The cleansing of the stomach with solution delivered through a nasogastric tube is known as what?
Gavage
Emesis
Lavage
Stomach pumping
Lavage
Gastric lavage is used to cleanse the stomach of a poison, overdose of medication, or other toxic substance. It is delivered through a nasogastric tube
You are providing care to a patient who has recently begun dialysis. Her daughter, with whom she lives and who prepares many of her meals, asks what types of foods she should incorporate into her diet and which she should avoid. Which of the following is NOT a food that this patient should be advised to avoid?
Avocado.
Lean red meat.
Dried fruit.
Bananas.
Lean red meat
Dialysis patients are encouraged to eat lean meat, including red meat. High quality proteins produce less waste and help the body heal and maintain regular processes. Dialysis patients should avoid foods high in potassium, including avocado, banana, and dried fruit, and should eat other potassium-containing foods in moderation.
Your 89-year-old patient presents with dyspepsia and nausea. After testing, you determine she is positive for Peptic Ulcer Disease. Of the following, which would LEAST likely be a differential diagnosis for Peptic Ulcer Disease?
Cholecystitis.
Migraines.
Gastric carcinoma.
Cardiovascular disease.
Migraines
Peptic Ulcer Disease is a gastrointestinal disorder. Other differential diagnoses of the condition are pancreatitis and biliary tract disease.
There are a good many diseases affecting the elderly that are the result of smoking. Counseling regarding smoking cessation is part of the GNP’s job. The components of brief intervention for treating tobacco use are:
Counsel, Document, Caution, Describe, Demonstrate
Advise, Confer, Describe, Document, Prescribe
Advise, Counsel, Intervene, Prescribe, Follow-up
Ask, Advise, Assess, Assist, Arrange
Ask, Advise, Assess, Assist, Arrange
Ask about tobacco use, Advise to quit, Assess willingness to make an attempt to quit, Assist in this quit attempt. Arrange a follow-up.
Mrs. Frasier, an 50-year-old patient, presents with a mosquito bite that she is concerned about. How do you diagnose this?
Cyst.
Bulla.
Wheal.
Plaques.
Wheal
Cyst: encapsulated, fluid-filled mass that varies in size. Bulla: fluid-filled, elevated, circumscribed lesion that’s larger than 5mm. Wheal: circumscribed, reddening with transient elevation lesion that’s 0.5 to 10mm diameter. Plaques: usually a grouping of papules; elevated and a variety of shapes; larger than 5mm.
Which of the following groups should be tested for abdominal aortic aneurysm?
males aged 65-75 who have ever smoked
females aged 65-75 who have hypertension
males and females over 75
females over 75
males aged 65-75 who have ever smoked
Abdominal aortic aneurysm (AAA) is more prevalent in males than in females. The American Heart Association recommends screening males once between ages 65-75 if they have ever smoked since that increases the risk of AAA.
With a giardia lamblia diagnosis, the NP would MOST likely prescribe what medication?
Metronidazole.
Erythromycin.
Ampicillin.
Trimethoprim-sulfamethoxazole.
Metronidazole.
The preceding drugs are typically used in treating the following: – Campylobacter jejuni: Erythromycin – Salmonella: Ampicillin – Shigella: Trimethoprim-sulfamethoxazole – Giardia lamblia: Metronidazole
A 65-year-old Caucasian male calls your office. He tells you he just came in from the woods and discovered a tick on his upper right thigh. He reports self removal of the tick and now the area is slightly red. What should you advise him to do?
He should come to the office for a ceftriaxone (Rocephin) injection.
He should be prescribed doxycycline.
He needs no treatment.
He needs a topical scrub to prevent Lyme Disease.
He needs no treatment.
To develop Lyme Disease from a tick bite, many factors must be present. The tick must belong to Ixodes species and must have been attached for at least 48 hours before the disease can spread. There is no need for prophylactic treatment in this case because the tick has not been present long enough.
As part of the treatment plan for your elderly patient, you recommend he see an Ophthalmologist. What body part(s) will this doctor evaluate?
Brain / nerves.
Eyes.
Bones / Joints / Muscles.
Ears / Throat.
Eyes
Neurologist – Brain / nerves Ophthalmologist – Eyes Orthopedist – Bones / Joints / Muscles Otolaryngologist – Ears / Throat
As a GNP you understand that due to physiological changes of aging, some laboratory test results will have age-related changes. Which of the following values would be the least likely to be affected?
red blood cell values
white blood cell counts
platelet range
hemoglobin values
platelet range
Due to the physiological changes of aging, red blood cell values tend to decrease, white blood cell counts tend to decrease slightly, hemoglobin values slightly decrease, but platelet range does not vary.
The family of a patient with dementia has asked you to tell them more about this condition. You would tell them all of the following except:
Dementia is the leading reason for institutionalization of older adults.
Some persons diagnosed with dementia have reversible pseudodementia.
Irreversible dementia has a gradual onset and a progressive downward course.
50% of the older adult population suffer from some form of dementia.
50% of the older adult population suffer from some form of dementia.
This statement is not true. It is estimated that between 10 and 20% of the older adult population suffer from some form of dementia. There are 1.2 million cases in the United States in people over the age of 65.
What is true regarding deep vein thrombosis (DVT)?
Contrast venography is the most commonly used test to diagnose this.
Because the presentation of DVT varies, making the diagnosis from clinical presentation alone is problematic.
Hypocoagulation state presents a considerable risk for DVT.
Therapy for patients with DVT is aimed at easing the pain.
Because the presentation of DVT varies, making the diagnosis from clinical presentation alone is problematic.
Choice B is the right answer. Contrast venography has the greatest sensitivity and specificity for the condition but due to the cost and nature of the test, ultrasound is more common as first-line diagnostic technique (choice A). A hypercoagulation state presents a considerable risk for DVT (choice C). Therapy for patients with DVT is aimed at minimizing the risk of pulmonary embolism and extension of peripheral thrombus (choice D).
It has been determined that an elderly patient is suffering from long term insomnia. Which of the following is LESS likely to be considered a long term cause of the condition?
Nocturia.
Environmental changes.
Congestive heart failure.
Alcohol and substance abuse.
Environmental changes.
There are various causes of insomnia in the elderly. While some may be the cause of short term insomnia and others long term insomnia, long term insomnia is more common in the elderly than short term.
In terms of the elderly which of the following is NOT true of hypothyroidism?
Symptoms are often similar to normal aging changes making it difficult to detect in older adults.
Symptoms usually have an insidious onset.
It usually occurs before age 50.
There is a greater risk for developing myxedema coma, which is life-threatening.
It usually occurs before age 50.
Hypothyroidism usually occurs after age 50. It is often diagnosed as depression. You must use caution against abruptly discontinuing medication.
When treating a patient with oral Vitamin B12, which drug interaction will result in decreased absorption of vitamin B12?
aminoglycosides
colchicine
potassium supplements
all of the above
all of the above
In addition to the drugs listed in the first three choices, ascorbic acid may destroy the vitamin B12 supplement within one hour of ingestion. These drugs should not be taken concomitantly with oral vitamin B12.
You are counseling a 72-year-old woman about nutrition. In the course of counseling you tell her that older adults are at increased risk of Vitamin D deficiency. Which of the following is NOT a factor that contributes to a Vitamin D deficiency?
too much exposure to sunlight
decreased exercise
diminished renal function
decreased body mass
too much exposure to sunlight
In actuality lack of sun exposure decreases synthesis of Vitamin D.
An 88-year-old female patient comes into the clinic with her heart “racing and feeling funny.” The ECG confirms atrial fibrillation. The GNP understands that this condition is managed by all of the following except:
treating the underlying disease
electrical cardioversion
heparin as the drug of choice with antithrombotic therapy
IV management with digoxin as first line therapy
heparin as the drug of choice with antithrombotic therapy
The antithrombotic drug of choice for atrial fibrillation is warfarin (Coumadin).
A patient you diagnosed with hypothyroidism was started on levothyroixine. At what interval should the GNP reassess her TSH?
1 to 2 weeks
2 to 4 weeks
4 to 6 weeks
6 to 8 weeks
6 to 8 weeks
In the treatment of hypothyroidism, T4 replacement is needed in the form of levothyroixine (Synthroid or Levoxyl). The initial dosages for an adult is 75 to 125 mcg. For an elderly person, the dose is 75% less than the adult dosage. Because of the long half-life of levothyroxine, the effects of a dosage adjustment or initiation would not cause a change in TSH for approximately five to six drug half-lives, or about 6 to 8 weeks.
A 67-year-old diabetic has been taking oral anti-hypoglycemics and is still having poor glycemic control. You make the decision to start insulin therapy. He weighs 60 kg. What should you order as an initial starting dose?
6 units short-acting insulin at breakfast, continue oral medication
6 units intermediate insulin at bedtime, stop oral medication
6 units long-acting before breakfast, stop oral medication
6 units long-acting insulin at bedtime, continue oral medication
6 units long-acting insulin at bedtime, continue oral medication
The American Diabetic Association algorithm for initiation and adjustment of therapy (2006) suggests an intermediate or long-acting insulin to be started at bedtime or morning as a once daily dose. The starting dose is either 10 units or 0.2 units per kilogram. Oral medication should be continued except for discontinuing sulfonylureas or meglitinides.
A 65 year patient has sub-occipital and posterior cranial head pain following a fall. The GNP conducts a musculoskeletal assessment by:
Palpating the acromioclavicular joint.
Assessing the gleno-humeral range of motion.
Palpating the cervical vertebrae.
Palpating anterior the thoracic muscles.
Palpating the cervical vertebrae.
The patient who is complaining of sub-occipital, posterior head pain should have the cervical vertebrae assessed. Additionally, the GNP will palpate the posterior neck muscles and assess the neck for range of motion.
A 67-year-old female is in the office with cataracts. She is asking what she needs to do about this. The GNP understands that all of the following are management for this except:
Surgery may be necessary if the cataract markedly decreases visual acuity.
No drugs are available that will halt the progression of the aging process of the eye.
Vision correction with corrective lenses are available if the cataracts are in the early stages.
Ophthalmic steroids that decrease the severity are available by prescription from an ophthalmologist.
Ophthalmic steroids that decrease the severity are available by prescription from an ophthalmologist.
No topical or oral medications exists that will cure or treat this condition. However, there are surgical options.
You are providing patient education to a patient who has recently been diagnosed with shingles. Which of the following is NOT true of the way this patient should care for his rash?
He should leave the rash uncovered to speed healing.
He should keep the rash covered.
He should keep the rash clean and dry.
He should use only nonadhesive bandages on the rash.
He should leave the rash uncovered to speed healing.
Patients with herpes zoster – shingles – should keep their rashes clean, dry, and covered. The adhesive in bandages can irritate the shingles, so only nonadhesive bandages should be used.
You are providing care for a patient who has been admitted to the hospital after a fall. Which of the following is NOT appropriate when providing patient education for when the patient returns home?
The patient should resume regular activities as soon as possible.
The patient should avoid returning to full activity until he is fully recovered.
The patient should take extra care of his feet.
The patient should engage in some type of regular exercise.
The patient should avoid returning to full activity until he is fully recovered.
Patients who have suffered a fall should return to normal activity as soon as possible. Avoiding routine activities may increase fear of falling and actually increase the risk of falling. Regular exercise and foot care can also help reduce the risk of falls.
Which of the following is true when performing a functional assessment with a geriatric patient?
It may be necessary to allow more time for the assessment if the patient has impaired mobility.
It is not necessary to perform the assessment if the patient uses a wheelchair.
It may be necessary to bring in someone to assist the patient with the assessment.
It is only necessary when the patient returns for follow-up after treatment.
It may be necessary to allow more time for the assessment if the patient has impaired mobility.
Functional assessments may take longer with geriatric patients due to impaired mobility. Allow for extra time to conduct the functional assessment if you are working with a geriatric patient whose mobility is limited.
You are managing a patient who has irritable bowel syndrome (IBS). Altering the gut pain threshold in IBS is a possible therapeutic outcome with the use of:
amitriptyline (Elavil)
loperamide (Immodium)
dicyclomine (Bentyl)
metrodionazole (Flagyl)
amitriptyline (Elavil)
Low dose tricyclic antidepressant or selective serotonin reuptake inhibitor use can be helpful in altering the gut pain threshold, resulting in less abdominal pain. Imodium and Bentyl are prescribed to treat diarrhea. Flagyl is not used in IBS, but is used to treat certain types of infectious colitis.
Which of the following is NOT a sign of depression in an older adult?
She neglects personal grooming.
She has difficulty concentrating.
She often becomes lost even in familiar places.
She worries about lapses in memory.
She often becomes lost even in familiar places.
Older adults who are depressed may have trouble concentrating or may have memory lapses. They often express concern about these lapses. Depression may lead to neglect of personal grooming as well. Depression does not lead to patients being disoriented or becoming easily lost. These symptoms are more often associated with dementia.
Change can be scary to anyone, but may be especially hard to deal with in the elderly population. According to the Lewin Theory of Change, which of the following is the second step?
Freezing.
Resisting.
Unfreezing
Change.
Change.
The Lewin Theory of Change represents three steps with regard to change. These are: Unfreezing – During this step, the individual realizes change is necessary and mentally prepares himself to do so. Change – Self-explanatory. Freezing (or refreezing) – Once the change has taken place, the individual regains a sense of stability or normalcy.
Which medication can cause urinary incontinence by relaxing the internal urethral sphincter and is used to treat BPH for this reason?
librium, a benzodiazepine
furosemide, a diuretic
prazosin, an alpha-adrenergic antagonist
amitripylline, a tricyclic antidepressant
prazosin, an alpha-adrenergic antagonist
This is not a good medication to use with a woman who has continence issues. These medication s potentially increase the risk of postural hypotension in the older adult, as well. Benzodiazepines cause alteration in sensorium and can lead to functional urinary incontinence. Diuretics increase frequency of voiding and volume of urine. Tricyclic antidepressants cause urinary retention, overflow incontinence, and alteration in sensorium
A 65-year-old patient that has transferred into your care from another provider presents with a history of migraine headaches. She is on Tylenol with codeine for treatment of these headaches but nothing for abortive therapy. The GNP understands that a good agent to prescribe for her for abortive therapy is:
ketorolac (toradol) 100 mg IM
amitriptyline (Elavil) 100 mg PO
sumatriptan (Imitrex) 6 mg IM
ergotamine (Ergostat) 2 mg SL
ergotamine (Ergostat) 2 mg SL
Ergotamine sublinginal at 2 mg is the correct dose of abortive therapy for migraine headaches. Ketorolac is give 30-60mg IM for pain, but does not help with abortive therapy. Sumatriptan is given subcutaneously (SC) or PO, not IM and is a good medication for abortive migraine therapy. Amitriptyline is not used in abortive therapy.
Of the following, which is the body system that is responsible for protecting the organs as well as allowing the body to move?
Nervous.
Skeletal.
Muscular.
Circulatory.
Skeletal
The human body is made up of 11 major body systems. These are Nervous, Skeletal, Muscular, Circulatory, Respiratory, Digestive, Endocrine, Reproductive, Excretory, Integumentary, and Immune. The Nervous System receives and sends messages to the body. The Skeletal System protects the body’s organs and helps with functions such as moving around. The Muscular System consists of bones and the tissues that bring them together. It helps with functions such as walking. The Circulatory System includes the heart and blood vessels and helps with the flow of blood throughout the body.
Ms. Villa asks the GNP the minimum number she can have for her LDL Cholesterol level to be considered “high”. What answer does she give her?
81 mg/dL.
113 mg/dL.
160 mg/dL.
134 mg/dL.
160 mg/dL.
The following LDL cholesterol guidelines are outlined by the American Heart Association: Less than 100 mg/dL = Optimal 100-129 mg/dL = Near or above optimal 130-159 mg/dL = Borderline high 160-189 mg/dL = High 190 mg/dL and above = Very high
Which of the following diseases can be described as the inability of the heart to pump out all the blood returned to it from the veins resulting in the organs of the body not receiving an adequate supply of blood?
artherosclerosis
hypertension
congestive heart failure
arteriosclerosis
congestive heart failure
Congestive heart failure is the inability of the heart to pump out all the blood returned to it from the veins. As a result of vital organs not receiving an adequate supply of blood fluid backs up into the lungs and body. Signs and symptoms include: congestion in the lungs, difficulty breathing, restlessness, anxiety and edema of the legs, feet, hands, face, and buttocks.
A retired businessman, age 71, is in the office today with complaints of pain over the inner aspect of the lower humerus of the arm. He reports that the pain is aggravated by wrist flexion and gripping. No swelling is noted upon examination. He is an avid golfer and works around the house doing carpentry work. What does the Geriatric Nurse Practitioner suspect is the cause of his ailment?
medial epicondylitis
lateral epicondylitis
olecranon bursitis
elbow strain
medial epicondylitis
Choice A is the right answer. This is often called golfers’ elbow because it results from repetitive activity such as lifting, tooling, and sports that require a tight grip. The patient will complain of pan over the medial epicondyle or inner aspect of the lower humerus. With lateral epicondylitis (choice B) the patient has pain over the outer aspect of the lower humerus. Olecranon bursitis (choice C) results in pain and swelling behind the elbow and a noticeable ball or sac hanging from the elbow. An elbow strain (choice D) is not likely to cause aggravated pain with wrist flexion and decreased grip.
An adult male patient with iron deficiency anemia presents in the office and gastrointestinal (GI) bleeding has been ruled out. The GNP determines that the next step is:
Prescribe ferrous sufate 300 mg PO tid and schedule patient to return in 1 month for a repeat CBC, serum iron, and TIBC.
Administer iron dextran 50 mg IM weekly for 4 weeks.
Schedule the patient to return in 6 months for additional stool guaiac testing.
Refer patient to a hematologist.
Prescribe ferrous sufate 300 mg PO tid and schedule patient to return in 1 month for a repeat CBC, serum iron, and TIBC.
To replenish the depleted body iron stores, treatment with iron orally for at least 6 months is necessary to correct the anemia. The patient should have hemoglobin/hematocrit, iron, and TIBC rechecked after 1 month of therapy. The patient should be referred to a hematologist if treatment shows no improvement and referral to a GI specialist or repeat of stool guaiac is unnecessary because there is no indication that the condition is related to bleeding.
When screening for alcohol abuse in the elderly, which test has been validated for this population?
CUT Screen
CAGE Screen
MINE Screen
LIST Screen
CAGE Screen
This is a screen for alcohol abuse that is validated in adults and the geriatric population.The C stands for “have you ever felt like you should CUT down”. The A stands for “does other’s criticism of your drinking ANNOY you”. The G stands for “have you ever felt GUILTY about your drinking”. The E stands for “have you ever had an EYE opener”.
You are assessing the pulse of an elderly patient. The reading is normal. Which of the following does NOT fit the “normal” range.
50 beats per minute.
72 beats per minute.
89 beats per minute.
65 beats per minute.
50 beats per minute
A normal pulse falls within the range of 60 to 100 beats per minute. It should be noted when a patient has irregular rhythms. An electrocardiogram may also be necessary.
When providing care for an adult female patient who has a history of prescription benzodiazepine dependence, you consider that:
The preferred method of treatment for this problem is rapid detoxification.
She is at significant risk for drug-induced hepatitis.
She is unlikely to have a problem with misuse of other drugs or alcohol.
She probably has an underlying untreated or under-treated mood disorder.
She probably has an underlying untreated or under-treated mood disorder.
The misuse and overuse of various mood-altering products is referred to as substance abuse and it affects 10-15% of primary care patients. Women have higher rates of misuse of prescription medications and are more likely to have mood disorders, including anxiety and depression.
Your patient, a 72 year old man, indicates that he is not urinating very often because is it painful and difficult to do so. He reports a burning sensation when he urinates as well. This patient should be further assessed for which of the following?
Enlarged prostate.
Bladder cancer.
Urinary tract infection.
STIs.
Urinary tract infection.
This patient’s symptoms are consistent with urinary tract infection. Geriatric patients may be more prone to UTIs. Further assess this patient for a UTI by ordering urinalysis on a clean catch specimen.
All but which of the following increase a geriatric patient’s risk of abuse or mistreatment?
Taking multiple medications.
Impaired mobility.
Risk for fall.
Being male.
Being male.
Geriatric patients may be at risk for elder abuse or mistreatment. Several factors increase the risk, especially those that contribute to overall frailty. Taking multiple medications, having decreased strength or factors that increase fall risk, cognitive impairment, and dependency on others all increase a patient’s risk. Female patients are at greater risk than male patients.
In order for effective teaching to take place, it is crucial that the GNP use the proper teaching style for each patient. What teaching style would BEST suit a patient with an “Interested Learner” style?
Facilitator.
Delegator.
Authority, expert.
Salesperson, motivator.
Salesperson, motivator.
Matching teaching style (TS) to learning style (LS) is crucial for effective communication. The following are the BEST matches: TS LS Authority Dependent Motivator Interested Facilitator Involved Delegator Self-directed
You are providing care for a patient who is hearing impaired. The patient’s chart notes that she was born with total hearing loss. You notice that the patient and her family members use American Sign Language when communicating among themselves. Which of the following is the MOST appropriate strategy when communicating with this patient about her care?
Speak directly to a family member and have him or her translate into ASL.
Communicate with the patient only in writing.
Attempt to communicate with the patient in ASL.
Engage a medical interpreter fluent in ASL.
Engage a medical interpreter fluent in ASL.
As is the case when working with any patient whose primary language is not your own, the use of a medical interpreter is the best course of action. A medical interpreter will know how to communicate complex concepts related to care that family members, though fluent, may not have the words for. Communicating with the patient in writing is a useful strategy, but it should not be the only strategy. Communicating directly with the patient (even through an interpreter) is key to helping maintain the patient’s dignity and agency.
An elderly patient presents with fever, left lower quadrant abdominal pain and diarrhea. Which of the following BEST describes the symptoms the patient is experiencing?
Acute hepatitis.
Iron deficiency anemia.
Testicular cancer.
Diverticulitis.
Diverticulitis.
Diverticulitis is when the colon secondary consists of pouchlike hernias. These hernias are caused by the lack of dietary fiber.
A 65-year-old male comes to the clinic complaining of severe abdominal pain, fever, and nausea with a change in his bowel habits. You diagnose diverticulitis. In educating him about this condition you tell him all but which of the following?
It occurs when one or more small bulging pouches in the digestive tract become inflamed or infected.
It is common, particularly in persons over 40.
Some cases of diverticulitis can be treated with rest, changes in the diet and antibiotics.
Diverticulitis may be the result of too much fiber in the diet.
Diverticulitis may be the result of too much fiber in the diet.
Diverticulitis is rare in countries where people eat a high-fiber diet that helps keep stools soft. But in the USA where the average diet is high in refined carbohydrates and low in fiber it is more common. Diverticulitis may be the result of too little fiber in the diet.
A 68 year female patient has frequent migraine headaches. Besides checking for possible triggers and the patient’s family history, the GNP should also assess the extent at which headaches limit all of the following except for:
Job performance.
Activities of daily living.
Medication absorption.
Social interaction.
Medication absorption.
The incidence of new onset migraine headaches reduces with age, but after age 65 the risk of headaches involving a serious medical condition increases significantly. The GNP should check for other co-existing conditions and medications the patient is taking. While the GNP cannot determine how well medications are being absorbed into the patient’s system without further diagnostics, the GNP should recognize during initial assessment that some medications may induce migraines.
A patient with folliculitis is given Isotretinoin. Of the following, which would be the correct dosage?
Apply tid before antibiotic ointment.
2%, apply bid X 10 days and cover with DSD.
Apply to area bid-tid.
0.5 to 1 mg/kg/day PO in divided doses.
0.5 to 1 mg/kg/day PO in divided doses.
The preceding medications should be administered at the following dosages: Mupirocin ointment – 2%, apply bid X 10 days and cover with DSD. Gentamicin Sulfate cream or ointment – Apply to area bid-tid. Isotretinoin – 0.5 to 1 mg/kg/day PO in divided doses. Anhydrous ethyl alcohol with 6.25% aluminum chloride – Apply tid before antibiotic ointment.
You have diagnosed a 74-year-old patient with angle-closure glaucoma. Which of these MOST likely caused the condition?
Sudden increase in intraocular pressure.
Hardening of the lens.
Lens clouding.
Gradual onset of increased intraocular pressure.
Sudden increase in intraocular pressure.
Presbyopia is caused by the hardening of the lens. Senile cataracts is caused by lens clouding. Open-angle glaucoma is caused by the gradual onset of increased intraocular pressure. Angle-closure glaucoma is caused by the sudden increase in intraocular pressure.
Which disease is NOT going to impact the older adult’s ability to eat?
stroke
dyphagia
Parkinson’s disease
hypertension
hypertension
Choice D is the right answer. Many diseases impact the older adult’s ability to eat. About 50% of patients who have had a stroke have impaired ability to eat (choice A). Parkinson’s disease and other neurological conditions involve the muscle movement that is necessary for chewing and swallowing (choice C). Dysphagia is difficulty swallowing (choice B) and has significant impact on feeding.
Which theory holds that a person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior?
Family Systems Theory
Systems Theory
Health Belief Theory
Self-Efficacy Theory
Self-Efficacy Theory
The Family Systems Theory holds that families develop at different rate and if one member is dysfunctional, the rest are affected negatively. The Systems Theory holds that all parts of a system are interrelated and dependent on each other. The Health Belief Theory holds that the person who feels susceptible to the disease and believes that he will benefit from changing his behavior is more likely to perform the healthier behavior.
A patient who has been prescribed Keflex for pneumonia should be advised to seek immediate medical attention if she experiences which of the following?
Vaginal itching.
Easy bruising.
Joint pain.
Nausea.
Easy bruising.
This is the sign of a potentially serious side effect. Patients taking Keflex may also experience vaginal discharge and itching, nausea, and joint pain. These are not usually considered serious. Because older adults may already be more prone to bruising than younger patients, they should pay special attention to any bruising that occurs while taking Keflex.
Your 76-year-old male patient has had a cardiovascular asessment and you found that he has a systolic heart murmur. In terms of this assessment which of the following statements is correct?
The patient most likely has some underlying heart disease and should undergo further tests.
He is a candidate for valve replacement.
He has the first signs of congestive heart failure.
This abnormality is common in older persons and is related to calcification and stiffening of the heart valves.
This abnormality is common in older persons and is related to calcification and stiffening of the heart valves.
This causes incomplete closure of the valve and results in systolic heart murmur.
A GNP understands that there are many skin changes as adults grow older. Which of the following would NOT be a typical skin change in the older adult?
thinner epidermis, dermis and subcutaneous layers
seborrheic keratoses
presbycusis
senile purpura
presbycusis
Presbycusis is sensorineural hearing loss. It is not a skin change. All of the other choices are changes that you might see in the skin of older adults along with less fat, less elasticity, slower wound healing and sebaceous glands hypertrophy.
A patient may be prescribed Prinivil for which of the following conditions?
Excessive blood clotting.
Hypertension.
Nerve pain associated with shingles.
Bacterial pneumonia.
Hypertension.
Prinivil (lisinopril) is prescribed for the treatment of hypertension. It may be prescribed to protect the kidneys from damage resulting from diabetes. Prinivil is an ACE inhibitor.
When discussing Human Immunodeficiency virus (HIV) testing with a patient, the GNP knows:
Sexually active homosexual men are the only ones at risk for HIV.
Receiving blood products from 1985 to 1995 is a risk factor for HIV.
The screening ELISA test (enzyme-linked immunosorbent assay) detects antibodies and is 99% sensitive and specific.
There is no need to recheck the ELISA if negative on the first test.
The screening ELISA test (enzyme-linked immunosorbent assay) detects antibodies and is 99% sensitive and specific.
Persons with a history of multiple sex partners, homelessness, STD’s, and IV drug use are also at risk for HIV. The receipt of blood products from 1975 to 1985 is a risk factor as well. The ELISA is recommended to be rechecked at a six month window period.
At what age is a person initially considered an older adult?
70
65
60
75
65
Nurses need to be familiar with the stages of life. Older adults at the age of 65 onward experience development changes. A decline in health and mobility affects life and function.
The “pill-rolling” tremor that is typical in patients with Parkinson’s disease is:
usually unilateral
worse when the patient sleeps
present at rest of and with movement
a late manifestation of the disease
usually unilateral
Choice A is the right answer. The “pill-rolling” tremor is the earliest manifestation of the disease. It occurs at rest but not with movement. The tremor is worse with emotional stress and gets better decreases with sleep.
The United States Preventive Services Task Force recommends screening older patients for depression:
at each visit
only if symptoms exist
if they are at high risk
annually
annually
Depression is very common among older adults. Recommendations are to screen every adult patient annually in the primary care setting. Untreated depression often leads to higher rates of mortality when other co-morbid conditions exist, especially heart disease.
You are assessing your aged patient and determine that he has Presbyopia. What causes Presbyopia?
Sudden increase in intraocular pressure.
Hardening of the lens.
Lens clouding.
Gradual onset of increased intraocular pressure.
Hardening of the lens.
Presbyopia is caused by the hardening of the lens. Senile cataracts is caused by lens clouding. Open-angle glaucoma is caused by the gradual onset of increased intraocular pressure. Angle-closure glaucoma is caused by the sudden increase in intraocular pressure.
Which statement is true regarding the Varicella vaccine?
The Varicella vaccine is administered only to adults over 50.
The Varicella vaccine provides temporary passive immunity to infection.
Women who do not have immunity should receive the first dose upon completion or termination of pregnancy and before discharge from the health-care facility.
The vaccine provides minimal protection against invasive Varicella.
Women who do not have immunity should receive the first dose upon completion or termination of pregnancy and before discharge from the health-care facility.
Pregnant women should be assessed for Varicella immunity and vaccinated if no evidence of immunity exists.
As we age, skin disorders are common. Which of the following statements about skin problems in older adults is false?
Intertrigo disorder is a painful inflammation in the skin folds and skin discoloration that occurs in older people.
Fungal infections are common skin disorders seen in older people.
Erysipelas is a condition involving large blisters that are usually found on the trunk of the body.
Bacterial infections such as cellulitis are common in aging adults.
Erysipelas is a condition involving large blisters that are usually found on the trunk of the body.
The correct statement should be: erysipelas is a condition involving small blisters that are usually found on the face. The other choices are correct statements.
All of the following are examples of active immunity except:
pneumococcal conjugate vaccine (PCV)
hepatitis B immune globulin (HBIG)
hepatitis A 2 dose series immunization
immunization for the influenza virus
hepatitis B immune globulin (HBIG)
Passive immunization occurs through the use of immune globulin (IG) whereas active immunization occurs through the use of vaccines. The other choices are vaccinations.
You tell your 71-year-old patient that she has cataracts of her eyes. She asks you to define cataracts. What do you say?
Complete blindness in both eyes.
Clouding of the eye lens.
Rapid blinking of the eyes.
Inability to blink.
Clouding of the eye lens.
An important part of being a GNP is not just assessing, diagnosing, and treating patients. GNPs must be knowledgeable of medical terminology and be eloquent in defining said terminology for patients.
In assessing a patient who has a lower extremity ulcer, the nurse assesses the temperature and skin. The nurse checks the shape of the patient’s leg. Chronic venous stasis gives the leg:
An apple shape.
A round shape.
A sausage shape.
A bowling pin shape.
A bowling pin shape.
Lower extremity ulcers can be a symptom of other conditions. A leg with chronic venous stasis has a bowling pin or champagne bottle shape.
Your elderly patient has developed a disorder as a result of asthma. Of the following, which did he MOST likely develop?
Airway disorder.
Pulmonary edema.
Parenchymal lung.
Pulmonary vascular.
Airway disorder.
There are a variety of disorders in which acute respiratory failure may occur. Others include chest, wall, and diaphragm, neuromuscular, and central nervous system disorders.
Which of the following is NOT true when using analgesics to manage persistent pain in older adults?
The least invasive method should be used when administering analgesics.
Analgesics should be administered directly into the bloodstream.
Small doses should be given to start, with upward titration as necessary.
The patient should be frequently reassessed to ensure proper dosage.
Analgesics should be administered directly into the bloodstream.
While direct administration methods such as bolus may get drugs into the bloodstream more quickly, it is recommended that the least invasive administration route (typically oral) is used when managing persistent pain in older adults. Frequent reassessment, as well as beginning with small doses and titrating upward as necessary, can help effectively manage persistent pain in this patient population.
When prescribing niacin therapy to treat an elevation in lipids, the GNP knows that she should consider that:
Drug-induced thrombocytopenia is a common occurrence.
Low-dose therapy is usually the best option for decreasing the LDL level.
Postdose flushing is often reported.
Liver function testing is not necessary.
Postdose flushing is often reported.
Postdose flushing can be decreased by taking aspirin 1 hour before niacin dose is taken. Thrombocytopenia is not a concern with niacin. Adverse effects include flushing postdose, hyperglycemia, hyperuricemia, upper GI distress, and hepatotoxicity. Niacin is particularly effective against high atherogenic liporotein if given in high dosages. Liver function testing is necessary to monitor for hepatotoxicity.
An elderly female is in the office with chest wall pain. Her shingles have healed but she reports “worse” pain now than when they were there. What are risk factors for the development of postherpetic neuralgia?
varicella lesions on the lumbar location
age younger than 50 years at the time of the outbreak
low volume of lesions
severe prodromal symptoms
severe prodromal symptoms
Choice D is the right answer. Postherpetic neuralgia is defined as pain persisting at least 1 month after the rash has healed. Risk factors for the development of this include the site of initial involvement, with greatest risk if the outbreak involved the trigeminal or brachial plexus region and moderate risk with a thoracic outbreak. Additionally, severe rash and intense prodromal pain are risk factors. Around 50% of elderly persons report this condition.
A common medication that could increase the risk of headaches includes:
Midrin.
Nitroglycerine.
Anacin.
Ibuprofen
Nitroglycerine.
Nitroglycerine is a common drug that can induce headaches. The other answer choices are often prescribed to manage headaches and migraines. Many elder patients self treat headaches with a combination of aspirin and caffeine, or Anacin.
You determine your patient is suffering from hyperinsulinemia. He asks what that means. What do you tell him?
Too much insulin in the blood.
High blood pressure.
Too much thyroid hormone.
Too much sugar in the blood.
Too much insulin in the blood.
An important part of being a GNP is not just assessing, diagnosing, and treating patients. GNPs must be knowledgeable of medical terminology and be eloquent in defining said terminology for patients.
What is the first-line drug intervention in an anaphylatic episode?
oral prednisone therapy
parental epinephrine
inhaled epinephrine
oral diphenhydramine
parental epinephrine
Parental epinephrine and diphenhydramine are priority medication interventions in anaphylaxis. Oral prednisone is often given once the patient is stable to decrease the inflammatory response. Inhaled epinephrine is not the standard of care. Oral diphenhydramine may be used after stabilization for symptom relief purposes.
You perform a rectal examination on a 73-year old man and find an abnormality of his prostate gland. You suspect prostate cancer due to these findings. The findings are described as:
a rubber, enlarged prostatic lobe
a boggy gland
profound tenderness
an area of prostatic induration
an area of prostatic induration
Choice D is the right answer. Prostate cancer is the most commonnon cutaneous cancer in men n the United States. Most are asymptomatic until the disease is advanced. An area of induration on the gland would alert the GNP of possible prostate cancer, which cannot be confirmed without biopsy.
You are treating a 68-year-old African-American female who has multiple risk factors for osteoporosis. Which of the following is NOT one of these risk factors?
her age
her excessive alcohol intake
her smoking
her race
her race
All of the choices are risk factors except her race. African-American race is not a risk factor. Caucasian and Asian race ARE risk factors.
A 65-year-old Caucasian female is in the office with rosacea. She is asking about treatment options. You have discussed nonpharmacologic care. What is the recommended treatment for her?
topical 5-fluorouracil
low-dose tetracycline
oral ketoconazole
oral hydrocortisone
low-dose tetracycline
Treatment with systemic low-dose tetracycline is a very effective measure for rosacea; topical treatment with metronidazole or a low-dose steroid cream may also be helpful. Topical 5-fluorouracil is used to treat actinic keratosis.
When treating a patient who has an extremely high P.T. level from coumadin (warfarin) usage, the GNP understands that which of the following is the antidote?
Vitamin K
Vitamin C
Vitamin A
Vitamin D
Vitamin K
The antidote for coumadin (warfarin) toxicity is Vitamin K. It is often given in injection form with extremely elevated P.T. levels. Dietary sources of Vitamin K include green leafy vegetables.
An 82 year old female patient who is on long-term anti-inflammatory medication is at risk for which of the following conditions?
Gastrointestinal bleeding.
Dehydration.
Stroke.
Depression.
Gastrointestinal bleeding.
Elderly patients who are on long-term anti-inflammatories are at increased risk for GI bleeding and anemia. They should be monitored regularly for these conditions.
You prescribe a medication for your elderly patient and note it should be taken a.c. What does this mean?
Twice a day.
At bedtime.
When needed.
Before meals.
Before meals.
p.r.n. – When needed a.c. – Before meals b.i.d. – Twice a day h.s. – At bedtime
One of the theories of development is Piaget’s (1969) Cognitive Development Theory. This theory focuses on intellectual changes and the way they relate to the environment. Which of the following is NOT a stage of this continuous interaction sequential manner?
Abstract Operations
Concrete Operations
Preoperational Thinking
Formal Operations
Abstract Operations
The stages are listed in this order:
1-Sensorimotor (infancy)
2-Preoperational Thinking
3-Concrete Operations
4-Formal Operations
There is no Abstract Operations stage in this theory model.
As a GNP you understand that older adults have bone loss. At what age does this bone loss start?
40
50
60
70
40
Bone loss begins at about age 40. Bone loss is more common in women than in men and so osteoporosis occurs more often in women.
How many daily servings of fruit should a patient on the 2000 calorie DASH diet consume?
6-8 servings.
As many as he or she desires.
4-5 servings.
2-3 servings.
4-5 servings.
Fruits are a key part of the DASH diet. A person on the 2000 calorie DASH should eat 4-5 servings of fruit each day. Some fruits such as grapefruit may interact with medication, so the patient may want to verify with you that these foods are acceptable.
You are evaluating your elderly patient and determine that she has a heart murmur. When listening to it, you note the sound is very loud and can even be heard with the stethoscope partially off the chest. How would this murmur be graded?
IV/VI.
I/VI.
V/VI.
III/VI.
V/VI.
Grading heart murmurs follows this system: I/VI: Heart murmur makes faint sound and may not be heard when patient changes position. II/VI: Heart murmur is quiet but can be heard as soon as the stethoscope is placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI: Heart murmur is loud and accompanied by a palpable thrill. V/VI: Heart murmur is very loud and can be heard with the stethoscope partially off the chest. VI/VI: Heart murmur is very loud and can be heard with the stethoscope completely off the patient’s chest.
Many older adults will have diabetes mellitus. What laboratory tests would the Geriatric Nurse Practitioner use to monitor this condition?
A1C, serum creatinine
AST/ALT
urinalysis, BUN
ferriten and total iron
A1C, serum creatinine
Choice A is the right answer. A1C should be assessed every 3 to 6 months. Fasting blood glucose needs checked often and as indicated. A fasting lipid profile should be done annually, as should a microalbumin/creatinine of the urine, serum creatinine, and thyroid assessment.
After fasting since 6:00 p.m. the night before, Mrs. Hilliard’s blood glucose is tested. The result is 115 mg/Dl. What does this mean?
She is diabetic.
She is in a coma.
Her blood glucose is normal.
She is prediabetic.
She is prediabetic.
Various blood glucose levels indicate different things. The following is true: A fasting blood glucose level of 70-99 mg/dL is normal. A fasting blood glucose level of 100-125 mg/Dl indicates prediabetes. A fasting blood glucose level of 126 mg/dL and above during more than one test means the patient is diabetic.
An elderly patient is concerned because she noticed her stools are watery, yellow-green in color and she has abdominal pain. When asked about the odor of her stools, the patient explained that she did not notice anything unusual with the smell. Of the following, which would MOST likely be the diagnosis of such?
Shigella.
Adenovirus.
Campylobacter jejuni.
Salmonella.
Shigella.
Shigella is a bacterial form of diarrhea. It is especially common in children 2-10 years old, but can occur at any age.
What is typically used to investigate suspected problems with the biliary system?
Barium study.
CT scan.
Ultrasound.
MRI.
Ultrasound.
The pancreas, liver, spleen, and gallbladder are part of the biliary system. An ultrasound is commonly used to look for abnormalities in the organs of the system.
When evaluating a 61-year-old patient, you determine that he is experiencing a type of incontinence in which he is not able to physically go to the bathroom when he needs to. What type of incontinence is this?
Overflow.
Urge.
Stress.
Functional.
Functional.
There are several types of incontinence. Overflow incontinence: Urine leaks as a result of forces against the bladder. Urge incontinence: Patient cannot keep himself from urinating when his bladder is full. Stress incontinence: Patient always urinates when there is pressure against his abdomen. Functional incontinence: Cognitive or physical impairments prevent the patient from urinating when he has the need to go.
A patient comes in the office for abdominal cramps and “really bad” diarrhea. The enzyme immunoassay test for C. difficile is positive and you inquire about antibiotic usage. He is on clindamycin for a tooth abscess. How should he be managed?
give metronidazole
treat the diarrhea, give metronidazole
stop the clindamycin, treat the diarrhea
stop the clindamycin if possible, give metronidazole
stop the clindamycin if possible, give metronidazole
The most important step in treating infection with C. difficile is stopping ingestion of the antibiotic. Metronidazole is recommended initially for non-severe infection. If the antibiotic cannot be stopped, treatment for C. difficile should be continued as long as the patient must take the offending antibiotic.
You are prescribing Valsartan for your 83-year-old patient with heart failure. What is the maximum daily dosage the patient can take of this medication?
200 mg/day.
100 mg/day.
160 mg/day.
320 mg/day.
320 mg/day.
There are a variety of drugs prescribed to patients to help manage heart failure. For example, the maximum daily dosage for Losartan is 100 mg/day. The daily max. for Valsartan is 320 mg/day. The daily maximum for Candasartan is 32 mg/day and Metoprolol, 200 mg/day.
What condition involves decline in sense of smell, usually gradual, and results in fine taste discrimination?
presbycusis
hyposmia
hyperosmia
presbyopia
hyposmia
Choice B is the right answer. The etiology of hyposmia is neural degeneration and it is accelerated by tobacco use. A gradual decline in sense of smell is seen.
In patient’s with chest pain, what determination should be made first when confirming a differential diagnosis?
A cardiac etiology should be ruled out first.
Gastro-intestinal conditions should be worked up as soon possible.
Renal etiology should be ruled out first.
Neurological referral should be made.
A cardiac etiology should be ruled out first.
The first step in diagnosing chest pain is to rule out a cardiac etiology. Chest pain can indicate many life-threatening conditions such as congestive heart failure.
Motivation is an important factor to consider when teaching patients. According to Maslow’s Hierarchy of Needs , which is the third need that must be met in order to motivate the patient?
Esteem needs.
Physiological needs.
Safety needs.
Social needs.
Social needs.
According to Maslow’s Hierarchy of Needs, needs must be met in a particular order to foster the motivation that encourages learning. In order, these needs are: – Physiological – Safety – Social – Esteem – Self-actualization
Which of the following is NOT a symptom of pericarditis?
dry cough
wet cough
chest pain
low grade fever
wet cough
While pericarditis is often accompanied by a cough, this is usually a dry cough. Pain when coughing is also common.
A patient with __ may have trouble understanding nonverbal communication.
Hearing impairment.
Visual impairment.
Limited mobility.
Chronic pain.
Visual impairment.
Nonverbal communication is important when addressing patient needs. Patients with visual impairment may not see nonverbal communication from nurses. Nurses need to adjust their communication style.
You are evaluating your elderly patient and determine that she has a heart murmur. When listening to it, you note the sound is faint and sometimes cannot be heard when your patient changes positions. How would this murmur be graded?
III/VI.
IV/VI.
I/VI.
II/VI.
I/VI.
Grading heart murmurs follows this system: I/VI: Heart murmur makes faint sound and may not be heard when patient changes position. II/VI: Heart murmur is quiet but can be heard as soon as the stethoscope is placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI: Heart murmur is loud and accompanied by a palpable thrill. V/VI: Heart murmur is very loud and can be heard with the stethoscope partially off the chest. VI/VI: Heart murmur is very loud and can be heard with the stethoscope completely off the patient’s chest.
You are prescribing acetaminophen to an older patient for pain. This patient has a history of alcohol abuse. Which of the following is true when prescribing to this patient?
You should not prescribe any acetaminophen to this patient.
You should prescribe double the usual dose for this patient.
You should prescribe a maximum dose that is 50-75% lower than for other patients.
You should prescribe a maximum dose that is 10% lower than for other patients.
You should prescribe a maximum dose that is 50-75% lower than for other patients.
Patients with a history of alcohol abuse may be at higher risk of internal bleeding when taking acetaminophen. Prescribe a maximum dose of this drug that is 50-75% lower than for other patients when prescribing to patients with a history of alcohol abuse.
In counseling a patient with insomnia, the GNP understands all of the following to be effective therapy regimen advice except:
“Do not nap during the day if possible.”
“Take work materials to bed or watch TV there.”
“Try to have a consistent bed time.”
“Rise from the bed at the same time every day regardless of hours slept.”
“Take work materials to bed or watch TV there.”
It is recommended that you do not use the bedroom for any activity other than sleeping and sexual activity. Therefore, working or watching TV would not be appropriate. The other choices are good night time regimens to treat insomnia.
Health maintenance is part of the role of the GNP. All of the following are things that a GNP would recommend to an older client for health maintenance except:
eating whatever they want
avoiding individuals who are ill, especially with infectious diseases
having periodic health appraisals as recommended
maintaining physical and mental activities
eating whatever they want
Older clients should be encouraged to have periodic health appraisals and counseling to prevent illness. They should be encouraged to stay away from individuals who are ill as well as maintain physical and mental activities. They should NOT be encouraged to eat anything they want. They should be encouraged to maintain proper nutrition and weight control
You are assessing a 68-year old woman with suspected pancreatic cancer. What should the Geriatric Nurse Practitioner anticipate to find?
a large palpable abdominal mass at midline
a positive Cullen’s sign
a positive obturator and psoas signs
mid-epigastric pain that radiates to the back
mid-epigastric pain that radiates to the back
Choice D is the right answer. Patients with pancreatic cancer most commonly present with abdominal pain, weight loss, anorexia, nausea, and vomiting. Risk factors include a history of chronic pancreatitis, tobacco use, and diabetes mellitus, but around 40% of cases occur sporadically with no identifiable risk factors.
Your elderly patient who lives alone tells you that she is afraid that she will fall and injure herself. You would tell her to to take all of the following precautions except:
have adequate lighting throughout the home
paint the edges of stairs a bright contrasting color
encourage person to change positions slowly to prevent orthostatic hypotension
encourage person to move about the home in bare feet or socks
encourage person to move about the home in bare feet or socks
The correct answer is that you would NOT encourage your patient to move about the house in bare feet or socks. You would encourage her to wear proper footwear that supports the foot and contributes to balance. Footwear should be made of nonslippery materials.
Your elderly patient has developed a disorder as a result of thrombotic obstruction (clot). Of the following, which did he MOST likely develop?
Pulmonary venous hypertension.
Chronic thromboembolic disease.
Pulmonary vasculature disorder.
Pulmonary arterial disease.
Chronic thromboembolic disease.
There are a variety of disorders in which acute respiratory failure may occur. Others include disorders of the lung or hypoxemia.
Your 71-year-old patient presents with shortness of breath, leg pain, and hemoptysis. After testing, you determine he is positive for Pulmonary Embolism. Which of the following would LEAST likely be a differential diagnosis for Pulmonary Embolism?
Right-sided heart failure.
CAD.
Common cold.
Heart valve disease.
Common cold.
Pulmonary Embolism is a respiratory disorder. Other differential diagnoses of the condition are Rib fractures and Pneumothorax.
A patient with which of the following Tinetti scores would be considered at low risk for falls?
23
10
21
26
26
The Tinetti Balance and Gait Assessment is a 28 point assessment. Any score above 24 is considered to indicate a very low risk of fall.
The theory that identifies an unstable molecule as the causative factor in aging is the _ theory.
free radical
What fact explains the shift of health care focus toward the older adult in the late 1960s?
Preventive health care practices increased longevity.
The Certified Nursing Assistant (CNA) caring for an older adult asks if the yellow, waxy, crusty lesions on the patient s axilla and groin are contagious. Which response shows the nurse s understanding for the cause of the lesions?
No. It is seborrheic dermatitis caused by excessive sebum.
What does the presence of a caregiver provide for the older adult living at home?
Source of motivation
What can suppress the defecation reflex?
Repeatedly ignoring the urge
When do the conditions of a living will go into effect?
When two physicians agree in writing that the criteria in the living will have been met
What housing option for the older adult offers the privacy of an apartment with restaurant-style meals and some medical and personal care services?
Assisted-living center
The nurse must tell a 94-year-old resident of a nursing home that his wife has fallen and has been hospitalized with a broken hip. What is the most effective method for the nurse to deliver the news?
Gather all pertinent information that is accurate.
Which assessment finding is the cardinal signs and symptoms of congestive heart failure?
Dyspnea and edema
The patient asks the nurse to describe the neuroendocrine theory of aging. What would be an appropriate response by the nurse?
The stimulation and/or inhibition of the hypothalamus causes age-related changes.
The home health nurse suggests to the 82-year-old man that he should wear a Medic Alert bracelet. Which of the following health conditions prompted the nurse to make this suggestion?
Pacemaker
Which patient would require special precautions when the nurse is performing a digital rectal exam?
Patient with congestive heart failure
The home health nurse is discussing oral hygiene with the older adult. Which practice would be appropriate to add to the current maintenance plan?
Using a fluoride toothpaste
What is a cause of pernicious anemia?
A deficiency of vitamin B12
A 70-year-old male patient taking corticosteroids for rheumatoid arthritis asks the nurse if he should take the vaccination to prevent shingles. What would be the nurse’s most helpful response?
“No. Persons with impaired immune systems should not take that vaccine.”
What is the correct term for the area between 18 inches and 4 feet of a person?
Personal space
What can the nurse do to improve communication with an older adult patient who has a hearing impairment?
Speak in a low tone, bending close to the patient.
Which senior citizen political action group uses volunteers and lobbyists to advance the interests of older adults?
American Association of Retired Persons (AARP)
What is a symptom of inadequate insulin coverage in a patient with diabetes mellitus type I?
Ketones in the urine
What position would be most appropriate to reduce pressure injuries in an immobile patient?
In a lateral position, with body rotated 30 degrees with gluteus bearing the weight
Which complaint by the 80-year-old resident would indicate a need for the nurse to complete a focused bowel assessment on the resident?
Feeling pressure and fullness in the rectum but is unable to defecate
An older adult states that her physician ordered her to drink a glass of wine daily. The nurse understands that alcohol is occasionally recommended for which of the following reasons?
Appetite stimulant
Which type of elder abuse is demonstrated by the nonprovision of medical care?
Neglect
What percent of communication is transmitted by verbal methods?
7
How often should a 75-year-old have a visual screening?
Every 12 months
Why would a nurse lead a group of postmenopausal women on a daily 15-minute walking tour through the long-term care facility?
To improve bone strength
The nurse cautions the Certified Nursing Assistants (CNAs) to use care when transferring or handling older adults. The nurse understands that the vascular fragility of the older adult can result in which condition?
Senile purpura
The patient says, “When I came to the hospital yesterday, everything got confused.” What would be the best response by the nurse?
“What happened?”
What would be the most effective action by the home health coordinator when interacting with an unpaid caregiver?
Be generous with positive feedback.
A 70-year-old woman asks, How in the world can my bones be brittle when I eat all the right foods? Which response by the nurse would be the most informative?
Calcium is continuously withdrawn from bone for nerve and muscle function.
The 93-year-old woman with chronic back pain is found crying. When the nurse approaches, the patient says, “I know you can’t do anything more, but I hurt so bad.” What nursing intervention would be most effective?
Touch the patient’s shoulder and sit quietly without speaking.
Which statement by the patient would indicate a need for further instruction regarding prevention of constipation?
“I’m never constipated. I take a gentle laxative every night.”
A 75-year-old male is worried that his wartlike dark macules with distinct borders are melanomas. What would be the most likely cause for the macules?
Seborrheic keratoses
The nurse assesses an area of skin on the patient’s upper thigh that is different in appearance than the surrounding skin. What documentation would be the most informative?
Erythematous scaly patch 2 ´ 2 cm on lateral aspect of right thigh. Patient denies pain
What would be the most effective action of the nurse when assisting an 85-year-old adult with weak abdominal muscles to defecate?
Place a footstool under the feet of the patient when seated on the toilet.
The caregiver who provides daily meals and attends to the daily needs of the older adult is classified as the _ caregiver.
primary
When the 70-year-old female patient says, “Keeping up with when to take the flu vaccine is a big hassle. I’m not going to add trying to keep up with a pneumonia vaccine as well. It’s too expensive.” Which response by the nurse would be the most helpful?
“The pneumonia vaccine needs to be repeated every 10 years.”
What is the goal of empathetic listening?
It allows the nurse to understand what the patient has said.
When the patient complains of dry mouth, what should the nurse assess for?
Difficulty in chewing and swallowing
Why is it important for the nurse to be cautious when using medical jargon with an older adult patient?
It could become a communication barrier.
A patient uses good health maintenance practices. What aging theory most accurately relates to the patient’s practices?
Wear-and-tear
The nurse is accompanying a group of older adults on a July 4th outing to monitor heat prostration. What factor is related to heat intolerance in the older adult?
A reduction of perspiration
The 75-year-old man who has been hospitalized following a severe case of pneumonia is concerned about his mounting hospital bill and asks if his Medicare coverage will pay for his care. What would be the most helpful response by the nurse?
Medicare Part A pays for inpatient hospital costs.
The patient who has been on long-term antibiotic therapy inquires what may have caused thrush. What is the most informative response of the nurse?
Long-term antibiotic therapy has destroyed the normal flora of his mouth
A person with Parkinsons disease has a nursing diagnosis of nutrition, less than body requirements related to difficulty swallowing. What change would the nurse make in the nursing care plan?
Offer a thick, high-nutrition shake as a snack.
Which caregiver could be found guilty of elder abuse?
A son who uses his mother’s checking account funds to purchase alcohol for himself
What type of abuse is demonstrated by restraining an older adult in a recliner?
Physical abuse
The daughter of a resident in a long-term care facility is frustrated with her 80-year-old mother’s refusal to eat. Which response would be the most appropriate?
The refusal to eat is an effort to maintain a portion of independence and self-direction.
What is the most frequent response to elder abuse by the abused older adult?
Nothing at all
The 60-year-old Asian man tells the home health nurse that he has stopped taking his antihypertensive medication because it causes him to be impotent. He reports that he is using acupuncture to control his hypertension. What would be the most effective response by the nurse?
“Let me check your blood pressure to see how acupuncture is working.”
Heat Application
- Heat produces vasodilation= dilation of the blood
blood flow to the rest of the body= decreases–result in increased pulse, dizziness, & shortness of breath
- Frequency & duration of heat therapy (HCP order)
- Hot moist compresses= increase circulation= decrease edema, & consolidate any purulent exudate
Cold Application
- Produces vasoconstriction= narrowing of blood vessels
decreases blood flow to area–blood flow to other organs & tissues increases (reaction–body shivers)
- Cold compresses= treat inflammation & prevent edema (clean/sterile)–applied for 20 min. at 59°F
analyze Pt. for: erythema, burning sensation, numbness, mottling, extreme paleness, cyanosis
(sensation pattern: cold>pain relief>burning skin pain>numbness)
Osteoporosis
- Loss of bone density
- Assessment: SD= ask complaints of pain that worsens when sitting, standing, coughing, sneezing, & straining
OD= Pt. spinal deformity/height loss, increased lordosis, scoliosis, & kyphosis, gait impairment associated w/ inability to maintain erect posture
+Diagnostic Tests= CBC: serum calcium, phosphorus, & alkaline phosphate, BUN, creatinine level, urinalysis, liver & thyroid fnx.
+Medical Management= calcium supplements (m=1000 mg, w=1500mg)
+Nursing Interventions & Pt. Teaching:
A diet rich in milk & dairy products
Teach Pt. relaxation techniques–stop smoking
Safety measures: side rails, bedside commodes w seat elevators, rubber mats in showers (prevent falls)
Encourage weight-bearing exercises to increase bone density
Decrease caffeine intake
*Vitamin D
Sleep Patterns
•Alzheimer disease
•Alcohol
•Changes in the body’s natural internal clock, causing some people to fall asleep earlier in the evening)
•Chronic disease, such as heart failure
•Certain medicines, herbs, supplements, and recreational drugs
•Depression (depression is a common cause of sleep problems in people of all ages)
•Neurological conditions
•Not being very active
•Pain caused by diseases such as arthritis
•Stimulants such as caffeine and nicotine
•Frequent urination at night
•Avoid large meals shortly before bedtime.
•Avoid stimulants such as caffeine after mid-afternoon.
•Get regular exercise early in the day.
•Go to bed and wake up at the same time every day.
•DO NOT take naps.
Constipation
+Loss of muscle tone
- (Laxatives last resort)
- Consume high-fiber diet
NGT Feedings (Interventions)
Incontinence
Skin Care & Changes (Prevention of PU)
Cane Use
Low Na Diet
Breads – Whole grain breads, English muffins, bagels, corn and flour tortillas, most muffins
●Cereals – Many cooked low-salt (read the label to determine sodium content) hot cereals (not instant) such as oatmeal, cream of wheat, rice, or farina, puffed wheat, puffed rice, shredded wheat
●Crackers and snack foods – All unsalted crackers and snack foods, unsalted peanut butter, unsalted nuts or seeds, unsalted popcorn
●Pasta, rice, and potatoes – Any type of pasta (cooked in unsalted water), potatoes, white or brown rice
●Dried peas and beans – Any cooked dried beans or peas (without seasoning packet), or low-salt canned beans and peas
●Meats and protein – Fresh or frozen beef, poultry, and fish; low-sodium canned tuna and salmon; eggs or egg substitutes
●Fruits and vegetables – Any fresh, frozen, or canned fruit, any fresh or frozen vegetables without sauce, canned vegetables without salt, low-salt tomato sauce/paste
●Dairy products – Milk, cream, sour cream, non-dairy creamer, yogurt, lower-sodium cottage and other cheeses (be sure to read labels for serving size)
●Fats and oils – Plant oils (olive, canola, corn, peanut), unsalted butter or margarine
●Soups – Salt-free soups and low-sodium bouillon cubes, unsalted broth, homemade soup without added salt
●Sweets – Gelatin, sherbet, pudding, ice cream (brands vary widely), salt-free baked goods, sugar, honey, jam, jelly, marmalade, syrup
●Beverages – Coffee, tea, soft drinks, fruit-flavored drinks, low-salt tomato juice, any fruit juice
Aging of Muscular System
Signs & Symptoms of Dehydration
•dry mouth
•the eyes stop making tears
•sweating may stop
•muscle cramps
•nausea and vomiting
•heart palpitations
•lightheadedness (especially when standing).
Shingles Vaccine
- Prevents shingles
Stages of Grief (DABDA)
- Denial
- Anger
- Bargaining
- Denial
- Acceptance
Sexuality (Geriatrics)
- Decreases
Erikson’s Stages of Development
Integrity v. Despair
Reminiscing
- Reflection of the past
Medication–Aricept
- Treat (confusion) dementia r/t Alzheimer’s disease
- May improve memory, awareness, & the ability to fnx.
- Enzyme blocker that work by restoring the neurotransmitters in the brain