1. The major impact of the physiological changes that occur with aging is:
All of the above ( reduced physiological reserve, reduced homeostatic mechanisms & impaired immunological response
2. The strongest evidence
...
1. The major impact of the physiological changes that occur with aging is:
All of the above ( reduced physiological reserve, reduced homeostatic mechanisms & impaired immunological response
2. The strongest evidence regarding normal physiological aging is available through:
Longitudinal studies
3. All of the following statements are true about laboratory values in older adults except:
Abnormal findings are often due to physiological aging
4. Biochemical individuality is best described as
Each individual’s variation is often much smaller than that of a larger group
5. Polypharmacy is best described as taking:
Even a single medication if there is not a clear indication for its use
6. Pharmacokinetic changes with aging is reflective of:
What the body does to the drug
7. All the following statements are false about drug absorption except: d
Underlying chronic disease has little impact on drug absorption
8. All of the following statements are true about drug distribution in the: a
Drugs distributed in water have lower concentration
9. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: c
Testosterone
10. The cytochrome p system involves enzymes that are generally: c
Inhibited or induced by drugs
11. A statement not shown to be true about pharmacodynamics changes with: a
Decreased sensitivity to oral anticoagulants
12. Atypical presentation of disease in the elderly is reflected by all the following except: c
Myocardial infarction with chest pain and diaphoresis
13. Functional abilities are best assessed by: b
Observed assessment of function
Ch 3
1. Exercise recommended for older adults should include activities that:
Strengthen muscles
2. Preferred amount of exercise for older adults is
60 minutes per day that includes 30 minutes of aerobic activity and 30 minutes of weight training five times a week
3. Which of the following medical conditions is not considered restrictive for engaging in physical activity?
Depression
4. The best recommendation for a patient who states they have no equipment to exercise would be:
Improvise with recommended objects at home that can be used
5. When the nurse practitioner recommends exercise for a sedentary older adult, which of the following pieces of advice should be considered for all types of exercise?
Start low and go slow
CH 8 for week 1 and 2 readings
1. In mitral stenosis, p waves may suggest:
Left atrial enlargement
2. Aortic regurgitation requires medical treatment for early signs of CHF
ACE inhibitors
3. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:
Women with ischemic heart disease many times do not present with chest pain & Some patients may have no symptoms or atypical symptoms. Diagnosis may only be made at the time of an actual myocardial infarction
4. The best evidence rating drugs to consider in a post myocardial infarction patient include:
ASA, ACE/ARB, beta-blocker, aldosterone blockade
5. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include:
Exercise stress test
6. Preceding a stress test, the following lab work might include:
CBC and differential to differentiate ischemic heart disease from anemia & Thyroid studies to rule out hyperthyroidism
7. Which test is the clinical standard for the assessment of aortic stenosis?
Echocardiography
8. What is the most common valvular heart disease in the older adult?
Aortic stenosis
9. On examination, what type of murmur can be auscultated with aortic regurgitation?
Austin flint
10. Ischemic heart disease is:
Defined as imbalance between oxygen supply and demand, Frequently is manifested as angina & Leading cause of death in the elderly.
11. Which test is the clinical standard for the assessment of aortic stenosis?
Echocardiography
12. The aging process causes what normal physiological changes in the heart?
The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis
13. An older adult may present with atypical clinical signs of pneumonia. The nurse practitioner needs to be aware that the clustering of all of the following signs and symptoms may be indicative of pneumonia in an older person except:
Bradycardia
14. Which of the following statements is true concerning anti-arrhythmic drugs?
Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic.
15. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? Coronary artery disease with angina pectoris
16. Jose M. is a 68-year-old man who presents to your primary care practice for a physical. Jose has had type 2 diabetes mellitus for 5 years, diet controlled. His BMI is 32. Smoker, pack per day for 25 years. He denies other medical problems. Family history includes CAD, CABG x4 for father, now deceased; CHF, type 2 diabetes mellitus, HT for mother. According to the AHA/ACC guidelines, what stage is Jose?
Stage A
17. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Chronic bronchitis
18. The best way to diagnose structural heart disease/dysfunction non-invasively is:
Echocardiogram
19. A common auscultatory finding in advanced CHF is:
S3 gallop rhythm
20. The organism most commonly responsible for community-acquired pneumonia in older adults is:
Streptococcus pneumonia
21. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely?
Pulmonary embolism
CH 5 ( chest only)
1. The term “geriatric syndrome” is best described as:
A condition that has multiple underlying factors and involves multiple systems
2. The anal wink reflex is used to test:
Sensation and pudental nerve function
3. Atypical presentation of acute coronary syndrome is:
More common in females
4. What disease can mimic and often co-exists with myocardial infarctions in elders with coronary artery disease?
Esophageal disease
5. Thoracic aortic dissection presents typically as:
Severe retrosternal chest pain that radiates to the back and both arms
6. Medications known to contribute to constipation include all of the following except:
Broad-spectrum antibiotics
7. Bordetella pertussis is best characterized by:
Sub-acute cough lasting greater than two weeks
8. The routine testing of tuberculosis should occur in all of the following vulnerable populations except: Hospitalized elderly
9. Which of the following statements about fluid balance in the elderly is
Assessment of skin turgor at the sternum is a reliable indicator of dehydration in the elderly.
10. Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the differential is:
Rapid change and fluctuating course of cognitive function
11. Presbystasis is best described as:
Age-related disequilibrium of unknown pathology characterized by a gradual onset of difficulty walking
12. If dizziness has a predictable pattern associated with it, the clinician should first consider:
Psychogenic etiology
13. All of the following are considered as contributors to dysphagia except:
Smooth muscle relaxants
14. Evidence shows that the most important predictor of a fall is:
Prior history of a fall
15. The most cost-effective interventions used to prevent falls are:
Home modifications and vitamin D supplements
16. Chronic fatigue syndrome is best described as:
Fatigue lasting longer than six months and not relieved by rest
17. Which form of headache is bilateral?
Tension
18. Microscopic hematuria is defined as:
Three or more RBCs on three or more samples of urine
19. Risk factors associated with the finding of a malignancy in a patient with hemoptysis include all of the following except:
Childhood asthma
20. Recent weight loss is defined as:
loss of >10 pounds over the past 3-6 months
21. The most common cause of disability in the elderly is due to:
Arthritis
22. Lymph edema is best described as:
Bilateral distribution of fat in the lower extremities
23. Drug-induced pruritus is distinguished because it:
May occur right after the drug is taken or months later
24. A form of syncope that is more common in the elderly than younger adults
Orthostatic hypotension
25. All of the following statements about tremor are true except:
The most common tremor is the Parkinson tremor
26. Overflow incontinence is usually associated with
Bladder outlet obstruction
27. Wandering is best described as:
Purposeful excessive ambulatory behavior
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