Health and Wellness of Older Adults: Symptoms, Promotion, and Challenges, Exams of Nursing

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NURS 6540 Exam Study Guide Advanced

Practice Care of Frail Elders, Elders Final

Review Full Chapter Questions AND

ANSWERS

1. Mrs. Smith, 75 years old, reports that she is weak, has difficulty urinating, and is dehydrated. Although she is afebrile, the nurse conducts a thorough physical examination, including urinalysis and complete blood count (CBC). The total assessment is necessary because:
   1. All body systems interact, and symptoms could indicate a variety of diagnoses.
   2. The symptoms are vague and may be signs of aging.
   3. There may be other signs or symptoms more indicative of the condition.
   4. Mrs. Smith may not be reporting all significant information. - 1. Answer: 1 Page: 2 Feedback

The clinician must be aware that all the systems interact and, in doing so, can increase the older person's vulnerability to illness/disease. 2. The nurse must not attribute symptoms only to the aging process.

There may be comorbidities accompanying this condition.

4. Assumptions of not reporting properly may not be true.
5. A patient with renal disease has blood work drawn, and the results show an increase in serum creatinine. The nurse practitioner needs to know which of the following laboratory values before ordering medications?

1. CBC

2. Culture and sensitivity of the urine
3. Creatinine clearance
4. Uric acid levels - 2. Answer: 3 Page: 3 Feedback

A CBC will not evaluate kidney function for a patient with renal disease.

3. A healthy body does not experience significant changes as one gets older.

4. Older patients do not feel any systemic symptoms, such as malaise and weight loss.

5. Even though the same joints are usually affected, age makes it feel different. - 4. Answer: 1 Page: 5 Feedback

Knowledge of the bimodality of age onset of certain disease conditions will aid the advanced practice nurse in avoiding misdiagnosis or delay in diagnosis due to lack of recognition.

Symptoms of rheumatoid arthritis may be different depending on the age of the patient.

Younger patients may not experience constitutional symptoms such as fever, malaise, weight loss, and depression.

In late-onset rheumatoid arthritis, the joint involvement is more often in the larger joints.

5. The nurse practitioner is examining an 85-year-old man with reports of abdominal pain, weakness, and loss of appetite. Which is the most likely condition to be tested for and ruled out?
6. Neoplasms and carcinomas
7. Partial seizure
8. Sarcopenia
9. Hirschsprung's disease - 5. Answer: 1 Page: 4 Feedback

Certain diseases, such as neoplasms and carcinomas, are more common in the elderly, and an understanding of the epidemiology is critical in the interpretation.

Partial seizure is more common in early old age.

Sarcopenia is more common in early old age.

Hirschsprung's disease is most common in infancy.

6. For individuals over 65 years old, the most common morbidities are related to:
7. Heart disease, arthritis
8. Respiratory problems, cancer
9. Diabetes, stroke

Heart disease, cancer, and diabetes combined are the most common morbidities in older patients.

7. A gerontological patient is being examined for a report of pain in the shoulder. The nurse practitioner completes a thorough systemic examination because:
   1. Older patients with one morbidity often express difficulties in general.
   2. Arthritis of the shoulder is accompanied by other neurological symptoms.
   3. Older patients with arthritis often experience pain in lower extremities.
   4. The patient may not report significant signs and symptoms. - 7. Answer: 1 Page: 5 Feedback

Older patients with late-onset rheumatoid arthritis experience joint involvement more often in the larger joints, such as the shoulder, and they also experience systemic symptoms such as fever, malaise, weight loss, and depression. 2. Older patients may express symptoms in any other physical systems.

Patients more often experience arthritis in smaller joints.

4. A thorough examination will detect objective indicators.
5. The nurse practitioner performs a thorough systemic examination of a patient who reports diarrhea and pain in the upper left quadrant of the abdomen. One possible diagnosis would be:
   1. Hirschsprung's disease
   2. Pancreatitis
   3. Appendicitis
   4. Gastrointestinal inflammatory bowel disease (GIBD) - 8. Answer: 4 Page: 5

Feedback

Hirschsprung's disease is an obstruction of the colon in infancy. 2. Diarrhea is not associated with pancreatitis.

Appendicitis is more common in younger patients than in older patients.

GIBD is manifested differently in a bimodal pattern.

5. I suggest that you see your primary caregiver for extensive testing. - 10. Answer: 2, 3, 5 Page: 2, 3 Feedback

Improved nutrition may not be the factor affecting health of elders. 2. Many factors can influence the health of elders, including lifestyle and medications.

Many factors can influence the health of elders, including changes in the immune system.

Viruses and other infections are not the only considerations for infections.

Biochemical individuality is important in detecting asymptomatic abnormalities in older adults. Significant homeostatic disturbances in the same individual may be detected through serial laboratory tests, even though all individual test results may lie within normal limits of the reference interval for the entire group.

11. An older woman is seen in the ambulatory clinic for a routine checkup. The patient asks about results of her blood work compared to last year's results. How is it best for the clinician to respond? Select all that apply.
    1. They are likely to be the same if you have had no diseases since then.
    2. Blood work results may be different just because of your aging process.
    3. Your results may be different because the body changes with disease and medications you are taking.
    4. Blood work is not a reliable indicator of health because many things can affect your health that may not show up in the results of your blood work.
    5. There is likely no significant difference as your body remains stable in its functioning. - 11. Answer: 2, 3 Page: 4, 5 Feedback

Biochemical individuality variation is often much smaller than variation within the larger group.

The aging process and decline in organ function may affect the health of elders.

Disease, nutrition, and medications affect the health of elders.

decrease. Their physician does not seem concerned, and the couple is wondering why. How is it best for the nurse practitioner to respond? Select all that apply.

1. Studies show that each person's pattern of chemical make-up is different.
2. There is no difference between one person's range of blood results and that of any other person.
3. Each person's chemical make-up is the same as that of others of the same gender and age group.
4. Many factors affect an individual's chemical make-up.
5. Ranges of the values provided by the laboratory are correct for any age. - 12. Answer: 1, 4 Page: 2, 3 Feedback

Individuals experience smaller variations in laboratory work than from the others in the same age group.

There are wider variations of laboratory results within a group of older people.

Laboratory values are determined by more than age and gender. 4. Laboratory values may vary as a result of nutrition, activity, and emotional status.

The reference values presented for the older adult cohort are not necessarily correct for the individual due to biochemical individuality.

13. Adam, 70 years old, is admitted for possible myasthenia gravis (MG). The nurse practitioner knows that MG is commonly seen in women between 20 and 40 years old. Adam, however, is experiencing an ocular form of MG, has dysphonia, and does not have any thymus abnormalities. Adam asks why the nurse is concerned about MG since he is older and this is a "young person's disease." Which of the following are the best answers? Select all that apply.
14. We need to assess for anything, just in case.
15. Some diseases show up in two different age and gender groups.
16. Older people often experience weakness, and we must rule out other conditions.

4. Your insurance will cover this, and we want to rule out as much as possible.
5. Signs and symptoms of illness are the same for each disease regardless of age. - 13. Answer: 2, 3 Page: 5 Feedback

Ordering more tests than needed violates the principle of "Do no harm."

MG is bimodal and can be found in younger women, as well as in both men and women.

15. Mr. Adams is 90 years old. In the last few months he appears unable to comply with the health- care plan developed by the nurse practitioner. The nurse practitioner considers which of the following reasons for noncompliance when updating his home care plan? Select all that apply.
    1. Polypharmacy
    2. Treatment burden
    3. Attending multiple appointments
    4. Affording complex drug regimens
    5. Cognitive ability only - 15. Answer: 1, 2, 3, 4

Page: 5 Feedback

As a patient ages, this correlates with more medications having been ordered.

Patients with multimorbidity are known to have a treatment burden in terms of understanding and self- care management of their conditions.

Patients with multimorbidity are known to have a treatment burden in terms of understanding and self- care management of their conditions.

This burden entails affording complex drug regimens.

Though cognitive ability may be a factor, there is much more to consider when noncompliance is an issue.

1. A patient asks the nurse practitioner what is meant by health promotion. Which of the following is the nurse practitioner's best response? Health promotion:
   1. Includes activities that an individual performs proactively to increase health and well-being.
   2. Is a process of keeping track of immunizations.
   3. Includes a set of programs that help people cope with the disease.
   4. Includes strategies that prolong life. - 1. Answer: 1 Page: 6 Feedback

Health promotion includes not only preventive and health-protective measures, but also actualization of one's health potential

4. Encouraging the advancement of alternative health therapies. - 2. Answer: 3 Page: 6 Feedback

Current health policies are ever-changing to improve services for citizens.

Federal legislation is being proposed to increase health services.

The World Health Organization has determined that healthy lifestyle promotion works best when coupled with supportive environments, community action, and healthy public policy formation. 4. This does not include preventive and health-protective measures, nor actualization of one's health potential.

3. Mr. Thomas comes in for a health examination appointment with his nurse practitioner. He asks why nurse practitioners are qualified to conduct these evaluations. Which of the following is the nurse practitioner's best response? The nurse practitioner:
4. Is concerned about health and not disease.
5. Saves the physician time in the office.
6. Can assess for minor conditions and refer to the doctor for other conditions.
7. Is prepared to assess health holistically. - 3. Answer: 4 Page: 6 Feedback

The nurse practitioner is concerned about health promotion, disease prevention, and early diagnosis.

The nurse practitioner may spend more time with the patient than the doctor is able to.

The nurse practitioner is prepared to diagnose and plan treatment for many conditions.

The nurse practitioner brings a holistic orientation to health and wellness development and possesses knowledge of developmental tasks and the wellness-illness continuum.

4. Mrs. Williams, 80 years old, asks her nurse practitioner to order a new alternative therapy for her. Mrs. Williams believes that this botanical supplement will provide pain relief for her fibromyalgia. The nurse practitioner explains that this therapy is likely not covered by Medicare because:
   1. The botanical is expensive and not approved for use.
   2. Medicare only covers treatments that are approved according to the stringent guidelines of the U.S. Preventive Services Task Force (USPSTF).