Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

NRNP 6540 Midterm Exam: Older Adult Psychosocial Needs & Medication Management, Exams of Nursing

A series of multiple-choice questions and answers related to the psychosocial needs of older adults, medication management, and common health concerns in geriatrics. It covers topics such as agitation, depression, cognitive decline, polypharmacy, and drug absorption in older adults. The questions are designed to assess understanding of key concepts and clinical considerations in geriatric care.

Typology: Exams

2024/2025

Available from 11/04/2024

titikshawales
titikshawales 🇺🇸

96 documents

Partial preview of the text

Download NRNP 6540 Midterm Exam: Older Adult Psychosocial Needs & Medication Management and more Exams Nursing in PDF only on Docsity!

NRNP 6540 MIDTERM EXAM 2024 -2025 UPDATED

QUESTIONS AND VERIFIED SOLUTIONS GRADED A+

BEST COMPLETE DOCUMENT FOR STUDY AND

EXAM PREPARATION

Mrs. James is 78 years old and comes to the clinic for an annual checkup. The nurse practitioner addresses the psychosocial needs of older adults and specifically the need for which of the following?

  1. Dependence.
  2. Dignity, credibility, and respect.
  3. Being alone.
  4. Not being touched.
  5. Dignity, credibility, and respect.

Mr. Slobinsky, 80 years old, is unable to leave his home due to mobility problems. The nurse practitioner conducts a social support assessment because Mr. Slobinsky:

  1. May not want to see anyone.
  2. Is not missing the cultural traditions of community activities.
  3. Has made frequent appointments for consultation with the practitioner.
  1. Looks forward to sharing his loneliness with the nurse practitioner.
  2. Has made frequent appointments for consultation with the practitioner.

Mrs. Khan is 89 years old and is reported to have bouts of agitation. The nurse practitioner is counseling her family that these periods of agitation can be triggered by which of the following?

  1. Silence and soft music.
  2. Dim lights.
  3. Approaches from other people.
  4. A feeling of appetite satiety
  5. Approaches from other people.

The nurse practitioner is considering ordering medications to help control an older patient's agitation. She chooses which of the following?

  1. Psychotropic medications
  2. Seizure medications
  3. Stimulants
  4. Depressants
  1. Psychotropic medications

The nurse practitioner is conducting an admitting assessment of a 69-year-old man. He has diminished ability to ambulate and has difficulty with activities of daily living (ADLs). In the interview, the nurse practitioner asks him if he drinks alcohol. He says, "Yes." The practitioner follows up with a psycho-social evaluation because:

  1. Physiological dynamics need to be ruled out as a possible contribution.
  2. His drinking may be a function of the environment where he lives.
  3. Criteria from the DSM-V is the same for people of any age.
  4. His condition could be related to a long-term usage of alcohol or a new occurrence
  5. His condition could be related to a long-term usage of alcohol or a new occurrence

The daughter of a 70-year-old woman asks the nurse practitioner why her mother has had a change in functional ability recently. The mother has regularly been drinking for 40 years, however, her behavior is changing. The nurse practitioner replies that:

  1. The concentration of alcohol in her body remains the same as she ages.
  2. Her change in behavior has nothing to do with any drugs she is taking.
  3. There are different types of alcoholism in older adults, and the change in behavior is related to the specific type.
  4. Physical changes due to aging affect the body's metabolism of alcohol differently.
  5. Physical changes due to aging affect the body's metabolism of alcohol differently.

The son of a 72-year-old man brings his father into the practitioner to plan for treatment of the patient's alcoholism. The nurse practitioner has several options available. Which is the first choice?

  1. Treat for anxiety.
  2. Begin with higher doses of anti-anxiety medications.
  3. The last choice for medication is serotonin uptake inhibitors

4.Buspirone and gabapentin are used as first-line choices.

  1. Treat for anxiety.

Elisabeth, 67 years old, comes to the practitioner with her daughter, who is her caregiver. The nurse practitioner notices that Elizabeth is very busy and always moving and placing things

in order within the waiting room. Along with this increase in energy, which of the following suggest bipolar with mania or hypomania? Select all that apply.

  1. Ability to focus on a task
  2. Flight of ideas
  3. Rapid speech
  4. Impulsivity
  5. Thoughtfulness
  6. Flight of ideas
  7. Rapid speech
  8. Impulsivity

The nurse practitioner is assessing a 69-year-old man for possible bipolar disorder. Which of the following will contribute to diagnosing this patient? Select all that apply.

  1. Complete blood count (CBC) and comprehensive metabolic panel, toxicology screen, urinalysis, thyroid function tests.
  2. Electroencephalogram (EEG) and magnetic resonance imaging (MRI).
  3. Mini-Mental State Examination.
  4. Saint Louis University Mental Status (SLUMS).
  1. Total body computed tomography (CT) scan
  2. Mini-Mental State Examination.
  3. Saint Louis University Mental Status (SLUMS).

Mark, 82 years old, is in a rehabilitation center for therapy post- knee replacement. The nurse practitioner is visiting Mark and finds him confused, disoriented, and with speech difficulty. The staff nurse says that his condition changed quickly over the last few hours. The nurse practitioner orders which of the following? Select all that apply.

  1. Pulse oximetry
  2. Evaluation for infections
  3. Assessment of change in medications
  4. Brain scan
  5. Radiology
  6. Pulse oximetry
  7. Evaluation for infections
  8. Assessment of change in medications
  9. Brain scan

Larry is 69 years old and beginning to experience a cognitive decline. His son brings him to the practitioner asking for an

evaluation. The nurse practitioner assesses for which of the following signs or symptoms? Select all that apply.

  1. Cognitive decline in complex attention, executive function, learning, and memory.
  2. Gradual onset and the course of illness and progression are typically slow.
  3. Impaired ability to care for oneself.
  4. Total or partial loss of the ability to recognize familiar people.
  5. Improvement in symptoms in time.
  6. Cognitive decline in complex attention, executive function, learning, and memory.
  7. Gradual onset and the course of illness and progression are typically slow.
  8. Impaired ability to care for oneself.
  9. Total or partial loss of the ability to recognize familiar people.

Mr. Dan is 75 years old and suffering from depression. He tells the nurse practitioner that he is tired of feeling so low. He asks if depression is a normal part of aging. The nurse practitioner tells him that depression is which of the following? Select all that apply.

  1. Not a normal part of aging.
  1. Related to nutritional deficiencies, especially vitamin B12 and vitamin D.
  2. Triggered by one life event.
  3. Learned helplessness, loss, and bereavement
  4. A state of balanced neurotransmitters in the brain.
  5. Not a normal part of aging.
  6. Related to nutritional deficiencies, especially vitamin B12 and vitamin D.
  7. Triggered by one life event

Ms. Smith, 70 years old, is being treated for geriatric depression. What choices does the nurse practitioner have to order? Select all that apply.

  1. Evaluate the present medication regimen.
  2. Treat any comorbidity.
  3. Maintain basic daily needs.
  4. Order a selective serotonin reuptake inhibitor (SSRI).
  5. Order Abilify.

ALL

Mrs. Smith is 90 years old and has a daytime caregiver. Her daughter stays with her during the evening and nighttime. The daughter suspects her mother is being abused. Which of the

following statements would confirm this for the nurse practitioner? Select all that apply.

  1. My mother complains of physical pain and has bruises on her arm.
  2. My mother is losing weight and is always hungry in the evening.
  3. My mother has lost her wallet and funds are going out of her bank account. 4. My mother has been withdrawing from others.
  4. My mother has burn marks on her body in the shape of a cigarette
  5. My mother complains of physical pain and has bruises on her arm.
  6. My mother is losing weight and is always hungry in the evening.
  7. My mother has been withdrawing from others.
  8. My mother has burn marks on her body in the shape of a cigarette

Mr. Hupp, 84 years old, lost his wife 2 months ago. He goes to his nurse practitioner and complains of the same symptoms that his wife had before she died. Possible treatment options available to the nurse practitioner include which of the following? Select all that apply.

  1. Educate him on normal signs of grieving.
  2. Take time to remember his wife and discuss memories.
  3. Provide emotional support.
  4. Monitor current chronic medical conditions.
  5. Encourage him to stay quiet at home and decrease his physical activity.
  6. Educate him on normal signs of grieving.
  7. Take time to remember his wife and discuss memories.
  8. Provide emotional support.
  9. Monitor current chronic medical conditions.

Polypharmacy is a primary predictor for any undesired or unwanted consequences that can occur because of taking medications. Which is of the following is the correct term for these undesired or unwanted consequences?

  1. Adverse drug reaction (ADR)
  2. Prototype drug
  3. Adverse drug event
  4. Schedule II drugs
  5. Adverse drug reaction (ADR)

Which of the following is related to the incidence of gastric acidity declining with age because of decreased intestinal blood flow?

  1. Drug metabolism
  2. Drug distribution
  3. Drug absorption
  4. Drug elimination
  5. Drug absorption

Biotransformation means chemical alteration of things such as nutrients, amino acids, toxins, and drugs in the body. In which organ does biotransformation occurs?

  1. Intestines
  2. Liver
  3. Pancreas
  4. Bile
  5. Liver

Which of the following is most affected by pharmacokinetic change?

  1. Distribution of drugs.
  1. Elimination of drugs.
  2. Absorption of drugs.
  3. Metabolism of drugs
  4. Elimination of drugs.

A patient is started on a low dose of a drug for safety but is never advanced to a therapeutic dose while another drug is added. Which of the following does this describe?

  1. Preferences of care.
  2. Risk-benefit ratio of drug.
  3. Narrow therapeutic index of drug.
  4. Clinical inertia.
  5. Clinical inertia.

There are over 35 assessment tools currently available to assist providers with the prescribing of medications. Which of the following consists of a list of potentially inappropriate medications (PIMs) to be avoided in older adults?

1. STOPP

2. START

  1. Beers criteria
  2. ADRs
  1. Beers criteria

After consultation with the patient, which of the following is prevented by prescribing only necessary drugs?

  1. Pharmacodynamics
  2. Polypharmacy
  3. Pharmacokinetics
  4. Pharmacy
  5. Polypharmacy

Initial and ongoing assessment should be the protocol when prescribing medications. Designating and training office staff to do the initial medication review can save time but still requires review by the provider. Which of the following terms refers to a patient bringing in all current medications for review?

  1. Brown bag
  2. OTC
  3. Rational polypharmacy
  4. Magic bag
  5. Brown bag

The aging process may alter the dynamic processes that drugs undergo to produce therapeutic effects. Which of the following are terms that refer to these changes? Select all that apply.

  1. Pharmacodynamics
  2. Prophylaxis
  3. Pharmacology
  4. Pharmacokinetics
  5. Pharmacist
  6. Pharmacodynamics
  7. Pharmacokinetics

Which of the following factors affect drug absorption? Select all that apply.

  1. Metabolic diseases
  2. Esophageal erosion
  3. Kidney diseases
  4. Drug-food interactions
  5. Huntington's disease
  6. Metabolic diseases
  7. Esophageal erosion
  1. Drug-food interactions

Drug distribution in the body is affected by aging and higher body fat. Which of the following is true regarding drugs distributed in fat? Select all that apply.

  1. There is a wider effect in drugs distributed in fat.
  2. The effect of drugs is less when distributed in fat.
  3. There is prolonged action in drugs distributed in fat.
  4. There is a more intense effect of drugs distributed in fat.
  5. There is a shorter effect of drugs distributed in fat.
  6. There is a wider effect in drugs distributed in fat.
  7. The effect of drugs is less when distributed in fat.
  8. There is prolonged action in drugs distributed in fat.

One of the things affecting drug distribution is the bioavailability of the drug. Which of the following factors may affect the amount of a drug that reaches the systemic circulation? Select all that apply.

  1. Handling of the drug.
  2. Dosage of the drug.
  3. Solubility of the drug.
  4. Route of administration.
  1. Generic drug.
  2. Solubility of the drug.
  3. Route of administration.

It is important to know the pharmacodynamic influences of the drug. Which of the following statements are true regarding pharmacodynamics? Select all that apply.

  1. A drug's pharmacodynamics describes the effect at the site of action.
  2. Pharmacodynamics is concerned with the movement of drugs within the body.
  3. A drug's pharmacodynamics describes the time and intensity of the drug effect.
  4. Pharmodynamics describes the rate and pathways by which drugs re eliminated from the body by metabolism and excretion
  5. Pharmacodynamics' fundamental concept is drug clearance
  6. A drug's pharmacodynamics describes the effect at the site of action.
  7. A drug's pharmacodynamics describes the time and intensity of the drug effect.

A patient sees the nurse practitioner for a post-hospitalization follow-up and presents new complaints with change in

functional status. Which of the following should the nurse practitioner do? Select all that apply.

  1. Evaluate for ADR.
  2. Prescribe patient medications for the new symptoms.
  3. Consult current resources for precautions before prescribing.
  4. Prescribe antibiotics for the patient.
  5. Leave as status quo.
  6. Evaluate for ADR.
  7. Consult current resources for precautions before prescribing.

Which of the following is true regarding STOPP/START criteria for prescribing medications? Select all that apply.

  1. Lists potential alternative drugs that can safely be used in older adults.
  2. Valuable tool for prescribers, but they are not meant to be mandates for prescribing.
  3. Screening tool to alert doctors to correct treatment.
  4. Screening tool of older persons' potentially inappropriate prescriptions.
  5. It is the Beers criteria that mandates prescribing.
  1. Valuable tool for prescribers, but they are not meant to be mandates for prescribing.
  2. Screening tool to alert doctors to correct treatment.
  3. Screening tool of older persons' potentially inappropriate prescriptions.

The nurse practitioner is conducting a health of older adults in- service with a group of older adults at a community center. The first concept she presents is a definition of chronic illness. Which of the following is the best definition?

  1. A situation that considers the meaning of the more than one long-term illness on the patient, family, and provider.
  2. A condition that requires medical attention for at least 6 months.
  3. Any condition that requires time-limited adjustments.
  4. There is only one definition of chronic illness.
  5. A situation that considers the meaning of the more than one long-term illness on the patient, family, and provider.

The nurse practitioner is speaking to a group of student nurses about the causes of death of older adults. Which of the following statements is true regarding mortality and morbidity of people older than 65 years?

  1. Seventy percent of the cohort older than 65 years dies of chronic conditions.
  2. Conditions that contribute to significant chronic illness include fractures.
  3. The number one cause of deaNthUoRfSbIotNhGolTdBer.mCeOnMand women is heart disease.
  4. Dyslipidemia is the leading cause of mortality of people over 65 years of age
  5. Seventy percent of the cohort older than 65 years dies of chronic conditions.

While teaching a family about the risks of chronic illness for James, who is 69 years old and the patriarch of the family, the nurse practitioner includes which of the following information?

  1. The American Heart Association reports that there is an increase in cardiovascular disease

with low levels of smoking, excluding second-hand smoke.

  1. Drinking high levels of alcohol contributes to an increase in chronic obstructive lung disease.
  2. Obesity is correlated with a higher risk of type 2 diabetes
  3. The lower the body mass index (BMI) the lower the risk of chronic illness
  1. Obesity is correlated with a higher risk of type 2 diabetes

The U.S. health-care system functions by managing and paying for illness by focusing on one problem at a time. The nurse practitioner analyzes this system and concludes it is ineffective because:

  1. As the number of comorbidities increases, so do the risks.
  2. Unintended outcomes of the one disease model include the collaboration of medical advice.
  3. There is no knowledge gap regarding people with multiple chronic conditions (MCCs).
  4. One in ten Medicare recipients has more than one chronic illness.
  5. As the number of comorbidities increases, so do the risks.

The nurse practitioner whose practice consists of geriatric-aged patients must consider which of the following when working with patients who experience multiple chronic illnesses?

  1. Addictions in older adults are predicted to decline in the next 20 years.
  2. Mental illness or behavior problems must be included as chronic conditions.
  1. Fragility and disability typically have multiple chronic conditions.
  2. Co-occurrence of mental and medical conditions is not necessarily disabling
  3. Mental illness or behavior problems must be included as chronic conditions.

Mrs. Jones, 80 years old, comes to the clinic for management of heart failure, diabetes, and depression. The nurse practitioner assesses that this patient is not compliant with the medication plan and has missed a couple of recent appointments. The nurse practitioner analyzes this information and concludes that perhaps Mrs. Jones is experiencing treatment burden because:

  1. At the age of 80 years, she may not understand the workload she is carrying daily.
  2. The comorbidities Mrs. Jones is dealing with are similar and do not necessitate many different

specific tasks.

  1. She is supposed to deal with several activities regarding her health daily.
  2. The depression may inhibit her from proper self-care.
  3. She is supposed to deal with several activities regarding her health daily.

Mr. Smith, 82 years old, is seen by a nurse practitioner and is potentially diagnosed with treatment burden. The nurse practitioner recommends the Chronic Disease Self-Management Program (CDSMP). This program addresses which of the following skills? Select all that apply.

  1. Techniques to deal with problems.
  2. Decision making.
  3. Using resources available.
  4. Patient-practitioner relationship. 5. Taking action.

ALL

Mrs. Hupp, 91 years old, lives with her daughter, Kim. Kim loves her mother and does everything she can to assist in providing a good quality life for her mother. Recently, Kim has been telling her nurse practitioner that she is experiencing lack of sleep, higher blood sugars, and anxiety. The nurse practitioner discusses which of the following with Kim? Select all that apply.

  1. The mother's treatment burden.
  2. Caregiver burden.
  3. The possibility of referring the mother to a long-term facility.
  4. The possibility of the caregiver not practicing self-care and not experiencing good health.
  1. Caregivers experience varying degrees of burden in caring for their parents.
  2. Caregiver burden.
  3. The possibility of referring the mother to a long-term facility.
  4. Caregivers experience varying degrees of burden in caring for their parents.

The nurse practitioner has conducted a thorough health assessment for Mr. York, who is 83 years old. As the nurse practitioner synthesizes the information and creates the discharge instructions, consideration must be given to which of the following? Select all that apply.

  1. His level of understanding of his health condition.
  2. His ability to provide self-care.
  3. His willingness to obtain preventive services.
  4. His number of medication errors.
  5. His basic reading level.
  6. His level of understanding of his health condition.

2.. His ability to provide self-care.

  1. His number of medication errors.
  2. His basic reading level.

Mrs. Morrison is 85 years old and on Medicare with supplemental insurance. She is obese and has diabetes and heart failure. The nurse practitioner collaborates with a social worker and with a representative from Medicare about the cost of her treatment choices. The nurse practitioner analyzes treatment burden and the costs of care to develop a practical and cost- effective plan of care. Which of the following puts Mrs. Morrison at risk for a financial burden for health care? Select all that apply.

  1. Chronic medical conditions.
  2. Obesity and diabetes.
  3. No history of hospitalization in the last 5 years.
  4. Higher costs of prescriptions.
  5. Lower total out-of-pocket expenses
  6. Chronic medical conditions.
  7. Obesity and diabetes.
  8. Higher costs of prescriptions.

The nurse practitioner is conducting an initial history and physical examination, along with a health assessment on a new patient. Mr. Carter is African American and 68 years old. He presents with complaints of dizziness, unstable gait, and polyuria. This combination of symptoms is blamed for his frequent falling at home. The nurse practitioner analyzes the

findings of the examination and suggests which of the following diagnostics? Select all that apply.

  1. Blood pressure measurements, including measuring for hypostatic hypertension to rule out hypertension.
  2. Fasting blood sugar and a glucose tolerance test to rule our diabetes.
  3. Testing for chronic kidney disease (CKD).
  4. Measurement of BMI.5. Definitive testing for Alzheimer's disease.
  5. Blood pressure measurements, including measuring for hypostatic hypertension to rule out hypertension.
  6. Fasting blood sugar and a glucose tolerance test to rule our diabetes.
  7. Testing for chronic kidney disease (CKD).

Mrs. Kesler, 91 years old, is considered frail and yet she is active and lives alone with supervision from her daughter. Her frailty is based on which of the following? Select all that apply.

  1. A 10-pound weight gain in the last month.
  2. Self-reported exhaustion
  3. Strength based on grip.