NR 601-Advanced Practice Nursing in The Care Of Older Adults 2ND Test Bank | Complete C, Exams of Nursing

Download NR 601-Advanced Practice Nursing in The Care Of Older Adults 2ND Test Bank | Complete C and more Exams Nursing in PDF only on Docsity! NR 601-Advanced Practice Nursing in The Care Of Older Adults 2ND Test Bank | Complete Chapters Chapter 1. Changes with Aging Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The major impact of the physiological changes that occur with aging is: A. Reduced physiological reserve B. Reduced homeostatic mechanisms C. Impaired immunological response D. All of the above 2. The strongest evidence regarding normal physiological aging is available through: A. Randomized controlled clinical trials B. Cross-sectional studies C. Longitudinal studies D. Case control studies 3. All of the following statements are true about laboratory values in older adults except: A. Reference ranges are preferable B. Abnormal findings are often due to physiological aging C. Normal ranges may not be applicable for older adults D. Reference values are not necessarily acceptable values 4. Biochemical individuality is best described as: A. Each individual’s variation is often much greater than that of a larger group B. The unique biochemical profile of a selected population C. The truly “normal” individual—falling within average range D. Each individual’s variation is often much smaller than that of a larger group 5. Polypharmacy is best described as taking: A. More than nine medications per day B. More than five medications per day C. Even a single medication if there is not a clear indication for its use D. When a drug is given to treat the side effect of another drug 6. Pharmacokinetic changes with aging is reflective of: A. What the drug does to the body B. What the body does to the drug C. The effect at the site of action and the time and intensity of the drug D. The side effects commonly associated with the drug 7. All the following statements are false about drug absorption except: A. Antacids increase the bioavailability of digitalis B. Gastric acidity decreases with age C. Anticholinergics increase colonic motility D. Underlying chronic disease has little impact on drug absorption 8. All of the following statements are true about drug distribution in the elderly except: A. Drugs distributed in water have lower concentration B. Drugs distributed in fat have less intense, more prolonged effect C. Drugs highly protein bound have greater potential to cause an adverse drug reaction D. The fastest way to deliver a drug to the action site is by inhalation 9. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: A. Less obesity rates than women B. Prostate enlargement C. Testosterone D. Less estrogen than women 10. The cytochrome p system involves enzymes that are generally: A. Inhibited by drugs B. Induced by drugs C. Inhibited or induced by drugs D. Associated with decreased liver perfusion 11. A statement not shown to be true about pharmacodynamics changes with aging is: A. Decreased sensitivity to oral anticoagulants B. Enhanced sensitivity to central nervous system drugs C. Drug responsiveness can be influenced by patient activity level D. There is a decreased sensitivity to beta blockers 12. Atypical presentation of disease in the elderly is reflected by all the following except: A. Infection without fever B. Depression without dysphoric mood C. Myocardial infarction with chest pain and diaphoresis D. Cardiac manifestations of thyroid disease 13. Functional abilities are best assessed by: A. Self-report of function B. Observed assessment of function C. A comprehensive head-to-toe examination D. Family report of function C. Readily available treatment measures D. Achieving an administrative goal for the congregate living facility 10. Performing range of motion exercises on a client who has had a stroke is an example of which level of prevention? A. Primary prevention B. Tertiary prevention C. Secondary prevention D. Rehabilitation prevention 11. The nurse practitioner demonstrates an understanding of primary prevention of falling among the elderly through which management plan? A. Evaluate a need for assistive devices for ambulation after the client has been injured from a fall. B. Provide resources to correct hazards contributing to falls in the home environment. C. Reinforce the need to use prescribed eyeglasses to prevent further injury from falls. D. Provide information about medications, side effects, and interactions. 12. An example of an active strategy of health promotion for an individual to accomplish would be: A. Maintaining clean water in the local environment B. Introducing fluoride into the water C. Beginning a stress management program D. Maintaining a sanitary sewage system 13. You are working with an older male adult with a long history of alcohol abuse and a 30-year history of smoking. In recommending an intervention for this client, your responsibility is to: A. Make the individual abandon his own health practices and follow your recommendations B. Register the patient for a local intervention program and secure payments C. Promote positive change in lifestyle choices D. Identify the barriers that the client will encounter 14. The four main domains of clinical preventive services that the practitioner will provide are: A. Counseling interventions, screening tests, immunizations, and chemoprophylaxis B. Counseling intervention, screening tests, immunizations, and education C. Counseling interventions, transportation, screening tests, and immunizations D. Screening tests, brief psychotherapy, immunizations, and chemoprophylaxis 15. Which organism that can be prevented by immunization is most often responsible for an infectious “outbreak” in the nursing home setting? A. Haemophilus influenza B. Streptococcus C. Influenza A D. Mycobacterium tuberculosis 16. What is the appropriate method for tuberculosis screening of an older adult entering a nursing home? A. 5 tuberculin units intramuscular PPD injection and if negative repeat with same dose one week later B. 5 tuberculin units intradermal PPD injection and if negative repeat with same dose one week later C. Chest x-ray at the same time of PPD testing D. 5 tuberculin units intradermal PPD injection and if positive repeat same dose in one week Chapter 2: Health Promotion Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 2. ANS: C PTS: 1 3. ANS: A PTS: 1 4. ANS: A PTS: 1 5. ANS: C PTS: 1 6. ANS: C PTS: 1 7. ANS: C PTS: 1 8. ANS: B PTS: 1 9. ANS: B PTS: 1 10. ANS: B PTS: 1 11. ANS: D PTS: 1 12. ANS: C PTS: 1 13. ANS: C PTS: 1 14. ANS: A PTS: 1 15. ANS: C PTS: 1 16. ANS: B PTS: 1 Chapter 3. Exercise in Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Exercise recommended for older adults should include activities that: A. Conserve energy B. Restrict flexibility C. Strengthen muscles D. Are anaerobic in nature 2. Preferred amount of exercise for older adults is: A. 10 minutes of physical activity each morning B. 30 minutes per day of aerobic activity five times a week C. Any increase in physical activity over a sedentary lifestyle D. 60 minutes per day that includes 30 minutes of aerobic activity and 30 minutes of weight training five times a week 3. Which of the following medical conditions is not considered restrictive for engaging in physical activity? A. Unstable angina A. Start with an open-ended question B. Start with the review of systems C. Focus on the chief complaint D. Complete the history before conducting the examination 6. A review of the evidence relative to screening of the elderly reveals the highest evidence rating for: A. Vision screening B. Mammography screening C. Hearing screening D. Dementia screening 7. Assessment of vital signs in the elderly reflect: A. Errors in blood pressure measurement are rare with automated recording devices B. Shortness of breath in the elderly is rare in the older, deconditioned, and immobile patient C. Older adults prefer a 0-10 pain rating scale D. Older adults could be septic with a temperature within normal limits 8. What statement is true about nutrition intake in the elderly? A. Deficiencies in protein intake are common with aging. B. Malnutrition is the most common nutritional disorder among the elderly living in the community. C. Increased caloric consumption is needed as one ages. D. The serum albumin is a good reflection of protein stores. 9. What is reflective of functional decline in older adults? A. Functional decline is synonymous with advanced age. B. Some individuals die of “old age” but have maintained an active and healthy lifestyle. C. Instrumental activities of daily living are preserved longer than activities of daily living. D. It is always possible to prevent functional deterioration. 10. The leading cause of traumatic death in the elderly is due to: A. Motor vehicle accidents B. Pedestrian injuries C. Falls D. Burns 11. Timing of the get-and-go test enhances its sensitivity. The process should take less than: A. Thirty seconds B. Sixteen seconds C. Sixty seconds D. Ten seconds 12. A validated tool for assessing cognitive function specific to dementia is: A. Mini-cog B. Confusion assessment method C. Yesavage GDS scale D. NuDesc 13. The medical outcome study short form 36 remains the gold standard of quality of life instruments. It measures: A. Mental and social domains B. Social domain C. Physical, mental, and social domains D. Physical domain Chapter 4: Comprehensive Geriatric Assessment Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: C PTS: 1 3. ANS: B PTS: 1 4. ANS: B PTS: 1 5. ANS: A PTS: 1 6. ANS: C PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: B PTS: 1 10. ANS: C PTS: 1 11. ANS: B PTS: 1 12. ANS: A PTS: 1 13. ANS: C PTS: 1 Chapter 5. Symptoms and Syndromes Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The term “geriatric syndrome” is best described as: A. A condition that has multiple underlying factors and involves multiple systems B. A condition that has a discreet etiology that is difficult to pinpoint C. Significant progress has been made in understanding geriatric syndromes, especially falls and delirium D. Therapeutic management of a geriatric syndrome can be accomplished once a specific diagnosis is made 2. The anal wink reflex is used to test: A. Rectal prolapse B. Sensation and pudental nerve function C. Baseline and squeeze sphincter tone D. Fissures and fistulas 3. Atypical presentation of acute coronary syndrome is: A. Most common in Hispanic females B. More common in men C. Most common in African American men D. More common in females A. Male sex B. Smoking history C. Over age 40 D. Childhood asthma 20. Recent weight loss is defined as: A. loss of >10 pounds over the past 3-6 months B. loss of >2 pounds a week C. 5% weight loss in three months D. 10% weight loss in one year 21. The most common cause of disability in the elderly is due to: A. Diabetes B. Arthritis C. Heart disease D. Chronic obstructive pulmonary disease 22. Lipedema is best described as: A. Bilateral accumulation of interstitial fluid B. Bilateral distribution of fat in the lower extremities C. Fluid retention caused by a compromised lymphatic system D. Lipid molecules that break down and cause fluid retention 23. Drug-induced pruritus is distinguished because it: A. Occurs soon after a new drug is taken B. Usually is a generalized rash C. May occur right after the drug is taken or months later D. Usually involves localized circumscribed lesions 24. A form of syncope that is more common in the elderly than younger adults is: A. Vasovagal B. Carotid sinus sensitivity C. Orthostatic hypotension D. Arrhythmias 25. All of the following statements about tremor are true except: A. The most common tremor is the Parkinson tremor B. Most individuals with tremor do not seek medical attention C. Psychogenic tremor is uncommon D. Tremor is more prevalent in whites than blacks 26. Overflow incontinence is usually associated with: A. Loss of urine that occurs with urgency B. Cognitive impairment C. Weak pelvic floor muscles D. Bladder outlet obstruction 27. Wandering is best described as: A. Aimless excessive ambulatory behavior B. Purposeful excessive ambulatory behavior C. Risk-seeking behavior in the cognitively impaired D. A result of boredom in those with dementia Chapter 5: Symptoms and Syndromes Answer Section MULTIPLE CHOICE 1. ANS: A PTS: 1 2. ANS: B PTS: 1 3. ANS: D PTS: 1 4. ANS: B PTS: 1 5. ANS: C PTS: 1 6. ANS: C PTS: 1 7. ANS: A PTS: 1 8. ANS: C PTS: 1 9. ANS: D PTS: 1 10. ANS: C PTS: 1 11. ANS: B PTS: 1 12. ANS: A PTS: 1 13. ANS: D PTS: 1 14. ANS: A PTS: 1 15. ANS: D PTS: 1 16. ANS: B PTS: 1 17. ANS: B PTS: 1 18. ANS: D PTS: 1 19. ANS: D PTS: 1 20. ANS: A PTS: 1 21. ANS: B PTS: 1 22. ANS: B PTS: 1 23. ANS: C PTS: 1 24. ANS: C PTS: 1 25. ANS: A PTS: 1 26. ANS: D PTS: 1 27. ANS: B PTS: 1 Chapter 6. Skin and Lymphatic Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which of the following dermatological conditions results from reactivation of the dormant varicella virus? A. Tinea versicolor B. Seborrheic keratosis A. Dry gauze dressings B. Duoderm C. Chemical debridement D. Calcium alginate dressings 15. Which of the following descriptions accurately documents cellulitis? A. Cool, erythematous, shiny hairless extremity with decreased pulse B. Scattered, erythematous ring-like lesions with clear centers C. Clearly demarcated, raised erythematous area of face D. Diffusely inflamed skin that is warm and tender to palpation 16. Asymmetrical bi-color lesion with irregular border measuring 8 mm is found on the right lower arm of an adult patient. This assessment finding is consistent with: A. Melanoma B. Basal cell carcinoma C. Leukoplakia D. Senile lentigines 17. Which of the following descriptions best illustrates assessment findings consistent with tinea capitis? A. Circular erythematous patches with papular, scaly annular borders and clear centers B. Inflamed scaly dry patches with broken hairs C. Web lesions with erythema and scaling borders D. Scaly pruritic erythematous lesions on inguinal creases 18. A hyperkeratatotic nodule formed as the result of exposure of the foot to moisture from perspiration is called: A. Hard corn B. Tinea pedis C. Soft corn D. Plantar warts (verrucae) 19. A 64-year-old male presents with an exacerbation of psoriasis. His social history includes 50-year two packs a day of cigarettes and a six-pack a week of beer. He states he had a recent sore throat, which he attributes to minding his young grandson. He reports that until recently the pruritis was only minimal. His BMI is 37. Which of the following factors most likely contributed to the acute presentation of psoriasis? A. Alcohol abuse B. Smoking C. Streptococcal infection D. Obesity 20. Treatment of complicated cellulitis of the lower extremity resulting from an anaerobe requires all of the following except: A. Extended antibiotic medication lasting at least 7-10 days B. Topical antifungal medication C. Inquiry when last tetanus toxoid booster was given D. Elevation of limb and consideration of compression bandaging Chapter 6: Skin and Lymphatic Disorders Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: B PTS: 1 3. ANS: C PTS: 1 4. ANS: B PTS: 1 5. ANS: A PTS: 1 6. ANS: B PTS: 1 7. ANS: C PTS: 1 8. ANS: A PTS: 1 9. ANS: B PTS: 1 10. ANS: D PTS: 1 11. ANS: B PTS: 1 12. ANS: B PTS: 1 13. ANS: A PTS: 1 14. ANS: D PTS: 1 15. ANS: D PTS: 1 16. ANS: A PTS: 1 17. ANS: B PTS: 1 18. ANS: C PTS: 1 19. ANS: C PTS: 1 20. ANS: B PTS: 1 Chapter 7. Head, Neck, and Face Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? A. Bacterium B. Allergen C. Virus D. Fungi 2. One of the first-line treatments in patients with allergic rhinitis is the use of nasal corticosteroid sprays. What is the anticipated onset of symptom relief with the use of these medications? A. Two weeks or more B. Immediate C. 1 to 2 days D. A minimum of one week 3. The nurse practitioner knows that antihistamines work primarily through which of the following mechanisms? A. Vasodilatation B. Blocking leukotriene effects C. Inhibiting histamine receptor sites D. Vasoconstriction 4. Cromolyn sodium may also be used in the treatment of allergic rhinitis. What is the mechanism of action of this medication? A. Mast cell stabilization B. Blocking the effects of IgE C. Leukotriene inhibition D. Histamine blockade 5. Patients that have atopic disorders are mediated by the production of IGE will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? A. Sinus pain, increased vascular permeability, and bronchodilation B. Bronchospasm, vascular permeability, and vasodilatation C. Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction D. Vasodilatation, bronchodilation, and increased vascular permeability 6. Which of the following maneuvers is used to induce symptoms of benign paroxysmal positional vertigo? A. The Fukuda stepping test B. The Dix-Hallpike maneuver C. Forced hyperventilation D. The head thrust test 7. You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? A. Ménière’s disease B. Benign paroxysmal positional vertigo C. TIA D. Migraine 8. Sensory impairment (vision and hearing) in the elderly is associated with: A. Impaired quality of life B. Decreased function C. Increased mortality D. All of the above 9. Which of the following conditions is the leading cause of blindness in the United States? C. Elderly patients have the most severe symptoms D. A & B only 4. The best evidence rating drugs to consider in a post myocardial infarction patient include: A. ASA, ACE/ARB, beta-blocker, aldosterone blockade B. Ace, ARB, Calcium channel blocker, ASA C. Long-acting nitrates, warfarin, ACE, and ARB D. ASA, clopidogrel, nitrates 5. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include: A. Echocardiogram B. Exercise stress test C. Cardiac catheterization D. Myocardial perfusion imaging 6. Preceding a stress test, the following lab work might include: A. CBC and differential to differentiate ischemic heart disease from anemia B. Liver enzymes to rule out underlying gall bladder disease C. Thyroid studies to rule out hyperthyroidism D. A & C only 7. Which test is the clinical standard for the assessment of aortic stenosis? A. Cardiac catheterization B. Stress test C. Chest x-ray D. Echocardiography 8. What is the most common valvular heart disease in the older adult? A. Aortic regurgitation B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis 9. On examination, what type of murmur can be auscultated with aortic regurgitation? A. Austin flint B. Systolic ejection C. Soft S1 and a Loud S2 D. Loud S1 10. Ischemic heart disease is: A. Defined as imbalance between oxygen supply and demand. B. Frequently is manifested as angina. C. Leading cause of death in the elderly. D. All of the above. 11. Which test is the clinical standard for the assessment of aortic stenosis? A. Cardiac catheterization B. Stress test C. Chest x-ray D. Echocardiography 12. The aging process causes what normal physiological changes in the heart? A. The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis B. Cardiology occurs along with prolapse of the mitral valve and regurgitation C. Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves D. Hypertrophy of the right ventricle 13. An older adult may present with atypical clinical signs of pneumonia. The nurse practitioner needs to be aware that the clustering of all of the following signs and symptoms may be indicative of pneumonia in an older person except: A. Bradycardia B. Malaise C. Anorexia D. Confusion 14. Which of the following statements is true concerning anti-arrhythmic drugs? A. Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile. B. Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality. C. Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic. D. Anti-arrhythmic therapy should be initiated in the hospital for all patients. 15. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? A. Musculoskeletal chest wall syndrome with radiation B. Esophageal motor disorder with radiation C. Acute cholecystitis with cholelithiasis D. Coronary artery disease with angina pectoris 16. Jose M. is a 68-year-old man who presents to your primary care practice for a physical. Jose has had type 2 diabetes mellitus for 5 years, diet controlled. His BMI is 32. Smoker, pack per day for 25 years. He denies other medical problems. Family history includes CAD, CABG x4 for father, now deceased; CHF, type 2 diabetes mellitus, HT for mother. According to the AHA/ACC guidelines, what stage is Jose? A. Stage A B. Stage B C. Stage C D. Stage D 17. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? A. Seasonal allergies B. Acute bronchitis C. Bronchial asthma D. Chronic bronchitis 18. The best way to diagnose structural heart disease/dysfunction non-invasively is: A. Chest x-ray B. EKG C. Echocardiogram D. Heart catheterization 19. A common auscultatory finding in advanced CHF is: A. Systolic ejection murmur B. S3 gallop rhythm C. Friction rub D. Bradycardia 20. The organism most commonly responsible for community-acquired pneumonia in older adults is: A. Pseudomonas aeruginosa B. Staphylococcus aureus C. Proteus mirabilis D. Streptococcus pneumonia 21. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? A. Pulmonary edema B. Heart failure C. Pulmonary embolism D. Pneumonia D. It improves aerobic capacity 11. Home exercise programs for peripheral arterial disease focus on: A. Walk until pain develops then stop B. Walk through the pain then stop C. Begin at a slow speed with 10 minutes a day and build up to 30 minutes D. Walk through the pain, rest until it goes away, then resume walking 12. When should surgical options for peripheral arterial disease be considered? A. Immediately after the diagnosis since the prognosis without revascularization is poor B. After two weeks of pentoxifylline (Trental) therapy C. Pain is not relieved with rest D. Pain limits the patient’s lifestyle or ulceration occurs 13. All of the following are classic signs of venous insufficiency except: A. Pain B. Dependent edema C. Hemosiderosis D. Dermatitis 14. Lower leg edema associated with pain is characteristic of: A. Venous insufficiency B. Heart failure C. Deep venous thrombosis D. Diabetes 15. The most common cause of secondary lymphedema is: A. Surgery B. Cancer treatment C. Infection D. Trauma 16. The imaging gold standard for lymphedema is: A. Lymphosonogram B. Lymphoscintigraphy C. Lymphoangiogram D. CT scan 17. Known risk factors for lymphedema include all of the following except: A. Osteoarthritis B. Rheumatoid arthritis C. Obesity D. Venous ulcer disease 18. Complete decongestive physiotherapy (CDP) works by: A. Stimulating the lymph vessels B. Breaking up subcutaneous fibrous tissue C. Redirecting lymph flow D. All of the above Chapter 9: Peripheral Vascular Disorders Answer Section MULTIPLE CHOICE 1. ANS: A PTS: 1 2. ANS: D PTS: 1 3. ANS: B PTS: 1 4. ANS: D PTS: 1 5. ANS: C PTS: 1 6. ANS: B PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: C PTS: 1 10. ANS: C PTS: 1 11. ANS: D PTS: 1 12. ANS: D PTS: 1 13. ANS: A PTS: 1 14. ANS: C PTS: 1 15. ANS: B PTS: 1 16. ANS: B PTS: 1 17. ANS: A PTS: 1 18. ANS: D PTS: 1 Chapter 10. Abdominal Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Your 70-year-old patient has gastroesophageal reflux disease (GERD). After a trial of lifestyle modifications and antacids, the patient continues to have occasional mild heartburn after occasional meals and at night. The most appropriate next action is: A. Prokinetic agents B. H2 antagonists C. Proton pump inhibitors D. Surcralfate 2. An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? A. Identification of a fluid wave B. Positive Murphy’s sign C. Palpable spleen D. Midepigastric pain that is not reproducible with palpation 15. Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease? A. Cases of dyspepsia with constipation B. Symptoms persisting after 6-8 weeks of therapy C. All clients with dyspepsia who smoke and drink alcohol D. When a therapeutic response to empiric treatment is obtained 16. A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she also experiences bouts of constipation. She has no known allergies and experienced no unintentional weight loss. What is the most likely condition? A. Inflammatory bowel disease B. Irritable bowel syndrome C. Giardiasis D. Lactose intolerance 17. The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal reflux. What are the nonpharmacological management interventions that should be included? A. Weight reduction and rest 30 minutes after each meal in the supine position B. Elevation of head of the bed 4-6 inches on blocks and weight reduction C. Encouraged to wear restrictive clothing to add support for diaphragmatic breathing D. Using oral mints to relieve gastric distress 18. In differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer can present with distinct signs and symptoms. Which of the following pieces of information from the patient’s history is the least useful for you to determine that the patient has a duodenal ulcer? A. Pain occurs on an empty stomach B. Diffuse epigastric pain C. Rarely associated with non-steroidal use D. Occurs in patients under 40 years of age 19. A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis? A. C-reactive protein level of 3 mg B. White blood cell count of 11,000 C. Direct serum bilirubin level of 0.3 mg/dL D. Serum amylase level of 145 U/L 20. Which of the following is not a contributing factor to the development of esophagitis in older adults? A. Increased gastric emptying time B. Regular ingestion of NSAIDs C. Decreased salivation D. Fungal infections such as Candida Chapter 10: Abdominal Disorders Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: D PTS: 1 3. ANS: B PTS: 1 4. ANS: C PTS: 1 5. ANS: D PTS: 1 6. ANS: B PTS: 1 7. ANS: A PTS: 1 8. ANS: B PTS: 1 9. ANS: A PTS: 1 10. ANS: B PTS: 1 11. ANS: D PTS: 1 12. ANS: B PTS: 1 13. ANS: C PTS: 1 14. ANS: C PTS: 1 15. ANS: B PTS: 1 16. ANS: B PTS: 1 17. ANS: B PTS: 1 18. ANS: B PTS: 1 19. ANS: D PTS: 1 20. ANS: A PTS: 1 Chapter 11. Urological and Gynecologic Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which ethnic group has the highest incidence of prostate cancer? A. Asians B. Hispanics C. African Americans D. American Indians 2. Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what intervals? A. Every 6 months B. Yearly C. Every 2 years D. Every 2 to 4 years 3. All of the following may be reasons associated with an elevated PSA besides prostate cancer except: A. Prostatitis B. Urinary tract infection C. Perineal trauma D. Digital rectal exam 4. In the diagnosis of acute bacterial prostatitis, a midstream urine culture is of benefit. To be diagnostic, the specimen should reveal how many white blood cells per high-power field? A. Five B. Ten C. Fifteen D. Twenty 5. In chronic bacterial prostatitis, what is the organism most commonly associated with the disease? A. Klebsiella B. Proteus C. Pseudomonas D. Escherichia coli 6. In acute prostatitis, an exam of the prostate may find the gland to be: A. Nodular B. Cool and pliable C. Swollen and tender D. Asymmetrical 7. All of the following antimicrobials may be indicated in chronic bacterial prostatitis except: A. Ciprofloxacin B. Levofloxacin C. Trimethoprim D. Azithromycin 8. Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: A. Increased estrogen production’s influence on the bladder and ureter B. Decline in bladder outlet function C. Decline in ureteral resistance pressure D. Laxity of the pelvic muscle 9. Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the past week. He has never had a surgical procedure in his life and seeks clarification on the availability of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is NOT a potential side effect of this procedure? A. Urinary incontinence B. Impotence C. Dribbling urine D. Selected low back pain Chapter 11: Urological and Gynecological Disorders Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 2. ANS: C PTS: 1 3. ANS: B PTS: 1 4. ANS: B PTS: 1 5. ANS: D PTS: 1 6. ANS: C PTS: 1 7. ANS: D PTS: 1 8. ANS: A PTS: 1 9. ANS: D PTS: 1 10. ANS: B PTS: 1 11. ANS: C PTS: 1 12. ANS: D PTS: 1 13. ANS: A PTS: 1 14. ANS: C PTS: 1 15. ANS: B PTS: 1 Chapter 12. Musculoskeletal Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Osteoarthritis of the cervical and lumbar spine causes pain that is related to all of the following except: A. Bone spur formation B. Pressure of the ligaments C. Reactive muscle spasm D. Crystal deposition 2. In differentiating osteoarthritis from chronic gout, pseudogout, or septic arthritis, the most valuable diagnostic study would be: A. Erythrocyte sedimentation rate (ESR) B. Synovial fluid analysis C. C-reactive protein analysis D. Complete blood cell count 3. Patients with osteoarthritis of the hip and knee often have a distinguishable gait described as: A. Ataxic B. Festinating C. Antalgic D. Steppage 4. Which of the following best describes the pain associated with osteoarthritis? A. Constant, burning, and throbbing with an acute onset? B. Dull and primarily affected by exposure to cold and barometric pressure C. Begins upon arising and after prolonged weight bearing and/or use of the joint D. Begins in the morning but decreases with activity 5. Joint effusions typically occur later in the course of OA, especially in the: A. Knee B. Elbow C. DIP joints D. Hips 6. You have ordered a CBC for your patient you suspect has polymyalgia rheumatica (PMR). Which two clinical findings are common in patients with PMR? A. Neutropenia and hypochromic, normocytic anemia B. Normochromic, normocytic anemia and thrombocytosis C. Microcytic, hypochromic anemia and reticulocytopenia D. Macrocytic, hyperchromic anemia and leukocytopenia 7. You suspect that your patient has polymyalgia rheumatica and now are concerned that the patient may also have Giant Cell Arteritis (GCA). Which of the following two symptoms are most indicative of GCA and PMR? A. Jaw pain and heart murmur B. Joint swelling and sudden loss of central vision bilaterally C. Hoarseness and the total inability to grasp small objects D. Scalp tenderness and aching in shoulder and pelvic girdle 8. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include: A. Recommending she increase her dietary intake of Calcium and Vitamin D B. Ordering once a year bisphosphonate and a proton pump inhibitor C. Participate in a fall prevention program D. Dual-energy x-ray (DEXA) scan and updating immunizations 9. Which of the following differential diagnosis for patients presenting with polymyalgia rheumatica (PMR) can be ruled out with a muscle biopsy? A. Parkinson’s disease B. Polymyositis C. Late onset rheumatoid arthritis D. Giant Cell Arteritis 10. In reviewing laboratory results for patients suspected with polymyalgia rheumatica (PMR), you realize that there is no definitive test to diagnosis PRM, rather clinical response to treatment. Results you would expect to see include: A. Elevated erythrocyte sedimentation rate (ESR) greater than 50mm per hour B. Elevated rheumatoid factor and anti-citrullinated protein antibodies (RF and ACPA) C. Decreased C-reactive protein level (CR-P) D. Elevated thyroid stimulating hormone (TSH) 11. Which of the following is the most appropriate laboratory test for monitoring gout therapy over the long-term? A. Erythrocyte sedimentation rate (ESR) B. Completer blood count (CBC) C. Serum urate level D. Serum albumin 12. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items: A. Green leafy vegetables B. Beer, sausage, fried seafood C. Sugar D. Gluten and bread items 13. The best method of verifying a diagnosis of gout in a joint is which of the following: A. Radiographic examination of the joint with two views B. Ultrasound C. Palpation D. Joint aspiration and polarized-light microscopy 14. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk): A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days B. Doxycycline 100 mg BID for 5 days C. Prednisolone 35 mg QD for 5 days D. Ice therapy 15. The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be: A. Symmetric joint space narrowing B. Soft tissue swelling C. Subluxations of the joints D. Joint erosions 16. The nurse practitioner is examining the hands of a 55-year-old woman with rheumatoid arthritis and notes bilateral spindle shaped deformities on the middle interphalangeal joints. These are known as: A. Haygarth’s nodes B. Frontal lobe C. Temporal lobe D. Parietal lobe 7. An elderly patient has had a CVA in the anterior cerebral circulatory system (frontal lobe). What symptoms are most likely expressed? A. Neglect of body and difficulty organizing space B. Wernicke’s aphasia (difficulty understanding speech) C. Disorders of behavior and cognition D. Bilateral motor and sensory problem 8. The most common neurological cause of seizures in an older adult is: A. Alzheimer’s disease B. Multiple sclerosis C. Stroke D. Peripheral neuropathy A. The handwriting is not affected by the tremor B. The tremor occurs with purposeful movements C. The tremor occurs at rest D. The tremor gets worse with alcohol ingestion 3. Which of the following assessments are commonly noted in a client with Parkinson’s disease? A. Macrographia and bradycardia B. Micrographia and bradykinesia C. Exaggeration of rapid successive movements D. Increased arm swing 4. An older adult client with a history of a seizure disorder comes into the clinic for a routine check-up. Although seizure free, the client continues on long-term phenytoin treatment. The nurse practitioner would assess for which of the following long-term effects? A. Lid lag and nystagmus B. Gingival hyperplasia and nystagmus C. Nystagmus and microcytic anemia D. Gingival hyperplasia and iron deficiency anemia 5. An elderly nursing home resident is maintained on phenytoin therapy for a history of a seizure disorder. In addition to periodic serum drug concentrations, which of the following are needed for annual evaluation? A. Complete blood count, liver function tests, and renal function tests B. Complete blood count, liver function tests, and platelet count C. Renal function and calculated creatinine clearance D. Serum albumin, liver function tests, and renal function tests 6. A 78-year-old female presents with a seizure that occurred over the weekend. In selecting the most important diagnostics for this presentation, it is important to know that the least common site of seizures in the elderly is: A. Cerebellum 9. You are evaluating an elderly patient’s complaint of a new onset of “hand shaking” when he drinks from a cup. The patient is euthyroid and does not drink alcohol. Which of the following signs indicate that this tremor is most likely an essential tremor rather than a Parkinson’s tremor? A. It is characteristic of “pill rolling” and occurs at rest B. It is a moderate amplitude tremor that occurs only with movement/activity C. The tremor is also associated with slowed movements D. The tremor is accompanied by dyskinesia 10. Mr. Andrews experienced a brief onset of right-sided weakness, slurred speech, and confusion yesterday. The symptoms have resolved. What should the nurse practitioner do? A. Assure the patient that he will not experience the symptoms again B. Identify modifiable cardiovascular risk factors C. Do a thorough medication review and a CT scan D. Order a stat EEG and administer O2 by mask 11. An older male patient is experiencing acute onset of right-sided weakness, slurred speech, and confusion. What should the nurse practitioner do promptly? A. Administer an aspirin by mouth B. Evaluate for stroke and arrange transport to the hospital right away C. Do a thorough medication review and stat blood sugar D. Order an EKG and administer O2 by cannula immediately 12. An older adult female patient had a stroke. What symptoms are not usually expressed by patients who have had a vertebrobasilar stroke? A. Vertigo B. Ataxia C. Dysarthria D. Monocular blindness 13. When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinson’s disease? A. Any presence of tremor B. Symptoms of slowed movement, unstable angina, and tremor C. Resting tremor, slow unsteady gait, and cogwheel resistance D. Cogwheel rigidity, bradykinesia, and amnesia 14. A 78-year-old man with Parkinson’s disease is being cared for in a nursing home. The nurses observe that he coughs at mealtime; he has the ability to still feed himself with adaptive equipment. He has had no aspirations. Oral exam is normal, except during his swallowing assessment you note there is slight delayed elicitation. You assess that he has only mild dysphagia. You recommend which of the following as the next step in his care? A. Consult gastroenterologist for g-tube decision B. Consult speech pathologist for video fluoroscopy C. Provide a trial of foods of differing consistency D. Require that he is fed all his meals 15. Which of the following assessment findings is commonly noted in a client with advanced Parkinson’s disease? A. Macrographia B. Micrographia C. Ataxic gait D. Increased arm swing 16. A middle-aged patient has been diagnosed with Parkinson’s disease. What influences the nurse practitioner’s decision to begin pharmacological treatment for this patient? A. Intentional tremors B. Gait instability requiring use of a cane C. Symptoms interfering with functional ability D. Medications initiated at first sign of unilateral involvement 17. An older male presents with incontinence, has a wide-based and irregular gait, and progressive dementia. Which of the following presents with these cardinal signs? A. Parkinson’s disease B. Normal pressure hydrocephalus C. Basilar artery CVA D. Progressive supranuclear palsy 18. In review of a nursing home patient’s chart, the nurse practitioner discovers that the neurology consult identified that the client has a homonymous hemianopsia. Which of the following statements accurately describes these findings? A. Partial loss of visual acuity in the ipsilateral peripheral fields B. Diplopia in the eye contralateral to the cerebral lesion C. Loss of vision in either the right or left halves of the visual fields D. Nystagmus in both eyes with asymmetrical movement 19. The Mini-Cog is a short screening tool used to assess cognition. Which of the following statements pertaining to the test is a true statement? A. The patient will be asked to repeat five words immediately following the directions by the practitioner. B. The patient is asked to draw the hour and minute hands on a picture of an analog clock. C. A score of 0-2 is a positive screen for dementia. D. The patient is asked to recall five images from picture cards following the drawing of the clock hands. B. Double the dose of Synthroid C. Discontinue the Synthroid D. Prescribe Liotrix (T3 & T4 combination) 9. A fluoroquinolone (Ciprofloxin) is prescribed for a male patient with a UTI. What should the nurse practitioner teach the patient regarding taking this medication? A. It must be taken on an empty stomach B. Its effectiveness is decreased by antacids, iron, or caffeine ingestion C. It may cause a metallic aftertaste D. Its effectiveness is not a concern and it can be taken with any medications 10. A patient has been prescribed metformin (Glucophage). One week later he returns with lowered blood sugars but complains of some loose stools during the week. How should the nurse practitioner respond? A. Discontinue the medication immediately B. Reassure the patient that this is an anticipated side effect C. Double the dosage of medication and have patient return in 1 week D. Order a chem. 7 to check for lactic acidosis 11. Which of the following signs of hyperthyroidism commonly manifest in younger populations, but is notably lacking in the elderly? A. Weight gain B. Constipation C. Bradycardia D. Exophthalmos 12. A 60-year-old obese male client has type 2 diabetes mellitus and a lipid panel of TC = 250, HDL = 32, LDL = 165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include: A. Advancing age, diabetes, hyperlipidemia, and male gender B. Diabetes, obesity, and hyperlipidemia C. Hyperlipidemia, smoking, and family history of heart disease D. Male with age > 45, diabetes mellitus, and hyperlipidemia 13. A diabetic patient presents with the complaint of right foot pain but denies any recent known injury. He states it has gotten progressively worse over the past few months. On exam, vibratory sense, as well as sensation tested with a monofilament, was abnormal. The patient’s foot is warm, edematous, and misshapen. The nurse practitioner suspects Charcot foot. What intervention is indicated? A. Warm soaks and return for follow-up in 1 week B. Referral to a pain management clinic C. Referral to an orthopedist D. Referral to a cardiologist for evaluation of peripheral vascular disease 14. What is a sign of insulin resistance that can present in African American patients? A. Acanthosis Nigricans B. Psoriasis Nigricans C. Seborrheic Nigricans D. Bullemic Nigricans 15. During a routine physical examination of a 62-year-old female patient, the nurse practitioner identifies xanthelasma around both his eyes. What is the significance of this finding? A. High potential for future blindness and requires immediate referral B. None, normal variant of aging process C. Abnormal lipid metabolism requiring medical management D. Hereditary variant that is of no consequence but requires watchful waiting 16. Mr. White is 62 years old and has chronic kidney disease that has been relatively stable. He also has a history of hyperlipidemia, osteoarthritis, and hypertension. He is compliant with his medications, and his BP has been well controlled on a calcium channel blocker. His last lipid panel showed: TC = 201, HDL = 40, TG = 180, LDL = 98. He currently takes Crestor 20 mg daily. In the office today, his BP is 188/90, and his urine dip now shows significant proteinuria. He denies any changes in his dietary habits or medication regimen. What would be the best medication change for Mr. White at this point? A. No change—have him return in 4 weeks for a re-check of his blood pressure and urine B. Increase the dose of the calcium channel blocker for his hypertension C. Change the calcium channel blocker to an ACE-I D. Increase the dose of his Crestor and have him return in 3 months for a re-check of his BP 17. You are working as a nurse practitioner in the Fast Track of the emergency room. A 76-year-old male presents with left upper quadrant abdominal pain. There can be many conditions that present as left upper quadrant pain, but which of the following is least likely to cause pain in the left upper quadrant? A. Splenic abscess B. Left pyelonephritis C. Splenic rupture D. Acute pancreatitis 18. Which is a “cardinal feature” of failure to thrive? A. Decline in toileting ability B. Gait disturbance C. Poor nutritional status D. Spiritual distress 19. Feeding gastrostomy tubes at end-of-life Alzheimer’s disease patients have been associated with: A. Prolongation of life B. Aspirational pneumonia C. Increase in skin infections D. Reversal of any clinical signs of failure to thrive 20. Which of the following nutritional indicators is not an indication of poor nutritional status in an older person? A. Albumin of < 3.5 g/dl B. Body mass index of 25 C. Total cholesterol < 150 mg/dl D. Loss of 10% body weight in 180 days Chapter 14: Endocrine, Metabolic, and Nutritional Disorders Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: B PTS: 1 3. ANS: B PTS: 1 4. ANS: A PTS: 1 5. ANS: B PTS: 1 6. ANS: B PTS: 1 7. ANS: A PTS: 1 8. ANS: B PTS: 1 9. ANS: B PTS: 1 10. ANS: B PTS: 1 11. ANS: D PTS: 1 12. ANS: B PTS: 1 13. ANS: C PTS: 1 14. ANS: A PTS: 1 15. ANS: C PTS: 1 16. ANS: C PTS: 1 17. ANS: D PTS: 1 18. ANS: C PTS: 1 19. ANS: B PTS: 1 20. ANS: B PTS: 1 Chapter 15. Hematologic and Immune System Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? A. Hemoglobin and hematocrit B. Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) C. Serum ferritin and serum iron D. Total iron binding capacity and transferrin saturation 2. Initial therapy for patients with IDA is: A. Blood transfusion B. Increasing dietary intake of green leafy vegetables C. Ferrous sulfate 325 mg orally bid-tid D. Parenteral administration of Venofer Chapter 15: Hematological and Immune System Disorders Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 2. ANS: C PTS: 1 3. ANS: D PTS: 1 4. ANS: C PTS: 1 5. ANS: C PTS: 1 6. ANS: C PTS: 1 7. ANS: B PTS: 1 8. ANS: C PTS: 1 9. ANS: D PTS: 1 10. ANS: C PTS: 1 11. ANS: C PTS: 1 12. ANS: B PTS: 1 13. ANS: A PTS: 1 14. ANS: D PTS: 1 15. ANS: A PTS: 1 Chapter 16. Psychosocial Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The prevalence of depression in nursing home residents is greater than adults living in the community. A. 1-2 times B. 2-3 times C. 3-4 times D. 5 times 2. The majority of depressed older adults remain untreated because of: A. Misdiagnosis B. Social stigma C. Environmental barriers D. All of the above 3. Symptoms of depression distinct to the elderly include: A. Flat affect B. Loss of pleasure in usual activities C. Appetite and weight disturbances D. Lack of emotions 4. The justification for ordering a CBC, TSH, and serum B12 for a patient you suspect may have clinical depression is: A. To determine the cause of sadness B. Because of overlapping symptoms with anemia, thyroid dysfunction, and nutritional deficiencies C. To differentiate between depression and metabolic disorders D. To rule out vascular disease 5. One major difference that is useful in the differential diagnosis of dementia versus delirium is that: A. Dementia develops slowly and delirium develops quickly B. The initial symptoms of dementia are more severe than the symptoms of delirium C. Dementia symptoms are not associated with underlying medical conditions and delirium symptoms usually result from underlying medical conditions D. Symptoms of delirium involve memory and attention and symptoms of dementia involve only memory 6. Which of the following is the most appropriate screening tool for delirium? A. Lawton Scale of Instrumental Activities of Daily Living B. Confusion Assessment Method C. Folstein’s Mini-Mental Status Examination D. Montreal Cognitive Assessment 7. The proposed mechanism by which diphenhydramine causes delirium is: A. Serotinergic effects B. Dopaminergic effects C. Gabanergic effects D. Anticholinergic effects 8. The elderly are at high risk for delirium because of: A. Multisensory declines B. Polypharmacy C. Multiple medical problems D. All of the above 9. A consistent finding in delirium, regardless of cause, is: A. Dopamine deficiency B. Serotinergic toxicity C. Acetylcholine deficiency D. Reduction in regional cerebral perfusion 10. Older adults with dementia sometimes suffer from agnosia, which is defined as the inability to: A. Use language B. Understand language C. Recognize objects D. Remember events and places 11. In late stages of dementia, a phenomenon called “sun downing” occurs, in which cognitive disturbances tend to: A. Improve as the day goes on B. Become worse toward the evening C. Fluctuate during the course of the day D. Peak mid-day 12. Of the following, which one is the most useful clinical evaluation tool to assist in the diagnosis of dementia? A. Folstein’s Mini-Mental Status Exam (MMSE) B. St. Louis University Mental Status Exam (SLUMS) C. Montreal Cognitive Assessment (MoCA) D. Geriatric Depression Scale (GDS) 13. The cornerstone of pharmacotherapy in treating Alzheimer’s disease is: A. Cholinesterase inhibitors B. NMDA receptor antagonist C. Psychotropic medications D. Anxiolytics 14. The comorbid psychiatric problem with the highest frequency in dementia is: A. Anxiety B. Depression C. Agitation and aggression D. Psychosis 15. When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed? A. Fluoxetine B. Desipramine C. Amitriptyline D. Mirtazapine a. has difficulty maintaining a list of current medications. b. experiences changes in visual capability. c. experiences alterations in mental capacity. d. may obtain prescribed drugs from various providers. ANS: D Polypharmacy is the prescription and administration of many drugs during the same period. This is more likely with the older client, who may see various healthcare providers to manage the health concerns that may accompany aging. 5. The diuretic hydrochlorothiazide (HCTZ; HydroDIURIL) is usually prescribed for the older adult in a lower dose. The nurse recognizes that this is an attempt to prevent the older adult from experiencing a(n): a. increase in potassium loss. b. decrease in sodium loss. c. decrease in blood sugar levels. d. increase in red and white blood cell count. ANS: A 6. The nurse notes that Cimetidine has been prescribed for an older adult client. The nurses highest priority would be to call: a. the physician. b. the pharmacist. c. the nursing supervisor. d. Poison Control. ANS: A Cimetidine is not recommended for the older adult because of its side effects and multiple potential drug interactions. Famotidine, nizatidine, and ranitidine may be prescribed for the geriatric client instead of cimetidine. 7. An older adult client says that he has difficulty removing the cap from his medication bottle. He says, Thats why I dont always take my medication. The nurse should suggest that he: a. ask a neighbor to help him remove the bottle cap. b. ask the pharmacist to put the drug in a nonchildproof container. c. have a family member visit daily to prepare his medications. d. ask the healthcare provider not to prescribe drugs that come in childproof bottles. ANS: B Childproof caps may be difficult to remove for older adults with arthritis or decreased strength or motor function. 8. A client is demonstrating signs and symptoms of disorientation. Which question by the nurse would be appropriate, related to the clients medication use? a. Are you taking any new medications? b. Do you take medications with a full glass of water? c. Do your medications make you constipated? d. Have you been diagnosed with dementia? ANS: A A new medication may be associated with changes in sensorium or other behavioral characteristics. This should be evaluated. 9. The nurse is caring for an older adult client and a middle-aged adult client. The nurse anticipates that the medication doses for the older adult will be those for the middle-aged adult. a. the same as b. less than c. slightly more than d. twice as much as ANS: B Because of changes in metabolism and excretion, doses are generally decreased to avoid accumulation and toxicity. 10. An older adult client is ordered to receive digoxin (Lanoxin). The client has decreased renal function. Which condition could indicate digoxin toxicity? a. Elevated blood pressure b. Decreased blood pressure c. Heart rate greater than 100 beats per minute d. Heart rate less than 60 beats per minute ANS: D Digoxin slows and strengthens the heart. Toxicity may be manifested by bradycardia. 11. A client takes ibuprofen to deal with the pain of arthritis. The client complains of gastrointestinal symptoms. Which is an appropriate strategy for the nurse to teach the client? a. Take the medication on an empty stomach. b. Do not take the medication if it has side effects. c. Try to take an antacid 1 hour before the dose. d. You must take the medication anyway. ANS: C D. Sleep apnea 9. Evidence-based clinical practice guidelines may have limited applicability in the older population because: A. They often are disease specific 2. The highest number of people with multiple chronic conditions are those that are: A. Over age 85 B. Diagnosed with type 2 diabetes C. African American women over age 65 D. Diagnosed with COPD 3. Long durations of a chronic illness that are most commonly associated in both women and men are: A. Heart disease and obesity B. Diabetes and COPD C. Arthritis and dementia D. Dyslipidemia and eye disease 4. The percentage of non-institutionalized elderly over age 75 with limitations in activity due to a chronic condition is: A. 25% B. Nearly 50% C. Over 75% D. Less than 15% 5. Which of the following statements are true? A. Most Medicare participants have a single care provider B. Chronic kidney disease patients have better outcomes due to the dialysis benefit C. Nearly half of Medicare participants have five or more chronic diseases D. Nearly half of Medicare participants have three or more chronic diseases 6. Which statement about chronic mental disorders is false? A. The numbers are projected to increase in the next decade B. Individuals with mental health problems actually have a decreased risk of medical problems C. The number of older adults with addiction problems is projected to increase in the next decade D. Nearly half of individuals with dementia are not diagnosed prior to hospitalization 7. All of the following criteria define frailty except: A. Unintentional weight loss >10 pounds in the past year B. Slow walking speed C. Stooped posture D. Self-reported exhaustion 8. All of the following are health consequences of obesity except: A. Mortality of aging B. Hypertension C. Coronary artery disease B. They often have complex comorbid conditions C. Both A and B D. None of the above evidence-based clinical practice guidelines are always the standard 10. Inter-professional care is distinguished from other models of team-based care in that: A. Independent providers share information B. Expert advice is shared from one provider to another C. Different disciplines work under one leader D. Shared leadership and accountability is a primary focus 11. All of the following statements about the Chronic Care Model are true except: A. It was developed with Robert Wood Johnson Foundation funding B. It focuses exclusively on a self-management model C. It is an evidence-based policy response designed to meet the needs of the chronically ill D. It directs quality improvement and system change for patients with chronic disease 12. The legislation signed in March 2010 with provisions for addressing chronic disease was: A. Accountable Care Organization Act B. Independence at Home Act C. Patient Protection and Affordable Care Act D. Patient Centered Medical Home Act 13. Reported outcome measures for the Patient Centered Medical Home include all of the following except: A. Emergency room use B. Hospitalizations C. Patient/family satisfaction D. Number of primary care visits 14. Transitional care is best described as: A. A set of actions to ensure the coordination and continuity of care across sites/settings B. The care received in transit from one site of care to another C. A discharge-planning model D. Long-term acute care that provides the transition from hospital to long-term care or home Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 2. ANS: A PTS: 1 3. ANS: B PTS: 1 4. ANS: B PTS: 1 5. ANS: D PTS: 1 6. ANS: B PTS: 1 7. ANS: C PTS: 1 8. ANS: A PTS: 1 9. ANS: C PTS: 1 10. ANS: D PTS: 1 11. ANS: B PTS: 1 12. ANS: C PTS: 1 13. ANS: D PTS: 1 14. ANS: A PTS: 1 Chapter 19. Palliative Care and End-of-Life Care Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Hospice care differs from palliative care in that: A. It is not covered by insurance B. Supports patients and families through both the dying and the bereavement process C. It cannot be provided in the nursing home D. The majority of those admitted to hospice die within 7 days 2. Evidence reflects the primary obstacle to implementing palliative care in the long-term care setting include all of the following except: A. Inadequate communication between decision makers B. Failure to recognize futile treatments C. Lack of advance directives D. Lack of sufficient staff 3. The most prevalent symptom in end-of-life care includes all of the following except: A. Lower extremity weakness B. Pain C. Dyspnea