Elders Final Guided Review

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.

-As you get older, the tissue in your lungs is not as flexible to aid in exhaling. -The body contains less water as you age, and the mucus begins to dry out.

The following nursing interventions represent each of the four steps of a nutritional assessment. Rank them in order, beginning with the first step.

Ask for an up-to-date list of medications. Examine the lips, gums, and oral cavity. Measure the midpoint of the upper arm. Obtain blood for serum transferrin level

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.

-Because you had chicken pox as a child, and you now have a depressed immune system, the chance of developing herpes zoster is high. -We are not certain at this point, however, these symptoms often occur before a break-out of herpes zoster.

In a life-threatening illness, which of the following are tools to help minimize and relieve suffering? Select all that apply.

-Offer a support system to help patients live as actively as possible until death. -Provide relief from pain and other distressing symptoms. -Integrate psychological and spiritual aspects of patient care.

Abdominal Aortic Aneurysm (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.

-There is no dominant ethnic group that develops AAA. -There is a familial history associated with AAA development. -AAA is the 13th leading cause of death in the United States.

Which of the following is true regarding STOPP/START criteria for prescribing medications? Select all that apply.

-Valuable tool for prescribers, but they are not meant to be mandates for prescribing. -Screening tool to alert doctors to correct treatment. -Screening tool of older persons' potentially inappropriate prescriptions

Mary, 72 years old, 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 nurse practitioner teach her about senior immunizations? Select all that apply.

. -Because the immune system may be weakened in older persons, immunizations are suggested. -Persons over the age of 50 years should have a yearly influenza vaccine. -The new Shingrix vaccine will help protect her from shingles.

15. Mr. Hupp, 84 years old, lost his wife 2 months ago. He goes to his nurse practitioner and complains of the same symptoms that his wife had before she died. Possible treatment options available to the nurse practitioner include which of the following? Select all that apply. 1. Educate him on normal signs of grieving. 2. Take time to remember his wife and discuss memories. 3. Provide emotional support. 4. Monitor current chronic medical conditions. 5. Encourage him to stay quiet at home and decrease his physical activity.

15. Answers: 1, 2, 3, 4 Page: 459 Feedback 1. Sleep disruptions are common in the first 2 weeks; education on sleep hygiene and assessing for pre-existing conditions such as obstructive sleep apnea may be necessary. Referral to a bereavement support group may help some individuals, but not all. 2. Reminiscence is helpful to many. 3. Provide emotional support, allowing the older adult to express feelings. 4. Those with pre-existing chronic medical conditions, particularly cardiac, will need to be monitored for adverse events; studies have demonstrated the occurrence of acute coronary syndrome (ACS/MI) after the death of a significant person. 5. Encourage patients to return to their normal routine as soon as possible. Daily physical exercise can help patients cope with the depression that accompanies grief.

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.

Which Ca/Vit,D combination is suitable for the daily diet of elders

Calcium 1500 mg and vitamin D 600 to 800 units

Which is a true statement about dental health in older adults?

Dentures should be cleaned once a day by brushing and soaking in cleaning solution

Miss Benton is a 65-year-old female who complains of a painful big toe on the right foot. She asks the nurse practitioner if this is normal for older people. The nurse practitioner explains that this appears to be gout, and gives her what information? Select all that apply.

Gout is an inflammatory condition of joints, tissues, and kidneys. Gout is a problem with a protein called purine. Long-term use of some medications can lead to gout.

The nurse instructs the unlicensed assistive personnel to feed an older adult. If the nurse is unable to observe feeding directly, which action should the nurse use to assess the older adult's risk for aspiration immediately following feeding

Inspect for pocketing

Which of the following is not a common age-related physical change that may affect digestion and food intake

Loss of the majority of taste buds

Which type of pain tends to occur along a well-defined path in a region of the body persistently?

Postherpetic pain

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?

Real-time ultrasonography of the gallbladder and biliary tree.

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.

Sensorineural Conductive

Which is a true statement about sleeping in older adults?

Sleep disturbances in the older adult can be caused by cardiovascular disease, arthritis, or diabetes

When other symptoms are presented with atrophic vaginitis, a biopsy is used as the diagnostic test to rule out which of the following diagnoses? Select all that apply.

Squamous cell hyperplasia Lichen sclerosis Lichen planus

Which statement is true about analgesic medications for older adults?

Stool softeners and laxatives should be used with opioids.

The nurse practitioner is conducting a safety class with community-living older adults. Which of the following should she include in her teaching of risks of burns for this population? Select all that apply.

Thinner skin. Less vascularity. Diminished nerve function. A weakened immune system.

The nurse practitioner is ordering laboratory testing to confirm her suspicion of acute pancreatitis. Which of the following would confirm her suspicions? Select all that apply.

Trypsinogen activation peptide (TAP). Blood urea nitrogen (BUN), creatinine, glucose An abdominal x-ray. Amylase and lipase amount three times the normal.

Which of the following is a contraindication for exercise therapy and prevents patients from joining an exercise program? Select all that apply.

Uncontrolled hypertension Unstable aortic aneurysm

Mrs. Parsons is 75 years old and is anticipating renewing her driver's license. The nurse practitioner conducts an eye examination and is concerned to find which of the following? Select all that apply.

Visual acuity worse than 20/40. Abnormality in the six cardinal fields of gaze.

Mrs. K 95 years old, comes to the nurse practitioner with her daughter to discuss her medical regime. She complains that she thinks some of the therapies are doing more harm than good. Mrs. K wants to discontinue some of the medical orders. The nurse practitioner reviews her medical plan and discusses a new model of care called minimally disruptive medicine (MDM). She explains to the daughter and to Mrs. K that this model does which of the following? Select all that apply.

. -Recognizes the difference between patient-centered and disease-centered treatment. -May suggest limitations on some traditional therapies for the frail patient with MCCs. -Revises clinical practice guidelines to consider minimally disruptive medicine. -Has clinicians use approaches that include patient values so that better decisions are made.

1. Polypharmacy is a primary predictor for any undesired or unwanted consequences that can occur because of taking medications. Which is of the following is the correct term for these undesired or unwanted consequences? 1. Adverse drug reaction (ADR) 2. Prototype drug 3. Adverse drug event 4. Schedule II drugs

1. Answer: 1 Page: 470 Feedback 1. ADR is a reaction attributed to the drug. It is any undesired or unwanted consequence that occurs because of taking medications. 2. A prototype drug is the original drug model from which other medications in a pharmacological class have been developed. 3. An adverse drug event is any event that occurs during treatment and is not necessarily caused by the drug itself. It is a side effect that was revealed after usage of the drug and is reported by the patient or the doctor who has personal experience with the event. 4. Schedule II drugs are drugs with abuse potential, and psychic and physical dependence liability.

10. Which of the following factors affect drug absorption? Select all that apply. 1. Metabolic diseases 2. Esophageal erosion 3. Kidney diseases 4. Drug-food interactions 5. Huntington's disease

10. Answer: 1, 2, 4 Page: 471 Feedback 1. Metabolic diseases such as thyroid disease or diabetes can cause an increase or decrease in transit time and therefore can cause either increased or decreased drug absorption. 2. Esophageal erosion has been noted with caustic drugs such as alendronate potassium and tetracycline. These types of drugs increase the potential for esophageal damage from the dissolution of drugs. 3. Kidney diseases can affect drug elimination. 4. Drug-food interaction is likely to influence drug absorption 5. Huntington's disease is a fatal genetic disorder that causes the progressive breakdown of nerve cells in the brain. It deteriorates a person's physical and mental abilities during their prime working years and has no cure.

11. Drug distribution in the body is affected by aging and higher body fat. Which of the following is true regarding drugs distributed in fat? Select all that apply. 1. There is a wider effect in drugs distributed in fat. 2. The effect of drugs is less when distributed in fat. 3. There is prolonged action in drugs distributed in fat. 4. There is a more intense effect of drugs distributed in fat. 5. There is a shorter effect of drugs distributed in fat.

11. Answer: 1, 2, 3 Page: 471 Feedback 1. Drugs distributed in fat have a wider distribution. 2. Drugs distributed in fat have a less intense effect. 3. Drugs distributed in fat have more prolonged action. 4. Drugs distributed in fat have a less intense effect. 5. Drugs distributed in fat have more prolonged action.

11. Larry is 69 years old and beginning to experience a cognitive decline. His son brings him to the practitioner asking for an evaluation. The nurse practitioner assesses for which of the following signs or symptoms? Select all that apply. 1. Cognitive decline in complex attention, executive function, learning, and memory. 2. Gradual onset and the course of illness and progression are typically slow. 3. Impaired ability to care for oneself. 4. Total or partial loss of the ability to recognize familiar people. 5. Improvement in symptoms in time.

11. Answers: 1, 2, 3, 4 Page: 443 Feedback 1. Cognitive decline must be in at least one of the following cognitive domains: complex attention, executive function, learning, and memory, language, perceptual motor or social cognition. 2. Dementia has a cognitive decline and must be in at least one of the following cognitive domains: complex attention, executive function, learning, and memory, language, perceptual motor or social cognition. 3. Symptoms vary from person to person, and cognitive deficits cause significant impairment in social and occupational functioning, impaired ability to care for oneself, and altered behavioral patterns. 4. Signs and symptoms progress from memory loss to impaired executive functioning, language deficits, coordination, and perception with total or partial loss of the ability to recognize familiar people or objects. 5. The etiology of dementia includes numerous systemic disorders, however, most cases of dementia are irreversible, because dementia is a progressive disease process unto itself.

12. One of the things affecting drug distribution is the bioavailability of the drug. Which of the following factors may affect the amount of a drug that reaches the systemic circulation? Select all that apply. 1. Handling of the drug. 2. Dosage of the drug. 3. Solubility of the drug. 4. Route of administration. 5. Generic drug.

12. Answer: 3, 4 Page: 471 Feedback 1. Doctors, nurse practitioners, and other health-care providers are trained in how to give medication safely. Administration of medication requires a thorough understanding of the drug, including proper storage, handling, and disposal. 2. Though dosages affect the amount of a drug in the body, it does not change the bioavailability of the drug. 3. The amount of the drug that reaches the systemic circulation may be increased or decreased, depending on the solubility of the drug. Aqueous solutions are available more quickly than oily ones. 4. Route of administration is important to consider because inhalants and drugs given intravenously and topically are usually more readily available to the body than drugs administered intramuscularly, subcutaneously, orally, or rectally. 5. Generic drugs have no significant difference from brand drugs in rate or extent of absorption when administered at the same dose under similar conditions.

12. Mr. Dan is 75 years old and suffering from depression. He tells the nurse practitioner that he is tired of feeling so low. He asks if depression is a normal part of aging. The nurse practitioner tells him that depression is which of the following? Select all that apply. 1. Not a normal part of aging. 2. Related to nutritional deficiencies, especially vitamin B12 and vitamin D. 3. Triggered by one life event. 4. Learned helplessness, loss, and bereavement 5. A state of balanced neurotransmitters in the brain.

12. Answers: 1, 2, 3 Page: 451, 452 Feedback 1. Depression is not a normal part of the aging process. Causative factors for depression include physiological influences such as medication side effects, neurological disorders, cardiac disease, neuroendocrine disturbances, and electrolyte and hormonal disturbances. 2. Nutritional deficiencies in vitamin B12 and vitamin D strongly correlate with depression, raising the risk of depression two-fold. 3. Depression can be triggered by a single major life event or a combination of events and stressors. Loss of any kind may contribute to depression and in the older adult may include loss of a spouse/loved one or loss of mobility and independence. 4. Psychosocial and cognitive theories postulate internalized loss with ego dysfunction, learned helplessness, loss and bereavement, and cognitive distortions with negative attitudes and thoughts as contributors to depression. 5. Biological theories point to impaired synthesis, deficiencies, increased uptake, and increased metabolism or breakdown of the neurotransmitters serotonin, norepinephrine, and dopamine as causative factors in depression.

13. It is important to know the pharmacodynamic influences of the drug. Which of the following statements are true regarding pharmacodynamics? Select all that apply. 1. A drug's pharmacodynamics describes the effect at the site of action. 2. Pharmacodynamics is concerned with the movement of drugs within the body. 3. A drug's pharmacodynamics describes the time and intensity of the drug effect. 4. Pharmacodynamics describes the rate and pathways by which drugs are eliminated from the body by metabolism and excretion. 5. Pharmacodynamics' fundamental concept is drug clearance.

13. Answer: 1, 3 Page: 471 Feedback 1. There is a general trend of assuming greater pharmacodynamic sensitivity in the older adult, however, this sensitivity is not universal. 2. Pharmacokinetics is concerned with the movement of drugs within the body. 3. An example of this is the difference in effect at the site on the older adult. Older adults tend to exhibit enhanced responses to drugs affecting the central nervous system (e.g., benzodiazepines), and this is attributed to greater tissue sensitivity caused by aging. 4. Pharmacokinetics describes the rate and pathways by which drugs are eliminated from the body. 5. A fundamental concept in pharmacokinetics is drug clearance; that is, elimination of drugs from the body (analogous to the concept of creatinine clearance).

13. Ms. Smith, 70 years old, is being treated for geriatric depression. What choices does the nurse practitioner have to order? Select all that apply. 1. Evaluate the present medication regimen. 2. Treat any comorbidity. 3. Maintain basic daily needs. 4. Order a selective serotonin reuptake inhibitor (SSRI). 5. Order Abilify.

13. Answers: 1, 2, 3, 4, 5 Page: 454 Feedback 1. The initial step in treating depression in older adults is to evaluate the present medication regimen and remove or change any medications that may contribute to symptoms. 2. Treat any systemic disorder that may have predisposed the patient to depression. 3. Ensure adequate nutrition, elimination, sleep, and physical activity. Optimum depression treatment for older adults should not be managed with medications alone and should include social interventions and possibly psychological modalities. 4. The most widely prescribed antidepressants with greatest evidence for achieving remission are the SSRIs. 5. Several second-generation antipsychotic agents are FDA-approved for augmentation to antidepressant therapy in treatment resistant depression, including aripiprizole (Abilify).

14. A patient sees the nurse practitioner for a post-hospitalization follow-up and presents new complaints with change in functional status. Which of the following should the nurse practitioner do? Select all that apply. 1. Evaluate for ADR. 2. Prescribe patient medications for the new symptoms. 3. Consult current resources for precautions before prescribing. 4. Prescribe antibiotics for the patient. 5. Leave as status quo.

14. Answer: 1, 3 Page: 472 Feedback 1. Whenever a patient presents with a new chief complaint, a change in cognitive or functional status, or a newly recognized health problem, evaluate for an ADR as the cause before prescribing. 2. Prescribing patient medications for new symptoms without evaluating for an ADR may result in the use of unnecessary drugs and increase the chance for ADRs. 3. Several categories of drugs can be problematic in older adults. Prescribers should consult current resources for precautions before prescribing. 4. Prescribing antibiotics for the patient without evaluating for an ADR may result in unnecessary drugs being added and increasing the chance for ADRs. 5. Leaving the situation status quo is never advisable, as symptoms may worsen if not addressed. A patient must be evaluated and possible ADRs identified.

14. Mrs. Smith is 90 years old and has a daytime caregiver. Her daughter stays with her during the evening and nighttime. The daughter suspects her mother is being abused. Which of the following statements would confirm this for the nurse practitioner? Select all that apply. 1. My mother complains of physical pain and has bruises on her arm. 2. My mother is losing weight and is always hungry in the evening. 3. My mother has lost her wallet and funds are going out of her bank account. 4. My mother has been withdrawing from others. 5. My mother has burn marks on her body in the shape of a cigarette.

14. Answers: 1, 2, 4, 5 Page: 457 Feedback 1. Unusual bruising in areas that are not usually thought to be accidental can raise suspicion of possible abuse. Any bruising around breasts or genital area and unexplained sexually transmitted diseases might indicate sexual abuse. 2. Neglect is a type of abuse due to failing to provide food, shelter, health care, or protection for a vulnerable older adult. 3. The National Institute of Justice warns sudden changes in finances, unexplained changes to wills or trusts, unexplained bank withdrawals, and loss of property may indicate a problem of exploitation of an older adult. 4. Emotional abuse can be suspected if a patient withdraws from his or her normal activities or has an unusual change in his or her level of alertness or any other change in behavior that has not been previously observed. 5. Physical signs include slap marks and unexplained burns or blisters, especially circular, as from a cigarette.

15. Which of the following is true regarding STOPP/START criteria for prescribing medications? Select all that apply. 1. Lists potential alternative drugs that can safely be used in older adults. 2. Valuable tool for prescribers, but they are not meant to be mandates for prescribing. 3. Screening tool to alert doctors to correct treatment. 4. Screening tool of older persons' potentially inappropriate prescriptions. 5. It is the Beers criteria that mandates prescribing.

15. Answer: 2, 3, 4 Page: 472 Feedback 1. The Beers criteria lists potential alternative drugs that can be safely used in older adults. 2. Clinical judgment, knowledge of the patient who has the disease, clinician and patient shared goals, risk-benefit considerations, and quality of life all factor into decision making for individual patients. 3. START is a screening tool to alert doctors to right treatment and is used in conjunction with STOPP. 4. STOPP is a screening tool of older persons' PIMs and is used in conjunction with START. 5. The Beers criteria are valuable tools for prescribers, but they are not meant to be mandates for prescribing. Clinical judgment, knowledge of the patient who has the disease, clinician and patient shared goals, risk-benefit considerations, and quality of life all factor into decision making for individual patients.

2. Which of the following is related to the incidence of gastric acidity declining with age because of decreased intestinal blood flow? 1. Drug metabolism 2. Drug distribution 3. Drug absorption 4. Drug elimination

2. Answer: 3 Page: Feedback 1. Drug metabolism is affected with decreased liver size and blood flow, which can result in decreased first-pass metabolism. Drug activity for some medications is prolonged because drugs are metabolized and eliminated more slowly. 2. Drug distribution is affected by aging, particularly in individuals of smaller body size, those who have decreased body water, and those with higher body fat. 3. Drug absorption is affected when gastric acidity declines with age because of decreased intestinal blood flow and fewer absorbing cells in the gastrointestinal (GI) tract. It is also affected with the presence of food and other drugs in the stomach at the same time. 4. Drug elimination is affected by the changes in the kidney functions.

3. Biotransformation means chemical alteration of things such as nutrients, amino acids, toxins, and drugs in the body. In which organ does biotransformation occurs? 1. Intestines 2. Liver 3. Pancreas 4. Bile

3. Answer: 2 Page: 470 Feedback 1. The intestines are vital organs in the GI tract of our digestive system and their functions are to digest food and enable the nutrients released from that food to enter the bloodstream. 2. Biotransformation occurs in all body tissues, but primarily in the liver, where enzymatic activity alters and detoxifies the drug and prepares it for excretion. 3. The pancreas plays an essential role in converting the food we eat into fuel for the body's cells. 4. The bile is critical for digestion and absorption of fats and fat-soluble vitamins in the small intestine.

4. Which of the following is most affected by pharmacokinetic change? 1. Distribution of drugs. 2. Elimination of drugs. 3. Absorption of drugs. 4. Metabolism of drugs.

4. Answer: 2 Page: 471 Feedback 1. Drug distribution relies on the bioavailability of the drug. 2. Kidney function changes, normal with aging, may prolong the half-lives of drugs. This is particularly important for drugs that are excreted unchanged in the urine and for drug categories known to be particularly nephrotoxic in older persons. 3. Drug absorption is generally thought to have a less significant impact on pharmacokinetics. 4. Being familiar with age-related pharmacokinetics of drugs is of the utmost importance when determining the initial and maintenance dosages, especially in the metabolism of drugs. When prescribing for an older patient, it is critical to understand whether the drug inhibits or induces the cytochromes P450 (CYP) enzymes.

5. A patient is started on a low dose of a drug for safety but is never advanced to a therapeutic dose while another drug is added. Which of the following does this describe? 1. Preferences of care. 2. Risk-benefit ratio of drug. 3. Narrow therapeutic index of drug. 4. Clinical inertia.

5. Answer: 4 Page: 472 Feedback 1. Preferences of care are factors to weigh before prescribing. 2. Risk-benefit ratio of a drug is a factor to weigh before prescribing. 3. Narrow therapeutic index of a drug is a factor to weigh before prescribing. 4. Clinical inertia can occur when a patient is started on a low dose of a drug for safety but is never advanced to a therapeutic dose or is maintained on a drug that has no therapeutic benefit while another drug is added. Both situations contribute to polypharmacy and the potential for ADRs.

6. There are over 35 assessment tools currently available to assist providers with the prescribing of medications. Which of the following consists of a list of potentially inappropriate medications (PIMs) to be avoided in older adults? 1. STOPP 2. START 3. Beers criteria 4. ADRs

6. Answer: 3 Page: 472 Feedback 1. STOPP is a screening tool to determine potentially inappropriate prescriptions for older people. It consists of 65 clinically important criteria that relate to PIMs. 2. START is a screening tool to alert doctors regarding correct treatment. It contains 22 criteria that are supported by evidence. It reminds prescribers to consider certain drugs that are appropriate for specific conditions but that may be omitted. 3. Beers criteria consists of a list of PIMs to be avoided in older adults; they are listed by drug category and by diagnosis. 4. ADRs are what we are seeking to avoid with the different screening tools for prescribing medications.

7. After consultation with the patient, which of the following is prevented by prescribing only necessary drugs? 1. Pharmacodynamics 2. Polypharmacy 3. Pharmacokinetics 4. Pharmacy

7. Answer: 2 Page: 472 Feedback 1. Pharmacodynamics is the branch of pharmacology concerned with the effects of drugs and the mechanism of their action. 2. Polypharmacy can be prevented by implementing parsimonious prescribing. 3. Pharmacokinetics is the branch of pharmacology concerned with the movement of drugs within the body. 4. Pharmacy is the science and technique of preparing and dispensing drugs.

8. Initial and ongoing assessment should be the protocol when prescribing medications. Designating and training office staff to do the initial medication review can save time but still requires review by the provider. Which of the following terms refers to a patient bringing in all current medications for review? 1. Brown bag 2. OTC 3. Rational polypharmacy 4. Magic bag

8. Answer: 1 Page: 472 Feedback 1. "Brown bag" is when the patient brings in all current medications for review. This may be helpful, but it is time consuming. Designating and training office staff to do the initial medication review can save time, but still requires review by the provider. 2. OTC stands for over-the-counter medications that do not require a prescription. 3. Rational polypharmacy refers to polypharmacy that is justified. 4. Magic bag is not a term that applies to polypharmacy.

9. The aging process may alter the dynamic processes that drugs undergo to produce therapeutic effects. Which of the following are terms that refer to these changes? Select all that apply. 1. Pharmacodynamics 2. Prophylaxis 3. Pharmacology 4. Pharmacokinetics 5. Pharmacist

9. Answer: 1, 4 Page: 470, 471 Feedback 1. Pharmacodynamics refers to what the drug does to the body. It is the study of the relationship between the concentration of drug at the site of action and the biochemical and physiological effect. 2. Prophylaxis refers to treatment or drug given to prevent a condition or disease. 3. Pharmacology is the branch of science specific to the study of drugs. 4. Pharmacokinetics refers to what the body does to the drug. It describes the processes of drug absorption, drug distribution, drug metabolism, and drug excretion. 5. A pharmacist is a person who is professionally qualified to prepare and dispense medicinal drugs.

9. A nurse practitioner is performing an annual checkup for a female patient. In the physical examination of the breast, for which of the following should the nurse practitioner assess? Select all that apply. 1. Temperature 2. Symmetry 3. Dimpling 4. Lumps 5. Size

9. Answer: 2, 3, 4 Page: 280 Feedback 1. Although changes in temperature may signal abnormalities, it is secondary to the physical examination of the breast. 2. Asymmetry can present any abnormalities that contribute to breast conditions. 3. Dimpling or puckering of the skin on the breast is important to recognize, as these may be signs of breast cancer or other breast conditions. 4. A lump on the breast is important to recognize, as this is the single early sign of breast cancer. Lumps may also be indicative of other breast conditions. 5. Size alone is not important, but asymmetry in size is important to recognize, as it may be a sign of breast cancer or other breast conditions.

An older adult who has iron deficiency anemia complains of abdominal pain, fullness, and diarrhea over 24 hours. Which patient data potentially indicate a systemic cause of this individual's constipation

Abdominal pain

Mr. Jones, a 70-year-old male, visits the urgent care and presents symptoms of unilateral eye pain, visual blurring with halos around lights, red eye, and photophobia. He also reports nausea and vomiting. Visual acuity shows a loss in the affected eye. He is immediately referred for a complete ophthalmic examination. Which of the following conditions may Mr. Jones be experiencing?

Acute glaucoma

A family member comes into the clinician's office with her older mother, the patient. In the process of the examination, the nurse practitioner identifies the patient as "frail older adult." The family member asks what that means. The nurse practitioner explains that this refers to:

An older person already exhibiting signs of decline.

Mrs. M. W. comes into the primary care office for her regular yearly checkup. The nurse practitioner begins the assessment by asking if there are concerns Mrs. M. W. has that need to be addressed. The patient says that she has been experiencing periodic episodes of abdominal cramps and diarrhea that just comes and goes. The nurse practitioner continues the assessment with which of the following?

Asking about the sequence of events and events that triggered each episode

Residents of a nursing home taking which medication(s) are at risk for sleep disturbances as an adverse effect of the medication

Celecoxib (Celebrex) Diltiazem (Cardizem) Venlafaxine (Effexor) Ipratropium (Atrovent) Oxycodone (Oxy-Contin)

Mr. Watson,75 years old, comes to the urgent care center with complaints of fever, fast heartbeat, a swollen gland under his right arm, and redness in his upper left arm that has hurt for 2 to 3 days. The patient says that he has had the redness in his arm for months without any difficulty. The nurse practitioner suspects which of the following? Select all that apply.

Cellulitis of upper left arm

The nurse practitioner knows that risk factors for coronary artery disease (CAD) include atherosclerosis. The nurse practitioner includes teaching on these factors that can be remediated to help prevent CAD:

Cholesterol levels and smoking.

A patient is started on a low dose of a drug for safety but is never advanced to a therapeutic dose while another drug is added. Which of the following does this describe?

Clinical inertia.

Bob is 85 years old and is suspected of experiencing adult Failure To Thrive. His family asks the nurse practitioner to evaluate what exactly is going on with him. The nurse practitioner knows to order which of the following? Select all that apply.

Complete blood count (CBC), serum albumin level, and thyroid-stimulating hormone (TSH). Cholesterol levels and comprehensive metabolic panel. Blood cultures. A nutritional assessment. Depression screening with the Geriatric Depression Scale.

The nurse practitioner is asked to order medication for pain and disease control for a 60-year-old patient who has suffered with RA for years. Which is the most common treatment? Select all that apply.

Corticosteroids NSAIDs Analgesics Biological disease-modifying antirheumatic drugs (DMARDs) Tumor necrosis factor (TNF) receptor antagonists

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?

Cystitis

The nursing home staff needs assistance to properly feed the residents who need assistance with feeding. Which should the nurse implement to ensure the residents are fed properly?

Draw on the availability of family members who are able to follow instructions

Which of the following is the best statement regarding dyspnea

Dyspnea is one of the most common reasons for visits to the emergency room for individuals with advanced disease.

The older female adult has mild hyponatremia and constipation. The NP is unable to use which remedy for constipation for this woman?

Encourage fluids by mouth

Ms. Smith, 70 years old, is being treated for geriatric depression. What choices does the nurse practitioner have to order? Select all that apply.

Evaluate the present medication regimen. Treat any comorbidity. Maintain basic daily needs. Order a selective serotonin reuptake inhibitor (SSRI). Order Abilify.

Which of the following terms refers to conditions that have multiple underlying factors and may involve multiple organs?

Geriatric syndrome

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?

Head tips backward.

The nurse practitioner is conducting an admitting assessment of a 69-year-old man. He has diminished ability to ambulate and has difficulty with activities of daily living (ADLs). In the interview, the nurse practitioner asks him if he drinks alcohol. He says, "Yes." The practitioner follows up with a psycho-social evaluation because:

His condition could be related to a long-term usage of alcohol or a new occurrence.

The older adult has osteoarthritis in the cervical spine and wants to receive injections of corticosteroids into the back for pain relief. To prevent complications of the therapy, which of the following should the nurse instruct the patient to avoid?

Hypocalcemia

Dan is 70 years old and has been having frequent bouts of kidney stones. They are painful, and he has had one procedure done for nephrolithiasis. Dan asks the nurse practitioner if there is anything he can do to prevent these. He says his brother also has them, so he wonders if it is just familial. How does the nurse practitioner respond? Select all that apply.

Increase the amount of fluids you drink daily. Avoid eating foods such as dairy, spinach, and nuts. Some medications can contribute to stone formation. Report signs of possible urinary tract infections to a physician for treatment.

An older female adult maintains an active lifestyle playing various games with friends. She reports to the NP that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the NP suggest to improve the quality of this woman's sleep?

Inquire about her nightly sleep rituals

An older man has Alzheimer's disease, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the man's duration of sleep?

Instruct the wife to increase his daily physical activity

Which disorder arising from a nutritional deficiency are older adults who practice the Hindu faith at risk to develop

Iron deficiency anemia

Compared with acute pain, the following is true of persistent pain

It can bring about changes in lifestyle

Which of the following may be included in the healthy lifestyle counseling during the initial Welcome to Medicare visit? Select all that apply.

Level of physical activity assessment. Physical therapy consultation. Referral to a health coach.

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?

Lymphedema

Hospice services are an option for patients with end-stage life-threatening illness. These services are covered by Medicare, Medicaid, and most private insurance providers. According to studies, which of the following are the current leading causes of death? Select all that apply.

Malignant neoplasms Cerebrovascular accidents

The nurse practitioner is trying to improve the nutritional status of residents in the nursing home. Which of his/her recommendations should be implemented?

Provide nutritious food according to the residents' expressed food preferences with liberal use of seasonings.

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.

Polypharmacy Treatment burden Attending multiple appointments Affording complex drug regimens

Mark, 82 years old, is in a rehabilitation center for therapy post-knee replacement. The nurse practitioner is visiting Mark and finds him confused, disoriented, and with speech difficulty. The staff nurse says that his condition changed quickly over the last few hours. The nurse practitioner orders which of the following? Select all that apply.

Pulse oximetry Evaluation for infections Assessment of change in medications Brain scan

A patient complains of dry, irritated, and itchy skin that has not been relieved with over-the-counter medications. On examination, the patient is also found to present cholestasis and jaundice. From which of the following conditions may the patient be suffering?

Pruritus

One of the things affecting drug distribution is the bioavailability of the drug. Which of the following factors may affect the amount of a drug that reaches the systemic circulation? Select all that apply.

Solubility of the drug. Route of administration

A patient is being assessed for symptoms of headaches, changes in mental function, language deficits, and visual problems. Diagnostic testing reveals that he does not have a brain tumor. Which of the following may be the differential diagnosis for the patient's symptoms? Select all that apply.

Stroke Subdural hematoma Meningitis (credit also given for DM)

Mrs. Cameron is a 72-year-old woman who comes to see her nurse practitioner for pain in her right thigh. The nurse practitioner assesses that Mrs. Smith has bruises on her thigh and muscle weakness distally, near the knee. The nurse practitioner suspects which of the following

Tendon rupture

Which is a true statement about sleep in older adults?

The time spent in bed increases, but the time spent asleep decreases.

Drug distribution in the body is affected by aging and higher body fat. Which of the following is true regarding drugs distributed in fat? Select all that apply.

There is a wider effect in drugs distributed in fat. The effect of drugs is less when distributed in fat. There is prolonged action in drugs distributed in fat.

12. Miss Benton is a 65-year-old female who complains of a painful big toe on the right foot. She asks the nurse practitioner if this is normal for older people. The nurse practitioner explains that this appears to be gout, and gives her what information? Select all that apply. 1. Gout is an inflammatory condition of joints, tissues, and kidneys. 2. Gout is a problem with a protein called purine. 3. Gout is rare in older people. 4. Gout is localized to the big toe. 5. Long-term use of some medications can lead to gout.

12. Answer: 1, 2, 5 Page: 312 Feedback 1. Gout can inflame not only various joints, but periarticular tissues, subcutaneous tissues, and kidneys as well. 2. Gout is the result of malfunctioning metabolism of purine, leading to overproduction or underexcretion of uric acid. 3. Gout is the most prevalent inflammatory condition occurring in older adults. 4. Gout can affect the joints, periarticular tissues, subcutaneous tissues, and kidneys. 5. Gout can be caused by long-term use of some medications, especially diuretic medications.

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.

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.

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. 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.

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.

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.

1. Mrs. M. W. comes into the primary care office for her regular yearly checkup. The nurse practitioner begins the assessment by asking if there are concerns Mrs. M. W. has that need to be addressed. The patient says that she has been experiencing periodic episodes of abdominal cramps and diarrhea that just comes and goes. The nurse practitioner continues the assessment with which of the following? 1. Asking about the sequence of events and events that triggered each episode. 2. Conducting a complete neurological examination. 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.

1. The genitourinary and reproductive systems undergo many age-related changes. Which of the following statements is true about these changes? 1. The older male patient undergoes more gradual changes than does the older female patient. 2. The older female patient undergoes more gradual changes than does the older male patient. 3. Older male and female patients undergo the same changes. 4. The older male patient undergoes less gradual changes than those of the older female patient.

1. Answer: 1 Page: 281 Feedback 1. This statement is correct. Older male patients undergo more gradual changes than those of older female patients. 2. Older male patients undergo more gradual changes than those of older female patients. 3. Older male patients undergo more gradual changes than those of older female patients. 4. Older male patients undergo more gradual changes than those of older female patients.

10. Mrs. Thomas is 82 years old and burned her hand while cooking. The nurse practitioner assesses second- and third-degree burns over approximately half of the back of her hand. The nurse practitioner chooses which of the following for initial treatment? Select all that apply. 1. Administer appropriate pain medication. 2. Rinse with cool tap water. 3. Clean with a strong detergent. 4. Remove any loose tissue but allow the blisters to remain. 5. Diagnose as first- and third-degree burns.

10. Answer: 1, 2, 4 Page: 100 Feedback 1. After administration of appropriate pain medication, wound management can begin. 2. Burn wounds should be immediately doused in cool tap water to disperse any remaining heat in the tissue. 3. Detergents and antibacterial soaps are not indicated. Burn wounds should be cleaned with mild soap and rinsed. 4. For small surface area burns, it is good to remove any loose tissue during cleansing and allow intact blisters to remain. 5. First-degree burns do not exhibit blisters, and third-degree burns do not exhibit pain.

10. During a breast examination, the patient should be asked if she has which of the following? Select all that apply. 1. Breast pain 2. Breast atrophy 3. Breast rash 4. Breast trauma 5. Proper support

10. Answer: 1, 3, 4 Page: 280, 281 Feedback 1. A patient should be asked if she is experiencing any breast pain and should point out the location. Description of the pain is also important. 2. Breast atrophy is an observation to be made by the nurse practitioner and not a question to be asked of the patient. 3. A patient should be asked if she has observed any rash on or around the breast. Also ask about onset, location, and sensations of the rash. 4. Patients should be asked if there was any breast trauma, as this could lead to injury of the breast. 5. Asking about the use of proper support may be helpful for some individuals, but it is not generally a question that is asked during the breast examination.

10. Mark, 82 years old, is in a rehabilitation center for therapy post-knee replacement. The nurse practitioner is visiting Mark and finds him confused, disoriented, and with speech difficulty. The staff nurse says that his condition changed quickly over the last few hours. The nurse practitioner orders which of the following? Select all that apply. 1. Pulse oximetry 2. Evaluation for infections 3. Assessment of change in medications 4. Brain scan 5. Radiology

10. Answers: 1, 2, 3, 4 Page: 440 Feedback 1. A careful medical evaluation that includes attention to the level of oxygenation is necessary to determine the cause of delirium. 2. A careful medical evaluation that includes attention to the level of oxygenation and possible occult infection (e.g., urinary tract infection), is desired. 3. The role of medications is essential. Although many medications can be a causative factor, those with anticholinergic effects are frequently responsible. 4. The following neurological events can contribute to delirium: stroke, intracranial hemorrhage, head trauma, seizures, and undiagnosed pain. 5. Changes in brain function, multiple general medical problems, polypharmacy, reduced hepatic metabolism of medications, multisensory declines, and brain disorders, such as dementia, make the older adult particularly vulnerable to delirium.

11. The nurse practitioner is preparing home-going instructions for a 66-year-old man with newly diagnosed type 2 diabetes. The goals include which of the following? Select all that apply. 1. Maintenance of weight at present status 2. Glycemic control 3. Good nutritional status 4. More rest 5. Exercise

11. Answer: 2, 3, 5 Page: 370 Feedback 1. The goal of treatment for patients with type 2 diabetes is glycemic control through good nutritional status with weight management. 2. The goal of treatment for patients with type 2 diabetes is glycemic control. 3. The goal of treatment for patients with type 2 diabetes is glycemic control through good nutritional status. 4. The goal of treatment for patients with type 2 diabetes is glycemic control. They recommend individualized treatment plans based on the health and functional ability of separate patients into three categories. 5. The goal of treatment for patients with type 2 diabetes is exercise.

12. Jessie is a 54-year-old patient with a history of atrophic vaginitis. Which of the following should be included in her patient education? Select all that apply. 1. Use of over-the-counter (OTC) medications for pain and discomfort. 2. Use of water-soluble lubricants. 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.

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.

13. Devon visits the urgent care facility for sudden symptoms of pain to his lower extremity. The initial diagnosis is acute arterial ischemia. Aside from pain, which other symptoms may arise from this diagnosis? Select all that apply. 1. Pulselessness 2. Paresthesia 3. Pallor 4. Purulence 5. Paralysis

13. Answer: 1, 2, 3, 5 Page: 219 Feedback 1. Pulselessness is a symptom for acute arterial ischemia. Checking pulses is notoriously unreliable. Arterial Doppler signals should be checked in anyone with suspected acute limb ischemia. 2. Paresthesia is present in over 50% of cases. Sensory nerves are smaller than motor nerves and more sensitive to ischemia so tend to be affected first. 3. Pallor is especially useful in comparison to the opposite limb; it is also useful to check venous filling. Acutely ischemic limbs are classically white rather than blue. Chronic critically ischemic limbs may appear pink due to compensatory vasodilation, the so-called sunset foot. 4. Purulence is not a symptom that may arise from acute arterial ischemia diagnosis. 5. Paralysis is a poor prognostic sign and indicates an element of irreversible ischemia.

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. The nurse practitioner is asked to order medication for pain and disease control for a 60-year-old patient who has suffered with RA for years. Which is the most common treatment? Select all that apply. 1. Corticosteroids 2. NSAIDs 3. Analgesics 4. Biological disease-modifying antirheumatic drugs (DMARDs) 5. Tumor necrosis factor (TNF) receptor antagonists

14. Answer: 1, 2, 3, 4, 5 Page: 324 Feedback 1. The drug management of RA is one of symptom and disease control. Symptom control includes corticosteroid treatment. 2. The drug management of RA is one of symptom and disease control. Symptom control includes NSAIDs. 3. The drug management of RA is one of symptom and disease control. Symptom control includes analgesics. 4. Biological DMARDs are newer therapies that target specific cytokines of the inflammatory response; they are administered subcutaneously, intravenously, and by mouth. 5. Some of the TNF inhibitor biological agents approved for use are etanercept, adalimumab, infliximab, certolizumab, and golimumab. Other biological therapies commonly used are rituximab and abatacept.

14. Treatment to slow the progression of PAD should include which of the following? Select all that apply. 1. Immobilization 2. Pharmacological 3. Surgical 4. Conservative 5. Heat

14. Answer: 2, 3, 4 Page: 220 Feedback 1. Immobilization does not slow the progression of PAD. 2. Pharmacological treatment is provided with conservative treatment and used to slow the progression of PAD. 3. Surgical treatment of PAD involves revascularization of the affected extremity and is used to slow the progression of PAD. 4. Conservative treatment involves modification of risk factors, including smoking. It also includes blood pressure and diet implementations to slow the progression of PAD. 5. Heat is not a treatment used to slow the progression of PAD.

15. Mr. Waterson is 76 years old and involved in a weight-loss program. He weighs 250 pounds and is 5 feet and 5 inches tall. He asks his nurse practitioner what he should do for exercise to enhance his modified eating style. The nurse practitioner advises him with which of the following statements? Select all that apply. 1. Anything you do is better than nothing. 2. Try moderate walking for 2 ½ hours a week. 3. Try to increase your moderate activity to 600 minutes a week. 4. Perform muscle-strengthening activities that are moderate or high intensity on 4 or more days a week. 5. Do exercises that improve balance, which may prevent falls.

15. Answer: 1, 2, 5 Page: 382 Feedback 1. All older adults should avoid inactivity. Some physical activity is better than none, and older adults who participate in any amount of physical activity gain some health benefits. 2. For substantial health benefits, older adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of aerobic activity that is of moderate-to-vigorous intensity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week. 3. For additional and more extensive health benefits, older adults should increase their aerobic physical activity to 300 minutes (5 hours) a week of moderate-intensity, or 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of aerobic activity that is of moderate-to-vigorous intensity. 4. Older adults should also do muscle strengthening activities that are moderate or high intensity and involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits. 5. Older adults should do exercises that maintain or improve balance if they are at risk of falling.

2. Lucy is a 56-year-old woman experiencing itching, discomfort, and bleeding after intercourse. Which of the following conditions may be developing in the patient? 1. Atrophic vaginitis 2. Vaginal cancer 3. Fibroadenoma 4. Cystitis

2. Answer: 1 Page: 282 Feedback 1. Atrophic vaginitis presents symptoms of itching, discomfort, and bleeding after intercourse. 2. Vaginal cancer presents symptoms of a watery vaginal discharge, a lump or mass in the vagina, painful urination, frequent urination, constipation, and pelvic pain. 3. Fibroadenoma is a solid, noncancerous breast lump. 4. 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.

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.

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 Feedback 1. The nurse practitioner is seeking symptoms that form a pattern, and in the thorough examination to do that, she will find any abnormalities or areas of concern. 2. Medications will be taken into consideration after examination findings. 3. A goal of the nurse practitioner in gathering information from the older adult is to try and determine if there is a pattern of symptoms. 4. In an adult over 65 years old who is not presenting any musculoskeletal issues, this type of examination may not be necessary.

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.

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.

3. Mrs. Khan is 89 years old and is reported to have bouts of agitation. The nurse practitioner is counseling her family that these periods of agitation can be triggered by which of the following? 1. Silence and soft music. 2. Dim lights. 3. Approaches from other people. 4. A feeling of appetite satiety.

3. Answer: 3 Page: 429 Feedback 1. Environmental triggers, such as noise and visual cues from television and physical surroundings, can also lead to agitation. 2. Environmental triggers, such as light, can trigger agitation. 3. Psychosocial triggers, such as the approach taken by staff and interaction with other residents, can contribute to agitation. 4. Chronic bedrest, pain, and hunger can precipitate episodes of agitation.

4. The nurse practitioner is considering ordering medications to help control an older patient's agitation. She chooses which of the following? 1. Psychotropic medications 2. Seizure medications 3. Stimulants 4. Depressants

4. Answer: 1 Page: 429 Feedback 1. There are two types of treatment for agitation: psychotropic medications and behavioral interventions. Psychotropic medications include antipsychotics, anxiolytics, and antidepressants. 2. Antiseizure drugs are used for manic-like symptoms. Evidence supports the use of antiseizure medications instead of antipsychotics. 3. Anxiolytics treat the symptoms of anxiety that often accompany agitation. 4. If there is evidence of depression, an antidepressant may be indicated.

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. 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.

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.

5. Mr. Jameson, 75 years old, comes to the clinic with complaints of severe sharp epigastric pain that radiates to his back. He has been nauseous and has vomited three times today. The nurse practitioner suspects which of the following? 1. Appendicitis 2. Gastrointestinal influenza 3. Acute pancreatitis 4. Insulin shock

5. Answer: 3 Page: 362 Feedback 1. Pancreatitis is manifested by mild-to-severe sharp epigastric pain, which possibly radiates to the back, chest, or flanks. 2. Other possible causes of acute pancreatitis are many and include viral infections (mumps, coxsackie B, mycoplasma pneumonia, and campylobacter). 3. The signal symptoms of acute pancreatitis include mild-to-severe sharp epigastric pain, which possibly radiates to the back, chest, or flanks. Nausea and vomiting accompany the pain in up to 90% of patients. 4. If not due to gallstones or alcohol use, two less common but useful to investigate causes in the older adult are drug-induced pancreatitis and hypertriglyceridemia-induced pancreatitis, typically with serum triglycerides over 1,000 mg/dL.

6. Mrs. Cameron is a 72-year-old woman who comes to see her nurse practitioner for pain in her right thigh. The nurse practitioner assesses that Mrs. Smith has bruises on her thigh and muscle weakness distally, near the knee. The nurse practitioner suspects which of the following? 1. Musculoskeletal lesions 2. Tendon rupture 3. Gout 4. Arthritis

6. Answer: 2 Page: 306 Feedback 1. Patients with presentation of soft tissue syndromes should be asked about the origin of the presentation of bruising. The pain may be related to an event. 2. Ecchymosis in the area of a joint may be indicative of tendon rupture. 3. Gout is polyarticular in older adults. 4. Arthritis is an ongoing synovial membrane attack that results in synovial proliferation; pannus formation; and destruction of bone, cartilage, and ligaments, leading to joint damage and deformity.

7. PVD is a disease that alters blood flow to or from the extremities and vital organs other than the heart. According to studies, which of the following remains the most important risk factor for PVD? 1. Smoking 2. Hypertension 3. Family history 4. Hypercoagulopathy

7. Answer: 1 Page: 219 Feedback 1. Smoking remains the most important risk factor to PVD. 2. Hypertension is an associated risk factor to PVD. 3. A strong family history of the disease is an associated risk factor to PVD. 4. Hypercoagulopathy is an associated risk factor to PVD.

7. Kefka Jones, 60 years old, has diabetes and is now having urinary tract symptoms. The nurse practitioner orders a glomerular filtration rate (GFR) from a urine sample. Which of the following would indicate a stage 1 chronic kidney disease (CKD)? 1. GFR greater than or equal to 120mL/min. 2. GFR greater than or equal to 90 mL/min with other symptoms. 3. GFR of 45 to 59 mL/min. 4. GFR less than 15 mL/min.

7. Answer: 2 Page: 236 Feedback 1. GFR of 120 mL/min is not a criterion for stages of CKD. 2. Stage 1 is when GFR is greater than or equal to 90 mL/min with other evidence of CKD damage. 3. Stage 3a is GFR 45 to 59 mL/min. 4. Stage 5 is GFR less than 15 mL/min or on dialysis.

8. Jose Mirrare is a 65-year-old male who is being treated for cirrhosis of the liver. Which of the following does the nurse practitioner include in his discharge teaching? Select all that apply. 1. Eliminate all alcohol consumption. 2. Attend an alcohol treatment program. 3. Do not self-medicate with over-the-counter (OTC) medications, including herbal products. 4. Eat three large meals of a balanced diet containing 4 to 5 mg protein/kg body weight per day. 5. Be cautious when driving, as you have encephalopathy.

8. Answer: 1, 2, 3 Page: 236, 237 Feedback 1. Chronic alcohol consumption, combined with a poor nutritional intake, contributes to cirrhosis. Drug-induced cirrhosis can occur in patients taking large doses of vitamin A, Aldomet, isoniazid, and methotrexate. Certain infectious diseases (tertiary syphilis, brucellosis, schistosomiasis) have predisposed patients to a risk of developing cirrhosis. 2. Recommend an alcohol treatment program and provide the telephone number for the nearest chapter of Alcoholics Anonymous. 3. Patients should be requested not to self-medicate with OTC medications, including herbal products. 4. Patients with cirrhosis should eat small, frequent meals of a balanced diet containing 1 to 1.5 mg protein/kg body weight per day, unless contraindicated by advanced disease. 5. Patients with encephalopathy should not be driving.

8. The nurse practitioner is ordering laboratory testing to confirm her suspicion of acute pancreatitis. Which of the following findings would confirm her suspicions? Select all that apply. 1. Trypsinogen activation peptide (TAP). 2. Blood urea nitrogen (BUN), creatinine, glucose. 3. An abdominal x-ray. 4. Amylase and lipase amount three times the normal. 5. Stool culture.

8. Answer: 1, 2, 3, 4, 5 Page: 363 Feedback 1. Another potential marker of acute pancreatitis is TAP that becomes markedly increased and may be useful in the detection of early acute pancreatitis. 2. Other useful laboratory tests are a metabolic panel to look at BUN, creatinine, and glucose levels. 3. The radiological evidence is used to confirm or exclude the clinical diagnosis, establish a cause, assess severity, and guide therapy. An abdominal x-ray is done first and helps to exclude other causes of abdominal pain, such as an obstruction or bowel perforation. 4. Amylase and lipase amounts are three times the normal amount of acute pancreatitis and are the most common laboratory markers used to establish a diagnosis of acute pancreatitis. Amylase is the most frequently ordered test, which rises within 6 to 12 hours of onset of pain, peaks around 24 hours, returns to normal within 3 to 5 days, and has a sensitivity of 81 to 95. Lipase has a higher sensitivity for acute pancreatitis (85% to 100%), rises within 8 hours of onset of symptoms, peaks at 24 hours, and returns to baseline within 8 to 14 days; it is now the preferred diagnostic blood test. 5. Other useful laboratory tests are a metabolic panel to look at BUN, creatinine, glucose, and calcium levels, as well as liver function tests, triglycerides, CBC, arterial blood gases, and a urinalysis.

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.

9. John Brown, 60 years old, asks the nurse practitioner if a lack of functioning insulin is the only cause of diabetes. Which of the following is the nurse practitioner's reply? Select all that apply. 1. More recently, other hormones have been found to be part of diabetes. 2. Besides insulin, glucagon, amylin, and incretin are involved. 3. Finding other factors of diabetes has resulted in new treatments. 4. The pancreas is not the only organ involved in diabetes. 5. Genetic factors lead to type 1diabetes only.

9. Answer: 1, 2, 3, 4, 5 Page: 369 Feedback 1. Early understanding of diabetes has been expanded by the discovery of other hormones involved in the regulation of glucose. 2. Hormones involved in the regulation of glucose include insulin, glucagon, amylin, and incretin. 3. These discoveries have resulted in new classes of medications to treat diabetes. 4. These hormones include pancreatic hormones: insulin and amylin secreted by the β cells and glucagon from the α cells, as well as the gut incretin hormones: gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). 5. Genetic predisposition for developing diabetes is more evident in type 2 diabetes.

9. Tom Brown is 62 years old and plays golf twice a week. He experiences pain in his shoulder and goes to the urgent care center to be seen by his nurse practitioner. The nurse practitioner asks which of the following questions? Select all that apply. 1. Does the shoulder hurt when you are not playing golf? 2. Is there any swelling, redness, or pain? 3. Is there any family history of arthritis? 4. Is there a history of taking ibuprofen? 5. Does your pain affect your golf game?

9. Answer: 1, 2, 5 Page: 308 Feedback 1. Determining the extent of pain will help with the diagnosis. 2. Identify all presenting and associated symptoms such as swelling, erythema, pain, reported decrease in ROM, limitations on ADLs, and alterations in sensations of hot or cold. 3. Question patient about family history of soft tissue conditions, aspiration of bursa, recent fever, fluoroquinolone use, and chronic medical conditions. 4. Question patient about prior history of fluoroquinolone use. 5. Identify all presenting and associated symptoms, such as swelling, erythema, pain, reported decrease in ROM, and limitation on ADLs.

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.

1. Mrs. Borden is 67 years old and her primary care physician wants her to be seen by a nurse practitioner who specializes in geriatric issues. On completing the interview and examination, the nurse practitioner tells Mrs. Borden that she will order a blood laboratory specimen for thyroid function and pancreatic function. Mrs. Borden asks what the reason is. Which of the following is the nurse practitioner's best response? 1. Diabetes is more common in older patients. 2. Thyroid issues are less common in older patients. 3. These are common tests to be done on any new patient. 4. These tests are necessary to obtain baseline information.

1. Answer: 1 Page: 361 Feedback 1. The nurse practitioner recognizes that normal aging changes of the endocrine system primarily are related to a decrease in pancreatic function (inability to sufficiently secrete insulin), resulting in diabetes mellitus. 2. The nurse practitioner needs to screen older adults periodically for diabetes mellitus and thyroid disease because the incidence of these conditions increases with age. 3. The nurse practitioner managing the care of older adults needs to differentiate among four clinical states. One of those is an endocrine function that is altered relative to that of younger patients, but is an expected consequence of normal aging. 4. Overall, the nurse practitioner managing the care of older adults needs to differentiate among four clinical states: 1. An endocrine function that is altered relative to that of younger patients, but is an expected consequence of normal aging. 2. Altered endocrine function secondary to coincident nonendocrine disease, but is not of known pathological significance. 3. Iatrogenic changes in endocrine function that largely reflect the polypharmacy seen in the older adult population. 4. Authentic endocrinopathy.

1. Mrs. Williams is 76 years old and comes in to have a wound checked on her right leg. She fell a month ago and the wound has not healed. She is concerned that something is wrong. The nurse practitioner examines the wound and sees that it has been cleaned properly and has no signs of infection. The edges are approximated, but the skin around the wound is red and tender to touch. The best response regarding Mrs. Williams' concern is: 1. Wound healing for older people may take up to four times longer than it does for younger people. 2. Let us talk about what you are eating. 3. Had you come in earlier, I would have ordered medicine that would have healed that right up. 4. I will order an antibiotic to prevent infection.

1. Answer: 1 Page: 96 Feedback 1. Skin renewal turnover time increases to approximately 87 days in older adults, compared with 20 days during youth. 2. The perceived extended healing time is not related to diet. 3. This is false hope, as there is no medication that will heal this wound quickly. 4. Prophylactic antibiotics are not appropriate when there are no signs or symptoms of infection.

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.

1. Mrs. James is 78 years old and comes to the clinic for an annual checkup. The nurse practitioner addresses the psychosocial needs of older adults and specifically the need for which of the following? 1. Dependence. 2. Dignity, credibility, and respect. 3. Being alone. 4. Not being touched.

1. Answer: 2 Page: 428 Feedback 1. The psychosocial assessment of the older adult entails an evaluation of the following basic needs: autonomy and independence. 2. The psychosocial assessment of the older adult entails an evaluation of the following basic needs: dignity, credibility, and respect. 3. The psychosocial assessment of the older adult entails an evaluation of the following basic needs: communication and belonging. 4. The psychosocial assessment of the older adult entails an evaluation of the following basic needs: touch.

10. Mr. Ed, 46 years old, experienced a mild stroke and was hospitalized through the emergency room. The general work-up showed that his blood glucose was 300 mg/dl. He denied knowing that his sugar was so high. He did report frequency of urination and polyphagia. On further examination, the nurse practitioner asked about family history, and he identified that his mother and grandfather both had adult-onset diabetes. Although he is under 65 years old, the nurse practitioner teaches him which of the following? Select all that apply. 1. A urine sample that shows ketones in the urine, his age, and his body mass index (BMI) will tell if he is a type 1 or type 2 diabetic. 2. Having the mild stroke is connected to having diabetes. 3. Medications could be associated with diabetes. 4. Because he had a family history of type 2 diabetes, he should have been screened every year. 5. Screening would not have identified him as a risk.

10. Answer: 1, 2, 3 Page: 370 Feedback 1. The determination of whether or not the diabetes is type 1 or type 2 is based on ketonuria, the age of onset, and BMI. 2. The primary presentation may be due to complications of underlying and undiagnosed hyperglycemia in conditions such as stroke, myocardial infarction, and ischemia, intermittent claudication, impotence, peripheral neuropathy, proteinuria, retinopathy, slow wound healing, or fatigue. 3. Drugs associated with hyperglycemia include alcohol, beta-adrenergic agents, calcium channel blockers, corticosteroids, lithium salts, rifampin, asparaginase, diazoxide, diuretics, glycerol, niacin, phenytoin, and sympathomimetics. 4. Screening should begin for the general population at 45 years old and be repeated at 3-year intervals. More frequent screening is recommended for individuals with several risk factors. 5. Among adults 40 years and older, diabetes often is discovered as an incidental finding during the work-up for cardiovascular, renal, neurological, or infectious diseases. More frequent screening is recommended for individuals with several risk factors.

10. Mrs. Rivets is an 80-year-old female who comes to the emergency department with complaints of a low-grade fever and pain in her lower leg that is aggravated by movement. Which early treatment does the nurse practitioner implement? Select all that apply. 1. Protection of the lower leg, rest, and application of an ice pack. 2. Salt compresses and an antibiotic. 3. Compression dressing and an antibiotic. 4. Compression dressing and warm compresses. 5. Elevation of the leg and pain medication.

10. Answer: 1, 5 Page: 309 Feedback 1. The treatment of acute soft tissue syndromes begins conservatively: protect with padding, braces, and changes in techniques; rest by avoiding activities that exacerbate pain, and use ice, as cryotherapy can relieve pain and decrease inflammation. 2. Salt compresses are not necessary, but compression dressings are helpful. If suspected infection/sepsis, then antibiotics are ordered. 3. Only when there is suspected infection/sepsis is a 4-week course of sensitivity-susceptible antibiotics is advised. 4. Compression and cold compresses will reduce swelling. 5. The treatment of acute soft tissue syndromes starts conservatively: elevation, raise the affected limb above the level of the heart; modalities, electrical stimulation or ultrasound; medications, such as NSAIDs, acetaminophen, and/or corticosteroid injections.

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. Mr. Jamison, a 67-year-old male, is being seen in the clinic for complaints of pain in his thigh. There is swelling in the soft tissue, dislocation, altered ROM, bruising, local tenderness, and pain with any motion. The nurse practitioner suspects a femoral neck fracture. What could have contributed to this fracture? Select all that apply. 1. Direct injury to the femur. 2. Sleeping on his side. 3. Osteoporosis. 4. Heavy lifting. 5. Bending over at the waist.

11. Answer: 1, 3 Page: 310 Feedback 1. Common sites for fractures include proximal humerus, distal radius, pelvic ramus, proximal femur, proximal tibia, and thoracic and lumbar vertebral bodies. 2. Symptoms do not indicate soreness from sleeping on the side. 3. Fractures most attributed to osteoporosis include femoral neck fractures, pathological fractures of the vertebrae and lumbar spine, and thoracic spine vertebral fractures. 4. Vertebral fractures may result from an activity, such as heavy lifting. 5. Vertebral fractures may result from an activity, such as bending over, that puts sudden stress on the spine.

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.

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.

11. Mr. Watson,75 years old, comes to the urgent care center with complaints of fever, fast heartbeat, a swollen gland under his right arm, and redness in his upper left arm that has hurt for 2 to 3 days. The patient says that he has had the redness in his arm for months without any difficulty. The nurse practitioner suspects which of the following? Select all that apply. 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.

11. When other symptoms are presented with atrophic vaginitis, a biopsy is used as the diagnostic test to rule out which of the following diagnoses? Select all that apply. 1. Urinary tract infection (UTI) 2. Sexually transmitted infection (STI) 3. Squamous cell hyperplasia 4. Lichen sclerosis 5. Lichen planus

11. Answer: 3, 4, 5 Page: 282 Feedback 1. UTI presents with the symptom of pain with urination and is usually treated with an antibiotic. No biopsy is indicated to diagnose. 2. STIs present symptoms of pruritis, burning, and a thick white discharge. No biopsy is indicated to diagnose. 3. Squamous cell hyperplasia presents symptoms of pruritus, which results in scratching and inflammatory changes in squamous cells of the vulvar area. These are seen on a biopsy. 4. Lichen sclerosis presents with whitish lesions on the vulva and squamous cells. A biopsy is needed to diagnose. 5. Lichen planus shows papular, purple lesions that are pruritic and thought to be immunological in origin. A biopsy is needed to diagnose.

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.

12. Mr. John has recently been given a diagnosis of diabetes. He asks the nurse practitioner if can try something nonpharmacological to control his diabetes. Which of the following would the nurse practitioner propose? Select all that apply. 1. Weight loss and exercise. 2. Self-monitoring blood glucose. 3. A moderate increase in activity. 4. Frequent follow-up appointments with the nurse practitioner. 5. Enrolling in a high-intensity physical activity program.

12. Answer: 1, 2, 3, 4 Page: 371 Feedback 1. One goal of treatment for patients with type 2 diabetes is weight management. 2. The frequency and timing of self-monitoring of blood glucose levels (SMBG) need to be individualized based on several factors, including age, ability to adhere, and oral versus insulin therapies. SMBG results in promoting glycemic control and reinforcing adherence to therapy. Even patients maintaining glucose levels by nonpharmacological means may benefit from intermittent either postprandial or fasting SMBG. 3. Lifestyle modifications of weight loss and exercise are particularly important. 4. After 3 to 6 months, if nonpharmacological treatment fails or the hyperglycemia is severe (fasting plasma glucose 200 to 300 mg/dL or a casual plasma glucose 250 to 350 mg/dL), oral agents may be added to the treatment regimen. 5. Although weight loss in frail older adults is not recommended due to the risk of sarcopenia, exercise of even a modest nature can be beneficial in decreasing insulin resistance.

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. A 65-year-old woman seeks relief from pain and swelling in her hands. She consults with a nurse practitioner for diagnosis and treatment. The nurse practitioner conducts an examination and interview about the patient's ADLs and how this pain and swelling inhibits her activity. Which of the following diagnostic tests will be ordered? Select all that apply. 1. Radiology of both hands. 2. Blood tests for conditions such as rheumatic factor. 3. Anti-cyclic citrullinated peptide (anti-CCP) antibodies. 4. Urinalysis. 5. Abdominal ultrasound.

13. Answer: 1, 2, 3 Page: 323, 324 Feedback 1. Radiographs of the hands and feet are needed to look for early signs of erosions, which are an important factor indicating the need to start an aggressive treatment approach aimed at halting further joint damage progression. 2. Blood tests such as rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein are useful in the presence of diagnostic indicators from physical examination. 3. Testing for antibodies to cyclic citrullinated peptide (anti-CCP antibodies) is newer than RF testing and is associated with higher sensitivity and specificity for RA. 4. Urinalysis for uric acid crystals would indicate gout, but not RA. 5. Additional radiographic findings in RA include soft tissue swelling, symmetrical joint space narrowing, and joint subluxations.

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 Feedback 1. Overweight or obese patients with NAFLD should consider a weight-loss program. It has been shown that weight loss and exercise reduce liver enzyme levels and steatosis. 2. Treatment for hyperlipidemia (atorvastatin, gemfibrozil) has been shown to improve liver enzymes and liver steatosis. 3. The hepatitis A and B vaccine should be given to patients without serological evidence of immunity. 4. Patients with NAFLD should avoid alcohol consumption. 5. Weight loss should not exceed 1 to 2 pounds a week. Patients should avoid rapid weight loss.

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.

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.

13. Annie is 89 years old and appears apathetic, unwilling to eat and drink, and shows functional decline. The nurse practitioner discusses with the family the possibility that Annie is experiencing a failure to thrive (FTT). The family asks how this happened. The nurse practitioner replies with which of the following statements? Select all that apply. 1. Adult FTT is a part of aging. 2. FTT can be associated with increased infections and diminished immunity. 3. FTT patients have often experienced multiple hospitalizations and several comorbidities. 4. FTT is complex, with many components. 5. The goal of early assessment is to prevent a decline in health.

13. Answer: 2, 3, 4 Page: 377 Feedback 1. Adult FTT is not considered a normal part of aging. 2. FTT is associated with increased infections and diminished cell-mediated immunity. 3. This population of gravely ill and impaired older adult patients has experienced multiple hospitalizations, has multiple diagnoses, and can be viewed as a paradigm of the very sick and frail older adults. 4. It can be concluded that patients given a diagnosis of FTT present with a complex picture of multifaceted problems across a spectrum of physiological ailments, psychological deficits, and social and environmental needs. 5. The goal of early assessment is to identify the precise needs of the patient in determining appropriate intervention strategies, providing necessary supports, and optimizing rehabilitation.

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.

14. Bob is 85 years old and is suspected of experiencing adult FTT. His family asks the nurse practitioner to evaluate what exactly is going on with him. The nurse practitioner knows to order which of the following? Select all that apply. 1. Complete blood count (CBC), serum albumin level, and thyroid-stimulating hormone (TSH). 2. Cholesterol levels and comprehensive metabolic panel. 3. Blood cultures. 4. A nutritional assessment. 5. Depression screening with Beck's PP depression scale.

14. Answer: 1, 2, 3, 4 Page: 377 Feedback 1. Consider ordering a CBC, serum albumin level, and TSH initially in patients presenting with signs of malnutrition over time. 2. Consider ordering cholesterol level and comprehensive metabolic panel initially in patients presenting with signs of malnutrition over time. 3. For patients with suspected infection or inflammation associated with malnutrition, consider blood cultures. 4. Conduct a nutritional assessment with the Mini Nutritional Assessment. A score of 17 or less indicates malnutrition. 5. Depression screening with the Geriatric Depression Scale should be included. A score of 5 to 9 is suggestive of depression and 10 or more is significant for depression.

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. Sharon is a 70-year-old patient with venous ulcers to her right lower extremity. She has a history of multiple pregnancies and surgeries, and has a sedentary lifestyle. Which of the following may be possible contributing factors to her diagnosis given her history? Select all that apply. 1. Obesity 2. Reduced mobility 3. History of breast cancer 4. Degenerative disease 5. Parkinsonism

15. Answer: 1, 2 Page: 221 Feedback 1. Obesity, or being overweight, can increase the risk of developing a venous leg ulcer, as this increases the pressure in the leg veins. 2. Decreased or reduced mobility in the ankle contributes to the diagnosis of venous leg ulcer. 3. History of breast cancer is not a contributing factor to venous leg ulcer. 4. Degenerative disease is not a contributing factor to venous leg ulcer. 5. Parkinsonism is not a contributing factor to venous leg ulcer.

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. 5. Newer agents are more likely to cure tinea pedis than the older generation of antifungals, including clotrimazole, which is fungistatic, whereas terbinafine is fungicidal.

15. Mrs. Owen, 70 years old, is being discharged from the rehabilitation center to go home. Her RA pain is under currently control. What does the nurse practitioner include in the follow-up instructions? Select all that apply. 1. Get plenty of rest during the day. 2. Exercise and move throughout the day. 3. Learn about the side effects of your medication. 4. Read literature for antidotes that cure RA. 5. Keep your regular health-care visits, as there are no support organizations for RA.

15. Answer: 1, 2, 3 Page: 325 Feedback 1. Patients should be taught the importance of incorporating periods of rest into their daily lives. 2. Patients should be taught the importance of incorporating periods of exercise into their daily lives. 3. Medication education is important in RA because of the potential for side effects associated with a complicated drug regimen. 4. Because there is no cure for RA, patients must be skeptical about antidotes promised for RA and check with their health-care providers if they have any concerns about treatments. 5. Patients can contact the Arthritis Foundation (1-800-282-7800) for information; a booklet, Overcoming Rheumatoid Arthritis, is available.

15. Dan is 70 years old and has been having frequent bouts of kidney stones. They are painful, and he has had one procedure done for nephrolithiasis. Dan asks the nurse practitioner if there is anything he can do to prevent these. He says his brother also has them, so he wonders if it is just familial. How does the nurse practitioner respond? Select all that apply. 1. Increase the amount of fluids you drink daily. 2. Avoid eating foods such as dairy, spinach, and nuts. 3. Some medications can contribute to stone formation. 4. Kidney stones are not familial. 5. Report signs of possible urinary tract infections to a physician for treatment.

15. Answer: 1, 2, 3, 5 Page: 270 Feedback 1. A major contributing factor to the development of calculi is decreased fluid intake leading to a high concentration in urine. 2. Certain food substances that augment the formation of kidney stones include dairy products, chocolate, green leafy vegetables (calcium oxalate stones), and eggs, fish, poultry, peanuts, and wheat (cystine stones). 3. Certain medications, such as triamterene, indinavir, acetazolamide, acyclovir, and sulfa can contribute to the development of nephrolithiasis. 4. Family history has also been found to contribute to stone formation, as well as increased oxalate absorption. 5. Chronic urinary tract infections may be precursors to struvite stone formation.

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.

2. The nurse practitioner is conducting patient rounds in a long-term care facility. As she talks with Mrs. Jones, she notices that her arms and elbows are excoriated and the skin is shearing. The nurse 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.

2. Mr. Jones is 70 years old and sees the nurse practitioner for a yearly checkup. He states that he needs to urinate a lot and seems to always be thirsty. He also finds himself gaining some weight. In the process of the examination, the nurse practitioner detects that he is vague in his answers. Which of the following may be the reason? 1. Mr. Jones is cold and bundled in a sweater. 2. There is no family history of diabetes. 3. The symptoms seem to have appeared slowly. 4. He does not want to admit to eating too much.

2. Answer: 3 Page: 361 Feedback 1. Explore with the patient any difficulty with temperature regulation, changes in skin texture, or distribution of body hair. 2. Reevaluate the patient's family history for endocrine and metabolic disease. 3. Because changes in the endocrine system may appear subtle to the older person or atypical as compared to younger patients, it may be difficult to pinpoint the onset of the presentation. 4. Review with the patient any episodes of unexplained weight loss or gain, new or increased fatigue, weakness, malaise, and recent infections.

2. Mr. Slobinsky, 80 years old, is unable to leave his home due to mobility problems. The nurse practitioner conducts a social support assessment because Mr. Slobinsky: 1. May not want to see anyone. 2. Is not missing the cultural traditions of community activities. 3. Has made frequent appointments for consultation with the practitioner. 4. Looks forward to sharing his loneliness with the nurse practitioner.

2. Answer: 3 Page: 428 Feedback 1. Older adults who are alone and lonely may also be depressed. 2. Specific to older adults, ethnic traditions and expectations are factors that should be addressed in the psychosocial assessment. 3. A positive correlation exists between the need for social supports and the use of health-care services by older adults. 4. Older adults may be reluctant to reveal social or emotional concerns and, in some cultures, may feel that it is unacceptable to share personal problems with outsiders. However, they may feel comfortable discussing a physical manifestation, such as pain or sleeplessness, with a health-care provider.

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. Mrs. Wilbur reports the presence of pain in her lower and upper back. The nurse practitioner responds by doing which of the following? 1. Determining where the pain is coming from. 2. Ignoring any history of injury. 3. Ruling out the presence of anything inflammatory. 4. Determining that this pain does not affect activities of daily living (ADLs), as the patient came in independently.

3. Answer: 1 Page: 305 Feedback 1. Initially, the nurse practitioner will need to determine if the presenting symptoms arise from the joints, tendons, muscles, or periarticular structures, such as bursae. 2. Past trauma may now be manifesting itself as an articular degeneration. Because patients who have had a structural deformity or amputation typically place excessive strain on the joints for years, as older individuals they may now experience degeneration of the bone and surrounding musculature. 3. Inflammatory and noninflammatory conditions can coexist in patients. 4. It is important to ask questions and determine how the pain and stiffness are affecting function and quality of life, regardless of how it appears.

3. Ms. Allen, 72 years old, is being evaluated by the nurse practitioner for type 2 diabetes. Because symptoms of endocrine disorders in older adults are vague, which of the following questions is best to ask? 1. Do you have any trouble carrying out your daily activities? 2. Can you tell me what you ate yesterday? 3. Have you seen a dentist in the last year? 4. Have you noticed that you have less hair?

3. Answer: 1 Page: 361 Feedback 1. Given the vagueness or atypical presentation of endocrine, metabolic, and nutritional disorders in older adults, specific questions directed at these conditions are imperative during the review of systems. Any alteration in the ability to carry out activities of daily living (ADLs) or instrumental ADLs due to fatigue or subjective weakness. 2. Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient or significant other(s) if there have been any acute changes in memory or mood. 3. Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient about any mouth ulcerations. 4. Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient about any noticeable dryness to hair or loss of hair.

4. Mrs. Smith, 80 years old, has been vomiting and having bouts of loose stools for several days. She is taking several medications that are prescribed. The nurse practitioner conducts a medication review because: 1. An accounting of all prescribed and over-the-counter (OTC) medications may uncover reasons for her symptoms. 2. There could be drug-drug interactions leading to her symptoms. 3. Side effects of the gastrointestinal tract are not seen in many medications. 4. The administration of some of her medications may be appropriate.

4. Answer: 2 Page: 362 Feedback 1. A thorough review of all medications, including OTC and home remedies, is important to discern for alterations in the absorption of medications. 2. It is important to discern if drug-drug interactions are responsible for alterations in the absorption of medications. 3. Certain medications may be responsible for a new onset of anorexia, diarrhea, or constipation. 4. Essential, too, is a thorough review of how the patient and medical facility are administering the medications (timing the doses to not conflict with food). Finally, review patient adherence and understanding of the medication regimen.

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. A reading of 100 to 120 mm Hg is too high. 2. A reading of 90 to 120 mm Hg is too high. 3. Good arterial pressure for those with AAA should fall between 60 and 70 mm Hg. 4. A reading of 80 to 100 mm Hg is too high.

4. When assessing a patient with a possible musculoskeletal condition, it is important to: 1. Know how much sleep the patient gets per night. 2. Be aware that older patients report any and all pains. 3. Determine ROM in all limbs. 4. Not refer to past injuries or conditions.

4. Answer: 3 Page: 306 Feedback 1. The amount of sleep the patient gets may be affected by pain, but knowing this will not affect the diagnosis. 2. It is important to remember that within the current cohort of older adults, a stoic attitude toward pain may be displayed despite the presence of an acute or chronic musculoskeletal condition. 3. Patients presenting with a functional limitation should be asked to demonstrate active ROM. Active ROM should be performed smoothly and effortlessly. 4. Ask if the patient has experienced any severe trauma in the past that may now be manifesting itself as an articular degeneration.

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. Which medical specialist is the best referral for patients with symptomatic AAA? 1. Vascular surgeon 2. Neurosurgeon 3. Cardiologist 4. Internist

5. Answer: 1 Page: 217 Feedback 1. A vascular surgeon is a specialist who is highly trained to treat diseases of the vascular system. 2. A neurosurgeon is a physician who specializes in the diagnosis and surgical treatment of disorders of the central and peripheral nervous system. 3. A cardiologist is a doctor who specializes in the study or treatment of heart diseases and heart abnormalities. 4. Internists are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum, from health to complex illness.

5. Mr. Cummins, a 69-year-old Caucasian male, presents with an inability to move his right arm sufficiently. The nurse practitioner tells him that she will perform a physical examination and order tests to rule out which of the following? 1. Gout 2. Rheumatoid arthritis (RA) 3. Muscle weakness from a systemic condition 4. Osteoarthritis (OA)

5. Answer: 3 Page: 307 Feedback 1. Because gout is an inflammatory disease that results in deposits of sodium urate crystals in the joints, periarticular tissues, and kidneys, and because the patient is only having a problem with one joint, it is not likely that gout is the diagnosis. 2. RA is a chronic systematic inflammatory process evidenced by symmetrical polyarthritis; it is the most common inflammatory arthropathy. 3. To determine if a patient is having true muscle weakness, the patient should perform against the examiner's resistance. One side should be compared to the other and a numerical value for tested muscle strength recorded. Flexor and extensor muscles should be tested for strength. 4. OA encompasses both symptoms and the structural remodeling of articular cartilage with inflammation of synovitis and ligament.

5. The nurse practitioner is conducting an admitting assessment of a 69-year-old man. He has diminished ability to ambulate and has difficulty with activities of daily living (ADLs). In the interview, the nurse practitioner asks him if he drinks alcohol. He says, "Yes." The practitioner follows up with a psycho-social evaluation because: 1. Physiological dynamics need to be ruled out as a possible contribution. 2. His drinking may be a function of the environment where he lives. 3. Criteria from the DSM-V is the same for people of any age. 4. His condition could be related to a long-term usage of alcohol or a new occurrence.

5. Answer: 4 Page: 431 Feedback 1. Neurotransmitter effects from alcohol and alterations in brain anatomy in patients with alcohol use disorders serve to reinforce the biological connection. 2. Several genetic markers have been studied, and a clear case for biological heritability has been established as one factor. 3. Older adults with alcohol problems often do not meet the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for alcohol use disorder, but are impaired nonetheless. 4. It is unclear whether risky drinking in older people represents a pattern of continued use, a return to using after a period of abstinence, new onset of use, or a combination of all these patterns.

6. Anne is a 50-year-old post-mastectomy patient diagnosed with secondary lymphedema. Based on her surgical history, which of the following may be the contributing factor to the lymphedema? 1. Gynecological cancer 2. Breast cancer 3. Urological cancer 4. Infection

6. Answer: 2 Page: 218 Feedback 1. Gynecological cancer is a contributing factor for secondary lymphedema, but it is not the best option for this scenario because of Anne's history. 2. Breast cancer is the best option and is a contributing factor for secondary lymphedema in Anne's case because of the previous mastectomy. 3. Urological cancer is a contributing factor for secondary lymphedema, but it is not the best option for this scenario because of Anne's history. 4. Infection is a contributing factor for secondary lymphedema, but it is not the best option for this scenario because of Anne's history.

6. The nurse practitioner is working in the emergency department and is called to assist with the diagnosis of a patient who just came in. Mr. Barn is 76 years old and complains of abdominal pain, and his serum amylase and lipase are three times the normal limit. The nurse practitioner confirms pancreatitis, as this meets which criteria? 1. CT severity index 2. Atlanta classification 3. APACHE II 4. Ranson criteria

6. Answer: 3 Page: 364 Feedback 1. The CT severity index developed by Balthazar (2002) is the only scoring system to use evidence of necrotic pancreas as criteria. 2. To rate severity, it uses prognostic signs (a score of 3 or higher on the Ranson criteria and an 8 or higher on the APACHE II) and presence of local pancreatic necrosis, peripancreatic fluid collection, etc. and organ failure. 3. The Atlanta classification is both used to diagnose acute pancreatitis and rate the severity of pancreatitis. Diagnosis is made based on the Atlanta classification when two of three criteria are met: abdominal pain consistent with acute pancreatitis, laboratory abnormalities (serum amylase and lipase three times the normal limit or higher), and imaging findings consistent with acute pancreatitis. 4. The Ranson criteria was the first system and remains the best known and most widely used, but has drawbacks in that it requires 2 days' worth of objective measures for the total score, 5, to be obtained on the first day and evaluated within 48 hours of the onset of pain. In addition, sensitivity is only 73% and 77% to predict mortality, and the threshold for abnormal values depends on whether the pancreatitis is caused by alcohol or gallstones.

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. Mild leukocytosis with increased band formation is the most common abnormality seen in laboratory studies; however, white blood cell counts may not be elevated in the older adult. 3. Elevation in lipase, amylase, and elevated liver function tests would prompt further evaluation for gallstone pancreatitis; however, laboratory values may be normal. 4. Real-time ultrasonography of the gallbladder and biliary tree is the diagnostic procedure of choice for both acute and chronic cholecystitis, showing gallstones, thickening of the gallbladder wall, and (if the common bile duct is obstructed) dilation of the biliary tract.

6. The daughter of a 70-year-old woman asks the nurse practitioner why her mother has had a change in functional ability recently. The mother has regularly been drinking for 40 years, however, her behavior is changing. The nurse practitioner replies that: 1. The concentration of alcohol in her body remains the same as she ages. 2. Her change in behavior has nothing to do with any drugs she is taking. 3. There are different types of alcoholism in older adults, and the change in behavior is related to the specific type. 4. Physical changes due to aging affect the body's metabolism of alcohol differently.

6. Answer: 4 Page: 433 Feedback 1. The changes associated with aging may increase the concentration of alcohol in the blood. 2. Another major concern associated with alcohol misuse in the older adult is the increased occurrence of drug-alcohol interactions. 3. Patterns of alcohol use disorder in older adults have been divided into two categories: early onset and late onset. 4. Concerns about alcohol consumption in the older adult are directed primarily toward the physiological changes that accompany aging and the problems posed by regular alcohol consumption.

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. The fact that the patient smokes is not the issue; safety is the issue.

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.

7. The nurse practitioner calls Mr. Smith to come into the examining room. As he is coming in, the nurse practitioner observes his gait to assess for musculoskeletal conditions. One abnormal sign is: 1. Unbalance in gait. 2. Lack of a lurch. 3. Symmetrical leg movement. 4. Ability to sit in and get out of a chair without using arms.

7. Answer: 1 Page: 306 Feedback 1. An unbalanced gait is abnormal and a risk for falling. 2. Note if the patient is having difficulty in shifting weight from one leg to the other and instead relies on shoulder movement from side to side. This is called a lurch and is abnormal. 3. Observe for any limping or asymmetrical leg. 4. Another important aspect of the gait examination is to note the patient's ability to sit in and rise from a chair. If a patient relies on a rocking motion and/or arm strength to stand, this is abnormal and could point to quadricep weakness.

7. Ms. Jenny is 72 years old and has managed her type 2 diabetes for 30 years. This condition is costly to her in more than one way. Which complications are common? 1. Financial challenges. 2. Good visual acuity. 3. Good renal functioning. 4. Increased circulation to lower extremities.

7. Answer: 1 Page: 370 Feedback 1. Diabetes is costly and has high morbidity and mortality rates. The total direct and indirect costs of treating diagnosed diabetics in 2012 was 245 billion dollars. This translates to a cost 2.3 times higher than care for those without diabetes. 2. Morbidity includes blindness. 3. Morbidity includes end-stage renal disease. 4. Morbidity includes lower extremity amputations.

7. The son of a 72-year-old man brings his father into the practitioner to plan for treatment of the patient's alcoholism. The nurse practitioner has several options available. Which is the first choice? 1. Treat for anxiety. 2. Begin with higher doses of anti-anxiety medications. 3. The last choice for medication is serotonin uptake inhibitors. 4. Buspirone and gabapentin are used as first-line choices.

7. Answer: 1 Page: 435 Feedback 1. Treatment for anxiety should reduce symptoms and improve functioning. Simply listening, being compassionate, and showing respect are important to improving outcomes. 2. Start low and go slow with medication dosing to avoid risks from drug interactions. Older adults are more likely to take many medications and may have side effects from aging changes in absorption, metabolism, distribution, and excretion of medication. 3. First-line treatment includes the SSRIs because they have the least risk of drug interactions, side effects, or worsening existing medical conditions. 4. Buspirone and gabapentin are also used as secondary agents when first-line therapy fails and anxiolytic therapy is warranted.

8. The nurse practitioner is conducting a safety class with community-living older adults. Which of the following should she include in her teaching of risks of burns for this population? Select all that apply. 1. Thinner skin. 2. Less vascularity. 3. Diminished nerve function. 4. A weakened immune system. 5. The burden of various comorbidities leading to enhanced wound healing and reepithelialization after burn injury.

8. Answer: 1, 2, 3, 4 Page: 98 Feedback 1. As one ages, there are significant changes in the skin, which becomes thinner, providing a less effective barrier to external stimuli. 2. With aging, there are fewer appendages and decreased vascularity. 3. Thinner skin and diminished nerve function often result in a higher incidence of deeper burns. 4. Advanced age results in a weakened immune system. 5. Along with the burden of various comorbidities, the fragility of older skin leads to delayed wound healing and reepithelialization after burn injury.

8. Mr. Weisner is a 65-year-old male who is experiencing pain in his joints. The nurse practitioner assesses which of the following? Select all that apply. 1. Movement of the joint in a relaxed position. 2. Movement of the joint in flexion. 3. Movement of the joint in extension. 4. Appearance of the limb being normal for his age. 5. Absence of any curvatures in the limb.

8. Answer: 1, 2, 3, 4, 5 Page: 307 Feedback 1. This is one facet of examination of the joints. 2. This is one facet of examination of the joints. 3. This is one facet of examination of the joints. 4. Enlargement and irregularity may indicate sequelae of childhood rickets, osteoporotic fractures, Paget's disease, OA, tophaceous gout, or bone tumors. 5. Excessive curvature and irregularity may indicate sequelae of childhood rickets, osteoporotic fractures, Paget's disease, OA, tophaceous gout, or bone tumors.

8. Which of the following differential diagnoses should be considered with the diagnosis of peripheral arterial disease (PAD)? 1. Marfan syndrome 2. Atelectasis 3. Raynaud's phenomenon 4. Carpal tunnel syndrome

8. Answer: 3 Page: 219, 220 Feedback 1. Marfan syndrome is a genetic disorder that affects the body's connective tissue. It is not related to the diagnosis of PAD. 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.

8. Elisabeth, 67 years old, comes to the practitioner with her daughter, who is her caregiver. The nurse practitioner notices that Elizabeth is very busy and always moving and placing things in order within the waiting room. Along with this increase in energy, which of the following suggest bipolar with mania or hypomania? Select all that apply. 1. Ability to focus on a task 2. Flight of ideas 3. Rapid speech 4. Impulsivity 5. Thoughtfulness

8. Answers: 2, 3, 4 Page: 437 Feedback 1. According to the DSM-5, the individual must also experience increased energy while having distractibility. 2. According to the DSM-5, the individual must also experience increased energy while having these flights of ideas. 3. According to the DSM-5, the individual must also experience increased energy while having rapid speech (can be garbled). 4. According to the DSM-5, the individual must also experience increased energy while having thoughtlessness (impulsivity). 5. According to the DSM-5, the individual must also experience increased energy while having thoughtlessness.

9. Mr. Edwards is 76 years old and received a burn on his leg when he dozed off and dropped his cigarette. The nurse practitioner examines his leg for the degree of burn and classifies it as second degree with some third degree in the center. Mr. Edwards asks what that means and why it hurts so much. What is the best answer? Select all that apply. 1. It means that this is a serious, deep burn in the center, and a less deep burn around the sides. 2. It hurts because the nerve endings are exposed in the second-degree area. 3. It means that the burn is advancing and getting worse. 4. It hurts because the nerves are destroyed. 5. It hurts because the nerves in the second-degree areas are exposed to the outside and are stimulated.

9. Answer: 1, 2 Page: 98 Feedback 1. Deep dermal burns extend further into the dermis; third-degree burns involve the full dermis, extending into the subcutaneous tissue. 2. In these burns there is pain from exposed nerve endings, but by the second day, pain is often described more as pressure. 3. The first step in treatment is to stop the burn. 4. Destroyed nerves do not register pain. 5. Superficial dermal burns involve the dermis and are characterized by blisters. The underlying tissue is pink, moist, and hypersensitive to touch.

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.

9. Ms. Jenny is 80 years old and is diagnosed with Clostridium difficile-associated diarrhea (CDAD). As she discusses her condition with her nurse practitioner, she asks how she obtained this disease. The nurse practitioner tells her which of the following? Select all that apply. 1. It used to be hospital-acquired only disease, but now this infection is in the community. 2. Risk factors include antibiotic exposure, being an older adult, and church or synagogue exposure. 3. Inflammatory bowel disease and compromised immunity can lead to CDAD. 4. Lesser known risk factors include prior hospitalization within several months and a state of malnourishment of the body. 5. The source of CDAD is currently unknown.

9. Answer: 1, 3, 4 Page: 242 Feedback 1. CDAD is no longer a hospital-acquired infection only, as outpatient incidences are rising. 2. Risk factors include antibiotic exposure, older adults, and health-care facility exposure. 3. The presence of inflammatory bowel disease and compromised immunity also play a role in increasing the risk for CDAD. 4. Lesser-known risk factors include intensive care admission, prior hospitalization within several months, ventilatory support, enteral feedings, use of histamine blockers and proton pump inhibitors, and malnourished states. 5. Bacterial spores are spread via the fecal-oral route and thrive on surfaces such as toilets, hospital equipment, and door handles. These spores have the potential to survive for months, even in harsh circumstances.

9. The nurse practitioner is assessing a 69-year-old man for possible bipolar disorder. Which of the following will contribute to diagnosing this patient? Select all that apply. 1. Complete blood count (CBC) and comprehensive metabolic panel, toxicology screen, urinalysis, thyroid function tests. 2. Electroencephalogram (EEG) and magnetic resonance imaging (MRI). 3. Mini-Mental State Examination. 4. Saint Louis University Mental Status (SLUMS). 5. Total body computed tomography (CT) scan.

9. Answers: 3, 4 Page: 437 Feedback 1. Diagnostic studies include a CBC and comprehensive metabolic panel, toxicology screen, urinalysis, thyroid function tests, rapid plasma reagin, HIV, electrocardiogram (EKG), and other individualized testing as indicated by the individual patient presentation and anticipation of treatment modalities. 2. In patients with new onset of psychosis, an EEG and MRI or CT scan may be appropriate to rule out medical pathologies. 3. Other screening tests for cognitive disorders include the Mini-Mental State Examination. 4. The Saint Louis University Mental Status (SLUMS) is more sensitive to detecting cognitive dysfunction. 5. CT scan may be appropriate to rule out medical pathologies.