Test Bank Advanced Practice Nursing in the Care of Older Adults 2 nd Edition Kennedy-Malon, Exams of Nursing

Download Test Bank Advanced Practice Nursing in the Care of Older Adults 2 nd Edition Kennedy-Malon and more Exams Nursing in PDF only on Docsity!

Test Bank Advanced Practice Nursing in the Care of Older Adults 2 nd^ Edition

Kennedy-Malone Questions And Answers

Test Bank Advanced

Practice Nursing in

the Care of Older

Adults 2

nd

Edition

Kennedy-Malone

A culture and sensitivity test reflects the presence of an infection and the antibiotic to which the organism is sensitive.

The calculation of creatinine clearance provides an estimation of renal function.

Uric acid level is elevated in the presence of gout.

3. Which of the following statements is true regarding diagnostic testing?
4. A test is ordered for a specific purpose.
5. A test is the most invasive available.
6. There is no need to discuss results with the patient.
7. If a test is needed, it should be ordered regardless of risk to the patient. - 3. Answer: 1 Page: 3

Feedback

The nurse practitioner should have a plan for the use of each test result value obtained.

When considering which laboratory tests to order, it is worth remembering the doctrine primum nonnocere— first, do no harm.

Once laboratory tests are available for review, tests results should be discussed with the patient, with abnormal test results interpreted for the aging individual and addressed with the patient and caregivers.

Any risks involved in laboratory testing must be considered concerning the patient's clinical condition and weighed against the test's expected benefits.

4. Janey, 25 years old, may experience arthritis differently than 65-year-old Mrs. Johnson because:
5. The body undergoes physiological changes with aging.
6. A healthy body does not experience significant changes as one gets older.
7. Older patients do not feel any systemic symptoms, such as malaise and weight loss.
8. 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
10. All of these are common morbidities. - 6. Answer: 4 Page: 5

Feedback

Heart disease is one of the common morbidities.

Cancer is common in the general population; however, specific types are more common in the older patient.

Diabetes is common in patients over 40 years of age.

9. A 70-year-old man is seeing a nurse practitioner because he is feeling weak and dizzy. The nurse practitioner is discussing a care plan with him and makes which of the following statements? Select all that apply.
   1. I want to order a test for your heart to evaluate its function.
   2. I will perform a thorough examination of your functional abilities.
   3. I will order a blood sugar test to check for diabetes.
   4. Many older people feel this way. It is to be expected.
   5. I will assess you for the presence of other conditions. - 9. Answer: 1, 2, 3, 5 Page: 2, 3

Feedback

A complete assessment will help differentiate signs of aging from disease.

All systems interact and can affect an existing condition.

Identifying underlying conditions will avoid undertreatment.

Attributing symptoms to aging can contribute to depression in an older person.

There are changes in the sympathetic response which contribute to the orthostasis and falls, as well as lack of hypoglycemic response.

10. The nurse practitioner is leading a class of seniors over age 65 years and is teaching about nutritional needs. One of the men asks why, even though he eats correctly according to the standards presented, he still feels weaker than he did 10 years ago. He also wonders why he gets more infections than he used to. Which of the following are helpful answers? Select all that apply.
    1. I suggest that you exercise a little more than you are currently doing.
    2. Some people experience a decrease in reserve energy.
    3. For some people, the immune system weakens.
    4. More viruses are being spread throughout the community.
    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.

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.

Although abnormal laboratory findings are often attributed to old age, rarely are they true aging changes.

Many factors can influence laboratory value interpretation in the elderly, including the physiological changes with aging, the prevalence of chronic disease, changes in nutritional and fluid intake, lifestyle (including activity), and the medications that are taken.

12. An elderly couple is discussing health concerns with the nurse practitioner. The couple is concerned that each of their individual blood studies show different results. One set of test results shows a significant decrease in blood sugar, but the test results of the partner does not show an equal

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

There should be a need for ordering a test and value attributed to the results.

The manifestations of illness and disease in the elderly can be very different, even if the underlying pathological process is the same as in younger individuals.

14. Mrs. Smith is 75 years old and has had type 2 diabetes for 30 years. She sees her nurse practitioner on a regular basis. Mrs. Smith asks the nurse practitioner why her treatment has not been changed, even though her laboratory values are seemingly out of normal range. Which of the following answers are best? Select all that apply.
    1. A decision to make changes must be based on a pattern and not on one set of laboratory results.
    2. The normal range charts are based on patients younger than 75 years.
    3. Currently, it is too expensive to change your treatment.
    4. Comparing new results with your prior results gives a more accurate picture.
    5. Normal values for laboratory tests differ as one gets older. - 14. Answer: 1, 4, 5 Page: 3

Feedback

Blood studies are more valuable when assessing for an increase or decrease in values.

It is not helpful to use aging as an explanation for possible abnormal results.

If a change in treatment is appropriate, the least expensive alternative should be sought.

Significant disturbances in the same individual may be detected through serial laboratory tests.

The clinician must determine whether a value obtained reflects a normal aging change, a disease, or the potential for disease.

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.2. 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

Immunizations are only one part of health promotion.

Health promotion occurs before the onset of disease.

Quality of life is the important focus of health promotion, not a prolongation of life.

2. The nurse practitioner knows that health promotion is accomplished on a broader scale by:
3. Maintaining current health services.
4. Maintaining federal legislation regarding health care at the current level.
5. Encouraging healthy lifestyle and healthy public policy formulation.

3. There is no reason to use these botanicals when opioids are proven effective.
4. This botanical is not on the Medicare list of approved medications. - 4. Answer: 2 Page: 6

Feedback

Although this botanical may not be approved by the U.S. Food and Drug Administration (FDA), its cost will depend on the distributor.

Medicare will only pay for A and B level recommendations that meet the USPSTF stringent evidence guidelines, leaving other beneficial interventions without coverage.

Opioids are not recommended for older patients.

It is important to use only prescribed and approved medications/treatments.

5. When a patient is seen by a nurse practitioner, the care plan is developed keeping which of the following objectives in mind?
6. Increasing the use of the emergency department for injuries from falls.
7. Maintaining the patient living in his or her home.
8. Increasing safety checks in the home.
9. Increasing use of the Welcome to Medicare visit. - 5. Answer: 4 Page: 6

Feedback

The objective is to decrease the use of the emergency department for falls.

There are many factors involved in the decision for an older adult to remain in the home.

Although it is useful to conduct home safety checks, they are not part of the Healthy People 2020 objectives.

The Healthy People 2020 program has set specific objectives for prevention in older adults; use of the Welcome to Medicare visit is one of those objectives.

6. The focus of advanced nurse practitioners is primary care. This is defined as activities that focus on:
7. Preventing the occurrence of a disease or condition.
8. Treating an illness after symptoms appear.
9. Enabling the patient to recover and convalesce.

4. Enriching the patient's appreciation of life. - 6. Answer: 1 Page: 7

Feedback

Primary preventive strategies focus on immunization, well-checks, and other health maintenance activities.

Secondary preventive strategies focus on prevention and treatment of illness.

Tertiary preventive strategies focus on rehabilitation.

Nurse practitioners focus on the wellness-illness continuum.

7. A health promotion topic included in the nurse practitioner visit is physical activity. Which of the following would be a good recommendation for the 75-year-old male? Select all that apply.
   1. Skydiving
   2. Horseback riding
   3. Swimming
   4. Dancing
   5. Whatever the patient is willing and able to do - 7. Answer: 3, 4, 5 Page: 7

Feedback

Skydiving is risky for older patients who may have cardiovascular issues.

Horseback riding could be risky for an older person who may have neurological or orthopedic issues.

Swimming is a good option if the patient is willing.

Dancing is a good option if the person is able.

When recommending physical activity, the person's functional abilities and desires need to be considered.

8. Understanding that the current life expectancy is 79 years, the nurse practitioner plans a patient's health promotion while considering which of the following? Select all that apply.
   1. Patient's health beliefs and goals.
   2. Present levels of function.
   3. Benefit of treatment.
   4. Patient's involvement in a religious community.

10. While counseling a patient about physical activity, the nurse practitioner considers which of the following? Select all that apply.
    1. A physical activity prescription that is individualized to the patient.
    2. Active hobbies that the patient enjoys.
    3. Alternative activities such as yoga or tai chi.
    4. Armchair activities for the frail older adult.
    5. Patient's ability to pay for involvement in activities. - 10. Answer: 1, 2, 3, 4 Page: 7
    6. Answer: 1, 2, 3, 4 Page: 7

Feedback

Each person is unique and may not respond the same to exercise.

Hobbies are enjoyable and give pleasure, while at the same time increasing activity.

Stretching routines are done slowly and to the level of endurance.

When the frail older person cannot ambulate, they can move other parts of their body such as core, arms, head, and neck. They may also do non-weight-bearing movements of legs and feet.

Movement, activity, and exercise can be done anywhere, anytime the individual desires. There is no need to join a group.

11. Nutrition counseling is part of health promotion. The nurse practitioner considers a teaching plan that includes which of the following information? Select all that apply.
    1. Level of involvement in community activities.
    2. Baseline information on current dietary intake.
    3. Current activity patterns.
    4. Current height and weight.
    5. Health status information. - 11. Answer: 2, 3, 4, 5 Page: 7, 8

Feedback

Active involvement in community activities does not reflect what the older person is eating.

The nurse practitioner needs the current state of nutrition to develop a plan for increasing or maintaining positive nutrition.

Knowing how much activity the person has affects the need for calories and nutrients.

Knowing the current height and weight aids in determining the body mass index, which is an indicator of normal weight or overweight.

Before initiating counseling about diet, obtain baseline information on other health status information.

12. A major concern for older adults is safety. The nurse practitioner addresses safety issues when assessing the following. Select all that apply.
    1. Presence of a gun in the home.
    2. Fear of falling.
    3. Strength of the patient.
    4. Presence of rugs and other hazards in the home.
    5. Urinary incontinence. - 12. Answer: 1, 2, 3, 4, 5 Page: 8

Feedback

Possession of a firearm combined with depression, caregiver stress, irreversible illness, or decline in functional abilities can invite self-inflicted injury, suicide pacts, or other acts of violence.

Fear of falling causes a person to walk guardedly and unevenly.

Potential recommendations include exercise programs to build strength.

Rugs, furniture, and pets can become obstacles for the older person to stumble over.

Urinary incontinence, day or night, causes the person to rush to the bathroom and increases the risk of falling.

13. Albert is 72 years old and complains of burning upon urination. He has recently returned from a vacation to another country. The nurse practitioner conducts a physical examination and observes that there is a white discharge from his penis. What does the nurse practitioner include in the treatment plan? Select all that apply.
    1. Teaching on safe sex practices.
    2. Teaching about the incidence of contracting sexually transmitted infections (STIs), even at an older age.
    3. Teaching that frequent testing and screening is needed if he continues to be sexually active.
    4. Assuring the patient that while traveling there are limited opportunities for sexual encounters.
    5. There is no need to assess an older patient's sexual preferences and practices. - 13. Answer: 1, 2, 3 Page: 8

2. Persons over the age of 50 years should have a yearly influenza vaccine.
3. The new Shingrix vaccine will help protect her from shingles.
4. The side effects of immunizations outweigh the benefits of immunizations.
5. The pneumococcal vaccine is given as a one-time dose. - 14. Answer: 1, 2, 3 Page: 12

Feedback

The older person is susceptible to organisms that cause infection due to decreased immunity, nutrition, hydration, and other factors.

The influenza virus mutates each year and an updated version of the vaccine is needed to provide immunity. Influenza vaccine is now recommended annually for all adults over 50 years old, unless contraindicated.

Recently released Shingrix has been found to be more effective than the Zostavax, which was given previously.

Side effects are most often mild and localized. Viruses can cause serious or even lethal conditions.5. Pneumococcal vaccine is recommended as follows: Administer one-time dose to PCV13-naive adults at age 65 years, followed by a dose of PPSV23 12 months later.

1. Mrs. Keating is a 70-year-old woman suffering from arthritis. She is seeing the nurse practitioner for her regular checkup. For a person with chronic degenerative conditions, which of the following should the nurse suggest for health promotion?
   1. Take herbal supplements.
   2. Increase physical activity.
   3. Take Aleve.
   4. Get a massage. - 1. Answer: 2 Page: 19

Feedback

Although there may be some herbal supplements that can help with arthritis, this is not the best suggestion because it does not promote increased physical activity.

Increased physical activity in older adults promotes wellness and quality of life.

Medication may be helpful for relief of symptoms but does not necessarily promote increased physical activity, which can help lead to better health.

Massage may provide temporary relief for arthritic joints, but physical activity is what can help lead to better health.

2. Many adults find reasons or barriers for not being able to exercise. Which of the following is an example of a patient barrier?
   1. Good health, no functional limitations.
   2. Insurance incentive.
   3. High body mass index (BMI).
   4. Frequent contact with prescriber. - 2. Answer: 3 Page: 20

Feedback

Good health, no functional limitations is an example of a patient facilitator because it is not counterintuitive to pursuing good health.

Insurance incentive is an example of a patient facilitator because it provides incentive for the patient.

High BMI is an example of a patient barrier because it is something that may seem insurmountable to a patient.

Frequent contact with the prescriber is an example of a patient facilitator because it provides accountability in the pursuit of good health.

3. Mr. Osorio is a 65-year-old male who recently retired because of a medical condition. He has good family support and is very motivated to start a wellness program to prevent worsening of his condition. These factors are an example of:
   1. Barriers
   2. Incentives
   3. Positive self-efficacy
   4. Facilitators - 3. Answer: 4 Page: 20

Feedback

Barriers are things that prevent or hinder patients from exercising.

Incentive is one kind of patient facilitator, like family support.

Positive self-efficacy is another kind of patient facilitator, like family support.

Facilitators are things that help a patient desire exercise and health promotion, so these are facilitators.

4. The American College of Sports Medicine (ACSM) has designed programs to incorporate exercise into every patient encounter. Which of the following is the correct phrase for this program?