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 2nd Edition Kennedy-Malone Questions And Answers Test Bank Advanced Practice Nursing in the Care of Older Adults 2nd Edition Kennedy-Malone 3. Younger patients may not experience constitutional symptoms such as fever, malaise, weight loss, and depression. 4. 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? 1. Neoplasms and carcinomas 2. Partial seizure 3. Sarcopenia 4. Hirschsprung's disease - 5. Answer: 1 Page: 4 Feedback 1. Certain diseases, such as neoplasms and carcinomas, are more common in the elderly, and an understanding of the epidemiology is critical in the interpretation. 2. Partial seizure is more common in early old age. 3. Sarcopenia is more common in early old age. 4. Hirschsprung's disease is most common in infancy. 6. For individuals over 65 years old, the most common morbidities are related to: 1. Heart disease, arthritis 2. Respiratory problems, cancer 3. Diabetes, stroke 4. All of these are common morbidities. - 6. Answer: 4 Page: 5 Feedback 1. Heart disease is one of the common morbidities. 2. Cancer is common in the general population; however, specific types are more common in the older patient. 3. Diabetes is common in patients over 40 years of age. 4. 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 1. 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. 3. Patients more often experience arthritis in smaller joints. 4. A thorough examination will detect objective indicators. 8. 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 1. Hirschsprung's disease is an obstruction of the colon in infancy. 2. Diarrhea is not associated with pancreatitis. 3. Appendicitis is more common in younger patients than in older patients. 4. GIBD is manifested differently in a bimodal pattern. 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 1. A complete assessment will help differentiate signs of aging from disease. 2. All systems interact and can affect an existing condition. 3. Identifying underlying conditions will avoid undertreatment. 4. Attributing symptoms to aging can contribute to depression in an older person. 5. 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 1. Improved nutrition may not be the factor affecting health of elders. 2. Many factors can influence the health of elders, including lifestyle and medications. 3. 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. 4. There should be a need for ordering a test and value attributed to the results. 5. 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 1. Blood studies are more valuable when assessing for an increase or decrease in values. 2. It is not helpful to use aging as an explanation for possible abnormal results. 3. If a change in treatment is appropriate, the least expensive alternative should be sought. 4. Significant disturbances in the same individual may be detected through serial laboratory tests. 5. 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 1. 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. 3. Patients with multimorbidity are known to have a treatment burden in terms of understanding and self- care management of their conditions. 4. This burden entails affording complex drug regimens. 5. 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 1. Health promotion includes not only preventive and health-protective measures, but also actualization of one's health potential 2. Immunizations are only one part of health promotion. 3. Health promotion occurs before the onset of disease. 4. 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: 1. Maintaining current health services. 2. Maintaining federal legislation regarding health care at the current level. 3. Encouraging healthy lifestyle and healthy public policy formulation. 4. Encouraging the advancement of alternative health therapies. - 2. Answer: 3 Page: 6 Feedback 1. Current health policies are ever-changing to improve services for citizens. 2. Federal legislation is being proposed to increase health services. 3. 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: 1. Is concerned about health and not disease. 2. Saves the physician time in the office. 3. Can assess for minor conditions and refer to the doctor for other conditions. 4. Is prepared to assess health holistically. - 3. Answer: 4 Page: 6 Feedback 1. The nurse practitioner is concerned about health promotion, disease prevention, and early diagnosis. 2. The nurse practitioner may spend more time with the patient than the doctor is able to. 3. The nurse practitioner is prepared to diagnose and plan treatment for many conditions. 4. 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). 5. Primary disease or condition affecting the patient. - 8. Answer: 1, 2, 3 Page: 6 Feedback 1. The nurse practitioner develops a collaborative plan that includes consideration of the patient's health beliefs and goals. 2. The nurse practitioner considers present and anticipated levels of function. 3. Risks need to be considered in light of benefits offered by interventions. 4. The nurse practitioner may consider whether the patient is connected to a religious community but cannot prescribe or recommend any specific plan. 5. Many disorders in older adults encompass multiple risk factors that involve several systems and interventions to achieve outcomes; this presents a challenge when measuring and synthesizing evidence, and reporting outcomes. 9. As the nurse practitioner is teaching about the need for more exercise, the patient says that it takes away too much energy needed for other activities. The nurse practitioner explains that the benefits of exercise include which of the following? Select all that apply. 1. Increased flexibility. 2. Increased muscle mass. 3. Maintenance of optimal weight. 4. Lower blood pressure. 5. Decreased urinary output. - 9. Answer: 1, 2, 3, 4 Page: 7 Feedback 1. The health benefits of regular physical activity are well documented and include flexibility. 2. Exercise increases muscle tone and mass. 3. Exercise uses calories from stored fat and allows for weight loss. 4. Exercise strengthens the cardiac muscle and thereby lowers blood pressure. 5. Exercise does not affect urinary output. 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 10. Answer: 1, 2, 3, 4 Page: 7 Feedback 1. Each person is unique and may not respond the same to exercise. 2. Hobbies are enjoyable and give pleasure, while at the same time increasing activity. 3. Stretching routines are done slowly and to the level of endurance. 4. 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. 5. 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 1. Active involvement in community activities does not reflect what the older person is eating. 2. The nurse practitioner needs the current state of nutrition to develop a plan for increasing or maintaining positive nutrition. 3. Knowing how much activity the person has affects the need for calories and nutrients. 4. Knowing the current height and weight aids in determining the body mass index, which is an indicator of normal weight or overweight. 5. 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 1. 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. 2. Fear of falling causes a person to walk guardedly and unevenly. 3. Potential recommendations include exercise programs to build strength. 4. Rugs, furniture, and pets can become obstacles for the older person to stumble over. 5. 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. 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 1. Good health, no functional limitations is an example of a patient facilitator because it is not counterintuitive to pursuing good health. 2. Insurance incentive is an example of a patient facilitator because it provides incentive for the patient. 3. High BMI is an example of a patient barrier because it is something that may seem insurmountable to a patient. 4. 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 1. Barriers are things that prevent or hinder patients from exercising. 2. Incentive is one kind of patient facilitator, like family support. 3. Positive self-efficacy is another kind of patient facilitator, like family support. 4. 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? 1. Back to Exercise 2. Health and Wellness 3. Exercise is Medicine 4. Exercise is Wellness - 4. Answer: 3 Page: 20 Feedback 1. Back to Exercise is not the correct phrase for the program the ACSM designed. 2. Health and Wellness is not the correct phrase for the program the ACSM designed. 3. Exercise is Medicine is the correct phrase for the program the ACSM has designed to incorporate discussion of exercise into patient encounters. 4. Exercise is wellness is not the correct phrase for the program the ACSM designed. 5. Which of the following should nurse practitioners suggest to counter common patient excuses for not exercising? 1. Join a gym. 2. Find an exercise "buddy." 3. Take a 10-minute walk every day. 4. Go to the YMCA. - 5. Answer: 3 Page: 20 Feedback 1. Joining a gym is not the best suggestion to counter excuses not to exercise because having to go to the gym may become another excuse. There may also be financial and transportation issues adding to the reasons not to exercise. 2. Finding an exercise "buddy" may be helpful but still may impose the excuse of not being able to find one. 3. Taking a 10-minute walk every day is the best suggestion. With this suggestion a patient cannot make the excuse of not having time or equipment. 4. Going to the YMCA is not the best suggestion to counter excuses for the same reasons as joining a gym is not the best suggestion. 6. Older adults who have chronic conditions and are considering an increase in their physical activity should: 1. Start slowly, using lower weights with high repetitions. 2. Consult with a personal trainer. 3. Consult a health-care provider to help set physical activity goals that are realistic and safe. 4. Start with low repetitions but heavier weights. - 6. Answer: 3 Page: 21 Feedback 1. Starting slowly with low weights and high repetitions may be a good start but must be monitored or initiated by an appropriate medical professional for instruction in proper use. 2. A consultation with a personal trainer is not the best option because some trainers may not be familiar with chronic conditions. 3. Consulting a health-care provider for physical activity goals that are realistic and safe is the best option. 4. Starting with low repetitions but heavier weights is not a good way to start an exercise program because it may result in injury. 7. Challenges to increasing physical activity are different for everyone. For instance, some patients may be experiencing depression or loss, some may have had significant life changes, and others may be dealing with functional limitations. As relates to increasing physical activity, these are examples of what? 1. Patient excuses 2. Patient facilitators 3. Patient ignorance regarding what to do 4. Patient barriers - 7. Answer: 4 Page: 20 various symptoms, such as shortness of breath and dizziness during exercise. Though it is not a contraindication for exercise therapy, its symptoms could be a barrier. 11. Which of the following may be included in the healthy lifestyle counseling during the initial Welcome to Medicare visit? Select all that apply. 1. Level of physical activity assessment. 2. Physical therapy consultation. 3. Referral to an herbalist. 4. Referral to a health coach. 5. Referral to an acupuncturist. - 11. Answer: 1, 2, 4 Page: 20 Feedback 1. Current level of physical activity is assessed during the initial Welcome to Medicare visit. 2. Physical therapy consultation may be recommended for patients with disabilities or functional limitations. 3. Referral to an herbalist is not part of the initial Welcome to Medicare visit. 4. Referral to a health coach may be recommended to patients during the initial Welcome to Medicare visit to keep them engaged. 5. Referral to an acupuncturist is not part of the initial Welcome to Medicare visit. 12. Incorporating exercise into patients' lifestyles can be effectively achieved by including which of the following in your discussions with patients? Select all that apply. 1. Talking about the importance of exercise. 2. Encouraging goal setting and self-monitoring by the patient. 3. Recommending the purchase of exercise equipment to use at home. 4. Informing the patient about resources that are available in the community for group exercise. 5. Giving an illustration of the exercises. - 12. Answer: 2, 4 Page: 21 Feedback 1. Handing a program or exercise prescription to the patient is more effective than just talking about it. 2. Goal setting and self-monitoring by the patient is very effective in persuading the patient to adopt a healthy lifestyle. 3. Recommending the purchase of exercise equipment to use at home may not be the best approach for different reasons, such as financial ability. 4. Informing patients about the resources that are available in the community for group exercise is a valuable adjunct to counseling. 5. Though not listed as something that could promote exercise, giving the patient illustrations for the exercise could be helpful when it is demonstrated and explained. 13. The goal of increasing physical activity is to promote a healthy lifestyle. Which of the following options help reduce the risk of injuries? Select all that apply. 1. Choosing physical activities that are appropriate for their current fitness level and health goals. 2. Remaining under the care of a health-care provider if they have chronic conditions or symptoms. 3. Choosing to do physical activities their friends are doing. 4. Enlisting spousal supervision and support. 5. Hiring a personal trainer. - 13. Answer: 1, 2 Page: 22 Feedback 1. Choosing to do types of physical activities that are appropriate for a patient's current fitness level and health goals helps reduce the risk of injuries. 2. Being under the care of a health-care provider if a patient has chronic conditions or symptoms helps reduce the risk of injuries. 3. Choosing to do types of physical activities one's friends are doing is not the best option in reducing risk for injuries because of differences in physical ability or medical conditions. 4. Being under the supervision of one's spouse for support is a good facilitator, but it is not the best option in reducing the risk for injures because a spouse may not understand the impact of physical activity on physical and medical conditions. 5. A personal trainer may not have the proper training for more complicated conditions. 14. The AHA Council on Nutrition, Physical Activity, and Metabolism identified patient facilitators to increasing physical activity in older adults. Which of the following is an example of patient facilitators? Select all that apply. 1. Frequent contact with prescriber. 2. Planned program. 3. Making time. 4. Purchasing new equipment. 5. Ignorance of exercise. - 14. Answer: 1, 2 Page: 20 Feedback 1. Frequent contact with a prescriber has been seen to be a patient facilitator. 2. A planned program has resulted in facilitation toward health motivation. 3. Making time is a patient choice rather than a facilitator toward making changes. 4. Purchasing new equipment is not an example of a patient facilitator and may not be doable for all patients. 5. Ignorance of what to do is not a patient facilitator but a barrier to increasing physical activities. 15. To perform physical activity safely and reduce the risk of injuries and other adverse events, which of the following are advisable? Select all that apply. 1. Start fast to get acclimated to the activities. 2. Use their instincts. 3. Use appropriate protective gear. 4. Follow rules and policies. 5. Have an exercise "buddy." - 15. Answer: 3, 4 Page: 21 Feedback 1. Starting fast could actually increase the possibility of injury. 2. There is no guarantee that instincts are correct. 3. Using appropriate protective gear is recommended to reduce the risk of injuries. 4. Rules and policies are made to inform and protect, therefore, following them will help to reduce the risk of injuries. 5. 5. Jane, 83 years old, comes to the clinic with her daughter for a geriatric assessment. The daughter asks about the necessity of this comprehensive assessment. The clinician explains that a CGA is a multidimensional process to: 1. Identify care needs and plans of care for older people. 2. Acquire information about past medical conditions. 3. Determine which diagnostic tests are necessary. 4. Satisfy requirements of Medicare. - 5. Answer: 1 Page: 26 Feedback 1. The CGA is a multidimensional, interdisciplinary, and diagnostic process to identify needs and plan outcomes. 2. The CGA includes information from medical history, as well as the current assessment. 3. The CGA helps identify diagnostics, treatments, and other plan-of-care strategies. 4. The CGA is not a requirement of Medicare. 6. Mary Jane is seeing a nurse practitioner for a CGA and asks which parts of her life will be examined. The nurse practitioner says the domains of the CGA include: 1. Internal organ health. 2. Social habits. 3. Physical and psychological health, as well as other facets of life. 4. History of family illness. - 6. Answer: 3 Page: 27 Feedback 1. The CGA includes more than internal health. 2. Learning about social habits is not the only component in determining health. 3. Domains of CGA include physical health, psychological health, socio-environmental supports, mobility, functional status, and a measure of the quality of life. 4. Although family health history provides information about genetics, the CGA is complete and includes current health status in several domains. 7. In conducting a CGA, the nurse practitioner looks for any impairments in communication with the patient. The assessment includes: 1. Interviewing prior to the physical examination. 2. Asking questions of the accompanying family member. 3. Reading the history forms provided by the patient after the examination. 4. Observing physical impairments. - 7. Answer: 1 Page:26 Feedback 1. Interviewing begins before the physical examination and continues throughout the examination. 2. Permission from the patient must be obtained before discussing anything with the family member. 3. When forms about the history of the patient are brought in, the nurse practitioner should review them before the examination. 4. Observation alone will not provide adequate information about communication impairments. 8. When an assessment is conducted, which of the following needs to be recorded when a new concern is identified? Select all that apply. 1. Location and radiation. 2. Quantity and quality. 3. Aggravating and alleviating. 4. Signs and symptoms. 5. Effect on financial status. - 8. Answer: 1, 2, 3, 4 Page:27 Feedback 1. A comprehensive assessment includes the location and radiation of the symptom. 2. A comprehensive assessment includes the quantity and quality of the symptom. 3. A comprehensive assessment includes aggravating and alleviating factors. 4. Associated signs and symptoms are included in a comprehensive assessment. 5. Financial concerns are considered after the findings of the assessment are understood. 9. After examining Adam, who is 79 years old, the nurse practitioner uses which of the following criteria to adjust Adam's medications? Select all that apply. 1. The Beers Criteria published in 1991 2. Medication Appropriateness Index 3. STOPP/START Criteria 4. HHS Guide to Geriatric Medications 5. Hospital formulary - 9. Answer: 2, 3 Page: 27 Feedback 1. The Beers Criteria, 1991, was revised in 2015. Other criteria were also developed to address weaknesses found in the original Beers Criteria. 2. The Medications Appropriateness Test was developed to address some of the weak areas of the Beers Criteria. 3. The STOPP/START Criteria were developed to determine when medications should be added and when another might be discontinued for an older patient. 4. The HHS Guide to Geriatric Medications does not guide in medication prescribing. 5. Hospital formulary provides a list of medications carried within that hospital. 10. While examining John, who is 80 years old, the nurse practitioner observes that as he rises from the chair he pauses and holds on to the rail. Asking John if this happens often, he replies, "Yes, I get lightheaded and feel like I will fall." The nurse practitioner decides to conduct testing for orthostatic hypotension. This test includes which of the following? Select all that apply. 1. Having the patient lie down for 5 minutes, then measuring blood pressure and pulse. 2. Having the patient stand and wait a minute, then measuring blood pressure and pulse. 3. Having the patient jump in place for 2 minutes and then lie down. 4. Having the patient breathe deeply five times and then stand up. 5. Having the patient get up from his chair without using his arms, walk two to three steps, then back up to his chair and sit down. - 10. Answer: 1, 2 Page:27 Feedback 1. Obtaining baseline blood pressures is important to assess any changes. 2. 1. Basic self-care. 2. Mobility. 3. Continence. 4. Ability to cook a meal. 5. Ability to interact with others within the community. - 14. Answer: 1, 2, 3 Page:30,31 Feedback 1. The ability to bathe and dress oneself is a basic daily need. 2. The ability to move around and walk safely is a basic daily need. 3. The ability to maintain urinary and bowel control is a basic daily need. 4. It is not a basic daily need to be able to cook. It is possible to eat food that does not require cooking. 5. Industrial ADLs measure community interactions within the home and outside the home. 15. The nurse practitioner performs a holistic assessment on an older patient. One component of this assessment is spirituality. Which of these options is appropriate to use to assess any spiritual needs? Select all that apply. 1. Use the HOPE assessment tool: source of Hope, a participant in an Organized religious group, Personal spirituality, Effect of spirituality on health care. 2. Ask the patient, "Are you at peace?" 3. Call a chaplain to conduct the assessment. 4. Wait until a sign of distress appears and then evaluate the source. 5. Administer the FICA assessment of spiritual needs. - 15. Answer: 1, 2, 5 Page:31 Feedback 1. HOPE is an acceptable assessment tool for spiritual distress. 2. Asking a direct question that is not directed at a specific faith or religion is appropriate. 3. Chaplains are helpful, but the nurse practitioner can make a basic assessment of a patient. 4. An early assessment can help to avoid distress by implementing comfort measures early. 5. FICA (Puchalski & Romer, 2000): Faith or belief, Importance or influence, Community Address is an acceptable assessment tool. 1. Geriatric assessments can be challenging for the health-care provider due to delay of recognition and/or reporting of symptoms by the patient. Which of the following best describes what is used by health-care providers to address this differential? 1. Clinical decision-making tools. 2. When symptoms were noticed. 3. Change in function and impact of symptoms. 4. Symptoms from comorbidities. - 1. Answer: 3 Page: 34 Feedback 1. Using clinical decision-making tools can be complicated because of different factors, such as patient denial of symptoms and their occurrences. 2. Using the time symptoms were noticed as the basis for assessment cannot be deemed an effective tool due to inaccuracies regarding the report of when symptoms first occurred. 3. Change in function as a measure of the impact of a symptom on the patient is an effective means of sorting out the differential. 4. Comorbidities can result in a delayed or atypical presentation. 2. Which of the following terms refers to conditions that have multiple underlying factors and may involve multiple organs? 1. Multifaceted syndrome 2. Aging syndrome 3. CFM syndrome 4. Geriatric syndrome - 2. Answer: 4 Page: 34 Feedback 1. Multifaceted syndrome is not the correct term, although conditions reflect the many contributing aspects to health care. 2. Aging syndrome is not the correct term, although aging may be a contributing factor to the condition. 3. CFM syndrome is not the correct term, although conditions may have cognitive, functional, and mobility impairments. 4. Geriatric syndrome is the term that refers to the conditions that have multiple underlying factors that may involve multiple organs. 3. Mrs. Rizzo is an 80-year-old Caucasian female who is presenting symptoms of chest pain, weakness, and lightheadedness. Which of the following may be a possible differential diagnosis of her symptoms? 1. Ischemic colitis 2. Spinal cord compression 3. Diabetic neuropathy 4. Costochondritis - 3. Answer: 4 Page: 38, 39 Feedback 1. Ischemic colitis is a possible differential diagnosis for fecal incontinence. 2. Spinal cord compression is a possible differential diagnosis for fecal incontinence. 3. Diabetic neuropathy is a possible differential diagnosis for fecal incontinence. 4. Costochondritis is the possible differential diagnosis for her symptoms of chest pain, weakness, and lightheadedness. 4. Steven is a 65-year-old male diagnosed with Parkinson's disease. He is taking anti- Parkinson's drugs, calcium supplements, and NSAIDs for his joint pain. Which of the following conditions could be caused by his medications? 1. Constipation 2. Hematuria 3. Headache 4. Chest pain - 4. Answer: 1 Page: 41 Feedback 1. Anti-Parkinson's drugs, calcium supplements, and NSAIDs are all known to cause constipation. 2. In older adult patients, the most common causes of hematuria are malignancy or benign prostatic hyperplasia. 3. Pruritus is an unpleasant, irritating, or itching sensation on the surface of the skin that may lead to a desire to scratch. Inflammation results from activation of the immune response. 4. Lichenification is the result of continued scratching and causes thickening of the skin. 9. Mr. Thomas noticed tremors in his right hand 2 years ago and attributed this to his elbow injury from a fall. The tremors have gradually worsened, and he now has tremors under his lip, some gait problems, and occasional stomach spasms. His wife has recently noticed these things and suggested he have a medical consultation. Which of the following reasons might Mr. Thomas have had for ignoring these symptoms? Select all that apply. 1. Fear of loss of independence 2. Fear of doctors 3. Symptoms do not interfere with functions 4. Attributes symptoms to the aging process 5. Lack of transportation - 9. Answer: 1, 3, 4 Page: 34 Feedback 1. Fear of loss of independence may result in older adults not seeking medical help for illnesses. 2. Fear of doctors is usually not a factor. 3. If symptoms do not interfere with one's ability to function, sometimes medical help will not be sought. 4. If an individual has a feeling that his symptoms are simply the results of aging, he may not feel there is a reason to seek medical help. 5. Not having transportation to get to the medical provider is not a factor because many facilities now have transportation services for patients who need it. 10. Mrs. Lee is experiencing moderate pain in her right leg and having difficulty sitting down on and standing up from a chair. She reports no other symptoms. Which of the following should be included in the assessment? Select all that apply. 1. Thorough medication history 2. Precipitating factors 3. Character of symptom 4. Family history 5. Social history - 10. Answer: 1, 2, 3 Page: 34 Feedback 1. Use of medications should be considered in formulating diagnostic possibilities. 2. Precipitating factors should be included in the assessment process as main descriptors to guide the diagnosis. 3. Character of symptoms are necessary descriptors to guide the diagnosis. 4. Family history, although helpful, is a secondary factor in the assessment process. 5. Social history would not provide helpful information for this physical condition. 11. When a patient is suffering from constipation, the clinician evaluates the etiology and contributing factors. Which of the following diagnoses are being ruled out in these evaluations? Select all that apply. 1. DVT 2. Fecal impaction 3. IBS 4. Botulism toxin 5. Bowel incontinence - 11. Answer: 2, 3 Page: 35, 37 Feedback 1. DVT is a condition that produces unilateral lower extremity swelling and tenderness.2. Fecal impaction is a differential diagnosis, so it needs to be ruled out. 3. IBS is a differential diagnosis that is being ruled out. 4. Botulism toxin is sometimes used for treatment of conditions arising from symptoms of chest pain, such as esophageal spasms. 5. Fecal or bowel incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. 12. Dizziness is an imprecise word used by patients to describe various subjective conditions. Care must be taken to establish what the patient means by dizziness in order to determine a diagnosis. Which of the following etiologies could be the cause of dizziness? Select all that apply. 1. Medications 2. Otolaryngologic conditions 3. Exercise 4. Psychiatric conditions 5. Hypothyroidism - 12. Answer: 1, 2, 4 Page: 51 Feedback 1. Some medications can cause dizziness. 2. Otolaryngologic conditions can result in symptoms of dizziness. 3. Exercise does not usually result in dizziness unless it is associated with other pathologies. 4. Psychiatric conditions can produce symptoms of dizziness. 5. Hypothyroidism (underactive thyroid) is a condition in which the thyroid gland doesn't produce enough of certain important hormones. Signs and symptoms of this condition may include fatigue, increased sensitivity to cold, constipation, dry skin, and weight gain, but not dizziness. 13. Joint pain is a condition that is caused by joint damage or injury that can interfere with movement. From which of the following etiologies may joint pain arise? Select all that apply. 1. Bursitis 2. Muscle spasm 3. Gout 4. Fractured humerus 5. Muscle strain - 13. Answer: 1, 3 Page: 72 Feedback 1. Bursitis is an inflammation of the fluid-field pads called bursa within the joint that can cause joint pain. 2. Muscle spasm is a condition that affects the muscles due to injury and does not necessarily cause joint pain. 3. Gout is a form of arthritis that causes joint pain. 4. practitioner explains to the staff that Mrs. Jones needs frequent assessment of her skin and protection provided to prevent skin breakdown because: 1. Her lack of activity causes the skin to tear. 2. Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such as the face, hands, and sacrum. This can result in injury. 3. She has lost weight and is in jeopardy of falling. 4. She picks at herself and causes skin breakdown. - 2. Answer: 2 Page: 96 Feedback 1. Lack of activity alone does not cause skin breakdown. 2. Fat is redistributed to the abdomen and thighs, leaving bony surfaces, such as the face, hands, and sacrum, exposed to potential injury, especially skin tears from shearing, friction forces and pressure ulcer development. 3. Although losing weight may be a risk factor for falling, it is not directly related to skin breakdown. 4. There is no evidence that she is picking at herself, as there is nothing reported anywhere else on her arms. 3. Mr. James is 91 years old. His daughter notices that he has bruises and lacerations on his arms and reports this to the nurse practitioner, who tells her that older people bruise easily due to their fragile blood vessels. The skin lacerations happen because he has thin skin. Even so, the nurse practitioner assures the daughter that she will investigate further to ensure that he is getting proper care. She says this because she understands that: 1. These markings on the patient's skin are part of aging skin. 2. Bruises and lacerations can indicate inadequate care. 3. The daughter needs assurance that her father is okay. 4. The patient is being abused. - 3. Answer: 2 Page: 97 Feedback 1. Markings on the skin may be signs of aging, a disease, or maltreatment. 2. Poorly healing wounds or chronic pressure ulcers may signal a problem not only with the patient but with the caregiver's ability to provide adequate care. Welts, lacerations, burns, and distinctive markings may indicate a need for intervention. 3. This is a result of the nurse practitioner addressing it further rather than the reason for addressing it.4. A professional cannot assume abuse without good reason. 4. The nurse practitioner assesses a patient's skin and finds an infectious lesion on the lower leg. The lesion is considered a secondary lesion. The nurse practitioner explains that a secondary lesion is one that: 1. Arises from changes to a primary lesion. 2. Is a complication of an underlying disease. 3. Is difficult to treat. 4. Is a normal sign of aging. - 4. Answer: 1 Page: 97 Feedback 1. Secondary lesions (infections) arise from changes to the primary lesion. 2. Secondary lesions are not necessarily the result of an underlying disease. 3. Secondary lesions can be treated with medications or surgery. 4. Secondary lesions arise as a condition not normal to aging. 5. Ms. Rose, 88 years old, comes to the nurse practitioner with a complaint about a growth on her hand. She wants to have a biopsy done. The nurse practitioner asks the following question: 1. Have you injured your hand recently? 2. Are you using a different detergent? 3. Has this growth changed, bled, or is it painful? 4. Has this growth made it difficult to put on your rings? - 5. Answer: 3 Page: 97 Feedback 1. An injury would not stimulate growth. 2. A reaction to a detergent would more likely be a rash. 3. Lesions that warrant biopsy are those that have changed, bleed, or are painful. 4. The ability to put on her ring is not the problem. 6. A 60-year-old male enters the burn center for triage and treatment due to a burn he received at a campfire. His left arm has an area that is erythematous and painful, and another area has a blister. What does the nurse practitioner record as the degree of burn? 1. First degree 2. Second degree 3. First and second degree 4. Second and third degree - 6. Answer: 3 Page: 98 Feedback 1. First-degree burns involving the epidermis are erythematous and painful but do not blister. 2. Second-degree burns involve the dermis and are characterized by blisters. 3. The patient presents with erythematous skin, painful with blisters, which indicates both first- and second-degree burn areas. 4. In third-degree burns there is no sensation when the wound is pinpricked. 7. The nurse practitioner is concerned with primary prevention strategies. How can the nurse practitioner implement primary prevention strategies for an 80-year-old male patient who smokes? 1. Review home fire safety protocols, including the proper use of smoke alarms, and discuss smoking cessation. 2. Inform him that if he does not stop smoking, the nurse practitioner cannot see him again. 3. Have a conference with his family about his smoking. 4. Plan a family meeting with the patient to discuss benefits of his smoking cessation. - 7. Answer: 1 Page: 115, 116 Feedback 1. Primary prevention includes educational programs designed to educate the public on safety. For example, the individual smoking in bed would hopefully benefit from smoking cessation programs in the community, as well as instruction in safety precautions. 2. Threatening refusal of care is not ethical. 3. The patient is at risk, not the family. 4. 1. Influenza 2. Upper respiratory infection 3. Cellulitis of upper left arm 4. Necrotizing fasciitis 5. Lymphangitis - 11. Answer: 3 Page: 103 Feedback 1. Influenza is systemic and not localized in any one area. 2. The patient has no respiratory symptoms. 3. Signs of cellulitis include worsening of erythema, edema, tenderness, and pain that has occurred for a few days. Symptoms are usually sudden. Systemic symptoms which indicate serious toxicity include fever, hypotension, and tachycardia. 4. Necrotizing fasciitis exhibits diffuse swelling of an arm or leg with bullae. 5. Systemic symptoms that indicate serious toxicity include fever, hypotension, tachycardia, leucocytosis, lymphadenopathy, and lymphangitis. 12. The treatment for cellulitis includes which of the following? Select all that apply. 1. Patients with mild cellulitis may be given oral antibiotics. 2. One drug of choice is dicloxacillin, 500 mg four times a day. 3. Treatment is dependent on the culture of the cells affected. 4. The drug of choice is given for a minimum of 3 days. 5. Administration of a tetanus booster injection. - 12. Answer: 1, 2 Page: 103 Feedback 1. Oral antibiotics are sufficient for mild cellulitis and IV antibiotics for organisms such as MRSA. 2. There are several drugs effective with cellulitis; dicloxacillin is one of them. 3. Treatment of MRSA should be guided by wound culture results, but not cellulitis. 4. The drug of choice is typically given for 7 days. 5. If the wound is grossly contaminated and the patient's last tetanus booster was 5 to 10 years ago, the practitioner should consider giving another booster at this time. 13. A 59-year-old female was admitted to the hospital for malaise, headache, fever, and flu-like symptoms. She has a decreased appetite and is having trouble sleeping. After a couple of days, she complains to the nurse practitioner of itching, burning, and tingling pain around her waist. The nurse practitioner advises the nursing staff to observe for vesicles for a few days. The patient asks why she is so sick. What would be the nurse practitioner's best response? Select all that apply. 1. We are not certain at this point, however, these symptoms often occur before a break-out of herpes zoster. 2. You have some very general systemic symptoms, so we are waiting for more specific symptoms to appear. 3. Because you had chicken pox as a child, and you now have a depressed immune system, the chance of developing herpes zoster is high. 4. These symptoms are probably a strong case of influenza. 5. Herpes zoster is more common in people 55 years old and older. - 13. Answer: 1, 3 Page: 106 Feedback 1. Patients usually experience itching, burning, or tingling pain at the site 4 to 5 days before the eruption appears. 2. Although there are general systemic symptoms, there is also itching, burning, and pain in the waist, which is leading to a herpes zoster diagnosis. 3. The patient has initial contact with VZV in the form of chicken pox. Individuals who are immunosuppressed are more likely to develop herpes zoster. 4. Herpes zoster is characterized by pain along the dermatomes and vesicles, which is not symptomatic of influenza. 5. This infection is most common in adults over 55 years old. The risk of herpes zoster increases with age. 14. Mrs. Person, 82 years old, comes to the well clinic to see a nurse practitioner for a bump on her ear. This growth has been there for almost a year but has recently grown. The area around the growth appears inflamed. Why would the nurse practitioner suggest a biopsy? Select all that apply. 1. The growth is elevated and increasing in size. 2. The ear has high exposure to the sun. 3. There is inflammation around the growth. 4. The patient is 82 years old and reports having lived in the south of the United States for many years. 5. There is no concern about familial tendencies. - 14. Answer: 1, 2, 3, 4 Page: 118 Feedback 1. Signs of malignancy include elevation; the original lesion may also have enlarged in size. 2. Common locations for skin cancers are the scalp, ears, lower lip, and dorsal side of the hands. 3. Signs of malignancy include inflammation of the lesion. 4. The incidence of all types of skin cancers increases with age and the degree and intensity of sun exposure. 5. Certain genetic predispositions can contribute to the development of skin cancer, and there is a familial tendency to develop melanoma. 15. The nurse practitioner is making patient rounds in a long-term care facility and is visiting Mr. Smith, 95 years old, who has a large amount of fungus growing from his toenails. The staff nurse asks what can be done to help alleviate this nail fungus. What does the nurse practitioner advise? Select all that apply. 1. Wash and completely dry the feet and toes daily. 2. Keep the patient's feet cool and dry. 3. Use aluminum acetate solution (Burow's solution). 4. Have the patient wear occlusive footwear. 5. Use clotrimazole (ointment, cream, or lotion). - 15. Answer: 1, 2, 3 Page: 123 Feedback 1. The key to prevention of recurrence is to keep the area dry. Use a hairdryer to thoroughly dry the area after bathing. 2. The key to prevention of all types is to keep the skin cool and dry. 3. The use of aluminum acetate solution (Burow's) and the application of antifungal or absorbent powder have all been shown to prevent recurrence. 4. Avoiding occlusive footwear, wearing absorbent materials, and practicing good hygiene offer the best primary prevention. 3. Hyphema 4. Uveitis - 4. Answer: 1 Page: 132 Feedback 1. Symptoms for acute glaucoma include unilateral eye pain, visual blurring with halos around lights, conjunctival injection, and photophobia. This requires immediate referral for a complete ophthalmic examination. 2. Symptoms for chronic glaucoma include tunnel vision, night blindness, and halos around lights. The treatment goal is to minimize the progression of the disease and preserve vision. 3. Hyphema is defined as the presence of blood within the aqueous fluid of the anterior chamber. The blood may cover most or all of the iris and the pupil, blocking vision partially or completely. The most common cause of hyphema is trauma. 4. Uveitis is a form of eye inflammation. It affects the middle layer of tissue in the eye wall (uvea). Symptoms include eye redness; eye pain; light sensitivity; blurred vision; dark, floating spots in the field of vision (floaters); and decreased vision. Possible causes of uveitis are infection, injury, or an autoimmune or inflammatory disease. 5. Which of the following is the correct term for the eye condition that presents a sterile mass on the eyelid that is painless and has no reddening? 1. Blepharitis 2. Entropion 3. Hordeolum 4. Chalazion - 5. Answer: 4 Page: 138 Feedback 1. Blepharitis is an inflammation of the eyelids, usually resulting in redness, swelling, and itching. 2. Entropion is the inward turning of the upper or lower eyelid so that the lid margin rests against and rubs the eyeball. 3. Hordeolum is an acute, purulent area of inflammation in the meibomian gland, commonly called a stye. It typically contains bacteria and can occur internally or externally at the lid margin. Not all styes are sterile. 4. Chalazion is an eye condition that presents a sterile mass on the eyelid that is painless and has no reddening. It is caused by an inflammation and obstruction of a meibomian gland of the upper or lower eyelid. Chalazion can interfere with vision at times and develops a rubbery consistency. 6. Oral cancer is a malignant tumor presented by a nonhealing sore in the mouth or lip that causes difficulty chewing or swallowing. Which of the following statements applies to an oral cancer diagnosis? 1. It cannot be prevented. 2. It involves unexplained lymph node swelling in the head and neck area. 3. It is three times more likely in women than men. 4. It involves unexplained lymph node swelling in the axillary area. - 6. Answer: 2 Page: 141 Feedback 1. The most important way to control oral cancer is the combination of early diagnosis and timely and appropriate treatment. Preventions include lifestyle changes, periodic checkups, and protection from sun exposure. 2. Unexplained lymph node swelling in the head and neck area is one of the symptoms of oral cancer. Additionally, a nonhealing sore in the mouth or lip and difficulty chewing or swallowing are also symptoms. 3. Men are almost three times more likely to develop oral cancer than women. 4. Unexplained lymph node swelling in the head and neck area is a symptom, but lymph node swelling in the axillary area is not. 7. A 67-year-old female patient comes in for an office visit presenting symptoms of nasal congestion, itching, and sneezing and is diagnosed with rhinitis. Which of the following is true about the types of rhinitis? 1. Allergic rhinitis (AR) is a condition of adulthood and is more common in the older adult. 2. AR develops when the body's respiratory system becomes sensitized and overreacts to something in the environment. 3. Nonallergic rhinitis (NAR) is most common between ages 10 and 39, declining after age 40. 4. NAR is a condition of adulthood and is more common in the older adult. - 7. Answer: 4 Page: 147 Feedback 1. AR is a condition of adulthood that declines in diagnosis after age 40. 2. AR develops when the body's immune system, not the respiratory system, becomes sensitized and overreacts to something in the environment that typically causes no problem in most people. 3. NAR is a condition of adulthood and is more common in the older adult. 4. NAR could be related to physiological changes in the older adult, as well as interactions from medications. 8. For which of the following evaluations should the patient be referred when sleep impairment is involved with chronic rhinitis? 1. Obstructive sleep apnea 2. Pharmacological therapy 3. Acupuncturist evaluation 4. Massage therapy - 8. Answer: 1 Page: 148 Feedback 1. Patients with chronic rhinitis may be referred for evaluation of obstructive sleep apnea in the presence of sleep-disordered breathing. 2. Pharmacological therapy is directed at control of the specific patient symptoms. 3. Acupuncture evaluation may be helpful to improve sleep, but may not be helpful in treating rhinitis. 4. Massage therapy may be helpful to improve sleep, but it is not helpful in treating rhinitis. 9. Evaluation for head and neck disorders should be performed with a systemic and thorough examination, including inspections of the face, head, and scalp. This includes which of the following? Select all that apply. 1. Palpating bones of the head for any anatomical irregularities. 2. Inspecting skin for any inflammation. 3. Inspecting the scalp and hair for any balding patterns. 4. Inspecting patient's features for any abnormalities. 5. Assessing for thoracic outlet syndrome. - 9. Answer: 1, 3, 4 Page: 127 Feedback Feedback 1. Most nosebleeds do not require medical attention; however, the individual should seek medical attention if a nosebleed lasts longer than 15 minutes, or if it occurs after an injury. This may be a sign of a posterior nosebleed, which is more serious. 2. If a second episode occurs within 1 week, a consultation with an ENT specialist is indicated, as it may have underlying conditions associated with the recurrence of symptoms such as sinusitis, septal hematoma/perforation, or mucosal pressure necrosis. 3. Dry air is the most common cause of nosebleeds. Living in a dry climate and using a central heating system can dry out the nasal membranes, which are tissues inside the nose. This dryness causes crusting inside the nose. Crusting may itch or become irritated if the nose is scratched or picked, and it can bleed. 4. Sneezing is an allergic reaction and can also dry out the nasal membranes and cause nosebleeds. Frequent nose blowing is another cause of nosebleeds. 5. ENT consultation is indicated when there is evidence of massive bleeding that cannot be stopped, as there can be a large amount of blood loss. 13. Hearing loss is a decreased ability or inability to hear. The loss may involve the external, middle, or inner ear and can be unilateral or bilateral. Which of the following etiologies may result in hearing loss? Select all that apply. 1. Sensorineural 2. Vascular occlusive disease 3. Conductive 4. Cerebral neoplasia 5. Aphasia - 13. Answer: 1, 3 Page: 136 Feedback 1. A lesion in the organ of Corti or in the central pathways, including the cranial nerve VIII and auditory cortex, causes sensorineural hearing loss. Presbycusis, noise-induced hearing loss, and ototoxic drug- related hearing loss all are sensorineural. 2. Vascular occlusive disease is predominantly a disease of the lower extremities and not an etiology of hearing loss. 3. 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, middle ear tumors, temporal bone fractures, injuries related to trauma, and congenital problems are some of the causes.4. Cerebral neoplasia is a brain tumor that may affect body organs; however, it is not a primary etiology that leads to hearing loss. 5. Aphasia is a loss of ability to understand or express speech caused by brain damage. 14. There is no specific diagnostic test for hordeolum or chalazion unless it becomes recurrent. Which of the following may be a differential diagnosis for these conditions? Select all that apply. 1. Orbital cellulitis 2. Contact dermatitis 3. Acute dacryocystitis 4. Strabismus 5. Amblyopia - 14. Answer: 1, 2, 3 Page: 138 Feedback 1. Orbital cellulitis is an infection of the soft tissues of the orbit posterior to the orbital septum. It is most often caused by extension of infection from adjacent sinuses, or by direct infection accompanying local trauma or contiguous spread of infection from the face or teeth. 2. Contact dermatitis is a red, itchy rash caused by direct contact with a substance or an allergic reaction to it. The rash isn't contagious or life threatening, but it can be very uncomfortable. 3. Acute dacryocystitis is an infection of the tear (lacrimal) sac usually due to a blockage in the tear (nasolacrimal) duct. The patient presents with pain, redness, and edema around the lacrimal sac. 4. Strabismus is a visual problem in which the eyes are not aligned properly and point in different directions. 5. Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called lazy eye. Many people make the mistake of saying that a person who has a crossed or turned eye (strabismus) has a lazy eye, but lazy eye (amblyopia) and strabismus are not the same condition. Strabismus can cause amblyopia. 15. The most common diagnostic test for AR is skin testing that involves scratching the surface of the skin with a single stylus for each allergen. Which of the following are possible if further testing is needed? Select all that apply. 1. Skin prick testing 2. CT scan 3. Blood test 4. MRI 5. Myelogram - 15. Answer: 1, 2 Page: 148 Feedback 1. Skin prick testing is a next step, but intradermal testing may be needed if results are negative. 2. CT scan should not be used in the absence of recurrent infection. 3. Blood test is a not common diagnostic testing for AR. 4. MRI is a not common diagnostic testing for AR. 5. A myelogram is a diagnostic imaging test generally done by a radiologist. It uses a contrast dye and x- rays or CT scan to look for problems in the spinal canal. 1. A patient comes to the health-care provider office for a checkup. The nurse practitioner notes that the patient is 67 years old and is presenting symptoms of dizziness, orthopnea, and edema. The nurse practitioner begins a focused assessment of the: 1. Cardiovascular system. 2. Respiratory system. 3. Neurological system. 4. Reproductive system. - 1. Answer: 1 Page: 152 Feedback 1. Key symptoms of cardiovascular assessment include dizziness, syncope, orthopnea, angina, edema, and claudication. 2. Edema is not commonly found in respiratory conditions. 3. Dizziness is a symptom in various conditions besides neurological conditions. 4. Dizziness, orthopnea, and edema have no direct connection with the reproductive system. Structural and physiological changes in the aging cardiovascular system cause decreased capacity to endure stresses and a decline in ability pertaining to physical activity performance. 4. Baroreceptors become less sensitive with age, and the response to changes in blood pressure is often blunted. 6. The nurse practitioner sees a patient in the emergency department with reports of chest pain and nausea. To analyze the patient's condition, what further information is needed? 1. Whether there has been constipation. 2. A description of the pain. 3. Information regarding last food intake. 4. Information regarding urinary difficulties. - 6. Answer: 2 Page: 153 Feedback 1. Constipation is not included in the major signs or symptoms of CAD. 2. Ask the following about chest pain: Precipitating/Palliating factors, Quality, Radiation, Severity, and Timing (PQRST). 3. Chest pain may be presented as heartburn or indigestion, particularly if the patient also has gastroesophageal reflux disease (GERD). GERD needs to be ruled out. 4. There are no associated urinary symptoms with chest pain. 7. The nurse practitioner and a student are examining the apical pulse of an 82-year-old man. The student perceives that there is an S4 sound. The nurse practitioner interprets that this is likely: 1. An early ventricular filling. 2. Heart blockage. 3. Mitral regurgitation. 4. Normal, due to the man's age. - 7. Answer: 4 Page: 153 Feedback 1. The early diastolic filling is reduced in healthy older adult persons, resulting in an end-diastolic volume maintained by an increase in atrial contribution to left ventricular filling. 2. A change in the loudness of S1, accompanied by a slow heart rate, may indicate heart blockage. 3. An S3 in an individual more than 50 years old is usually pathological and reflects an increased filling rate, indicating heart failure or mitral regurgitation. 4. This condition may cause an S4, which, in the absence of other findings, is considered normal in older adult persons. 8. The nurse practitioner identifies a late cardiac murmur in an older adult patient. A student nurse asks what condition this suggests. The nurse practitioner responds that this kind of murmur is most often due to which of the following? Select all that apply. 1. Weakening valves 2. Papillary muscle dysfunction 3. Mitral annular calcification 4. Heart blockage 5. Mitral stenosis - 8. Answer: 2, 3 Page: 153 Feedback 1. An apical late systolic murmur occurs frequently in older persons, resulting from floppy valves that become regurgitant over time. 2. One of the two most common causes of mitral regurgitation is papillary muscle dysfunction.3. One of the two most common causes of mitral regurgitation is mitral annular calcification. 4. Diastolic murmurs, which are almost always pathological in older persons, may be caused by heart blockage. 5. Diastolic murmurs, which are almost always pathological in older persons, may be caused by mitral stenosis. 9. Ms. Jameson, 72 years old, comes to the clinic with concerns about her breathing. She states that she is having trouble with mucus collection and difficulty coughing it out. The nurse practitioner suggests which of the following? Select all that apply. 1. As you get older, the tissue in your lungs is not as flexible to aid in exhaling. 2. The muscles that help to inhale become stronger as you age. 3. The body contains less water as you age, and the mucus begins to dry out. 4. As you get older, there is an increase in the exchange of gases between the lungs and the blood vessels. 5. The cough reflex is normal, but the mucus is too thick. - 9. Answer: 1, 3 Page: 154 Feedback 1. The aging process is characterized by a loss of elasticity and flexibility in collagen and elastin tissue components, which impedes the normal expiratory recoil of the lung. 2. A part of aging is the weakening of inspiratory muscles. 3. The concurrent decrease in body water composition dries mucous membranes. 4. Loss of elastin also affects the alveoli and the basement membrane of the capillary wall, where gas exchange occurs. A thickening occurs in both areas, limiting the amount of diffusion. 5. Because of decreased muscular strength, the cough reflex is not as forceful or as effective. This is one of the changes that occurs gradually as one ages and is hardly noticeable unless a physiological challenge or stress arises. 10. The nurse practitioner is seeing patients in the respiratory clinic. An 85-year-old woman comes in with concerns about having difficulty breathing. When considering asthma, the nurse practitioner asks which of the following questions? Select all that apply. 1. Do you feel out of breath during the day? 2. Do you have a cough, especially at night? 3. Do you feel a tightness in your chest? 4. May I listen for wheezing in your breathing? 5. Do you feel any dyspnea? - 10. Answer: 1, 2, 3, 4 Page: 155 Feedback 1. Chronic inflammation is associated with airway hyperresponsiveness that leads to breathlessness.2. Chronic inflammation is associated with airway hyperresponsiveness that leads to coughing, particularly at night or early in the morning. 3. Chronic inflammation is associated with chest tightness. 4. Chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing. 5. Older adults are less likely to sense dyspnea related to airway obstruction. 11. The nurse practitioner is preparing discharge instructions for a 79-year-old man with newly diagnosed asthma. Which of the following are important instructions to include? Select all that apply. 1. Have you ever smoked cigarettes? 2. Have you ever worked in a factory or foundry? 3. How long have you experienced these symptoms? 4. Do you have any past history of respiratory difficulties? 5. Have your symptoms increased as you've gotten older? - 14. Answer: 1, 2, 3, 4, 5 Page: 164, 165 Feedback 1. The most significant risk factor for chronic obstructive pulmonary disease (COPD) is cigarette smoking. 2. Occupational/industrial gases or fumes, and indoor/outdoor air pollution are all contributing risk factors for COPD. 3. Advancing age is a factor, with symptoms often presenting after the age of 40 to 50 years old. Individuals aged 65 to 74 years and 75 years and older have the highest incidence of COPD. 4. Inadequate lung growth and development during childhood contribute to risk factors for COPD. 5. Advancing age is a risk factor for COPD, although the evidence is unclear if healthy aging leads to COPD or if it is a result of the cumulative sum of exposures throughout life. 15. John is 80 years old and is experiencing the following: weight gain, tachycardia, neck vein distention, and cognitive impairment. The nurse practitioner assesses for which of the following to support a diagnosis of heart failure? Select all that apply. 1. Laterally displaced point of maximum impulse of apical pulse. 2. Rales in bilateral lower lobes not due to atelectasis or ascites. 3. Functional impairment. 4. Increase in appetite and alertness. 5. Asymptomatic. - 15. Answer: 1, 2, 3 Page: 171 Feedback 1. Signs that suggest heart failure include weight gain, tachycardia, S3 or S4 heart sound, and laterally displaced point of maximum impulse. 2. Signs that suggest heart failure include rales in bilateral lower lobes that are not due to atelectasis, positive hepatojugular reflux, and ascites. 3. Heart failure classification is based on risk, cardiac structural changes, symptom presentation, and functional impairment. 4. Progressive lower extremity and abdominal symptoms (pain, distention, nausea) related to hepatic enlargement are symptoms suggestive of right ventricular failure or systemic venous congestion. 5. Asymptomatic means without symptoms of disease. Geriatric patients with severe heart failure may be asymptomatic, but in this case, the patient does have symptoms. 1. In the assessment for peripheral vascular disorders, the clinician should begin with which of the following after the general history and physical examination? 1. Auscultation of the carotid arteries bilaterally. 2. Palpation of the carotid arteries bilaterally. 3. Inspection of the carotid arteries bilaterally. 4. Order diagnostic testing. - 1. Answer: 1 Page: 215 Feedback 1. The clinician should begin with auscultation of the carotid arteries bilaterally because cardiac murmurs will usually radiate into the carotid arteries. 2. After auscultation of the carotid and subclavian arteries, the clinician should proceed to palpation of the brachial, radial, and ulnar arteries. 3. After auscultation and palpation, careful inspection should be performed of the distal fingers and the nail beds. 4. Diagnostic testing is usually ordered when areas of concern are found. 2. Which of the following conditions is signaled by symptoms of swelling of the affected body part, usually the limb, because of impaired flow of lymph fluid? 1. Abdominal aortic aneurysm (AAA) 2. Venous ulcers 3. Peripheral vascular disease (PVD) 4. Lymphedema - 2. Answer: 4 Page: 218 Feedback 1. AAA presents the signal symptoms of persistent or intermittent pain in the middle or lower abdomen, radiating to the lower back. 2. Venous leg ulcers present signal symptoms of swelling that subside with elevation of lower extremities, eczematous skin changes, dull ache in lower extremities, and presence of varicosities. 3. PVD is a disease that alters blood flow to or from the extremities and vital organs other than the heart. It presents signal symptoms of pain, intermittent claudication of the feet, and tissue loss in affected leg/arm. 4. Lymphedema presents the signal symptoms of swelling of the affected body part, usually the limb, because of impaired flow of lymph fluid. 3. In the initial screening for a diagnosis of AAA, which of the following is the best screening test? 1. CT scan 2. Complete blood count (CBC) 3. Ultrasound in the abdominal area 4. Angiography - 3. Answer: 3 Page: 216 Feedback 1. CT screening is indicated when surgery is planned. 2. CBC may be a secondary screening when surgery is planned. 3. Ultrasound in the abdominal area is the best initial screening test for AAA.4. Angiography screening is indicated when surgery is planned. 4. Mrs. Prentiss is diagnosed with symptomatic AAA. The initial treatment is aggressive blood pressure control. At which of the following readings should mean arterial pressure be maintained? 1. Between 100 and 120 mm Hg. 2. Between 90 and 120 mm Hg. 3. Between 60 and 70 mm Hg. 4. Between 80 and 100 mm Hg. - 4. Answer: 3 Page: 217 Feedback 1. 2. Atelectasis is a condition where some, or all, of the air-filled sacs (alveoli) inside the lungs collapse, thereby reducing the lungs' capacity to deliver oxygen to the body. It is not related to the diagnosis of PAD. 3. Raynaud's phenomenon is a type of vascular disease characterized by a pale to blue to red sequence of color changes of the digits, most commonly after exposure to cold, and should be considered with the diagnosis of PAD. Buerger's disease is also a differential diagnosis for this disease. 4. Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. It is not related to the diagnosis of PAD. 9. Patient education is very important for individuals who have AAA. The patient and their family should be taught the importance of follow-up and the management of which of the following? Select all that apply. 1. Hypertension 2. Hypercholesterolemia 3. Smoking 4. Chondromalacia 5. Pain - 9. Answer: 1, 2, 3, 5 Page: 220, 221 Feedback 1. Education about hypertension management is important for patients with AAA. Antihypertensive agents are used to reduce tension on the vessel wall in patients with AAAs who have elevated blood pressure. 2. Patients with AAA need to learn about control of hypercholesterolemia (also called high cholesterol). Hypercholesterolemia is characterized by high serum cholesterol levels and premature coronary atherosclerosis. Hypercholesterolemia is one of the factors promoting the arteriosclerotic process and is a major cause of aortic aneurysm. 3. Smoking cessation should be considered by patients with AAA. Smoking appears to increase the risk of aortic aneurysms. Smoking can be damaging to the aorta and weaken the aorta's walls. 4. Chondromalacia is a pain in the knee and has no relationship to AAA. 5. Pain is the most common symptom of an AAA. Pain associated with an AAA may be in the abdomen, chest, lower back, or groin area. The pain may be severe or dull. Sudden, severe pain in the back or abdomen may mean the aneurysm is about to rupture. 10. AAA is mostly atherosclerotic in nature, but can also be caused by trauma, infection, and inflammation. Which of the following is a true statement regarding the tendency to develop AAA? Select all that apply. 1. There is no dominant ethnic group that develops AAA. 2. Caucasians have a higher risk of developing AAA. 3. Women have a higher risk of developing AAA. 4. There is a familial history associated with AAA development. 5. AAA is the 13th leading cause of death in the United States. - 10. Answer: 1, 4, 5 Page: 216 Feedback 1. There is no dominant ethnic group that develops AAA, but there is a familial history associated with AAA development. 2. There is no dominant ethnic group that develops AAA. 3. Onset occurs around age 50 years for men and 60 years for women. Incidence steadily increases with age and peaks at age 80 years. AAA is five times more likely in men than in women. 4. There is no dominant ethnic group that develops AAA, but there is a familial history associated with AAA development. 5. According to studies, AAAs are the 13th leading cause of death in the United States. Mortality rates for ruptured aneurysms are 70% to 90% compared with 5% operative mortality for elective open surgical repair, and 2% to 3% for endovascular stent AAA exclusion. 11. In treating AAA, arterial monitoring is recommended. Which of the following IV antihypertensive agents should be used to rapidly and consistently maintain blood pressure in the mean arterial pressure ranges? Select all that apply. 1. Nicardipine 2. Sertraline 3. Esmolol 4. Nitroglycerin 5. Carbidopa - 11. Answer: 1, 3, 4 Page: 217 Feedback 1. Nicardipine is an IV antihypertensive agent that should be used to rapidly and consistently maintain blood pressure in mean arterial pressure ranges. 2. Sertraline is used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, and social anxiety disorder. 3. Esmolol is an IV antihypertensive agent that should be used to rapidly and consistently maintain blood pressure in mean arterial pressure ranges. 4. Nitroglycerin is an IV antihypertensive agent that should be used to rapidly and consistently maintain blood pressure in mean arterial pressure ranges. 5. Carbidopa is a medication used with a combination to treat symptoms of Parkinson's disease or Parkinson-like symptoms. 12. Lymphedema is characterized by swelling of the extremity. Which of the following symptoms are also presented with lymphedema? Select all that apply. 1. Overall lethargy 2. Aching in the affected area 3. Restricted range of motion 4. Purulence 5. Cellulitis - 12. Answer: 2, 3, 5 Page: 218 Feedback 1. Lethargy, or tiredness, is a state with a lack of energy and enthusiasm and not generally presented with lymphedema. Lethargy has been reported by people with multiple sclerosis, rheumatoid arthritis, hepatitis C, high blood pressure, and depression. 2. Lymphedema usually develops gradually over time and the swelling can be mild, moderate, or severe. Swelling, aching, discomfort, and fatigue in the affected limb may become present. 3. Restricted range of motion is a symptom presented with lymphedema due to the swelling in the affected limb. 4. Purulence is not presented with lymphedema. 5. Cellulitis is a sudden, noncontagious infection of the skin, characterized by redness, swelling, and heat, and is accompanied with pain and tenderness. Patients with lymphedema are particularly susceptible to cellulitis because the lymphatic system is damaged or overloaded and does not function adequately to fight infection. 3. Collecting a urine specimen. 4. Evaluating abdominal pain. - 1. Answer: 1 Page: 225 Feedback 1. Determining the sequence of events that triggered each symptom and inquiring about precipitating factors such as a meal, position of the body, use of caffeine, or alcohol and smoking will lead to a differential diagnosis. 2. Information regarding episodes of anorexia, dyspepsia, dysphagia, heartburn, nausea, regurgitation, vomiting, painful or difficult defecation, diarrhea, tenesmus, or constipation can be clustered to form a differential diagnosis. 3. The physical examination is often unremarkable, and laboratory findings may not provide diagnostic information because the presentation of illness in an older adult is usually subdued. 4. Ask about the severity of pain by having the patient rate her pain on a scale of 1 to 10. Realize, however, that in older adults, pain may be blunted despite the underlying pathology. 2. Part of the abdominal examination the nurse practitioner will conduct is the assessment of skin color. As the nurse practitioner assesses the abdominal skin, the findings include which of these signs that are concerning? 1. Generalized pinkness. 2. Bluish discoloration on the flanks. 3. Yellow tint around the lower left quadrant. 4. Blue in the upper left quadrant. - 2. Answer: 2 Page: 226 Feedback 1. Pinkness is normal for a Caucasian patient. 2. If the bluish discoloration is on the flanks, this is known as Grey Turner's sign and is often indicative of retroperitoneal bleeding, as with pancreatitis. 3. Jaundice in the area of the umbilicus is known as Ransohoff's sign and is a result of a ruptured common bile duct. 4. If a bluish discoloration is detected around the umbilicus, this is known as Cullen's sign, which is often found in patients with bleeding in the peritoneum. 3. Mrs. M.W. asks the nurse practitioner what she is listening to in her belly and what it means. The nurse practitioner tells her that she is listening to determine: 1. That her bowels are moving properly. 2. If the blood vessels are not circulating blood. 3. Circulation and bowel function. 4. A diagnosis of her symptoms. - 3. Answer: 3 Page: 226 Feedback 1. Studies have refuted the usefulness of auscultation when differentiating between patients with normal bowel sounds versus those with pathological bowel sounds. 2. Other sites to auscultate for bruits during an abdominal examination include the iliac arteries and the femoral arteries. 3. To auscultate for bruits during an abdominal examination, include the iliac arteries and the femoral arteries. When auscultating bowel sounds, take the time to listen for the presence of bowel sounds. 4. Nurse practitioners should not rely on auscultation alone for diagnostic purposes. 4. Mr. Person comes to the health-care clinic with a presenting symptom of not urinating as much as usual. The nurse practitioner assesses Mr. Person by asking which of the following? 1. How much do you drink per day? 2. Is your urine a clear yellow color? 3. Do you experience urgency and frequency of urination? 4. What medications have you taken recently or are you currently taking? - 4. Answer: 4 Page: 228 Feedback 1. Patients may have nausea, vomiting, and diarrhea, leading to volume depletion. 2. The patient may have noticed a change in his urine consistency or color. 3. The patient may have symptoms directly resulting from alterations in kidney function, such as decreased to no urine output. 4. Specific questions regarding the use of medications that can cause renal injury, including NSAIDs and antihypertensive medications, such as ACE inhibitors and angiotensin receptor blockers, as well as recent antibiotic use, need to be asked of the patient. 5. J. T. is a 69-year-old Caucasian male who presents with dysuria. During the examination, he asks the nurse practitioner if there is a chance he has cancer. The nurse practitioner tells him that before she can determine what is causing the problem she will need to perform a physical examination and order which of the following diagnostic tests? 1. Computed tomography (CT) scan of the abdomen and pelvis 2. IV pyelogram 3. Urine dipstick and cytology 4. Ultrasound - 5. Answer: 1 Page: 230 Feedback 1. CT scans should include both the abdomen and pelvis; scans need to be done with and without contrast, and they should include delayed images to identify defects in the collecting system. 2. CT scan is replacing the IV pyelogram as the procedure of choice. 3. Urine dipstick, cytology, and screening for tumor-specific molecular markers in the urine are not recommended for screening asymptomatic patients due to low specificity, low sensitivity, and cost, respectively. 4. Although CT scan provides better visualization of tumors than ultrasound, it may miss tumors less than 1 cm in size. 6. Jane Smith is a 70-year-old Caucasian woman who comes to see her nurse practitioner for pain in her abdomen. The nurse practitioner is aware that Mrs. Smith is obese and has diabetes. Which of the following is a definitive diagnostic test for cholecystitis? 1. A flat plate of the abdomen. 2. Complete blood count (CBC). 3. Lipase, amylase, and liver function tests. 4. Real-time ultrasonography of the gallbladder and biliary tree. - 6. Answer: 4 Page: 232 Feedback 1. A flat plate of the abdomen will not provide the information that a real-time ultrasound will. 2. 10. A patient who is an 80-year-old female comes to the emergency department with complaints of a low-grade fever and left lower quadrant pain aggravated by movement. She also reports that the pain is precipitated by eating and describes a colicky pain in the right side of the abdomen. Which diagnostic tests does the nurse practitioner order? Select all that apply. 1. A total body CT scan 2. Abdominal x-rays 3. CBC, amylase, lipase 4. Urinalysis 5. Sigmoidoscopy - 10. Answer: 2, 3, 4 Page: 250 Feedback 1. Patients should be scheduled for a CT scan of the abdomen and pelvis. CT scans performed with oral, IV, and rectal contrast can enhance the accuracy of the diagnostic image. 2. Initially, plain abdominal radiographs can be ordered. 3. A CBC, amylase, lipase, urinalysis, complete C-reactive protein, and sedimentation rate need to be ordered to distinguish diverticulitis from other causes of acute abdominal pain. 4. Urinalysis may reveal sterile pyuria due to adjacent colonic irritation. 5. Sigmoidoscopy, colonoscopy, and barium enema are usually avoided during acute diverticulitis because these tests may cause further perforation or leakage of bowel contents. 11. Bill James, 67 years old, is being seen in the clinic for complaints of regurgitation, pyrosis, hoarseness, chronic cough, and atypical chest pain. The nurse practitioner suspects gastroesophageal reflux disease (GERD). As home-going instructions are developed, the nurse practitioner includes which of the following? Select any that apply. 1. Raise the head of the bed 2 inches. 2. Avoid tight, restrictive clothing. 3. Avoid smoking and ingestion of fatty foods. 4. Avoid eating a meal for at least 20 minutes before becoming recumbent. 5. Avoid caffeine and acidic foods. - 11. Answer: 2, 3, 5 Page: 262 Feedback 1. Patients with reflux esophagitis should be instructed to raise the head of the bed 4 to 6 inches with shock blocks or use a foam wedge that can be placed at the head of the bed. 2. While there has been limited evidence to suggest that making lifestyle changes (such as avoiding tight, restrictive clothing to decrease abdominal pressure) counteracts the symptoms of GERD, nurse practitioners should encourage patients to adopt this strategy. 3. The patient should avoid smoking and ingestion of fatty foods, coffee, chocolate, mints, citric juices, alcohol, and large quantities of fluids with meals. 4. Patients should avoid eating a meal for at least 3 hours before becoming recumbent. 5. Important to the management of GERD are the lifestyle changes or nonpharmacological measures that patients need to incorporate along with the medication regimen. These include avoidance of smoking, alcohol, and food products such as chocolate, mints, spicy or acidic foods, and caffeine. 12. Lucy is 65 years old and has been coping with irritable bowel syndrome-diarrhea (IBS-D) for over 10 years. She has tried various treatments with minimal effectiveness. She asks the nurse practitioner if there is anything else that might be helpful to control this diarrhea. The nurse practitioner suggests which of the following? Select any that apply. 1. Antispasmodics 2. Caffeinated beverages 3. Antidiarrheal medications 4. Eluxadoline,75 mcg, twice daily with food 5. Rifaximin - 12. Answer: 4, 5 Page: 267 Feedback 1. Antispasmodics are not recommended for treatment of IBS-D in older adults because of the anticholinergic side effects of these medications. 2. Foods that may exacerbate IBS-D should be avoided (e.g., caffeinated beverages). 3. Antidiarrheal medications are not beneficial in treating global IBS-D symptoms. 4. A newer agent recently approved for the treatment of IBS-D is a combination mu-opioid receptor agonist and delta-opioid receptor antagonist called eluxadoline in doses of 100 mcg and 75 mcg to be given twice a day with food. This has been shown effective in improving both diarrhea and abdominal pain symptoms associated with IBS-D. 5. Early studies point to the use of rifaximin, an antibiotic, for consideration of the treatment of IBS without constipation and can be considered for use with patients who have not had success with other treatments. 13. Mark is 60 years old. He reports a swelling in his right side, loss of weight, and a slight discoloration of his skin. The nurse practitioner conducts a history and physical examination and orders which of the following to rule out cancer of the liver? Select all that apply. 1. CBC to identify anemia. 2. Serum alkaline phosphatase, AST, ALT for liver damage. 3. Ultrasound to identify any enlargement. 4. Magnetic resonance imaging (MRI). 5. Radiology for lesions found in the liver. - 13. Answer: 1, 2, 3, 4, 5 Page: 269 Feedback 1. Patients with liver disease may have mild anemia and electrolyte disturbances. 2. Serum alkaline phosphatase, AST, ALT, and gamma-glutamyl transpeptidase (GGT) are often abnormal in a nonspecific pattern. 3. Identification of a liver nodule that is smaller than 1 cm should be reimaged with an ultrasound in 3 months. 4. Nodules that are larger than 1 cm should be reimaged with contrast-enhanced MRI. Nodules that demonstrate arterial hypervascularity and venous or delayed phase washout are consistent with hepatocellular carcinoma (HCC). Those nodules that do not demonstrate arterial hypervascularity and venous or delayed phase washout should be reimaged with another contrast-enhanced study such as a CT scan or MRI. 5. Lesions that demonstrate arterial hypervascularity and venous or delayed phase washout are diagnostic for HCC. Lesions that do not demonstrate arterial hypervascularity and venous or delayed phase washout should undergo percutaneous biopsy. 14. Thom is 60 years old and has been treated for nonalcoholic fatty liver disease (NAFLD) for over 10 years. He still suffers from fatigue, abdominal pain, and an enlarged liver. The nurse practitioner discusses which of the following home-care plans to assist him in adjusting to his disease? Select all that apply. 1. Monitor weight and stay within optimal weight limits. 2. Avoid anti-lipid medications, such as atorvastatin. 3. Obtain a hepatitis A and B vaccine, if not immune. 4. May drink alcohol socially, but not daily. 5. If obese, set a goal for rapid weight loss. - 14. Answer: 1, 3 Page: 272 Cystitis presents with symptoms of change in urination: dysuria, frequency, urgency, and change in urine character. It also can include suprapubic tenderness and mental status changes. 3. Which of the following is the single most signal symptom for possible breast cancer? 1. Nipple retraction 2. Breast discharge 3. Breast mass 4. Breast redness - 3. Answer: 3 Page: 286 Feedback 1. Other than a mass in the breast, there are no other early signal symptoms. 2. Other than a mass in the breast, there are no other early signal symptoms. 3. Breast mass is the only early signal symptom of breast cancer. 4. Other than a mass in the breast, there are no other early signal symptoms. 4. Which of the following conditions presents nonproliferating lesions and does not affect future cancer risk? 1. Atypical lobular hyperplasia 2. Fat necrosis 3. Radial scar 4. Papilloma - 4. Answer: 2 Page: 287 Feedback 1. Atypical lobular hyperplasia is a proliferating lesion with atypia and has an increase in cancer risk of four to five times. 2. Fat necrosis is a nonproliferating lesion and does not affect future cancer risk. 3. Radial scar is a proliferating lesion without atypia and has an increase in cancer risk of approximately one to two times. 4. Papilloma is a proliferating lesion without atypia and has an increase in cancer risk of approximately one to two times. 5. Mr. Angulo is an 89-year-old patient who was recently an inpatient for pneumonia and was bedridden for 1 week. He is now presenting dysuria, suprapubic tenderness accompanied by fever, and increased confusion. Based on his recent history, which of the following conditions may be developing? 1. Cystitis 2. Distended bladder 3. Prostate stones 4. Subacute prostatitis - 5. Answer: 1 Page: 289 Feedback 1. Symptoms are indicative of cystitis, and because the patient was bedridden and may have had placement of a catheter, this increases the likelihood. 2. Distended bladder is less likely to be the condition the patient is developing, given the history and symptoms. 3. Prostate stones are less likely to be the condition the patient is developing, given the history and symptoms. 4. Subacute prostatitis is less likely to be the condition the patient is developing, given the history and symptoms. 6. Which of the following statements is true for untreated symptomatic cystitis? 1. Untreated symptomatic cystitis can lead to pneumonia. 2. Untreated symptomatic cystitis can resolve on its own. 3. Untreated symptomatic cystitis can lead to pyelonephritis, sepsis, shock, and death. 4. Untreated symptomatic cystitis can lead to prostatic cancer, vaginitis, and sepsis. - 6. Answer: 3 Page: 291 Feedback 1. Pneumonia is a complication in the respiratory system. 2. Treatment is indicated to resolve cystitis. 3. Untreated symptomatic cystitis can lead to pyelonephritis, sepsis, shock, and death. 4. Untreated symptomatic cystitis does not lead to prostatic cancer or vaginitis, but it can lead to sepsis. 7. Women developing ovarian cancer may be asymptomatic, making it hard to detect until the condition has worsened. Which of the following is the best initial diagnostic tool for suspected ovarian cancer? 1. Transvaginal ultrasonography 2. Pelvic examination 3. Laparoscopy 4. Complete blood count (CBC) - 7. Answer: 1 Page: 294 Feedback 1. Transvaginal ultrasonography is the best initial study for suspected ovarian cancer.2. Pelvic examination gives limited diagnostic results, as ovarian enlargement cannot always be palpated. 3. Laparoscopy is performed after a histopathological tissue report has been confirmed. 4. A CBC is also part of the initial evaluation, but secondary to transvaginal ultrasonography. 8. Prostate cancer is the most common and leading cause of cancer death in men. Which of the following statements is true about prostate cancer? 1. There is usually a sudden onset of pain in the early stages. 2. Asian men are at highest risk for developing prostate cancer. 3. Development of prostate cancer has been linked with prior vasectomy. 4. There are usually no symptoms with early disease. - 8. Answer: 4 Page: 299 Feedback 1. There are usually no symptoms with early disease. 2. African Americans have the highest incidence of prostate cancer in the world, with Asian and Hispanic men at lower risk than white men. 3. No link has been determined with prior vasectomy. 4. Once symptoms occur, there is usually progression of the disease. 3. Benefits of regular sexual activity. 4. Identifying and addressing age-related changes. 5. Benefits of sexual-aid stimulators. - 12. Answer: 2, 3, 4 Page: 283, 284 Feedback 1. First-line therapies to alleviate atrophic vaginitis symptoms include vaginal lubricants and moisturizers, plus regular sexual activity. 2. The use of water-soluble lubricants may alleviate symptoms. 3. Regular sexual activity can be beneficial in alleviating symptoms. 4. Knowledge of age-related changes is beneficial for understanding and alleviating the symptoms of atrophic vaginitis. 5. The use of a stimulator with sexual activity is not typically discussed with patients diagnosed with atrophic vaginitis. 13. Breast cancer is more prevalent in the female gender, with a median age of 61 years. Which of the following are modifiable risk factors that may contribute to the diagnosis of breast cancer? Select all that apply. 1. Postmenopausal obesity 2. Alcohol intake 3. Early menarche 4. Menopause hormone therapy 5. Ethnicity - 13. Answer: 1, 2, 4 Page: 285 Feedback 1. Addressing postmenopausal obesity by encouraging healthy eating and exercise can reduce the risk factor of breast cancer. 2. Minimizing alcohol intake can help reduce the risk of developing breast cancer. 3. Early menarche is a nonmodifiable risk factor of breast cancer. 4. Menopause hormone therapy is a modifiable risk factor for breast cancer. Patients need to be informed about the risk of using combined estrogen and progestin menopause hormone therapy. 5. Ethnicity is a nonmodifiable risk factor, along with age and family history. 14. Which of the following are the main laboratory clinical manifestations of cystitis? Select all that apply. 1. White blood cell (WBC) count 2. Bacteriuria 3. Pyuria 4. Fungi 5. E. coli - 14. Answer: 2, 3 Page: 289 Feedback 1. WBCs, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. Increased or decreased WBC count can indicate infection but is not the main laboratory clinical manifestation of cystitis. 2. Bacteriuria is the presence of bacteria in urine and is one of the main laboratory clinical manifestations of cystitis. 3. Pyuria is the presence of pus in the urine and is one of the main laboratory clinical manifestations of cystitis. 4. The presence of fungi does not lead to a diagnosis of cystitis. 5. The presence of E. coli is not a main laboratory clinical manifestation of cystitis. E. coli is a bacterium found in the environment, foods, and intestines of people and animals. 15. Marie, 63 years old, is presenting with symptoms of postmenopausal bleeding and is diagnosed with endometrial cancer. Other than gender and age, which of the following can be contributing factors in the development of endometrial cancer? Select all that apply. 1. Diabetes 2. Use of tamoxifen 3. Use of hormonal contraception 4. Obesity 5. Lynch syndrome - 15. Answer: 1, 2, 4, 5 Page: 292, 293 Feedback 1. Diabetes has been correlated with endometrial carcinoma. 2. Use of tamoxifen in postmenopausal women is a risk factor for endometrial carcinoma. 3. Use of hormonal contraception is a negative risk factor for endometrial carcinoma. 4. Obesity is a contributing factor in the development of endometrial cancer. 5. Women who have Lynch syndrome, which is an autosomal dominant genetic condition causing hereditary nonpolyposis colorectal cancer, are at high risk for endometrial malignancies. 1. The nurse practitioner is serving in a clinic dedicated to patients over age 65 years. The nurse practitioner observes several common characteristics in the posture of elderly patients. Which of the following is common? 1. Increase in the length of the trunk in relationship to the upper extremities. 2. Head tips backward. 3. Disappearance of bony prominences. 4. Increase in the range of motion (ROM). - 1. Answer: 2 Page: 305 Feedback 1. Aging often brings about a decrease in height, resulting from a decrease in the length of the trunk with respect to the length of the extremities. 2. An older person may tilt the head backward to compensate for the bend in the thoracic spine, producing the typical posture of those in this age group. 3. Because of the loss of subcutaneous fat caused by aging, bony prominences became more noticeable. 4. Without continued use, muscles stiffen and ROM becomes impaired as an older person continues to age. 2. While conducting a thorough examination of the musculoskeletal system, the patient asks why such detail is necessary. Which of the following is the nurse practitioner's best response? 1. I don't want to miss any signs of something serious. 2. The purpose of conducting this examination is to regulate your medications. 3. I am looking for symptoms that form a pattern. 4. This is routine for all patients over 65 years of age. - 2. Answer: 3 Page: 305