be used โ When you recommend exercise for the elderly which of the following pieces of advice should be considered for all types of exercise. Answer: Start low and go slow โ Biochemical individuality is best described as. Answer: Each individual's variation is often much smaller than that of a larger group โ All of the following statements about drug absorption are false except. Answer: Underlying chronic disease has little impact on drug absorption โ The cytochrome p system involves enzymes that are generally:. Answer: Inhibited or induced by drugs โ A statement not shown to be true about pharmacodynamic changes with aging is. Answer: Decreased sensitivity to oral anticoagulants
โ The major impact of the physiological changes that occur w/aging is:. Answer: Reduced physiological reserve, reduced homeostatic mechanisms, impaired immunological respons โ The strongest evidence regarding normal physiological aging is available through. Answer: Longitudinal studies โ Pharmacokinetic changes with aging is reflective of. Answer: What the body does to the drug โ All of the following statements are true about drug distribution in the elderly except. Answer: Drugs distributed in water have a lower concentration โ Men have faster and more efficient biotransformation of drugs and this is thought to be due to:. Answer: Testosterone โ Atypical presentation of disease in elderly is reflected by all of the following exept. Answer: MI with CP and diaphoresis โ Polypharmacy is best described as. Answer: Even a single med if there is not a clear indication for its use
โ In the elderly population, the fastest growing group is the age range. Answer: 85 years or older โ Which statement correctly describes normal changes of aging. Answer: Individual variations are enormous at every age and in every part of the body โ Compared with acute pain, persistent chronic pain requires in the nurse practitioner to. Answer: Educate the patient to the benefit of specific lifestyle changes โ When considering Erikson's developmental stages, the task for later life is referred to as. Answer: Ego integrity โ What is the method of action of anticholinergics. Answer: Block the effect of acetylcholine on muscarinic type 3 receptors resulting in bronchodilation โ What is the method of action of beta agonists. Answer: Stimulates beta-2 adrenergic receptors, increasing cyclic AMP, resulting in relaxing airways โ What is tuberculosis. Answer: Chronic, necrotizing infection caused by slow-growing acid fast bacillus (mycobacterium
tuberculosis). Most common cause of death related to infectious disease worldwise โ What is aortic regurgitation?. Answer: Retrograde blood flow through an incompetent aortic valve into left ventricle during ventricular diastole โ What is aortic stenosis. Answer: abnormal narrowing of the aortic valve โ What is mitral stenosis. Answer: Abnormal narrowing of the mitral valve orifice โ What is mitral regurgitation. Answer: Retrograde blood flow during systole from the left ventricle into the left atrium through incompetent mitral valve โ What is mitral valve prolapse?. Answer: Mitral regurgitation associated with bulging of one or both mitral valve leaflets into the left atrium during ventricular systole โ What happens in valvular regurgitation. Answer: Portion of the ejected blood leaks back into the upstream cardiac chamber
โ What is the bed guideline for ASCVD for 40-75 y/o with DM. Answer: Their 10 year risk is >7.5% so high intensity statin โ What is the med guideline for LDL 79-189. Answer: Their 10 year risk is ,7.5% so moderate intensity statin โ What is the ASCVD med guideline for 40-75 y/o without ASCVD or DM. Answer: Their 10 year risk is >7.5% so moderate to high intensity statin โ When is Zostavax recommended. Answer: Anyone over 60, given as a single dose โ What is primary prevention. Answer: Activities to prevent occurrence of disease or adverse health condition, including mental health. โ What is secondary prevention. Answer: Activities aimed at detection of disease or adverse health condition in asymptomatic patient who has risk factors but no detectable disease โ What is teritiary prevention. Answer: Management of existing conditions to prevent disability and minimize complications, striving for optimal function and QOL
โ The symptoms of depression may encompass what 4 domains. Answer: Affect/mood, cognition, physiological, behavioral โ What is transient insomnia. Answer: Lasts a few night, related to emotional issues, usually resolved without meds when elderly adapts to or removes change โ What is short-term insomnia. Answer: Lasts <1 month, related to acute medical/psychological condition or to persistent situational stress โ What is chronic insomnia. Answer: Lasts >1 month, results from age related changes in sleep or chronic stressors. โ What are some symptoms of polymyalgia rheumatica. 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 โ What are common lab findings in PMR. Answer: Elevated ESR and CRP, normochromic normocytic anemia, thrombocytosis โ What is the treatment for PMR. Answer: If s.s are only of PMR and not of GCA as well, start low dose prednisone 10-20mg daily and taper dose
โ What is neuropathic pain. Answer: Direct neuronal injury, burning, tingling, lancinating. Often occurs in a dermatomal pattern โ Treatment goals for stage A HF are. Answer: Heart healthy lifestyle โ The Beer's criteria are appropriate for use in evaluating use of certain meds in patients. Answer: >65 y/o โ The pathophysiology of heart failure is due to. Answer: Inadequate cardiac output to meet the metabolic and O2 demands of the body โ Which of the following nutritional indicators is not an indication of poor nutritional status in the elderly. Answer: BMI 25 โ You examine the hands of a 55 year old woman and note bilateral spindle shaped deformities on middle interphalangeal joints. These are known as. Answer: Haygarth's nodes โ The comorbid psych problem with the highest frequency in dementia is. Answer: Anxiety
โ When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed. Answer: Amitriptyline โ Performing ROM exercises on a patient who has had a CVA is an example of which level of prevention. Answer: Tertiary โ You demonstrate an understanding of primary prevention of falling among the elderly through which management plan?. Answer: Provide info about meds, SE and interactions โ An example of an active strategy of health promotion for an individual to accomplish would be. Answer: Beginning stress management progrma โ You are working with an older adult male with a long history of alcohol abuse and a 30 year history of smoking. In recommending an intervention, your responsibility. Answer: Promote positive change in lifestyle choices โ Which organism that can be prevented by immunization is most often responsible for an infectious "outbreak" in the nursing home setting. Answer: Influenza A
