Final Exam Review (Quizzes: One, Two, Nutrition & Pain/Sleep)

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

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

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

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

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 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

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

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

Loss of the majority of taste buds

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

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

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

Postherpetic pain

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.

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

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

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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

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

Calcium 1500 mg and vitamin D 600 to 800 units

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.