NSG 6420-Adult-Geriatrics Test Questions Study Guide, Exams of Nursing

Download NSG 6420-Adult-Geriatrics Test Questions Study Guide and more Exams Nursing in PDF only on Docsity! NSG 6420-Adult-Geriatrics Test Questions (2) BEST STUDY GUIDE LATEST DOWNLOAD 2 . Points R:eceived: Student Comments: a2nodf 2this is thought to be due to: Answer: NSG 6420-Adult-Geriatrics Test Questions (2) BEST STUDY GUIDE LATEST DOWNLOAD Question : The major impact of the physiological changes that occur withaging is: Student Answer : Reduced physiological reserve Reduced homeostatic mechanismsImpaired immunological responseAll of the above Instructor Explanatio n: The major impact of all of these physiological changes can be highlighted with three primary points. First, there is a reduced physiological reserve of most body systems, particularly cardiac, respiratory, and renal. Second, there are reduced homeostatic mechanisms that fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance. Third, there is impaired immunological function: infection risk is greater, and autoimmune diseases are more prevalent. (Kennedy-Malone 3) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014- 01-14. VitalBook file. Questio n Questio n Men have faster and more efficient biotransformation of drugs - 582355588 MultipleChoic e 1 True Points Received: Comments: 2 of 2 Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. AdvancedPractice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. Question 3 . Question : The cytochrome p system involves enzymes that are generally: Student Answer : Inhibited by drugsInduced by drugs Inhibited or induced by drugs Associated with decreased liver perfusion Less estrogen than women Instructor Explanatio n: Men have faster and more efficient biotransformation, presumably becauseof serum testosterone. Conditions of increased or decreased liver perfusionalter the overall level of the drug that is absorbed and how it is metabolized. (Kennedy-Malone 5) - 582355 5 87 Multipl eC hoice 2 True 0 - 582355 5 87 Multipl eC hoice 2 Instructor Explanatio n: Biotransformation occurs in all body tissues but primarily in the liver,where enzymatic activity (cytochrome P [CYP] system) alters and detoxifies the drug and prepares it for excretion. (Kennedy- Malone 5) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Points Received: Comments: 2 of 2 Advance d Practice Nursing in the Care of Older Adults. F.A. DavisCompany, 2014-01-14. VitalBook file. - 582355 5 86 Multipl eC hoice 3 True Points Received: Comments: 0 of 2 Serum ferritin and serum iron Total iron binding capacity and transferrin saturation Instructor Explanatio n: RBC indices reveal an MCV (mean corpuscular volume/RBC size) thatwill be decreased to <80 fL in adults; MCH (mean corpuscular hemoglobin/RBC color) will show hypochromia or pale cells; RBC distribution width (RDW)/volume variation will be increased. (Kennedy-Malone page 519) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. - 582355 5 84 Multipl eC hoice 5 False 0 - 582355 5 84 Multipl eC hoice 5 Question 6 . Question : When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): Student Answer : Hemoglobin <12 g/dl, MCV decreased, MCH decreasedHemoglobin >12 g/dl, MCV increased, MCH increased Hemoglobin <12 g/dl, MCV normal, MCH normal Hemoglobin >12 g/dl, MCV decreased, MCH increased Instructor Explanatio n: Hemoglobin (Hgb): <12 g/dL (120 g/L) women <13 g/dL (130 g/L) men Rarely <10 g/dL (100 g/L) Mean corpuscular volume: 80–96 mcm3 (normocytic) Mean corpuscular hemoglobin Normochromic (normal color) RBC distribution width: normal (Kennedy-Malone page 517) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin- Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. Question 7 . Question : The pathophysiological hallmark of ACD is: Student Answer : Depleted iron stores Impaired ability to use iron stores Chronic uncorrectable bleeding Reduced intestinal absorption of iron Points Received: Comments: 0 of 2 - 582355 5 83 Multipl eC hoice 6 False 0 - 582355 5 83 Multipl eC hoice 6 Instructor Explanati o n: Treatment: Treatment of ACD focuses on management of the underlying disorder. Iron supplementation is of no benefit in ACD, except in cases of coexisting IDA. A therapeutic trial of iron supplementation of no longer than 1 month may be useful in delineating between ACD and IDA. In ACD, there would be no hematological response to iron therapy (Chen & Gandhi, 2004). (Kennedy-Malone page 518) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin- Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014- 01-14. VitalBook file. Questio n Questio n In addition to the complete blood count (CBC) with differential, 9 Points R:eceived: . Comments: Student w2 hofic2h of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? Serum iron Transferrin saturation Instructor Explanatio n: Treatment: Treatment of ACD focuses on management of the underlying disorder. Iron supplementation is of no benefit in ACD, except in cases of coexisting IDA. A therapeutic trial of iron supplementation of no longer than 1 month may be useful in delineating between ACD and IDA. In ACD, there would be no hematological response to iron therapy (Chen & Gandhi, 2004). - 5A8n23sw5 MultipleChoic e 8Total iron b inTdruine g capacit y0 -582355581 MultipleChoic e 8in Points Received: Comments: 2 of 2 Question 10 . Question : Symptoms in the initial human immunodeficiency virus (HIV)infection include all of the following except: Student Answer : Sore throat Fever Weight loss Headache (Kennedy-Malone page 518) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. AdvancedPractice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. - Multiple C 9 True 582355 5 80 hoice 0 - 582355 5 80 Multipl eC hoice 9 Instructor Explanatio n: Signal symptoms: The initial HIV infection is characterized by mononucleosis-like illness with fever, sore throat, lymphadenopathy, headache, and fatigue. A roseola-like rash may also develop. These initial symptoms are followed by an asymptomatic phase, which may last 10 years or more. Later, if untreated, lymphadenopathy, weight loss, myalgias, and diarrhea may develop (Cohen, Kuritzkes, & Sax, 2011). In advanced disease, malignancies and opportunistic infections occur. Co-infection with hepatitis B or C is common (25% to 30%) in IV drug users, so hepatitis symptoms may also appear (Centers for Disease Control and Prevention [CDC], 2010a). (Kennedy-Malone page 521) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014- 01- 14. VitalBook file. Points Received: 0 of 2 Student Answer : Clinical practice guidelineClinical decision rule Clinical algorithm Clinical recommendation Instructor Clinical decision (or prediction) rules provide another support for clinical Points Received: Comments: 2 of 2 Question 13 . Question : The first step in the genomic assessment of a patient is obtaininginformation regarding: Student Answer : Family history Environmental exposuresLifestyle and behaviors Current medications Explanation: reasoning. Clinical decision rules are evidence-based resources that provideprobabilistic statements regarding the likelihood that a condition exists if certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain situations, settings, and/or patient characteristics. Goolsby page 7 - 582355 5 77 Multipl eC hoice 12 True 0 - 582355 5 77 Multipl eC hoice 12 Explanatio n: the use of family history. Family history is considered the first genetic screen (Berry & Shooner 2004) and is a critical component of care because it reflects shared genetic susceptibilities, shared environment, and common behaviors (Yoon, Scheuner, & Khoury 2003). Goolsby page 18 QuePstoioinnts ReQceuiveesdti:onI2noaf u2tosomal recessive (AR) disorders, individuals need: 14 . Comment:s: the Instructor A critical first step in genomic assessment, including assessment of risk, is - 5S8t2u3d5 5e5n7t6 MultipleChoic e 1O3 nly one m utTartueed gene on the sex chromosomes to acquire 0 Answer : -582355576 d MultipleChoiceisease 13 Comments: Points Received: Comments: 0 of 2 Question 16 . Question : A woman with an X-linked dominant disorder will: Student Answer: Not be affected by the disorder herself Transmit the disorder to 50% of her offspring (male or female)Not transmit the disorder to her daughters Transmit the disorder to only her daughters Instructor Explanatio n:Everyone born with an X-linked dominant disorder will be affected withthe disease. Transmission of the disorder to the next generation varies bygender, however. A woman will transmit the mutation to 50% of all her offspring (male or female). Goolsby page 29 - 582355 5 74 Multipl eC hoice 15 True 0 - 582355 5 74 Multipl eC hoice 15 - Multiple C 16 False 582355 5 73 hoice 0 - 582355 5 73 Multipl eC hoice 16 Question 17 . Question : According to the Genetic Information Nondiscrimination Act(GINA): all patients Employers cannot inquire about an employee’s geneticinformation Student Answer: Nurse Practitioners (NPs) should keep all genetic information of patients confidential NPs must obtain informed consent prior to genetic testing of Points Received: Comments: 2 of 2 All of the above Instructor Explanati o n: On May 21, 2008, President George W. Bush signed the Genetic Information Nondiscrimination Act (GINA) to protect Americans againstdiscrimination based upon their genetic information when it comes to health insurance and employment, paving the way for patient personalized genetic medicine without fear of discrimination (National Human Genome Research Institute 2012). Goolsby page 43 - 582355 5 72 Multipl eC hoice 17 True 0 - 582355 5 72 Multipl eC hoice 17 Question 18 . Question : Which of the following would be considered a “red flag” thatrequires more investigation in a patient assessment? Student Answer: Colon cancer in family member at age 70 Breast cancer in family member at age 75 Myocardial infarction in family member at age 35All of the above Asking the patient to complete a family history workshee t prior to the appointm ent saves time in the visit while offering the patient an opportuni ty to contribut e to the collection of an accurate family history. Reviewin g the family informati on can also help establish family rapport while verifying medical condition s in individua l family members. If a hereditar y condition is being considered but family medical information isunclear or unknown, requesting medical records and pathology or autopsyreports may be warranted. Goolsby page 32 impactionOtitis media Ménière’s disease 1. Question : An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearingaid malfunction, this condition is often due to: Student Answer : Acoustic neuroma Cerumen Instructor Explanati o n: Elderly clients frequently present with complaints of hardened cerumen and decreased hearing resulting from cerumen impaction aggravated by hearing aid wear. (Goolsby 137-138) Conductive hearing loss is caused by a lesion involving the outer and middle ear to the level of the oval window. Various structural abnormalities, cerumen impaction, perforation of the tympanic membrane, middle ear fluid, damage to the ossicles from trauma or infection, otosclerosis, tympanosclerosis, cholesteatoma, middle ear tumors, temporal bone fractures, injuries related to trauma, and congenital problems are some of the causes. (Kennedy-Malone 170-171) Questio n Questio n In examination of the nose, the clinician observes gray, pale 2 Points R:eceived: . Comments: Student m2 oufco2us membranes with clear, serous discharge. This is most likely indicative of: Bacterial sinusitis : - 5A8n04sw9 MultipleChoic e 1 True 0 -580490446 MultipleChoic e 1 Bicillin L-A © Dicloxacilli n Points Received: Comments: 2 of 2 Instructor Explanation :Points Received: QueCstoiomnmenQtsu:estion MedU Card #1 2 of 2 Presbycusis is the hearing impairment that is associated with: 4 : . -580490444 MultipleChoic e 3 True 0 Student Answer: -580490444 M P ul h ti y p s lei C o h lo oi g ce i c Ménière’s d ag 3 ing isease Instructor Explanati o n: Cerumen impaction Herpes zoster Presbycusis is an age-related cause of gradual sensorineural hearing loss and involves diminished hairy cell function within the cochlea as well as decreased elasticity of the TM. Although the changes associated with presbycusis often start in early adulthood, the decreased hearing acuity is usually not noticed until the individual is older than 65. (Goolsby 138) Because presbycusis is gradual and insidious, hearing loss may go unnoticed until it has progressed significantly. (Kennedy-Malone 170) - 580490443 MultipleChoic e 4 True 0 -580490443 MultipleChoic e 4 Points Received: Comments: 2 of 2 Question 5 . Student Answer : Question : Epistaxis can be a symptom of: Over-anticoagulation Hematologic malignancyCocaine abuse All of the above Instructor Explanatio n: Cocaine abuse, which is more common than might be expected, frequentlycauses epistaxis. Hematologic disorders likely to cause bleeding include thrombocytopenia, leukemia, aplastic anemia, and hereditary coagulopathies. High doses of anticoagulants can cause epistaxis and bleeding from the gums. (Goolsby 142) Epistaxis results from a spontaneous rupture of a blood vessel in the nose, usually in the anterior septum in Kiesselbach's plexus (Nguyen, 2012). The bleeding may be secondary to local infections, systemic infections, drying ofthe nasal mucous membrane, trauma, arteriosclerosis, hypertension, or bleeding disorders. Trauma is usually the primary mechanism of disruption of the nasal mucosa. Posterior epistaxis can result in nausea and respiratory compromise. In older adults, nasal and paranasal tumors may be involved (Mäkitie, 2010). (Kennedy-Malone 168-169) - 580490 4 42 Multipl eC hoice 5 True 0 - 580490 4 42 Multipl eC hoice 5 Instructor Explanati o n: Most oral malignancies are painless until quite advanced, so patients are often unaware of the lesion unless the lip or anterior portion of the tongue is involved. The patient may become aware of the lesion if it bleeds. Squamous cell cancer lesions vary in appearance, from the reddened patches of erythroplakia to areas of induration/thickening, ulceration, or necrotic lesions. Lesions of malignant melanoma have varied pigmentation, including brown, blue, and black. Even lesions that appear flat and smooth may be nodular, indurated, or fixed to adjacent tissue on palpation. Even though patients with squamous cell malignancies often have a history of heavy alcohol and/or tobacco use or poor dentition, these are not risk factors for malignant melanoma. In Behcet’s syndrome, the patient complains of recurrent episodes of oral lesions that are consistent with aphthous ulcers. The number of lesions ranges from one to several; the size of the ulcers varies from less than to greater than 1 cm. Like aphthous ulcers, the lesions are well defined, with a pale yellow or gray base surrounded by erythema. The majority of patients also develop lesions on the genitals and eyes. (Goolsby 153) Tobacco use and heavy alcohol consumption, alone or synergistically, are strongly related to the development of oral cancer. Pipe smoking and sun exposure have been implicated in lip cancer. Leukoplakia and erythroplasia are often precursors to oral cancer. Relationships between oral cancer and Epstein-Barr virus, HPV, herpes simplex virus, and immunodeficiency states also have been found (Stenson, 2011). (Kennedy-Malone 177). Questio n Questio n A 26 year old patient presents with cough and general malaise 7 Points R:eceived: . Comments: f2oorf 2 3 days. They note that their eyes have been watering clear fluid and a ‘runny nose’ since yesterday. They note they ‘feel ething to make them feel better. What - 580490441 MultipleChoic e mi6serable’ and dTermu and som 0 -580490441 MultipleChoic e 6 Points Received: Comments: 0 of 2 would be the best first plan of treatment? Student Answer: Saline nasal spray for congestion and acetaminophen as needed for pain. Z-pack (azithromycin) for infection and Cromolyn nasal for congestion Hydrococone/acetaminophen as needed for pain and Guaifensin for congestion Cephalexin for infection and Cromolyn ophthalmic for Instructor Explanatio n: congestion MedU Card #4 - 580490 4 40 Multipl eC hoice 7 False 0 - 580490 4 40 Multipl eC hoice 7 Question 8 . Question : Which of the following findings should trigger an urgent referralto a cardiologist or neurologist? Student Answer : History of bright flash of light followed by significantly blurred vision History of transient and painless monocular loss of vision History of monocular severe eye pain, blurred vision, andciliary flush A l Instructor Explanatio n: l of the above Amaurosis fugax is a monocular, transient loss of vision. It stems from transient ischemia of the retina and presents an important warning sign forimpending stroke. Depending on the circumstances reported, the patient Points Received: Comments: 2 of 2 Chronic open-angle glaucoma Instructor Explanatio n: If the patient has experienced sudden onset of eye pain, it is important notto dilate the eyes before determining whether acute closed-angle glaucomais present because dilating the eye may increase the intraocular pressure. (Goolsby 108) Acute glaucoma, also known as angle-closure or narrow-angle glaucoma, isan obstruction to the outflow of aqueous humor from the posterior to the anterior chamber through the trabecular meshwork, canal of Schlemm, and associated structures. It results in an elevation of intraocular pressure, damaging the optic nerve and causing loss of peripheral vision, eye pain, and redness. This type of glaucoma is uncommon but may occur as a primary disease or secondary to other conditions and constitutes an ophthalmic emergency (Kennedy-Malone 161) - Multiple C 10 True 580490 4 37 hoice 0 - 580490 4 37 Multipl eC hoice 10 Question 11 . Question : Mr. GC presents to the clinic with nausea and vomiting for 2 days, prior to that time he reports occasional ‘dizziness’ that got better with change in position. He denies a recent history of URIor any history of headaches or migraines. What would the most likely diagnosis be? Student Answer: Vestibular neruitis Benign paroxysmal positional vertigoVestibular migraine Benign hypertensive central vertigo Instructor Explanatio n: MedU Card #9 Points Received: 2 of 2 Comments: - 580490 4 36 Multipl eC hoice 11 True 0 - 580490 4 36 Multipl eC hoice 11 Question 12 . Question : Which of the following patients with vertigo would requireneurologic imaging? Student Answer: A 68-year-old woman with a history of hypertension and sudden acute onset constant vertigo. She has right nystagmus thatchanges direction with gaze and that does not disappear when shefocuses. A 45-year-old man with recurrent episodes of brief intense vertigo every time he turns his head rapidly. He has no other neurologic signs or symptoms. He has a positive Dix- Hallpikemaneuver. A 66-year-old man with recurrent episodes of vertigo associated with tinnitus and hearing loss. His head thrust test ispositive. A 28-year-old otherwise well woman with new onset constant Instructor Explanatio n: vertigo with no other neurologic symptoms. On physical exam, she has unidirectional nystagmus that disappears when her gaze isfixed. MedU Card #11. There are multiple reasons to be concerned about a central lesion and possible infarct in this patient. Her age puts her at risk as does her hypertension. Her physical exam shows nystagmus that changes direction and that does not inhibit with focus. Both of these findings are consistent with a central lesion. She needs an urgentMRI. Points Received: Comments: 2 of 2 Instructor Explanati o n: Preauricular nodes are nonpalpable and nontender in allergic conjunctivitis, usually nonpalpable in bacterial conjunctivitis, and palpable in viral conjunctivitis. (Goolsby 112) QuePstoioinnts ReQceuiveesdti:on I2noaf s2sessing the eyes, which of the following is considered a “red 14 Comment : s: . Instructor Explanatio n: flag” finding when associated with eye redness? pisodes Grossly visible corneal defect Photophobia Red flag warnings for eye redness include pain (not discomfort or irritation), decreased vision, profuse discharge, and corneal defect grossly visible. (Goolsby 112) - 5S8t0u4d9 MultipleChoic e 1H3 istory of p riTorruered- eye e 0 Answer : -580490434 MultipleChoic e 13os Question 15 . Question : A 64-year-old male presents with erythema of the sclera, tearing,and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because ofthe inflammation? Student Answer : Bacteriu m Allergen Virus Fungi - 580490 4 33 Multipl eC hoice 14 True 0 - 580490 4 33 Multipl eC hoice 14 Instructor Explanatio n: Patients with seasonal allergic rhinitis report rhinorrhea, sneezing, obstructed nasal passages, and pruritic eyes, nose, and oropharynx during the spring and fall. Patients with perennial allergic rhinitis have similar symptoms associated with exposure to environmental allergens typically in their homes. Physical examination may reveal a pale, boggy nasal mucosa, injected conjunctiva, enlarged turbinates, dark discoloration or bags under the eyes, and mouth breathing; absence of pale, boggy nasal mucosa does not rule out allergic rhinitis. (Kennedy-Malone 182-183) QuePstoioinnts ReQceuiveesdti:on P2 aotfie2nts that have atopic disorders are mediated by the 16 Comment : s: . production of Immunoglobulin E (IgE) will have histamine stimulated as a n his release of histamine results in ich of the following? ular permeability, and - 580490432 MultipleChoice i m1m5 ediate phas eTrrueesponse. T 0 Student An -580490432 wh MultipleChoic e 15increased vasc Benign paroxysmal positional vertigoTransient ischemic attack (TIA) Migraine several hours to days and is accompanied by tinnitus and hearingloss. You suspect which of the following conditions? Student Answer: Ménière’s disease Instructor Explanation : Points Received: Ménière's disease commonly involves a triad of symptoms— severe vertigo, tinnitus, and hearing loss (Goolsby 140) 2 of 2 QueCstoiomnmentQs:uestion 18 : In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. patient has been referred for a biopsy to be sent for pathology. al precancerous lesion? Student Answer: Instructor Explanatio n: Fictional keratosis Keratoacanthoma Lichen planus Leukoplakia The cause of most episodes of leukoplakia is not determined. However, this condition, which results in the development of white patches on the oral mucosa, is associated with an increased risk of oral squamous cell cancer. Risk factors for the development of leukoplakia include chronic/recurrent trauma to the affected site and the use of smokeless and smoked tobacco and alcohol. (Goolsby 152) . -580490430 MultipleChoic e Th1e7 True 0 -580490430 Wh MultipleChoic e 17ost common r Points Received: Comments: 2 of 2 Points Received: Comments: 2 of 2 - 580490 4 29 Multipl eC hoice 18 True 0 - 580490 4 29 Multipl eC hoice 18 Question 19 . Question : Rheumatic heart disease is a complication that can arise fromwhich type of infection? Student Answer : Epstein-Barr virusDiphtheria Group A beta hemolytic streptococcus Streptococcus pneumoniae Instructor Explanati o n: Group A beta-hemolytic streptococcal (GABHS) pharyngitis is a bacterialinfection of the pharynx, commonly called strep throat. Complications of GABHS pharyngitis, although rare, include rheumatic heart disease and glomerulonephritis, and the condition requires prompt diagnosis and definitive treatment. Most patients with GABHS pharyngitis are children and youths. Other bacterial causes of pharyngitis include mycoplasmal pneumonia, gonorrhea, and diphtheria. (Goolsby 156) - 580490 4 28 Multipl eC hoice 19 True Throat culture All of the above Instructor Explanatio n: 1. Question : Student Answer: Instructor Explanatio n: The physical examination for sore throat should include a comprehensive assessment of the upper and lower respiratory systems, including ears, nose, mouth, throat, and lungs. The neck assessment should include, at a minimum, assessment of the cervical lymph nodes. Strep screens, throat cultures, and mononucleosis screens are common diagnostic studies used to narrow the differential diagnosis of sore throat. A CBC with differential count is helpful in determining the cause of sore throat. (Goolsby 156) Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Seasonal allergies Acute bronchitis Bronchial asthma Chronic bronchitis The pulmonary component includes an abnormal inflammatory response to noxious stimuli, principally tobacco, but also occupational and environmental pollutants. The hallmark of chronic bronchitis is a daily chronic cough with increased sputum production lasting for at least 3 consecutive months in at least 2 consecutive years, usually worse on awakening; this may or may not be associated with COPD (GOLD, 2011). Emphysema is characterized by obstruction to airflow caused by abnormal airspace enlargement distal to terminal bronchioles. Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin- Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014- Points Received: Comments: 2 of 2 01-14. VitalBook file. (page 206)& Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. DavisCompany, 11/2014. VitalBook file. (page 213) - 576289 5 21 Multipl eC hoice 1 True 0 - 576289 5 21 Multipl eC hoice 1 Question 2 . Question : A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion and drainage. On the day the symptoms began he had a low-grade fever that hasnow resolved. His nasal congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal.Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is tenderness when youlightly percuss his maxillary sinus. What would your treatment plan for this patient be? Student Answer: Observation and reassurance Treatment with an antibiotic such as amoxicillin Instructor Explanation: Points Received:2 of 2 Kennedy -Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. AdvancedPractice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 206) Comments: - 576289 5 19 Multipl eC hoice 3 True 0 - 576289 5 19 Multipl eC hoice 3 Question 4 . Question : When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia,tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction: Student Answer : No palpable vibration is feltDecreased fremitus is felt Increased fremitus is felt Vibration is referred to the non-obstructed lobe Instructor Explanatio n: Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. Conversely,areas of decreased fremitus raise the suspicion of abnormal fluid- or air-filled spaces, such as occurs with pleural effusion, pneumothorax, or emphysema. In the instance of an extensive bronchial obstruction, no palpable vibration is felt in the related field. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. DavisCompany, 11/2014. VitalBook file. (page 209) & Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. AdvancedPractice Nursing in the Care of Older Adults. F.A. Davis Points Received: Comments: 2 of 2 Compan y, 2014-01-14. VitalBook file. (page 193) Points Received: Comments: 2 of 2 Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin- Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. DavisCompany, 2014-01-14. VitalBook file. (page 251) Question 7 . Question : A 26-year-old, non-smoker, male presented to your clinic withSOB with exertion. This could be due to: Student Answer : Exercise-induced coughBronchiectasis Alpha-1 deficiency Pericarditis Explanation: they may reveal a nodule, mass, or other abnormality. A CT scan of thechest is typically diagnostic. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A.Davis Company, 11/2014. VitalBook file. (page 217-218) - 576289 5 16 Multipl eC hoice 6 True 0 - 576289 5 16 Multipl eC hoice 6 Instructor Explanatio n: When younger patients or nonsmokers develop findings consistent with COPD, alpha-1 antitrypsin deficiency should be suspected. Currently, the American Thoracic Society (2003) recommends that all individuals with COPD or asthma with chronic obstructive changes be tested for alpha-1 antitrypsin deficiency. If alpha-1 antitrypsin deficit is suspected, a qualitative serum should be performed as a screen, Goolsby, Mary J., Laurie Grubbs. Advance d Assessm ent Interpre ting Findings and Formula ting Differen tial Diagnos es, 3rd Edition. F.A. Davis Compan y, 11/2014. VitalBo ok file. (page 213) followed by quantitati vestudy, as indicated. Points Received: Comments: 2 of 2 QuestionQuestion 8: . Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater thanthe other. This could be due to: Student Answer : Pneumothorax Pleural effusion Pneumonia Pulmonary embolism Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. AdvancedPractice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 206) - 576289 5 Multipl eC hoice 7 True 15 0 - 576289 5 15 Multipl eC hoice 7 Instructor Explanati o n: The problem may occur when these symptoms are attributed to aging or existing comorbidities. Dyspnea (acute onset), anxiety or apprehension, pleuritic chest pain, cough, tachypnea, and accentuation of the pul-monic component of S2 are frequently present and may be accompanied by diaphoresis, syncope, tachycardia, S3 or S4 gallop, hypoxemia, or hemoptysis . Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin- Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014- 01-14. VitalBook file. (page 246) Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file (page 202) Points Received: 2 of 2 Comments: Question 10 . Question : A cough is described as chronic if it has been present for: Student Answer : 2 weeks or more 8 weeks or more 3 months or more6 months or more - 576289 5 13 Multipl eC hoice 9 True 0 - 576289 5 13 Multipl eC hoice 9 Instructor Explanatio n: Cough is classified as acute (less than 3 weeks in duration), subacute (lasting 3 to 8 weeks), and chronic (8 or more weeks in duration), and these distinctions help to narrow the potential differential diagnoses. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 211) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin- Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014- 01-14. VitalBook file. ((page 206) Questio n Question Testing is necessary for the diagnosis of asthma because history 11 Points Re:ceived: . Comments: a2nodf 2physical are not reliable means of excluding other diagnoses or determining the extent of lung impairment. What is the study that is used to evaluate upper respiratory symptoms with new - 576289512 MultipleChoic e on1s0et wheeze? True 0 - 576289512 MultipleChoic e 10 Comments: Question 13 . Question : The following criterion is considered a positive finding whendetermining whether a patient with asthma can be safely monitored and treated at home: Student Answer : Age over 40 Fever greater than 101 Tachypnea greater than 30 breaths/minuteProductive cough - 576289 5 10 Multipl eC hoice 12 True 0 - 576289 5 10 Multipl eC hoice 12 Instructor Explanatio n: Decision Rule: CURB-65 provides framework for determining whether the patient diagnosed with community-acquired pneumonia can be safely monitored and treated at home. One point is awarded for each of the following factors present: • Confusion of new onset • BUN greater than 20mg/dL • Respiratory rate of ≥ 30 breaths/minute • Blood pressure is less than 90 mmHg systolic or diastolic ≤ 60 mm Hg • Age 65 or older Patients scoring 3 to 5 typically require hospitalization for observation and therapy. Scores of 0 to 1 indicate likelihood that outpatient management is appropriate. A score of 2 is inconclusive. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Points Received: Comments: 2 of 2 Question 14 . Question : Medications are chosen based on the severity of asthma. Considering the patient that is diagnosed with moderate persistentasthma, the preferred option for maintenance medication is: Student Answer: High-dose inhaled corticosteroid and leukotriene receptor antagonist Oral corticosteroid—high and low dose as appropriateShort acting beta2 agonist inhaler and theophylline Company, 11/2014. VitalBook file (page 214-216) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.( page 241) - 576289 5 Multipl eC hoice 13 True 09 0 - 576289 5 09 Multipl eC hoice 13 Comments: Question 16 . Question : Which of the following is considered a “red flag” whendiagnosing a patient with pneumonia? Student Answer : Fever of 102 Infiltrates on chest X-ray Pleural effusion on chest X- rayElevated white blood cell count - 576289 5 07 Multipl eC hoice 15 False 0 - 576289 5 07 Multipl eC hoice 15 17 . Points Re:ceived: Comments: c2hoifld2hood is likely to have which of the following: Instructor Explanatio n: With pneumonia, the chest film typically reveals an area of infiltrate. It is a red flag if a pleural effusion is also visualized, in which case adequate follow-up to exclude development of an empyema is mandatory. This often involves prompt referral to a pulmonologist for possible thoracentesis. Cultures and Gram stains of sputum are usually not ordered for outpatients. The white blood cell count is often elevated. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 214) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin- Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014- 01-14. VitalBook file. (page 240) Questio n Questio n A 23-year-old patient who has had bronchiectasis since - 576289506 MultipleChoic e 16 True 0 -576289506 MultipleChoic e 16 Points Received: Comments: 2 of 2 Student Answer : Barrel-shaped chestClubbing Pectus excavatum Prolonged capillary refill Instructor Explanatio n: In bronchiectasis, there is usually a history of chronic, productive cough. Sputum is typically mucopurulent and produced in increased amounts. Othercommon findings include shortness of breath, wheezing, fatigue, and possibly hemoptysis. Physical examination reveals rhonchi and/or wheezing.In advanced disease, clubbing and cyanosis may be present. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. DavisCompany, 11/2014. VitalBook file (page 216) - 576289 5 05 Multipl eC hoice 17 True 0 - 576289 5 05 Multipl eC hoice 17 Question 18 . Question : Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and anunintentional weight loss of 10 pounds over the last month. Thesesymptoms should prompt the clinician to suspect: Student Answer : Instructor Explanatio n: Dyspnea is the most common symptom associated with pleural effusion, but effusion may be accompanied by cough, pain, and systemic symptoms, such as malaise and fever. Abnormal physical findings become evident as the Points Received: Comments: 2 of 2 effusion increases in volume. These include decreased lung sounds, dullness over the effusion, decreased fremitus, egophony, and whispered pectoriloquy.With extremely large effusions, the mediastinum and trachea may shift to theopposite side. The exception involves effusion related to malignancy, in which case the mediastinum and trachea may be pulled toward the malignancy. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. DavisCompany, 11/2014. VitalBook file (page 217-218) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01- 14. VitalBook file.(page 232) - 576289 5 03 Multipl eC hoice 19 True 0 - 576289 5 03 Multipl eC hoice 19 Question 20 . Question : A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident.Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect: Student Answer : Pulmonary embolismPleural effusion Pneumothorax Fracture of ribs Instructor Explanati o n: Pneumothorax involves air in the pleural cavity. A pneumothorax can occur spontaneously in otherwise healthy individuals or be secondary to trauma or intrinsic lung disease. There is history of sudden onset of shortness of breath associated with chest pain. The patient usually presents in great distress, with tachycardia and tachypnea, and is often splinting the chest. There is decreased fremitus and increased hyperresonance on the affected side. Lung Points Received: Comments: 2 of 2 Instructor Explanation : The key symptom of IHD is chest pain, but other common symptoms include arm pain, lower jaw pain, shortness of breath, and diaphoresis. These symptoms are referred to as angina equivalents and can also include fatigue or breathlessness. Some patients may have no symptoms or atypical ones so that CAD may not be diagnosed until they experience a myocardial infarction. (Kennedy-Malone 227) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin- Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. Points Received: Comments: 2 of 2 - 572739 3 08 Multipl eC hoice 2 True 0 - 572739 3 08 Multipl eC hoice 2 Question 3 . Question : A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan mayinclude: Student Answer : Echocardiogram Exercise stress test Cardiac catheterization Myocardial perfusion imaging Instructor Explanatio n: Once all the results of the initial laboratory and ECG testing are reviewed, apretest probability of disease can be generated and additional tests can be ordered.2 The probability of CAD can be calculated by considering the chosen noninvasive test's sensitivity and specificity.2 Selection of the propercardiac test (see Table 115-1) for an individual depends on the person's risk stratification, age, and tolerable level of activity. The most common and least invasive test for diagnosis of CAD is the stress test, also called the exercise tolerance test (ETT) or treadmill exercise. (Buttaro 488) Buttaro, Terry, JoAnn Trybulski, Patricia Bailey, Joanne Sandberg-Cook. Primary Care, 4th Edition. Mosby, 2013. VitalBook file. - 572739 3 07 Multipl eC hoice 3 True 0 - Multiple C 3 takes Ibuprofen and rest that the chest pain does seem to ease off. Upon 572739 3 07 hoice Question 4 . Question : Jenny is a 24 year old graduate student that presents to the clinictoday with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she