Test Bank for Advanced Practice Nursing in the Care of Older Adults, 3rd Edition Kennedy-, Exams of Nursing

Download Test Bank for Advanced Practice Nursing in the Care of Older Adults, 3rd Edition Kennedy- and more Exams Nursing in PDF only on Docsity!

EXAMS PREPARATION GUIDE

Test Bank for Advanced

Practice Nursing in the

Care of Older Adults, 3rd

Edition | Kennedy-Malone

| Chapters 1 – 23 | Verified

& Updated 2025

EXAM

1. Mrs. Smith, who is 75 years old, reports that she is weak, has

difficulty urinating, and is dehydrated. Although she is afebrile, the

nurse conducts a thorough physical examination including

urinalysis and complete blood count (CBC). The total assessment is

necessary because:

1. All body systems interact, and symptoms could indicate a variety of diagnoses.
2. The symptoms are vague and may be signs of aging.
3. There may be other signs or symptoms more indicative of the condition.
4. Mrs. Smith may not be reporting all significant information.
5. All body systems interact, and symptoms could indicate a variety of diagnoses. The clinician must be aware that all the systems interact and, in doing so, can increase the older adult's vulnerability to illness/disease.

2. A patient with renal disease has blood work drawn, and the

results show an increase in serum creatinine. Which of the following

laboratory values does the advanced practice registered nurse

(APRN) need to know before ordering medications?

1. Complete blood count
2. Culture and sensitivity of the urine
3. Creatinine clearance
4. Uric acid levels
5. Creatinine clearance The calculation of creatinine clearance provides an estimation of renal function.

3. Which of the following statements is true regarding diagnostic

testing?

1. Depression
2. Heart failure
3. Hypothyroidism
4. Malignancy
5. Depression
6. The older adult may have atypical presentations of some conditions. These symptoms may be atypical presentation of depression.
7. Atypical presentation of heart failure in the older adult may include anorexia, confusion, and nocturia.
8. Atypical presentation of hypothyroidism may include confusion and agitation, new onset of anorexia, and ataxia.
9. Atypical presentation of malignancies may be new or worsening back pain secondary to metastases from slow growing breast masses or silent masses of the bowel.

6. A gerontological patient is being examined for a report of pain in

the shoulder. The APRN completes a thorough systemic examination

because:

1. Older adults with one morbidity often express difficulties in general.
2. Arthritis of the shoulders can be accompanied by other neurological symptoms.
3. Older adults with arthritis often experience pain in the lower extremities.
4. The older adult may not report significant signs and symptoms.
5. Older adults with one morbidity often express difficulties in general.
6. Older patients with late-onset RA 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.
7. Older adults 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.

7. The APRN performs a thorough systemic examination of a

patient who reports melena, weight loss, intermittent confusion, and

dyspepsia. The older adult denies abdominal pain. One possible

diagnosis would be:

1. Pneumonia
2. Ulcerative colitis
3. Appendicitis
4. Peptic ulcer disease
5. Peptic ulcer disease
6. Pneumonia in the older adult may present with mild cough, tachycardia and tachypnea, anorexia, and other atypical symptoms.
7. Diarrhea is associated with ulcerative colitis.
8. Appendicitis is more common in younger patients than in older patients. The older adult may experience pain in the right lower abdomen that becomes diffuse.
9. Peptic ulcer disease is manifested differently in a bimodal pattern. It presents in the older adults with no abdominal pain, melena, dyspepsia, anorexia, confusion, and other atypical symptoms.

8. An older woman is being seen in the ambulatory clinic for a

routine check-up. The patient asks about results of her blood work

compared to last year's results. Which response is best for the

clinician to offer?

1. They are likely to be the same if you have had no diseases since then.
2. Your results may be different because the body changes with disease and medications you are taking.

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. I want to wait to order further tests. Many older adults feel this way, but it may resolve.
5. I will assess you for the presence of other conditions. Answer: 1, 2, 3, 5
6. A complete assessment will help differentiate signs of aging from disease.
7. All systems interact and can affect an existing condition.
8. Identifying underlying conditions will avoid undertreatment.
9. Attributing symptoms to aging can contribute to depression in an older adult. Furthermore, failing to take action at this time risks undertreating the client.
10. There are changes in the sympathetic response that contribute to the orthostasis and falls as well as lack of hypoglycemic response.

11. The APRN is leading a class of older adults over age 65 years old

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 answers are

helpful? Select all that apply.

1. I suggest that you exercise a little more than you are currently doing.
2. Older adults experience a decrease in reserve energy.
3. Older adults have immune system weakness.
4. More viruses are being spread throughout the community.
5. I suggest that you see your primary care giver for extensive testing. Answer: 2, 3, 5

1. Improved nutrition may not be the factor affecting the health of the older adult.
2. Many factors can influence the health of older adults, including lifestyle and medications.
3. Many factors can influence the health of older adults, including changes in the immune system.
4. Viruses and other infections are not the only considerations for infections.
5. Biochemical individuality is important in detecting asymptomatic abnormalities in older adults. Significant homeostatic disturbances in the same individual may be detected through serial laboratory tests, even though all individual test results may lie within normal limits of the reference interval for the entire group.

12. An older adult couple is discussing health concerns with the

APRN. The couple is concerned that each of their individual blood

studies show different results. One set of test results shows a

significant decrease in blood sugar, but the test results of the

partner do not show an equal decrease. Their physician does not

seem concerned, and the couple is wondering why. How is it best for

the APRN to respond? Select all that apply.

1. Studies show that each person's pattern of chemical make-up is different.
2. There is no difference between one person's range of blood results and that of any other person.
3. Each person's chemical make-up is the same as that of others of the same gender and age group.
4. Many factors affect an individual's chemical make-up.
5. Ranges of the values provided by the laboratory are correct for any age. Answer: 1, 4
6. Reference ranges are used in laboratory value interpretation, so some individuals may experience smaller variations in lab work than others in the same age group.
7. There are wider variations of laboratory results within a group of older adults.

14. Mrs. Smith is 75 years old and was diagnosed with type 2

diabetes mellitus 30 years ago. She sees her APRN on a regular

basis. Mrs. Smith asks the APRN why her treatment has not been

changed even though her lab values are seemingly out of the normal

range. With which of the following statements would the APRN

respond? Select all that apply.

1. A decision to make changes must be based on a pattern and not on one set of lab 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. Answer: 1, 4, 5
6. Blood studies are more valuable when assessing for an increase or decrease in values for a specific patient.
7. It is not helpful to use aging as an explanation for possible abnormal results.
8. If a change in treatment is appropriate, the least expensive alternative should be sought.
9. Significant disturbances in the same individual may be detected through serial laboratory tests.
10. The APRN 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 adhere to the health-care plan developed by the APRN.

The APRN considers which of the following reasons for the patient's

nonadherence when updating his home-care plan? Select all that

apply.

1. Polypharmacy
2. Diminished functional capacity

3. Attending multiple appointments
4. Affording complex drug regimens
5. Lack of dedication Answer: 1, 2, 3, 4
6. As a patient ages this correlates with more medications having been ordered.
7. Patients with multi-morbidities or chronic conditions may experience diminished functional capacity. This diminished capacity may make it difficult to adhere to plans of care for some patients.
8. Patients with multi-morbidities or chronic conditions are known to have a treatment burden in terms of understanding and self-care management of their conditions. This burden includes difficulty attending all appointments.
9. A form of treatment burden may be difficulty affording complex drug regimens.
10. While certain patients may lack dedication to a treatment program, there is much more to consider when noncompliance is an issue.

16. A patient asks the advanced practice registered nurse (APRN)

what is meant by health promotion. The best answer regarding

health promotion is:

1. It includes activities that an individual performs proactively to increase health and well-being.
2. It is a process of keeping track of immunizations.
3. It includes a set of programs that help people cope with the disease.
4. It includes strategies that prolong life.
5. It includes activities that an individual performs proactively to increase health and well-being. *Health promotion includes not only preventive and health-protective measures but also taking control of one's health.

17. The APRN knows that health promotion on a broad scale is

accomplished by:

1. The aspirin is not approved for use in patients over 80 years.
2. Medicare covers treatments that are approved according to the guidelines of the U.S. Preventive Services Task Force (USPSTF).
3. There is no reason to use aspirin when other medications are proven effective.
4. Aspirin is not on the Medicare list of approved medications.
5. Medicare covers treatments that are approved according to the guidelines of the U.S. Preventive Services Task Force (USPSTF). *Medicare will only pay for A and B level recommendations that meet the USPSTF stringent evidence guidelines, leaving other beneficial interventions without coverage.

20. When a patient is seen by an APRN, the care plan is developed

keeping which objective in mind?

1. Increasing the use of the emergency department for injuries from falls
2. Maintaining the patient living in their home
3. Increasing safety checks in the home
4. Increasing use of the "Welcome to Medicare" visit
5. Increasing use of the "Welcome to Medicare" visit *The Healthy People 2020 program has set specific objectives for prevention in older adults. Use of the "Welcome to Medicare" visit is one of those objectives.

21. The focus of APRNs is primary prevention. This is defined as

activities that focus on:

1. Prevention of the occurrence of a disease or condition
2. Screening for signs of illness

3. Slowing the prevention of disease
4. Enriching the patient's appreciation of life
5. Prevention of the occurrence of a disease or condition *Primary preventive strategies focus on intervention before there is injury or a health problem, such as immunization.

22. A health promotion topic that should be included in the APRN

visit is physical activity. Which of the following would be a good

recommendation for the 75-year-old male?

1. Team sports
2. Horseback riding
3. Walking
4. Aerobics
5. Walking

Team sports could be risky for an older person who may be more susceptible to falls or orthopedic issues.

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

Walking is a good option for the older adult to perform When recommending physical activity, the person's functional abilities and desires need to be considered.

Aerobics may be too aggressive of an exercise for an older person.

1. Increased flexibility
2. Increased muscle mass
3. Maintenance of optimal weight
4. Lower blood pressure
5. Decreased urinary output Answer: 1, 2, 3, 4

The health benefits of regular physical activity are well documented and include flexibility.

Exercise increases muscle tone and mass.

Exercise uses calories from stored fat and allows for weight loss.

Exercise strengthens the cardiac muscle and thereby lowers blood pressure.

Exercise does not affect urinary output.

25. While counseling a patient about physical activity, the APRN

considers which of the following? Select all that apply.

1. Physical activity prescription 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. Ability to pay for involvement in activities

Answer: 1, 2, 3, 4

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

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

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

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

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

26. Nutrition counseling is part of health promotion. The APRN

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 Answer: 2, 3, 4, 5

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

Potential recommendations include exercise programs to build strength.

Food intake has to do with nutritional status rather than safety.

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

29. Albert is 72 years old and complains of burning upon urination.

He has recently returned from a vacation to another country. The

APRN conducts a physical examination and observes that there is a

white discharge from his penis. What does the APRN 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
3. Assuring the patient that while traveling there are limited opportunities for sexual encounters
4. Explaining possible medication side effects to the patient Answer: 1, 2, 3

Safe sex education is important because older adults are less likely to practice safe sex and use condoms.

Older people may be at increased danger from sexually transmitted infections because of the decreased perception of risk.

Current sexual history may determine the need for continued screening for STIs, human papillomavirus (HPV), and cervical cancer.

Traveling does not limit potential sexual encounters with fellow travelers, locals, or commercial sex workers.

While medication education is important, this patient's symptoms and circumstances indicate teaching on sexual health is required.

30. Mary is 72 years old and goes to the pharmacy to pick up her

prescriptions. The pharmacist asks if she has had her

immunizations. Mary replies, "I had all my childhood shots, so I do

not need any now." What should the APRN teach her about senior

immunizations? Select all that apply.

1. The immune system may be weakened in older persons, so immunizations are suggested.
2. Persons over the age of 50 years should have a yearly influenza vaccine.
3. Mary requires the new Shingrix vaccine to help protect her from shingles.
4. The side effects of immunizations outweigh the benefits of immunizations.
5. Mary will be eligible for a pneumococcal vaccine when she turns 75 years old. Answer: 1, 2, 3

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

The influenza virus mutates some each year and needs an updated version of the vaccine to provide immunity.