Adult Gerontology - Health Promotion

Alcohol, especially when used with tobacco, is a dietary factor in which type of cancer? A. Liver B. Esophagus C. Bladder D. Breast

Answer B Alcohol, especially when used with tobacco, is a dietary factor in cancer of the esophagus. Alcohol is also a factor in liver cancer. Dietary factors related to bladder cancer are unknown. A high-calorie diet (with high fat and low fiber) is a factor in breast cancer.

Women tend to outlive men by an average of A. 3 to 4 years. B. 5 to 6 years. C. 6 to 7 years. D. 7 or more years.

Answer C In more developed countries, since the late 1970s, the difference in life expectancy for men and women has narrowed, but on average women still outlive men by 6 to 7 years.

One of the most common causes of involuntary weight loss is A. malignancy. B. pulmonary disease. C. endocrine disturbances. D. substance abuse.

Answer A Malignancies (lung, lymphoma, gastrointestinal tract), along with gastrointestinal diseases and psychiatric disorders, are the most common causes of involuntary weight loss. Other less common causes include pulmonary disease, endocrine disturbances, and substance abuse.

Mary, a 70-year-old woman with diabetes, is at your office for her 3-month diabetic checkup. Mary's list of medications includes metformin (Glucophage XR) 1,000 mg daily, an angiotensin converting enzyme (ACE) inhibitor daily, and one baby aspirin (ASA) daily. Mary's blood work showed a fasting blood sugar of 112 and glycosylated hemoglobin (HgbA 1c ) of 6.5. You tell Mary that her blood work shows A. that her diabetes is under good control and she should remain on the same medications. B. that her diabetes is controlled and she needs to have her medications decreased. C. that her diabetes is not controlled and her medications need to be increased. D. that her diabetes has resolved and she no longer needs any medication.

Answer A A person with diabetes mellitus type 2 should have a HgbA 1c of 6.5 or less and a fasting blood sugar (fbs) less than 130 for optimal control. Because the client's lab results fall in those categories, she is under good control and her medications should stay the same.

3-36 Susan is traveling to South America on business and wonders if she should get a tetanus and diphtheria (Td) vaccination. You tell her that A. she needs one if she has not had a Td shot within the past 10 years. B. she should have tetanus immune globulin administered before departure. C. she should receive a tetanus shot now. D. tetanus and diphtheria are no longer a serious problem in South America.

Answer A Because tetanus and diphtheria remain serious problems in South America, it is recommended that all travelers be current (within 10 years) on these vaccinations. Tetanus immune globulin should be administered to persons not previously immunized.

Margo, age 50, is perimenopausal. She tells you she is taking dehydroepiandrosterone (DHEA) and wants to start on hormone replacement therapy (HRT). When she asks for your opinion, you tell her that A. taking both DHEA and HRT is not recommended because it is like "double dosing." B. DHEA is safe and will not affect prescribed medications. C. she will be safe as long as she takes the minimumdose of both therapies. D. DHEA has the same pharmacotherapeutic effects as HRT.

Answer A Dehydroepiandrosterone (DHEA) is a hormone that is abundant in the body and is naturally produced from cholesterol by the adrenal glands, with smaller amounts manufactured by ovaries. Taking both DHEA and hormonal replacement therapy (HRT) is not recommended because it is like "double dosing." It is not absolutely contraindicated, but because most clients do not adequately regulate the dosage of over-the-counter medications, the combination therapy may produce excessively high levels of estrogen. Additionally, because almost a third of clients today are taking some sort of herbal therapy, it is essential to ask in the history and physical what other therapies are being used.

For primary prevention of skin cancer, you would recommend a sunscreen with how much ultraviolet (UV) wave protection? A. 15 B. 25 C. 30 D. 45

Answer A For primary prevention of skin cancer, a sunscreen with an ultraviolet (UV) wave protection factor of 15 has been shown to be as effective as those with higher numbers. In addition, for primary prevention of skin cancer, all clients should be counseled to avoid UV waves from either the sun or tanning booths and to wear protective clothing.

Which health-care system delivers comprehensive health maintenance and treatment services to members of an enrolled group who pay a pre-negotiated and fixed payment? A. Health maintenance organizations (HMOs) B. Preferred provider organizations (PPOs) C. Fee-for-service (FFS) independent practices D. Exclusive provider organizations (EPOs)

Answer A Health maintenance organizations (HMOs) deliver comprehensive health maintenance and treatment services to members of an enrolled group who pay a pre-negotiated and fixed price. Preferred provider organizations (PPOs) allow persons to go to any doctor in the network, whereas clients of HMOs must choose their doctor ahead of time. Fee-for-service (FFS) independent practices permit an individual to be treated in any facility, with the full fee paid by the client. Exclusive provider organizations (EPOs) limit clients to providers belonging to one organization. Some may be able to use outside providers at an additional out-of-pocket charge.

Providers understand the effects of stress on the body. These effects go beyond the skin and can impair hair follicles. Which of the following conditions in a female can be described as hair "coming out in handfuls?" A. Telogen effluvium B. Alopecia areata C. Female pattern hair loss D. Androgenic baldness

Answer A In telogen effluvium, clients usually describe this condition as hair "coming out in handfuls." Stress can cause some hair roots to be pushed prematurely into the resting state. Two months after an extremely stressful event, some clients report losing as much as 70% of scalp hair. The condition may resolve after the stress subsides. This is not the same as gradual genetic hair thinning. Alopecia areata is thought to be an organ-specific autoimmune disease that manifests as round or oval patches of non-scarring hair loss. Female pattern hair loss may be the result of alterations in androgen metabolism at the level of the hair follicle or in systemic hormonal changes. This balding pattern may develop during perimenopause or menopause.

Which is the leading cause of cancer deaths? A. Lung cancer B. Prostate cancer C. Colon cancer D. Breast cancer

Answer A Lung cancer is the leading cause of cancer death, and cigarette smoking causes almost all cases. Compared to nonsmokers, men who smoke are about 23 times more likely to develop lung cancer, and women who smoke are about 13 times more likely. Smoking causes about 90% of lung cancer deaths in men and almost 80% in women. While breast, prostate, and colon cancer are widely prevalent, people don't die from them as frequently as from lung cancer.

Which of the following is a major risk factor associated with osteoporosis and fragility fractures? A. Body weight less than 127 lb B. Alcohol intake greater than 2 drinks/day C. Estrogen deficiency occurring before 45 years of age D. Low physical activity

Answer A Many major risk factors are associated with osteoporosis and fragility fractures. The major risk factors are: body weight less than 127 lb, personal history of fracture as an adult, history of fracture in a first-degree relative, oral corticosteroid therapy of longer than 3 months, and current smoking. Minor risk factors include: alcohol intake of more than two drinks per day, dementia, estrogen deficiency occurring before age 45, impaired vision, low lifelong calcium intake, low physical activity, poor health/frailty, and recent falls.

Dennis, age 62, has benign prostatic hyperplasia (BPH). He tells you that he voids at least four times per night and that he has read about a preventive drug called terazosin hydrochloride (Hytrin) that might help him. What do you tell him? A. "It's not a preventive drug, but it relaxes smooth muscle in the prostate and bladder neck." B. "It changes the pH of the urine and prevents infections caused by urinary stasis." C. "It relaxes the urethra." D. "It shrinks the prostate tissue."

Answer A Terazosin (Hytrin) is an alpha-1 adrenergic blocker. It is not a preventive drug, but it does relax smooth muscle in the prostate and bladder neck and allows complete emptying of the bladder, relieving frequent nocturnal urination. Terazosin is begun at 1 mg at bedtime initially and then titrated upward to 10 mg once a day. Doxazosin (Cardura) is also effective as an alpha-1 adrenergic blocker. It is begun initially at 1 mg at bedtime, with the dosage doubled every 1 to 2 weeks to a maximum of 8 mg per day. Finasteride (Proscar), a 5-alpha reductase inhibitor, decreases the volume of the prostate within about 3 months. At 12 months, it reaches its peak effectiveness. Finasteride is given 5 mg daily for at least 6 months; then the client is reevaluated.

According to the Joint National Committee (JNC) 8 on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines, Jesse, who has stage 1 hypertension, should be placed on which treatment plan for control of his hypertension? A. Thiazide diuretic B. Diet and exercise C. One drug from one of the following classes: ACE inhibitor, calcium channel blocker, or angiotensin receptor blocker (ARB) D. Thiazide diuretic and either ACE inhibitor, calcium channel blocker, or ARB

Answer A The JNC 8 guidelines for treating initial hypertension recommend use of one of four classes of medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACE inhibitors, and ARBs. Lifestyle modification with diet and exercise should already be in place.

Sam, age 20, has a total cholesterol level of 186 mg/dL. How often should he be screened for hypercholesterolemia? A. Every 5 years B. Every 2 years C. Every year D. Whenever blood work is done

Answer A The National Cholesterol Education Program recommends that adults aged 20 years or older have their cholesterol checked every 5 years. This is for individuals of average or low risk of developing CVD. Screening should occur more often for individuals whose levels are close to therapeutic thresholds. Less than half of young adults who have these risk factors don't get cholesterol screening even though up to a quarter of them have elevated cholesterol.

The U.S. government report Healthy People 2020, National Health Promotion and Disease Prevention Objectives lists which of the following as leading health indicators? A. Obesity, substance abuse, and immunizations B. Obesity, responsible sexual behavior, and driver education C. Obesity, substance abuse, and driver education D. Obesity, immunizations, and driver education

Answer A The U.S. government report Healthy People 2020, National Health Promotion and Disease Prevention Objectives cites obesity, substance abuse, and immunizations as leading health indicators. Driver education is not considered a leading health-care indicator. The fourth-generation plan, Healthy People 2020, builds on past achievements, reaffirms the two overarching goals from the past decade, and adds two more: promoting quality of life, healthy development, and healthy behaviors across life stages; and creating social and physical environments that promote good health.

Bone density studies to screen for osteoporosis should be performed on which of the following clients? A. Perimenopausal women who used to smoke but no longer do B. Only on women after menopause C. All women who have had hysterectomies D. Women with drinking problems

Answer A The USPSTF recommends screening for osteoporosis in women aged 65 years and older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white women who has no additional risk factors. For women younger than 65, the literature supports screening only for perimenopausal women with risk factors that include Caucasian or Asian race, a history of bilateral oopherectomy before menopause, a slender build, smoking or having smoked tobacco, low calcium consumption patterns, a sedentary lifestyle, and a positive family history of the condition. Women who have had a hysterectomy but not an oopherectomy are not considered at particular risk. Alcohol negatively impacts bone health by interfering with the absorption and use of calcium and vitamin D and other bone nutrients. Because there are a number of negatives about drinking and bone density, it would be wise for persons with problems with bone loss to decrease or eliminate alcohol.

What is the ultimate goal of crisis intervention? A. To help persons function at a higher level than in their pre-crisis state B. To help persons eliminate the crisis and get back to where they were C. To prevent further crises D. To eliminate stress altogether

Answer A The ultimate goal of crisis intervention is to help people function at a higher level than their pre-crisis state. Eliminating the current crisis and returning people to the functional level where they were before the crisis will put them back in the same situation and make them susceptible to the crisis all over again.

Martin, an 83-year-old man, is at your office for his yearly physical exam. He has a history of hypertension, hyperlipidemia, cigarette smoking, and chronic obstructive pulmonary disease (COPD). Martin states that he has been feeling increased fatigue with minimal activity but denies any chest pain or shortness of breath. Martin's list of medications includes the following: one baby aspirin daily, one ACE inhibitor daily, diuretic daily, and statin medication daily. Martin's physical exam was normal. His blood pressure was 130/68, his heart rate was 88, and his respiratory rate was 22. Observing Martin during your examination, you detect that he utilizes pursed-lip breathing throughout the exam. What medication should he be started on for his COPD? A. Inhaled corticosteroid B. Inhaled anticholinergic and inhaled beta-2 agonists C. Oral steroids daily D. Inhaled beta-2 agonists

Answer B According to the Global Initiative for COPD guidelines, all symptomatic COPD clients should be started on an inhaled anticholinergic drug and a beta-2 agonist. Both are well tolerated by older adults and have few side effects

Mark, a 56-year-old man, comes to your practice seeking help to quit smoking. You prescribe varenicline (Chantix), a prescription medication, to aid with his attempt. What instructions do you give Mark regarding how to stop smoking with Chantix? A. Start the Chantix today according to the dosing schedule and then quit smoking after the 12-week medication schedule. B. Start the Chantix today according to the dosing schedule and then pick a date to stop smoking about 7 days after starting Chantix. C. Pick a date to stop smoking and start Chantix that day according to the dosing schedule. D. Start Chantix today, take it twice a day for 2 weeks, and then stop smoking.

Answer B Chantix has been shown to be more effective in helping smokers quit than Zyban, another nonnicotine prescription medicine for smoking cessation. While Chantix contains no nicotine, it works on the same receptors as nicotine. It's the addiction to nicotine inhaled from smoking that makes quitting so hard. The recommended dosing schedule for Chantix is as follows: Day 1 to day 3 - one 0.5 mg tablet per day; Day 4 to day 7 - one 0.5 mg tablet twice a day (once in the morning and once in the evening); Day 8 to the end of treatment: one 1 mg tablet twice per day (once in the morning and once in the evening). Chantix should be taken with a full glass of water after eating. The client should choose a quit date to stop smoking. Chantix should be taken for 7 days before the quit date. This lets Chantix build up in the body. Smoking should cease on the quit day, and Chantix should be continued for up to 12 weeks. If the client has not completely quit smoking by 12 weeks, another 12 weeks may help the client stay cigarette free. The most common side effect is nausea (30%), but not enough to make the client discontinue the medication.

You are sharing with your client the idea that he needs to get some counseling to deal with his severe stress because it is affecting his physiological condition. Which of the following hormonal changes occurs during severe stress? A. A decrease in catecholamines B. An increase in cortisol C. A decrease in antidiuretic hormone D. A decrease in aldosterone

Answer B During severe stress, the cortisol level increases, allowing mobilization of free fatty acids. This triggers a series of reactions. With the increased cortisol, glucose production from amino acids increases. During severe stress, as glucagon release increases, catecholamine levels increase. The insulin-to-glucagon ratio decreases, glycogen breakdown increases, and glucose production from amino acids increases. The release of antidiuretic hormone also increases during stressful periods, increasing the retention of water, and the level of aldosterone increases, leading to the increased retention of sodium.

For which patient would you administer the HPV vaccination? A. Susie, age 7 B. Janice, age 17, who had a baby 6 months ago and is breastfeeding C. Alice, age 18, who is allergic to yeast D. Jill, age 30, who is pregnant

Answer B HPV vaccination is not recommended for use in women who are pregnant. A contraindication to the HPV vaccines is a history of immediate hypersensitivity to yeast. Women who are lactating or immunocompromised are eligible to receive the vaccine. It is also recommended for females aged 9 to 25 years, whether or not they have had sex yet and even if the women already have a history of genital warts, a positive HPV test, or an abnormal Pap test.

How much higher are health-care costs for smokers than for nonsmokers? A. 20% B. 40% C. 60% D. 80%

Answer B Health-care costs for smokers at any given age are as much as 40% higher than for nonsmokers. Although smokers have more diseases than nonsmokers, nonsmokers live longer and can incur more health costs at advanced ages.

When can Pap smears be safely discontinued? A. At age 80 B. At age 65 if the previous three Pap smears have been normal C. Never; they should be continued throughout life. D. After menopause or hysterectomy

Answer B Pap smears may be discontinued at age 65 if the previous three Pap smears have been normal. At or after the age of 30, women who have had three consecutive normal tests may have screening extended to once every 2 to 3 years. An exception to this is for women who are at higher risk of cervical cancer, such as women exposed to DES in utero or those who are HIV positive or immunocompromised for another reason. If a woman has had a hysterectomy, there is a need for a Pap smear only if the cervix has been left intact.

To quantify the margin of error in a screening instrument, the measure of validity is divided into two components: sensitivity and specificity. Sensitivity refers to a screening test's ability to A. recognize negative reactions or nondiseased individuals. B. identify persons who actually have the disease. C. predict populations at risk. D. give the same result regardless of who performs the test.

Answer B Sensitivity refers to a screening test's ability to identify persons who actually have a disease (true positives), whereas specificity measures a screening test's ability to recognize negative reactions or non-diseased individuals (true negatives). For example, if a screening tool were used on 100 individuals known to have prostate cancer and it detected 90 persons with prostate cancer, missing 10 of the individuals, the sensitivity would be 90%.

Max, age 46, states that he cannot give up drinking beer, but he will cut down. You suggest that his limit should be A. one can of beer a day. B. two cans of beer a day. C. three cans of beer a day. D. four cans of beer a day.

Answer B The Committee on Diet and Health of the National Research Council recommends that alcohol consumption per day be limited to the equivalent of less than 1 oz of pure alcohol. This equates to two cans of beer, two small glasses of wine, or two average cocktails. This does not apply to pregnant women, who should avoid alcohol altogether. Obviously, the ideal would be for no alcohol, which is probably unrealistic for Max.

Which industry is responsible for the most injuries? A. Mining B. Construction C. Transportation and utilities D. Manufacturing

Answer B The construction industry is responsible for the most injuries (15 injuries per 100 full-time workers per year). Next in line are the agriculture, fishing, and forestry industries, followed by the manufacturing, transportation and utilities, and mining industries.

What are the two leading causes of death in the United States for all ages? A. Cancer and stroke B. Heart disease and cancer C. AIDS and heart disease D. Accidents and heart disease

Answer B The two leading causes of death in the United States for all ages are heart disease and cancer. Almost two-thirds of the deaths in the United States every year are from these causes.

lab value that is commonly decreased in older adults is A. creatinine clearance. B. serum cholesterol. C. serum triglyceride. D. blood urea nitrogen.

Answer: A The creatinine clearance value is commonly decreased in older adults because of impaired renal function. Serum cholesterol, serum triglyceride, and blood urea nitrogen values are usually increased in older adults.

Oral health problems are common and painful. Years ago, it was common to see almost all adults with complete dentures. Today, what percentage of U.S. adults aged 75 and older have lost all their teeth? A. 10% B. 25% C. 50% D. 75%

Answer B Twenty-five percent of U.S. adults aged 75 and older have lost all of their teeth. Advanced gum disease affects 4% to 12% of adults. Half of the cases of severe gum disease in the United States are the result of cigarette smoking. Three times as many smokers have gum disease as people who have never smoked. More than 7,600 people, mostly older Americans, die from oral and pharyngeal cancers each year.

A conservative, preventive health approach for healthy adults is to recommend limiting salt intake to how many grams per day? A. 2 g B. 4 g C. 6 g D. 8 g

Answer C A conservative, preventive health approach for healthy adults is to recommend limiting salt intake to 6 g or less per day. This includes salt added to food during cooking or at the table, salt added as an ingredient to processed foods, and salt that occurs naturally in foods. Table salt is approximately 40% sodium by weight; therefore, a diet incorporating 6 g of salt contains about 2.4 g of sodium.

By 2030, the number of U.S. adults aged 65 or older will more than double to about 71 million. What percentage of older adults have one chronic condition? A. 30% B. 50% C. 80% D. almost 100%

Answer C About 80% of older adults have one chronic condition. Fifty percent of older adults have at least two chronic conditions. Infectious diseases (such as influenza and pneumococcal disease) and injuries also take a disproportionate toll on older adults. Efforts to identify strategies to prevent or reduce these risks and to effectively intervene in these conditions must be pursued.

Sal is traveling out of the country for business and asks for a prescription to prevent traveler's diarrhea. What do you give him? A. Trimethoprim with sulfamethoxazole (TMPSMX) double strength daily B. Bismuth subsalicylate, 2 tablets qid C. Nothing, but tell him to "cook it, boil it, peel it, or forget it" D. Nothing, but tell him to use bottled drinking water

Answer C Although antibiotics and bismuth subsalicylate are effective in the prevention of traveler's diarrhea, they are not generally recommended because of the potential side effects. Instead, advise clients to "cook it, boil it, peel it, or forget it.".

Carol, a nursing student, is at your office for her nursing school admittance physical exam and immunizations. On reviewing Carol's allergies, you find that she is allergic to baker's yeast. What would you tell Carol regarding the hepatitis B vaccine? A. You recommend that she receive the first hepatitis B vaccine today. B. You advise her to wait until she is starting her clinical rotations to get the first hepatitis B injection. C. You advise her that she cannot receive the hepatitis B vaccine because of her allergy to baker's yeast. D. You instruct her to receive the first hepatitis B vaccine today, the second injection in 6 months, and the third injection in 1 year.

Answer C An allergy to baker's yeast is a definite contraindication to receiving the hepatitis B vaccine. Yeast is used in making the vaccine and is still present in the vaccine.

Anorexia nervosa is a steady, intentional loss of weight with maintenance of that weight at an extremely unhealthy low level. Which statement is true regarding anorexia nervosa? A. The poor eating habits result in diarrhea. B. It may cause tachycardia. C. It may occur from prepubescence into the early 30s. D. It may cause excessive bleeding during menses.

Answer C Anorexia nervosa may occur from prepubescence into the early 30s and occurs most commonly from early to late adolescence. It occurs more frequently in women and may cause bradycardia, arrhythmias, and amenorrhea. Constipation is common in clients with anorexia because of their poor eating habits.

68-year-old woman presents to your office for screening for osteoporosis. Sandy states that her grandmother and mother both lost inches in their old age. Sandy has been postmenopausal for the past 15 years and never took any hormone replacement medications. She is Caucasian, weighs 108 lb, and is 5 ft 1 in. tall on today's measurement. When do women lose the greatest amount of bone density? A. During adolescence B. The first year of menopause C. The first 10 years after menopause D. Bone loss occurs continuously at the same rate from menopause to death.

Answer C Bone loss begins at a rate of 0.5% a year in a woman's middle to late 40s. When menopause occurs, the rate increases up to 7% a year for the first decade after menopause. This increase in the rate of bone loss is directly related to a decrease in a woman's estrogen. After menopause, the bone loss decreases to 0.5% to 1% a year until death. This patient should be encouraged to do weight-bearing exercises and have an adequate calcium intake of 1,000 to 1,500 mg/day with sufficient amounts of vitamin D.

What is an example of an active strategy of health promotion? A. Maintaining clean water B. Introducing fluoride into the water C. Enacting a stress management program D. Maintaining a sanitary sewage system

Answer C Enacting a stress management program is an active strategy of health promotion because it requires individuals to become personally involved. Maintaining clean water, introducing fluoride into the water, and maintaining a sanitary sewage system are all examples of passive strategies—those done for individuals and communities by others.

Jan's mother has Alzheimer's disease. Jan tells you that her mother's recent memory is poor and that she is easily disoriented, incorrectly identifies people, and is lethargic. Jan asks you, "Is this as bad as it gets?" You tell her that her mother is in which stage of the disease? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

Answer C Families of persons with Alzheimer's disease (AD) need to know that AD is a progressive disorder of the brain affecting memory, thought, and language. Although the progression of the stages is individual, and changes may occur rapidly or slowly over the course of several years, knowing what stage a family member is in helps family members in planning and knowing what to expect. Stage 1 is the onset, which is insidious. Spontaneity, energy, and initiative are decreased; slowness is increased; word finding is difficult; the person angers more easily; and familiarity is sought and preferred. In stage 2, supervision with detailed activities such as banking is needed, speech and understanding are much slower, and the train of thought is lost. In stage 3, personality change is marked, and depression may occur. Directions must be specific and repeated for safety, recent memory is poor, disorientation occurs easily, people are incorrectly identified, and the person may be lethargic. In stage 4, apathy is noticeable. Memory is poor or absent, urinary incontinence is present, individuals are not recognized, and the person should not be alone.

Harry is taking his entire family to Central America and is wondering about protection against mosquito bites causing malaria. What advice do you give him? A. Use an insect repellent with diethyltoluamide (DEET) for the entire family, applying it sparingly to small children. B. Make sure the family is in well-screened or indoor areas from dusk to dawn. C. Use an insect repellent with DEET for adults and permethrin for children, and stay inside from dusk to dawn. D. Stay inside from dusk to dawn, and use an insect repellent with permethrin.

Answer C Insect repellents with high concentrations (greater than 35%) of diethyltoluamide (DEET) are effective in preventing mosquito bites; however, DEET is not recommended to be applied to the hands or faces of young children. Permethrin is effective as a scabicide (at 5%) and as a pediculicide (at 1%). It is very effective at a low concentration against malaria-carrying mosquitoes and is safe for all ages. Other preventive measures include remaining in well-screened or indoor areas from dusk to dawn, using mosquito nets, and wearing clothing that covers most of the body.

What is the most common type of occupational (nonfatal) illness in the United States? A. Poisoning B. Respiratory conditions caused by toxic agents C. Repetitive stress injury D. Skin disorders

Answer C Occupational repetitive stress injuries result from wear and tear on the body over a period of time. Repetitive stress injuries are one of the fastest growing workplace injuries and can happen any time there is a discrepancy between the physical requirements of a job and the physical capacity of the worker's body. Risk factors include repetitive motion, force, awkward posture, heavy lifting, or some combination of these factors. Teaching proper body mechanics is a good form of prevention. Skin disorders represent up to 20% of all occupational illnesses. Many incidences of workplace skin disease go unreported, and the true rate of occupational skin disease is probably much higher. The most common occupational skin disease is contact dermatitis, which may be classified as acute (weepy, edematous, vesicular, blistered) or chronic (dry, cracked, scaly, thickened). This is followed by respiratory conditions, then poisoning.

Which class of drugs causes the most adverse reactions? A. Chemotherapeutic agents B. Anticonvulsants C. Antibiotics D. Antidepressants

Answer C Of all the drug classes, antibiotics cause the most adverse reactions. The other drug classes that cause a high number of adverse drug reactions are, in order, chemotherapeutic agents, cardiovascular agents, antihypertensive agents, anticonvulsants, and antidepressants.

Postmenopausal women who are not on hormone replacement therapy need how much calcium per day to help prevent osteoporosis? A. 1,000 mg B. 1,200 mg C. 1,500 mg D. 1,800 mg

Answer C Postmenopausal women who are not taking hormone replacement therapy need 1,500 mg of calcium a day to help prevent osteoporosis. Because treatment for osteoporosis is limited, prevention is necessary to reduce the occurrence.

When is routine screening for hypothyroidism performed? A. When a client reaches age 65 B. Whenever a client exhibits symptoms C. Never; it is not routinely recommended. D. When a client has a family history of thyroid problems

Answer C The U.S. Preventive Services Task Force (USPSTF) updated its clinical guidelines on screening for thyroid dysfunction in 2015. Conflicting with recommendations from the American Thyroid Association (ATA) and the American Academy of Clinical Endocrinology (AACE), the USPSTF still advises against routine screening of thyroid-stimulating hormone (TSH) levels in nonpregnant, asymptomatic adults. Instead, the expert panel recommends targeted TSH screening for patients with certain risk factors. Factors that place patients at greater risk for elevated TSH levels include older age, Caucasian ethnic background, type 1 diabetes, Down syndrome, and external-beam radiation in the head and neck area, according to the USPSTF. Other factors include family history of thyroid disease, goiter, and previous hyperthyroidism. Risk factors associated with low TSH levels include female gender, older age, African ancestry, low iodine intake, and chronic use of medications containing an iodine moiety—most prominently amiodarone. Patients with a personal or family history of thyroid disease are also at risk of developing low TSH levels.

Which of the following definitions refers to the epidemiologic term endemic ? A. Outbreaks of an illness/disease that occur occasionally and are unrelated in space and time B. Presence of an event (illness or disease) at a much higher than expected rate based on past history C. Presence of an illness/disease constantly present or present at a rate that is expected based on history D. Presence of an event in epidemic proportions affecting many communities and countries in a short period of time

Answer C The definition of endemic is answer C. Option A defines sporadic; B defines epidemic; and D defines pandemic .

Herbert, a 69-year-old man, comes to your office complaining of nocturia. On questioning Herbert, you find that for the past 3 months he has been getting up at least five times a night to void. He came in to seek help today because of his wife's insistence that he be checked out. When you perform the digital rectal exam, you find that his prostate protrudes 3 to 4 cm into the rectum. What grade would you assign to Herbert's prostate enlargement? A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4

Answer C The degree of prostate enlargement is based on the amount of projection of the prostate into the rectum. The normal prostate protrudes less than 1 cm into the rectum. Grade 1 enlargement is a protrusion of 1 to 2 cm, Grade 2 is 2 to 3 cm, Grade 3 is 3 to 4 cm, and Grade 4 is greater than 4 cm.

Marvin is a gay man who is ready to "come out." What is the last step in the process of coming out? A. Testing and exploration B. Identity acceptance C. Identity integration and self-disclosure D. Awareness of homosexual feelings

Answer C The last step in the process of a gay man or lesbian "coming out" is that of identity integration and self-disclosure. The process of discovering and revealing one's sexual orientation can occur at any age and is known as "coming out." Stage theories for coming out have been summarized as a four-step process: 1 - Awareness of homosexual feelings, 2 - Testing and exploration, 3 - Identity acceptance, and 4 - Identity integration and self-disclosure. If the ultimate costs of self-disclosure are felt to be too high, an individual may become socially isolated or deny gay or lesbian identity.

Sandra, a 27-year-old nurse, states that she does not want to get the hepatitis B virus vaccine because of its adverse effects. You tell her that the most common adverse effect is A. fatigue. B. headache. C. pain at the injection site. D. elevated temperature.

Answer C The most common adverse reaction to the hepatitis B virus vaccine is pain at the injection site (13%-20% in adults, 3%-9% in children). Other mild, transient systemic adverse effects are fatigue and headache (11%-17% in adults, 8%-18% in children) and temperature elevation (1%-6% of all injections).

Which of the following is a true contraindication to immunizations? A. Mild to moderate local reaction to a previous immunization B. Mild acute illness with a low-grade fever C. Moderate or severe illness with or without a fever D. Recent exposure to an infectious disease

Answer C The only true contraindications to immunizations, according to the American Academy of Pediatrics, are a moderate or severe illness with or without a fever and an anaphylactic reaction to a vaccine or a vaccine constituent. Illnesses themselves are not true contraindications to vaccinations. Early symptoms may be a prodrome of something else; however, risks of the diseases are usually greater than the complications of vaccination. even a fever of 104.5°F (40°C) with a previous diphtheria, tetanus, and pertussis (DTaP) immunization is not a contraindication to a subsequent DTaP shot.

Utilization review refers to a system A. of reviewing access to and utilization of healthcare services. B. that uses retrospective review of client records to reveal problems that may be addressed in the future. C. to monitor diagnosis, treatment, and billing practices to assist in lowering costs. D. that has clients use an identification card to be able to use health-care services.

Answer C Utilization review is a system to monitor diagnosis, treatment, and billing practices. It assists in lowering health-care costs by discouraging unnecessary procedures.

Many of the 78 million baby boomers have a hearing loss. In a survey, all of the following statements were reported by baby boomers. Which statement was shared by the greatest percentage? A. Hearing loss is affecting the home life of baby boomers. B. Baby boomers have problems hearing on cell phones. C. Baby boomers are reluctant to admit the impact of their hearing loss. D. Hearing loss is affecting the work/jobs of baby boomers.

Answer C When the 78 million baby boomers were growing up, television, rock concerts, and other intense audio programs were coming of age. Earplugs were unheard of. This generation does not want to wear hearing aids or anything that marks them as being different or disabled. As a result, baby boomers frequently avoid seeking help from hearing aid professionals. The following statistics are from a national survey of baby boomers: 75% said they find themselves in situations in which people are not speaking loudly or clearly enough or they can't hear the TV, 53% said they have at least a mild hearing loss, 25% said their hearing loss affects their work, and 57% said they have trouble hearing on their cell phone.

Marian's husband, Stu, age 72, has temporal arteritis. She tells you that his physician wants to perform a biopsy of the temporal artery. She asks if there is a less invasive diagnostic test. What test do you tell her is less invasive? A. Computed tomography (CT) scan B. Magnetic resonance imaging (MRI) C. Electroencephalogram (EEG) D. Color duplex ultrasonography

Answer D A biopsy of the temporal artery is usually required to confirm the diagnosis of temporal arteritis. Color duplex ultrasonography (a combination of ultrasonography and the flow-velocity determinations of a Doppler system) has been shown to examine even small vessels, such as the superficial temporal artery, and show a halo around the inflamed arteries when temporal arteritis is present. Therefore, it is a much less invasive procedure than biopsy. A computed tomography (CT) scan and magnetic resonance imaging (MRI) are done to detect neurological damage from hemorrhage, tumor, cyst, edema, or myocardial infarction. These tests may also identify displacement of the brain structures by expanding lesions. However, not all lesions can be detected by CT scan or MRI. An electroencephalogram is used to evaluate the electrical activity of the brain. It can identify seizure activity as well as certain infectious and metabolic conditions.

A diagram that depicts each member of a family, shows connections between the generations, and includes genetically related diseases is called a A. family assessment diagram. B. family generation illustration. C. generations diagram. D. genogram.

Answer D A genogram is a diagram that depicts each member of a family and shows connections among the generations, including all members of the extended family for several generations. It includes the health status of each member, including any genetic diseases.

Martha, age 82, has an asymptomatic carotid bruit on the left side. What do you recommend? A. ASA therapy B. Coumadin therapy C. Surgery D. No treatment at this time

Answer D Clients with asymptomatic carotid bruits have a 2% incidence of cerebrovascular accidents (CVAs), also known as strokes or brain attacks, per year. Although ASA, anticoagulants, and surgery are frequently ordered, there are not sufficient data to prove that these treatments reduce the risk of CVA in clients with asymptomatic carotid bruits. Starting an asymptomatic older woman on ASA therapy may produce more problems, such as skin bruising or gastrointestinal bleeding.

One of the major criteria for diagnosing chronic fatigue syndrome is A. generalized headaches. B. unexplained, generalized muscle weakness. C. sleep disturbance. D. fatigue for more than 6 months.

Answer D Fatigue for more than 6 months and absence of other clinical conditions that may explain such fatigue are the two major criteria the client must demonstrate to be diagnosed with chronic fatigue syndrome. Other minor criteria include generalized headaches, unexplained generalized muscle weakness, sleep disturbances, sore throat, mild fever or chills, and migratory arthralgias without swelling or redness.

When should glaucoma screening be instituted? A. When the client is age 65 B. When the client exhibits vision problems C. At the client's annual exam D. Starting at age 40

Answer D Glaucoma is an elevated intraocular pressure that is measured with the use of a tonometer. While the USPSTF found insufficient evidence to recommend for or against screening adults for glaucoma, the American Academy of Ophthalmology recommends screening for glaucoma as part of the comprehensive adult medical eye evaluation, starting at the age of 20, with a frequency depending on an individual's age and other risk factors for glaucoma. The Department of Veterans Affairs recommends that every veteran over the age of 40 be screened for glaucoma in a primary care setting with a frequency depending on age, ethnicity, and family history. Looking at all guidelines, option D is the best choice. Waiting until the client exhibits vision problems may be too late.

Which of the following individuals should get the shingles (herpes zoster) vaccine? A. Jerry, who has a mild upper respiratory tract infection and is allergic to neomycin B. Timmy, who has been on prolonged use of high dose steroids for his COPD C. Joan, whose husband recently had shingles, and who is trying to get pregnant D. Joe, who has a stressful job

Answer D Joe, who has a stressful job, is a candidate for the shingles (herpes zoster) vaccine. All of the other conditions are contraindications for receiving the vaccine: allergy to neomycin, prolonged use of high-dose steroids, and pregnancy or possibility of pregnancy. Women should not get pregnant until 4 weeks after receiving the vaccination.

Since 2001, the major public health and safety focus in the United States has shifted to A. cardiovascular risk reduction. B. domestic abuse and violence. C. unintended pregnancies. D. the threat of bioterrorism.

Answer D Since 2001, the major public health and safety focus has shifted to safety from the threat of bioterrorism. Other health promotion concerns that are continuing include the threat of cardiovascular disease, cancer, childhood infectious diseases, sexually transmitted diseases, and unintended pregnancies. In addition, clients face problems related to domestic violence, abuse, poverty, and addictions. While nursing education programs have prepared providers to deal with these issues, it wasn't until recently that bioterrorism threats were integrated into curricula.

How do you respond when Jill, age 42, asks you how long she should work out each week? A. Exercise for at least 30 minutes every day B. Exercise a total of 2 hours per week C. Exercise for at least 20 minutes, 3 or more days per week D. Exercise for at least 30 minutes, 5 days per week

Answer D The American College of Sports Medicine (ACSM) recommends 3 to 5 days per week for most cardiovascular exercise programs. For cardiovascular benefits, aim for 20 to 60 minutes in your target heart rate zone, apart from the warm-up and cool-down period. ACSM's overall recommendation is for most adults to engage in at least 150 minutes of moderate-intensity exercise each week. If you encourage patients to exercise most days of the week, they might make this goal.

Andrea, a 20-year-old nursing student, never had her second measles, mumps, rubella (MMR) immunization. What test must you do before giving Andrea her second MMR? A. Complete blood count B. Complete metabolic panel C. Lipid profi le D. Urine pregnancy test

Answer D The MMR is a live attenuated vaccine, and therefore a female client must not be pregnant when she receives the vaccination. Female clients must also be informed that they need to refrain from becoming pregnant for the 3 months following MMR vaccination or risk birth defects to the fetus.

When does the U.S. Preventive Services Task Force recommend cholesterol screening for persons with no family history of coronary heart disease? A. Starting at age 20 and then at least every 5 years B. Whenever any other blood test is ordered C. At the annual routine physical D. Men aged 35 and older

Answer D The U.S. Preventive Services Task Force recommends cholesterol tests for: • Men aged 35 and older • Men aged 20 to 35 who have risk factors for heart disease • Women aged 20 and older who have risk factors for heart disease.

When should an African American man start to be screened for prostate cancer by a digital rectal exam? A. Age 60 and then yearly B. Age 40 and then every 2 years C. Never D. After discussing the latest research

Answer D The evidence is insufficient to determine whether screening for prostate cancer with prostate-specific antigen (PSA) or digital rectal exam (DRE) reduces mortality from prostate cancer. Screening tests are able to detect prostate cancer at an early stage, but it is not clear whether this earlier detection and consequent earlier treatment leads to any change in the natural history and outcome of the disease. Observational evidence shows a trend toward lower mortality for prostate cancer in some countries, but the relationship between these trends and intensity of screening is not clear, and associations with screening patterns are inconsistent. The observed trends may be due to screening, or to other factors such as improved treatment. Results from two randomized trials show no effect on mortality through 7 years but are inconsistent beyond 7 to 10 years. Not all medical institutions agree on when men should begin screening (routine testing) for prostate cancer or even if a DRE should be part of the screening.

The U.S. Department of Health and Human Services recommends which of the following exercise guidelines for Americans to reduce the risk of chronic disease in adulthood? A. Participate in 45 minutes of cardiovascular exercise at least three times per week. B. Walk 1 hour every day. C. Engage in vigorous intense activity 60 minutes most days of the week. D. Engage in 30 minutes or more of moderately intense physical activity at least 5 days per week

Answer D To reduce the risk of chronic disease in adulthood, engage in 30 or more minutes of moderately intense physical activity at work or at home at least 5 days per week. Greater health benefits may be obtained by participating in activity that is more vigorous in intensity or of longer duration. To help manage body weight and prevent a gradual increase in weight gain, 60 minutes of moderate to vigorous intensity activity may be done on most days of the week without increasing dietary caloric intake.

Twenty percent of colorectal cancers can be attributed to which dietary cause? A. High-fat diet B. High-carbohydrate diet C. Use of alcohol D. Lack of fiber in the diet

Answer D Twenty percent of colorectal cancers can be attributed to a lack of fiber in the diet. A high-fat diet has also been secondarily implicated.

Which federal insurance program went into effect in 1966 to provide funds for medical costs for persons aged 65 and older, as well as disabled persons of any age? A. Medicare B. Title XIX of the Social Security Act C. Medicaid D. Omnibus Reconciliation Act

Answer: A Medicare was established in 1966 by the U.S. government as a federal insurance program to provide funds for medical costs for persons aged 65 and older and disabled persons of any age. Medicaid, an amendment to Title XIX of the Social Security Act, went into effect in 1967 to provide basic health services to low-income persons. The Omnibus Budget Reconciliation Act was implemented in 1982 and updated in 1993, when 20 programs were combined into four block grants.

Tuberculin skin testing using the Mantoux test should be considered for A. high-risk adolescents, recent immigrants, and homeless individuals. B. all clients every 2 years. C. all clients at their annual physical. D. all children before entrance into fi rst grade.

Answer: A For high-risk individuals with HIV, an induration of 5 mm or greater when read at 48 to 72 hours is considered positive. Foreign-born persons from high-risk countries may be considered positive with an induration of greater than 10 mm. For all other persons, an induration of greater than 15 mm is considered positive.

Which part of Medicare is basic hospital insurance? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D

Answer: A Medicare Part A is basic hospital insurance. Medicare Part B is supplementary voluntary medical insurance supported by tax revenues and by additional monies paid by the insured to cover physician services, laboratory services, home health care, and outpatient hospital treatments.

Which of the following statements is true about depression and the older adult? A. Older adults are at an increased risk for depression. B. Depression is a normal part of aging. C. Depression may just be the emotion felt when a person is grieving the loss of a spouse. D. Most antidepressive drugs do not work without psychotherapy on older adults.

Answer: A Older adults are at an increased risk for depression because of the associated chronic health conditions that may also exist. Older adults are often misdiagnosed and under-treated. Depression is a true and treatable medical condition, not a normal part of aging. Depression is not just having "the blues" or the emotions one feels when grieving the loss of a loved one. It is a true medical condition that is treatable, like diabetes or hypertension. Most older adults see an improvement in their symptoms when treated with anti-depressive drugs alone, with psychotherapy, or with a combination of both.

Most anal cancers are potentially preventable. Which of the following is a cause of anal cancer? A. Sexually transmitted diseases (STDs) B. A low-fiber diet C. Hemorrhoids D. Foreign bodies used as sexual stimulants

Answer: A Sexually transmitted diseases (STDs) are a cause of anal cancer. For women, other risk factors for anal cancer include an increased number (greater than 10) of sexual partners, having their fi rst sexual experience before age 16, having four or more sexual partners before age 20, and anal intercourse. For men, other risk factors include having more than 10 sexual partners and being homosexual or bisexual

If a screening test used on 100 individuals known to be free of breast cancer identified 80 individuals who did not have breast cancer while missing 20 of the individuals, the specificity would be A. 80%. B. 60%. C. 40%. D. 20%.

Answer: A Specificity measures a screening test's ability to recognize individuals who are non-diseased or those with negative reactions (true negatives). It can be represented by a ratio of tested negatives to the total number of known, or true, negatives. In this case, the number of negatives that the test recognized was 80, with the total number of known, or true, negatives being 100. Therefore, 80 out of 100 (80/100) equals a specificity of 80%.

Eileen, a 42-year-old woman, comes to your office with the chief complaint of fatigue, weight loss, and blurred vision. Eileen has a negative past medical history for any chronic medical problems. You obtain a fasting chemistry panel, lipid profile, complete blood count (CBC), and a HgbA1c. The results of the blood work show Eileen's blood sugar to be elevated at 356 mg/dL, total cholesterol elevated at 255, high-density lipoprotein (HDL) cholesterol low at 28, LDL elevated at 167, triglycerides 333, and HgbA 1c 12. On questioning Eileen further, you discover that both her grandmothers had adult-onset diabetes mellitus. You diagnose type 2 diabetes mellitus. Your treatment plan should include a cholesterol-lowering agent, an agent that lowers blood sugar, and which other class of medication? A. ACE inhibitor B. Diuretic C. Weight-loss medication D. Beta blocker

Answer: A Studies have shown the use of ACE inhibitors in clients with diabetes with or without hypertension has slowed the progression of nephropathy. You must monitor the client's creatinine and potassium levels routinely. If the client's renal function does decrease, elevated potassium levels may occur. Some clinicians disagree on this approach and recommend waiting until microalbuminuria is present before initiating an ACE inhibitor.

When performing a sports physical exam on Kevin, a 16-year-old healthy boy, which question in the history is important to ask Kevin or his guardian? A. Did anyone in your family ever have sudden cardiac death? B. Does anyone in your family have elevated cholesterol levels? C. Did you ever have any injury requiring stitches? D. Does anyone in your family have a history of asthma?

Answer: A The risk of sudden death during sports activities from hypertrophic cardiomyopathy may be greatly reduced with a thorough cardiac history and examination. If a child has a relative who died of sudden cardiac disease before age 55, that child could possibly have hypertrophic cardiomyopathy. Family history of asthma is not relevant to this exam question

Who is the most important source of social support for an adult? A. Spouse (if applicable) B. Parents C. Close friends D. Children

Answer: A The spouse has been shown to be the most important source of social support for an adult. If there is no spouse, family members are the next most important source. Research has shown that support from outside the family cannot compensate for what is missing within the family

How do you respond when Mattie, a 32-year-old who is taking levothyroxine (Levothroid, Synthroid), says she has read that she should not eat brussels sprouts? A. "Brussels sprouts contain a high amount of iodine, and therefore you should not eat them." B. "Brussels sprouts interfere with the absorption of the medication." C. "There is no reason why you should not eat brussels sprouts." D. "It is safe if you take the medication in the morning and don't eat brussels sprouts until the evening."

Answer: A Clients taking levothyroxine (Levothroid, Synthroid) should avoid foods high in iodine, such as brussels sprouts, cabbage, cauliflower, rutabagas, soy, and turnips, because these foods, when added to the medication, raise client's iodine levels.

Lewin's change theory involves fundamental shifts in a person's behaviors to evoke and successfully implement change. The final phase is referred to as A. implementation. B. refreezing. C. finalizing. D. change.

Answer: B Lewin's change theory has three distinct and vital stages: "unfreezing"; "moving to a new level or changing" or "movement"; and "refreezing.".

When should a woman start getting Pap tests? A. When she becomes sexually active B. At age 21 C. During her first pregnancy D. Before birth control is prescribed

Answer: B Women are advised to begin Pap testing at the age of 21, regardless of when they started having sexual intercourse. For a young teenager, birth control may be prescribed without first performing a pelvic exam. Earlier screening for cervical cancer may lead to unnecessary and possibly harmful treatments for an increasingly rare cancer, according to ACOG, the leading U.S. professional organization for obstetricians and gynecologists.

The CAGE screening test for alcoholism is suggestive of the disease if two of the responses are positive. What does the E in CAGE stand for? A. Every day B. Eye opener C. Energy D. Ego

Answer: B C - Cutting Down A - Annoyed by Criticism G - Guilty feelings about drinking E - Eye Opener

Which immunization may prevent meningitis? A. Hepatitis B B. Haemophilus infl uenzae type B (Hib) C. Measles, mumps, and rubella (MMR) D. Varicella

Answer: B Meningitis is one of the most severe manifestations of Haemophilus influenzae infection, and the H. influenzae type B (Hib) immunization may help prevent its occurrence. The Hib vaccination is especially important for children aged 5 years and younger. It should be given at ages 2 months, 4 months, and 6 months, with the fourth dose given between ages 12 and 18 months. Hepatitis B vaccination is important for all infants to help prevent liver disease as adults. A measles, mumps, and rubella (MMR) vaccination protects against measles, mumps, and rubella (German measles); and varicella vaccination protects against chickenpox

Gerald, a 67-year-old retired maintenance worker, comes to your office for a physical. On reviewing Gerald's history, you discover that he has had pneumonia twice in the past 5 years. When you question Gerald about his immunization history, he reveals that his last tetanus and diphtheria (Td) immunization was 6 years ago, and his last flu shot was 8 months ago, during the last fl u season. He denies ever having had a pneumonia vaccination. Which immunizations should you offer to Gerald today? A. Td B. Pneumococcal vaccine C. Infl uenza D. Td and pneumococcal vaccine

Answer: B Prevention of pneumococcal disease in older people is one of the health initiatives of the U.S. government report Healthy People 2020, National Health Promotion and Disease Prevention Objectives. The goal for health-care providers is to have 90% of all clients older than 65 years immunized against pneumococcal disease by the year 2020. The pneumococcal vaccine is a one-time injection that may need to be repeated in 8 years. Gerald does not need a Td booster because his last injection was only 6 years ago, and the Centers for Disease Control and Prevention recommend a Td booster every 10 years. The influenza injection would not be appropriate at this time. Influenza vaccine is adjusted yearly to address the type of influenza that is thought to be prevalent in that year. Also, the influenza vaccine is given just before fl u season.

The National Cancer Institute recommends that adults eat how many grams of fiber a day? A. 10 to 20 g B. 20 to 30 g C. 30 to 40 g D. 40 to 50 g

Answer: B The National Cancer Institute recommends that adults eat 20 to 30 g of fiber a day to prevent colon cancer. The plant kingdom is the only source of fiber-containing foods.

An indicator of body fat measured by dividing weight in kilograms by height in meters is the A. weight/height chart. B. body mass index. C. body fat measurement. D. anthropometric measurement.

Answer: B The body mass index (BMI) is an indicator of body fat. It is derived by dividing weight in kilograms by height in meters. It shows a direct and continuous relationship to morbidity and mortality in studies of large populations. The weight/height chart gives a range of what the ideal weight is for each height, but it does not reflect body fat. Anthropometric measurement is the measurement of the size, weight, and proportions of the human body.

Harriet, a 76-year-old woman, comes to your office every 3 months for follow-up on her hypertension. Harriet's medications include one baby aspirin daily, lisinopril 5 mg daily, and calcium 1,500 mg daily. On today's visit, Harriet's blood pressure is 168/88. According to the Joint National Committee (JNC) 8 guidelines, what should you do next to control Harriet's blood pressure? A. Increase her dose of lisinopril to 20 mg daily. B. Add a thiazide diuretic to the lisinopril 5 mg daily. C. Discontinue the lisinopril and start a combination of ACE inhibitor and calcium channel blocker. D. Discontinue the lisinopril and start a diuretic.

Answer: B The eighth report of the Joint National Committee on Prevention, Detection, and Treatment of Hypertension recommends that hypertension be treated with a thiazide diuretic, an ACE inhibitor, ARB, or calcium channel blocker. She is already tolerating the ACE inhibitor. She would benefit from a thiazide diuretic. If the diuretic were the first drug she had been on, that might have been sufficient in itself.

The primary objective of screening is to A. prevent a disease. B. detect a disease. C. determine the treatment options. D. promote genetic testing to prevent passing on the disease.

Answer: B The primary objective of screening is to detect a disease in its early stages to be able to treat it and change its progression. Treating a disease at the early asymptomatic period can significantly alter the course of the disease

The two main causes of death among U.S. adults aged 65 years or older are A. heart disease and stroke. B. stroke and suicide. C. heart disease and Alzheimer's disease. D. heart disease and cancer.

Answer: D The two main causes of death among U.S. adults aged 65 years or older are heart disease (28.2%) and cancer (22.2%). Stroke accounts for 6.6%, chronic lower respiratory disease 6.2%, Alzheimer's disease 4.2%, and diabetes 2.9%.

Molly, age 48, is healthy and has well controlled asthma. She asks if she should get an annual flu vaccination. You tell her that she should A. get it only after she reaches age 65. B. get it only during the fall season when her asthma is bothering her. C. get it on an annual basis. D. not get it because she has a respiratory problem (asthma).

Answer: C Molly should get an annual fl u vaccination because she has a long-term pulmonary problem. New guidelines from the Centers for Disease Control and Prevention state that everyone over the age of 6 months should receive an annual fl u vaccination

Which individuals does the U.S. Preventive Services Task Force (USPSTF) recommend screening for depression? A. Adults who are experiencing gender issues B. Adults who have already tried unsuccessfully to commit suicide C. All adults D. If a provider suspects depression, the individual should be referred to a specialist rather than screening in the primary care office.

Answer: C The USPSTF recommends screening all adults for depression in practices that have systems in place to assure accurate diagnosis, effective treatment, and adequate follow-up. Evidence shows that screening improves the accurate identification of depressed patients in primary care settings and that treating depressed adults identified in primary care settings reduces clinical morbidity. While the individuals in answers A and B should certainly be screened, answer C is more inclusive.

Mimi, age 52, asks why she should perform a monthly breast self-examination (BSE) when she has her mammograms on schedule. You respond, A. "If you are faithful about your annual exams and mammograms, that is enough." B. "More breast abnormalities are picked up by mammograms than by clinical exams or BSE." C. "More than 90% of all breast abnormalities are first detected by self-examination." D. "Self-examinations need to be performed only every other month."

Answer: C More than 90% of all breast abnormalities are fi rst detected by self-examination. All women older than age 20 should examine their breasts monthly, a week after their period. After menopause, women should examine their breasts at the same time each month.

Josephine, a 60-year-old woman, presents to your office with a history of elevated total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol. She was started on a statin medication 4 weeks ago and is concerned about some muscle pains she has been experiencing. On questioning Josephine, you discover that she has had pain in both her thighs for the past 2 weeks. What possible complication of statin therapy are you concerned that Josephine might be experiencing? A. Liver failure B. Renal failure C. Rhabdomyolysis D. Rheumatoid arthritis

Answer: C Rhabdomyolysis is a syndrome that results from destruction of skeletal muscle. It is usually diagnosed from laboratory findings that are characteristic of myonecrosis. Although there are no standard creatine kinase values that establish the diagnosis of rhabdomyolysis, elevations above 10,000 IU/L are usually indicative of clinically signifi cant rhabdomyolysis. The syndrome usually affects muscles used in exercise, but it may present as generalized muscle weakness. It usually resolves on stopping the statin medication, but severe cases may lead to renal failure and death.

Which statement about gender disparities and suicide is true? A. Women take their own lives more often than men. B. Men attempt suicide more often than women. C. Suicide rates for males are highest among those aged 75 and older. D. Poisoning is the most common method of suicide for both sexes.

Answer: C Suicide rates for males are highest among those aged 75 and older. Suicide rates for females are highest among those aged 45 to 54. Males take their own lives at nearly four times the rate of females and represent 78.8% of all U.S. suicides. During their lifetime, women attempt suicide about two to three times as often as men. Firearms are the most commonly used method of suicide among males (55.7%). Poisoning is the most common method of suicide for females (40.2%).

Sally, age 25, is of normal weight. She follows a diet of 70% carbohydrates, 10% fat, and 20% proteins. How do you respond when she asks you if this is a good diet? A. "Yes, this is a good diet." B. "No, you should eat more proteins." C. "You should be eating only about 55% carbohydrates." D. "Make sure your fats are divided among saturated, polyunsaturated, and monounsaturated fats."

Answer: C The National Cholesterol Education Program recommends that carbohydrates make up about 55% of total calories, fat no more than 30% of total calories, and proteins 15% to 20% of total calories.

Margaret, age 29, is of medium build and 5 ft 4 in. tall. You estimate that she should weigh about A. 105 lb. B. 110 lb. C. 120 lb. D. 130 lb.

Answer: C To estimate a client's ideal weight, use the following formula: For women older than age 25, allow 100 lb for the first 5 ft, then add 5 lb for each inch thereafter. For men, allow 106 lb for the first 5 ft, then 6 lb for each inch thereafter. Multiply the number by 110% for a client with a large frame and 90% for a client with a small frame.

The U.S. Preventive Services Task Force (USPSTF) recommends that mammography, as a method of screening for breast cancer, should be performed A. every year after the age of 40. B. only after a woman finds a lump when performing monthly breast self-examinations. C. every 2 years after the age of 50. D. after a clinical breast exam every 2 years.

Answer: C Women Before Age 50 Years The decision to start regular, biennial screening mammography should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. Women Age 50-74 Years The USPSTF recommends biennial screening mammography. Women 75 Years and Older The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in these women.

A heart-healthy diet should be recommended to clients A. with a low-density lipoprotein (LDL) cholesterol level greater than 160 mg/dL. B. with a total cholesterol level greater than 200 mg/dL. C. with a high-density lipoprotein (HDL) cholesterol level below 35 mg/dL. D. regardless of age or risk.

Answer: D A heart-healthy diet should be recommended for all clients regardless of age or risk. It is especially important that children learn healthy eating habits early in life. A heart-healthy diet follows the Dietary Guidelines for Americans developed by the U.S. Departments of Agriculture and Health and Human Services. It is designed for healthy people older than age 2 to maintain their health. The guidelines include eating a variety of foods; balancing the food you eat with physical activity; maintaining or improving your weight; choosing a diet with plenty of grain products, vegetables, and fruits; choosing a diet low in fat, saturated fat, and cholesterol; choosing a diet moderate in sugars; choosing a diet moderate in salt and sodium; and, if you drink alcoholic beverages, doing so in moderation.

Harvey, age 55, comes to the office with a blood pressure of 144/96 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the examination, it remains at 144/96. What should your next action be? A. Start him on an ACE inhibitor. B. Start him on a diuretic. C. Have him monitor his blood pressure at home. D. Try nonpharmacological methods and have him monitor his blood pressure at home.

Answer: D Before drug therapy for hypertension is instituted (unless the BP is extremely elevated), lifestyle modification and non-pharmacological methods such as salt restriction, weight reduction, biofeedback, and exercise should be considered. Aggressive treatment of all clients aged 18 to 59 with a systolic pressure greater than 140 mm Hg and/or a diastolic pressure greater than 90 mm Hg is essential. The client should monitor his or her blood pressure at home and call the health-care provider if it exceeds the parameters discussed. In this case, Harvey should try non-pharmacological methods and monitor his blood pressure at home and then return in 1 to 2 weeks for follow-up. If his diastolic pressure is still 96 mm Hg after 2 weeks, a diuretic or an ACE inhibitor would be indicated.

Emily, a healthy 26-year-old woman, asks you how she can prevent bone loss as she ages. She is concerned because both her maternal grandmother and now her mother have severe osteoporosis. What guidance would you give to Emily? A. Drink all the soda you like—it has no effect on your bone density. B. It has not been proved that smoking affects bone loss. C. Replace estrogen when you reach menopause. D. Perform aerobic exercise at least three times a week.

Answer: D Emily is only 26 years old and has not reached her peak bone mass yet. It has been proven that aerobic exercise increases bone mass. Smoking and soda drinking both have been shown to decrease bone mass. Estrogen replacement therapy is no longer recommended for bone health; it is recommended only for short-term use to alleviate vasomotor symptoms of menopause.

How can health-care providers help prevent the spread of antibiotic resistance? A. By ordering medications empirically B. By ordering an antibiotic that is not commonly given C. By ordering an antibiotic that the patient has not received before D. By ordering an agent targeting the likely pathogens

Answer: D Health-care providers can help prevent the spread of antibiotic resistance by prescribing antibiotic therapy only when it is likely to be beneficial to the patient, using an agent targeting the likely pathogens, and using the antibiotic for the appropriate dose and duration.

Performing range-of-motion exercises on a client who has had a cerebrovascular accident (CVA), also called a brain attack or stroke, is an example of which level of prevention? A. Primary prevention B. Secondary prevention C. Complications prevention D. Rehabilitation prevention

Answer: D Performing range-of-motion exercises on a client who has had a cerebrovascular accident (CVA), also called a stroke or brain attack, is an example of rehabilitation prevention. Primary prevention would be eating a healthy diet as a young adult to prevent atherosclerosis, which might precipitate a CVA. Secondary prevention would include taking lipid-lowering drugs to prevent a CVA after having already developed hyperlipidemia. Although it is desirable to prevent any complications from the CVA, there is no level of prevention called complications prevention.

Joseph, a 55-year-old man with diabetes, is at your office for his diabetes follow-up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Joseph receive today regarding the care of his feet? A. Wash your feet with cold water only. B. See a podiatrist every 2 years, inspect your own feet monthly, and apply lotion to your feet daily. C. Go to a spa and have a pedicure monthly. D. See a podiatrist yearly; wash your feet daily with warm, soapy water and towel-dry between the toes; inspect your feet daily for any lesions; and apply lotion to any dry areas.

Answer: D The American Diabetes Association recommends careful inspection of a diabetic client's feet for corns, calluses, and open lesions to prevent further deterioration into diabetic foot ulcers. The client should wash his or her feet daily with warm, soapy water and towel-dry them, especially between the toes, to prevent fungal infections. Diabetic clients should see a podiatrist yearly. Encourage patients to use a mirror to inspect the bottoms of their feet.

Screening test recommendations for HIV infection include A. all clients. B. persons getting married. C. teenagers who have been sexually active for 1 year. D. intravenous drug users and clients with high-risk behaviors.

Answer: D The Centers for Disease Control and Prevention recommend that all clients with high-risk behaviors be encouraged to be screened for HIV antibodies to identify those who are already infected so that interventions can be started to further halt the spread of the virus.

Which tumor marker is specifically elevated in prostate cancer? A. Prostate cancer tumor marker (PCTM) B. Cancer antigen (CA) 125 C. Carcinoembryonic antigen (CEA) D. Prostate-specific antigen (PSA)

Answer: D The tumor marker that is elevated in prostate cancer is prostate-specific antigen (PSA). Determined by a simple blood test, PSA is a tumor marker whose level in the bloodstream becomes elevated with prostate cancer, although it may also become elevated in BPH. There is no prostate cancer tumor marker (PCTM). Levels of cancer antigen (CA) 125 are increased in the following cancers: epithelial ovarian, fallopian tube, endometrial, endocervical, hepatic, and pancreatic. It is also used to monitor for persistent or recurrent serous carcinoma of the ovary in the postoperative period or during chemotherapy. Measurement of the level of carcinoembryonic antigen (CEA) is used primarily for monitoring persistent, metastatic, or recurrent cancer of the colon after surgery and less frequently for breast or other cancers.

Who should get the annual fl u vaccination? A. Patients who have asthma and COPD B. Residents in a nursing home C. All individuals, including infants D. All persons aged 6 months and older

Answer: D While A and B are correct, answer D is more inclusive. The Centers for Disease Control and Prevention recommends a routine influenza vaccination for all persons aged 6 months and older. This represents an expansion of the previous recommendations for annual vaccination of all adults aged 19 to 49 years and is supported by evidence that annual influenza vaccination is a safe and effective preventive health action with potential benefit in all age groups.

Cataplexy

Cataplexy is often associated with narcolepsy. It is marked by abrupt attacks of muscular weakness and hypotonia triggered by an emotional stimulus such as anger or fear.