NR 601 / NR601: Primary Care of the Maturing & Aged Family Practicum Midterm Exam Review (Fall 2020) Chamberlain College Of Nursing

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NR-601 Primary Care of the Maturing & Aged Family Practicum Mid-term Exam Review 1. 63 yo Caucasian patient with PMR will begin tx corticosteroids until the condition has resolved. You look over her r... ecords and it has been 2 years since her last physical exam and any labs or diagnostic tests as she relocated and had not yet ID'd a provider. In prioritizing your management plan your first orders should include - Duel energy X-ray scan and updating immunizations 2. 55-year-old post-menopausal woman with h/o HTN c/o jaw pain on heavy exertion. No c/o CP. EKG is normal sinus rhythm without ST segment abnormalities. Your plan may include - Exercise stress test 3. Elderly may present with atypical signs of pneumonia. You may need to be aware that clustering of all of the following s/s may indicate pneumonia in the elderly except - Bradycardia 4. 72-year-old woman and her husband are driving cross country. After a long day of driving, they stop to eat. Midway through the meal, the woman because very SOB with CP and a sense of panic. Which problem is most likely? - Pulmonary embolism 5. When you recommend exercise for the elderly which of the following pieces of advice should be considered for all types of exercise - Start low and go slow 6. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: - Testosterone 7. Patient has poorly controlled HTN for >10 years. Indicate the most likely position of his PMI - 5th ICS left of MCL 8. 43-year-old Hispanic male has audible diastolic murmur best hard at the mitral point. No audible click. He has been monitored for 2 years. What is the most likely murmur? - Mitral Stenosis 9. The caregiver for an older adult with cognitive impairment is concerned about the individuals seeming disinterest in eating. Which suggestion does the NP offer based upon a known effect of dementia on a client’s nutrition? - Establish a routine of when and where the individual will have their meals. 10. An older man has a hx of medication therapy for hypertension. Which intervention does the nurse practitioner implement when the client reports that, I've fallen twice in 5 weeks? - 11. Which of the following nutritional indicators is not an indication of poor nutritional status in the elderly? - 12. You examine the hands of a 55-year-old woman and note bilateral spindle shaped deformities on middle interphalangeal joints. These are known as - 13. Which test is clinic standard for assessment of aortic stenosis? - 14. Ischemic heart disease is - 15. Preceding a stress test, the following lab work might include - 16. On exam, what type of murmur can be auscultation with aortic regurgitation - 17. Which of the following statements is true regarding anti-arrhythmic drugs? - 18. In mitral stenosis, p waves may suggest - 19. Aortic regurgitation requires medical treatment for early signs of CHF with - 20. The best evidence rating drugs in a post MI pt include - 21. What is the most common valvular heart disease in the elderly? - 22. A common auscultory finding in CHF is - 23. The most common organism responsible for CAP in the elderly is - 24. Exercise recommended for elderly should include activities that - 25. Preferred amount of exercise for elderly is - 26. Which of the following medical conditions is not considered restrictive for engaging in physical activity? - 27. The best recommendation for patient who says they have no equipment to exercise is - 28. Biochemical individuality is best described as - 29. All of the following statements about drug absorption are false except - 30. The cytochrome p system involves enzymes that are generally: - 31. A statement not shown to be true about pharmacodynamic changes with aging is - 32. The major impact of the physiological changes that occur w/aging is: - 33. The strongest evidence regarding normal physiological aging is available through - 34. Pharmacokinetic changes with aging is reflective of - 35. All of the following statements are true about drug distribution in the elderly except - 36. Atypical presentation of disease in elderly is reflected by all of the following except? - 37. Polypharmacy is best described as - 38. What is the major difference between varicose veins and atherosclerosis? - 39. The following are true statements about bipolar disorders in older adults except - 40. In the elderly population, the fastest growing group is the age range - 41. Which statement correctly describes normal changes of aging - 42. Compared with acute pain, persistent chronic pain requires in the nurse practitioner to - 43. When considering Erikson's developmental stages, the task for later life is referred to as - 44. What is the method of action of anticholinergics? - 45. What is the method of action of beta agonists? - 46. What is tuberculosis - 47. What is aortic regurgitation? - 48. What is aortic stenosis - 49. What is mitral stenosis - 50. What is mitral regurgitation - 51. What is mitral valve prolapse? - 52. What happens in valvular regurgitation - 53. What happens in valvular stenosis - 54. What is the purpose of functional assessment of the elderly? - 55. How should HTN be managed - 56. What is first line meds for non-black HTN population including those with DM - 57. What is the med guideline for ASCVD for those </= 75 y/o - 58. What is the med guideline for ASCVD for those >75 y/o - 59. What is the guideline for meds for LDL>=190? - 60. What is the bed guideline for ASCVD for 40-75 y/o with DM? - 61. What is the med guideline for LDL 79-189? - 62. What is the ASCVD med guideline for 40-75 y/o without ASCVD or DM? - 63. When is Zostavax recommended? - 64. What is primary prevention - 65. What is secondary prevention - 66. What is tertiary prevention - 67. The symptoms of depression may encompass what 4 domains - 68. What is transient insomnia - 69. What is short-term insomnia - 70. What is chronic insomnia - 71. What are some symptoms of polymyalgia rheumatica? - 72. What are common lab findings in PMR - 73. What is the treatment for PMR? - 74. What is osteoporosis - 75. Primary osteoporosis - 76. Secondary osteoporosis - 77. What is a T-score of -2.5 indicative of? - 78. What is a T-score of -1.0 to -2.5 indicative of? - 79. What is a T-score of -1.0 or higher indicative of? - 80. What is a Z-score of <-1.5 indicative of? - 81. What is nociceptive pain - 82. What is neuropathic pain - 83. Treatment goals for stage A HF are - 84. The Beer's criteria are appropriate for use in evaluating use of certain meds in patients - 85. The pathophysiology of heart failure is due to - 86. The comorbid psych problem with the highest frequency in dementia is - 87. When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed - 88. Performing ROM exercises on a patient who has had a CVA is an example of which level of prevention - 89. You demonstrate an understanding of primary prevention of falling among the elderly through which management plan? - 90. An example of an active strategy of health promotion for an individual to accomplish would be - 91. Thoracic aortic dissection presents typically as - 92. A statement not shown to be true about pharmacodynamic changes with aging is - 93. The percentage of the FVC expired in one second is - 94. The aging process causes what normal physiological changes in the heart - 95. A 55 yo Caucasian male follows up after referral to cardiologist. He thinks his med is causing a cough and sometimes he has difficulty breathing. Which med was most likely prescribed? - 96. MJ presents with h/o structural damage with current s/s of HF. Treatment will be based on his stage of HF which is - 97. 65 yo Caucasian presents with mitral valve stenosis, physical exam is unremarkable. you know her stage of HF is - 98. The best way to diagnose structural heart disease/dysfunction noninvasively is - 99. Chronic pain can have major impact on patient’s ability to function and have profound impact on overall QOL. Ongoing pain may be linked to - 100. The Beers criteria are appropriate for use in evaluating use of certain meds in patients - 101. All of the following statements are true about lab values in older adults except - 102. According to the 2017 ACC HTN guidelines, the recommended BP goal for a 65y/o African American woman with a h/o HTN and DM and no h/o CKD is - 103. The pathophysiology of HF is due to - 104. The volume of air a patient to exhale for total duration of the test during maximal effort is - 105. According it the 2017 ACC HTN guidelines, normal BP is - 106. Functional abilities are best assessed by - 107. LB is a 77 yo with chronic poorly controlled HTN. You know that goals include prevention of target organ damage. During your eval you will assess for evidence of - 108. Aortic regurgitation requires medical treatment for early signs of HF with - 109. The volume of air in the lungs at max inflation is - 110. Preferred amount of exercise for older adults is - 111. You know the following statements regarding the pain of acute coronary syndrome are true except - 112. Elderly patient presents with new onset of feeling heart race, fatigue. EKG reveals Afib with rate >100. Patient also has a new tremor in both hands. Which of the following would you suspect? - 113. Which patient is more likely to have osteoporosis? - 114. Post-menopausal woman with osteoporosis is taking bisphosphonate daily po. What action info statement would indicate she understood your instructions regarding this med? - 115. 60 y/o obese male has T2DM and lipid panel of TC= 250 HDL=32, LDL=165. You teach him about his modifiable cardiac risk factors which include - 116. OA of cervical and lumbar spine causes pain related to all of the following except - 117. In differentiating OA from chronic gout, pseudo gout, or septic arthritis, the most valuable diagnostic study would be - 118. Patients with OA of the hip and knee often have a distinguishable gait described as - 119. Which of the following best describes pain associated with OA? - 120. Joint effusions typically occurs later in the course of OA, especially in the - 121. You ordered CBC for your patient you suspect has polymyalgia rheumatica. Which 2 clinical findings are common in patients with PMR? - 122. You suspect your patient has PMR and now are concerned that they may have Giant Cell Arteritis too. Which of the following 2 symptoms are most indicative of GCA and PMR? - 123. Which of the following DD for patients presenting with PMR can be ruled out with a muscle biopsy? - 124. In reviewing lab results for patients with suspected PMR, you realize there is no definitive test to diagnose PMR, rather clinical response to treatment. Results you would expect to see include: - 125. Which of the following is the most appropriate lab test for monitoring gout therapy over the long-term? - 126. In providing health teaching related to dietary restrictions, you should advise a patient with gout to avoid which of the following dietary items - 127. The best method of verifying gout diagnosis in a joint is which of the following - 128. The most appropriate first line treatment for acute gout flare, assuming no kidney disease or elevated bleeding risk - 129. You order bilateral wrist XR on 69 yo man with c/o both wrists x6 weeks, not related to any known trauma. You suspect early RA. The initial XR finding in a patient with elderly onset RA would be - 130. A 72 female has been diagnosed with gout. She also has chronic HF. The most likely contributing factor to development of gout in this older female is - 131. Which of the following statements about OA is true? - 132. In considering the specificity of lab data, the most reliable diagnostic test listed below would be - 133. When examining the spine of an older adult you notice a curvature with a sharp angle. This is referred to as - 134. The prevalence of depression in nursing home residents is __________________ greater than adults living in the community - 135. The majority of depressed older adults remain untreated because of - 136. Symptoms of depression distinct to the elderly include - 137. The justification for ordering CBC, TSH, serum B12 for a patient you may suspect have clinical depression is - 138. One major difference that us useful in the DD of dementia versus delirium is that - 139. Which of the following is the most appropriate screening tool for delirium? - 140. The proposed mechanism by which diphenhydramine causes delirium is - 141. The elderly are at risk for delirium because of - 142. A consistent finding in delirium regardless of cause is? - 143. Older adults with Dementia sometimes suffer from agnosia, which is defined as the inability to - 144. In late stages of dementia, a phenomenon called sun downing, in which cognitive disturbances tend to - 145. Of the following, which one is the most useful clinical eval tool to assist in the diagnosis of dementia - 146. The cornerstone of pharmacotherapy in treating Alzheimer's is - 147. The comorbid psych problem with the highest frequency in dementia in - 148. When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed - 149. Which of the following should be avoided in countries where food and water precautions are to be observed? - 150. What insect precautions are not necessary to prevent insect borne diseases in the Tropics - 151. An example of secondary prevention you could recommend/order for older adults would be to - 152. Ali is a 72-year-old male who recent came to the US from Nigeria. He reports having BCG vax as a child. Which of the following is correct regarding a TB skin test? - 153. A local chapter on NP organization has begun planning a community-based screening for HTN at a local congregate living facility. The organization was select3d on the basis of - 154. Performing ROM exercises on a patient who has had a CVA is an example of which level of prevention - 155. You demonstrate an understanding of primary prevention of falling among the elderly through which management plan - 156. An example of an active strategy of health promotion for an individual to accomplish would be - 157. The 4 main domains of clinical preventive services that you will provide are - 158. What is the appropriate method for TB screening of an older adult entering a nursing home? - 159. The term "geriatric syndrome" is best described - Condition that has multiple underlying factors and involves multiple systems 160. Atypical presentation of acute coronary syndrome is - 161. What disease can mimic and often co-exists with MI in elderly with CAD - 162. Thoracic aortic dissection presents typically as - 163. Bordetella pertussis is best characterized - 164. Routine testing of TB should occur in all of the following vulnerable populations except - 165. Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the DD is - 166. Evidence shows that the most important predictor of a fall is - 167. The most cost-effective interventions used to prevent falls are - 168. Chronic fatigue syndrome is best described as - 169. Risk factors associated with the finding of a malignancy in a patient with hemoptysis include all of the following except - 170. The most common cause of disability in the elderly is - 171. Drug-induced pruritis is distinguished because it - 172. A key symptom of ischemia heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because [Show More]

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