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NURS 6540 Exam Study Guide | Advanced Practice
Care of Frail Elders, Elders Final Review –
Full Chapter Questions & Answers
- Mrs. Smith, 75 years old, reports that she is weak, has difficulty urinating, and is dehydrated. Although she is afebrile, the nurse conducts a thorough physical examination, including urinalysis and complete blood count (CBC). The total assessment is necessary because:
- All body systems interact, and symptoms could indicate a variety of diagnoses.
- The symptoms are vague and may be signs of aging.
- There may be other signs or symptoms more indicative of the condition.
- Mrs. Smith may not be reporting all significant information. - 1. Answer: 1 Page: 2 Feedback
The clinician must be aware that all the systems interact and, in doing so, can increase the older person's vulnerability to illness/disease. 2. The nurse must not attribute symptoms only to the aging process.
There may be comorbidities accompanying this condition.
- Assumptions of not reporting properly may not be true.
- A patient with renal disease has blood work drawn, and the results show an increase in serum creatinine. The nurse practitioner needs to know which of the following laboratory values before ordering medications?
- CBC
- Culture and sensitivity of the urine
- Creatinine clearance
- Uric acid levels - 2. Answer: 3 Page: 3 Feedback
A CBC will not evaluate kidney function for a patient with renal disease.
A culture and sensitivity test reflects the presence of an infection and the antibiotic to which the organism is sensitive.
The calculation of creatinine clearance provides an estimation of renal function.
Uric acid level is elevated in the presence of gout.
- Which of the following statements is true regarding diagnostic testing?
- A test is ordered for a specific purpose.
- A test is the most invasive available.
- There is no need to discuss results with the patient.
- If a test is needed, it should be ordered regardless of risk to the patient. - 3. Answer: 1 Page: 3 Feedback
The nurse practitioner should have a plan for the use of each test result value obtained.
When considering which laboratory tests to order, it is worth remembering the doctrine primum no nnocere—first, do no harm.
Once laboratory tests are available for review, tests results should be discussed with the patient, with abnormal test results interpreted for the aging individual and addressed with the patient and caregivers.
Any risks involved in laboratory testing must be considered concerning the patient's clinical condition and weighed against the test's expected benefits.
- Janey, 25 years old, may experience arthritis differently than 65-year-old Mrs. Johnson because:
- The body undergoes physiological changes with aging.
- A healthy body does not experience significant changes as one gets older.
- Older patients do not feel any systemic symptoms, such as malaise and weight loss.
- Even though the same joints are usually affected, age makes it feel different. - 4. Answer: 1 Page: 5 Feedback
Knowledge of the bimodality of age onset of certain disease conditions will aid the advanced practice nurse in avoiding misdiagnosis or delay in diagnosis due to lack of recognition.
Symptoms of rheumatoid arthritis may be different depending on the age of the patient.
Heart disease, cancer, and diabetes combined are the most common morbidities in older patients.
- A gerontological patient is being examined for a report of pain in the shoulder. The nurse practitioner completes a thorough systemic examination because:
- Older patients with one morbidity often express difficulties in general.
- Arthritis of the shoulder is accompanied by other neurological symptoms.
- Older patients with arthritis often experience pain in lower extremities.
- The patient may not report significant signs and symptoms. - 7. Answer: 1 Page: 5 Feedback
Older patients with late-onset rheumatoid arthritis experience joint involvement more often in the larger joints, such as the shoulder, and they also experience systemic symptoms such as fever, malaise, weight loss, and depression. 2. Older patients may express symptoms in any other physical systems.
Patients more often experience arthritis in smaller joints.
- A thorough examination will detect objective indicators.
- The nurse practitioner performs a thorough systemic examination of a patient who reports diarrhea and pain in the upper left quadrant of the abdomen. One possible diagnosis would be:
- Hirschsprung's disease
- Pancreatitis
- Appendicitis
- Gastrointestinal inflammatory bowel disease (GIBD) - 8. Answer: 4 Page: 5 Feedback
Hirschsprung's disease is an obstruction of the colon in infancy. 2. Diarrhea is not associated with pancreatitis.
Appendicitis is more common in younger patients than in older patients.
- GIBD is manifested differently in a bimodal pattern.
- A 70-year-old man is seeing a nurse practitioner because he is feeling weak and dizzy. The nurse practitioner is discussing a care plan with him and makes which of the following statements? Select all that apply.
- I want to order a test for your heart to evaluate its function.
- I will perform a thorough examination of your functional abilities.
- I will order a blood sugar test to check for diabetes.
- Many older people feel this way. It is to be expected.
- I will assess you for the presence of other conditions. - 9. Answer: 1, 2, 3, 5 Page: 2, 3 Feedback
A complete assessment will help differentiate signs of aging from disease.
All systems interact and can affect an existing condition. 3. Identifying underlying conditions will avoid undertreatment.
Attributing symptoms to aging can contribute to depression in an older person.
There are changes in the sympathetic response which contribute to the orthostasis and falls, as well as lack of hypoglycemic response.
- The nurse practitioner is leading a class of seniors over age 65 years and is teaching about nutritional needs. One of the men asks why, even though he eats correctly according to the standards presented, he still feels weaker than he did 10 years ago. He also wonders why he gets more infections than he used to. Which of the following are helpful answers? Select all that apply.
- I suggest that you exercise a little more than you are currently doing.
- Some people experience a decrease in reserve energy.
- For some people, the immune system weakens.
- More viruses are being spread throughout the community.
- I suggest that you see your primary caregiver for extensive testing. - 10. Answer: 2, 3, 5 Page: 2, 3 Feedback
Improved nutrition may not be the factor affecting health of elders. 2. Many factors can influence the health of elders, including lifestyle and medications.
decrease. Their physician does not seem concerned, and the couple is wondering why. How is it best for the nurse practitioner to respond? Select all that apply.
- Studies show that each person's pattern of chemical make-up is different.
- There is no difference between one person's range of blood results and that of any other person.
- Each person's chemical make-up is the same as that of others of the same gender and age group.
- Many factors affect an individual's chemical make-up.
- Ranges of the values provided by the laboratory are correct for any age. - 12. Answer: 1, 4 Page: 2, 3 Feedback
Individuals experience smaller variations in laboratory work than from the others in the same age group.
There are wider variations of laboratory results within a group of older people.
Laboratory values are determined by more than age and gender. 4. Laboratory values may vary as a result of nutrition, activity, and emotional status.
The reference values presented for the older adult cohort are not necessarily correct for the individual due to biochemical individuality.
- Adam, 70 years old, is admitted for possible myasthenia gravis (MG). The nurse practitioner knows that MG is commonly seen in women between 20 and 40 years old. Adam, however, is experiencing an ocular form of MG, has dysphonia, and does not have any thymus abnormalities. Adam asks why the nurse is concerned about MG since he is older and this is a "young person's disease." Which of the following are the best answers? Select all that apply.
- We need to assess for anything, just in case.
- Some diseases show up in two different age and gender groups.
- Older people often experience weakness, and we must rule out other conditions.
- Your insurance will cover this, and we want to rule out as much as possible.
- Signs and symptoms of illness are the same for each disease regardless of age. - 13. Answer: 2, 3 Page: 5 Feedback
Ordering more tests than needed violates the principle of "Do no harm."
MG is bimodal and can be found in younger women, as well as in both men and women.
Knowledge of the bimodality of age onset of certain disease conditions will aid the nurse practitioner in avoiding misdiagnosis or delay in diagnosis due to lack of recognition.
There should be a need for ordering a test and value attributed to the results.
The manifestations of illness and disease in the elderly can be very different, even if the underlying pathological process is the same as in younger individuals.
- Mrs. Smith is 75 years old and has had type 2 diabetes for 30 years. She sees her nurse practitioner on a regular basis. Mrs. Smith asks the nurse practitioner why her treatment has not been changed, even though her laboratory values are seemingly out of normal range. Which of the following answers are best? Select all that apply.
- A decision to make changes must be based on a pattern and not on one set of laboratory results.
- The normal range charts are based on patients younger than 75 years.
- Currently, it is too expensive to change your treatment.
- Comparing new results with your prior results gives a more accurate picture.
- Normal values for laboratory tests differ as one gets older. - 14. Answer: 1, 4, 5 Page: 3 Feedback
Blood studies are more valuable when assessing for an increase or decrease in values.
It is not helpful to use aging as an explanation for possible abnormal results.
If a change in treatment is appropriate, the least expensive alternative should be sought.
Significant disturbances in the same individual may be detected through serial laboratory tests.
The clinician must determine whether a value obtained reflects a normal aging change, a disease, or the potential for disease.
- Mr. Adams is 90 years old. In the last few months he appears unable to comply with the health- care plan developed by the nurse practitioner. The nurse practitioner considers which of the following reasons for noncompliance when updating his home care plan? Select all that apply.
- Polypharmacy
- Treatment burden
- Attending multiple appointments
- Affording complex drug regimens
- Cognitive ability only - 15. Answer: 1, 2, 3, 4
- Encouraging the advancement of alternative health therapies. - 2. Answer: 3 Page: 6 Feedback
Current health policies are ever-changing to improve services for citizens.
Federal legislation is being proposed to increase health services.
The World Health Organization has determined that healthy lifestyle promotion works best when coupled with supportive environments, community action, and healthy public policy formation. 4. This does not include preventive and health-protective measures, nor actualization of one's health potential.
- Mr. Thomas comes in for a health examination appointment with his nurse practitioner. He asks why nurse practitioners are qualified to conduct these evaluations. Which of the following is the nurse practitioner's best response? The nurse practitioner:
- Is concerned about health and not disease.
- Saves the physician time in the office.
- Can assess for minor conditions and refer to the doctor for other conditions.
- Is prepared to assess health holistically. - 3. Answer: 4 Page: 6 Feedback
The nurse practitioner is concerned about health promotion, disease prevention, and early diagnosis.
The nurse practitioner may spend more time with the patient than the doctor is able to.
The nurse practitioner is prepared to diagnose and plan treatment for many conditions.
The nurse practitioner brings a holistic orientation to health and wellness development and possesses knowledge of developmental tasks and the wellness-illness continuum.
- Mrs. Williams, 80 years old, asks her nurse practitioner to order a new alternative therapy for her. Mrs. Williams believes that this botanical supplement will provide pain relief for her fibromyalgia. The nurse practitioner explains that this therapy is likely not covered by Medicare because:
- The botanical is expensive and not approved for use.
- Medicare only covers treatments that are approved according to the stringent guidelines of the U.S. Preventive Services Task Force (USPSTF).
- There is no reason to use these botanicals when opioids are proven effective.
- This botanical is not on the Medicare list of approved medications. - 4. Answer: 2 Page: 6 Feedback
Although this botanical may not be approved by the U.S. Food and Drug Administration (FDA), its cost will depend on the distributor.
Medicare will only pay for A and B level recommendations that meet the USPSTF stringent evidence guidelines, leaving other beneficial interventions without coverage.
Opioids are not recommended for older patients.
It is important to use only prescribed and approved medications/treatments.
- When a patient is seen by a nurse practitioner, the care plan is developed keeping which of the following objectives in mind?
- Increasing the use of the emergency department for injuries from falls.
- Maintaining the patient living in his or her home.
- Increasing safety checks in the home.
- Increasing use of the Welcome to Medicare visit. - 5. Answer: 4 Page: 6 Feedback
The objective is to decrease the use of the emergency department for falls.
There are many factors involved in the decision for an older adult to remain in the home.
Although it is useful to conduct home safety checks, they are not part of the Healthy People 2020 objectives.
The Healthy People 2020 program has set specific objectives for prevention in older adults; use of the Welcome to Medicare visit is one of those objectives.
- The focus of advanced nurse practitioners is primary care. This is defined as activities that focus on:
- Preventing the occurrence of a disease or condition.
- Treating an illness after symptoms appear.
- Enabling the patient to recover and convalesce.
- Primary disease or condition affecting the patient. - 8. Answer: 1, 2, 3 Page: 6 Feedback
The nurse practitioner develops a collaborative plan that includes consideration of the patient's health beliefs and goals.
The nurse practitioner considers present and anticipated levels of function.
Risks need to be considered in light of benefits offered by interventions.
The nurse practitioner may consider whether the patient is connected to a religious community but cannot prescribe or recommend any specific plan.
Many disorders in older adults encompass multiple risk factors that involve several systems and interventions to achieve outcomes; this presents a challenge when measuring and synthesizing evidence, and reporting outcomes.
- As the nurse practitioner is teaching about the need for more exercise, the patient says that it takes away too much energy needed for other activities. The nurse practitioner explains that the benefits of exercise include which of the following? Select all that apply.
- Increased flexibility.
- Increased muscle mass.
- Maintenance of optimal weight.
- Lower blood pressure.
- Decreased urinary output. - 9. Answer: 1, 2, 3, 4 Page: 7 Feedback
The health benefits of regular physical activity are well documented and include flexibility.
Exercise increases muscle tone and mass.
Exercise uses calories from stored fat and allows for weight loss.
Exercise strengthens the cardiac muscle and thereby lowers blood pressure.
Exercise does not affect urinary output.
- While counseling a patient about physical activity, the nurse practitioner considers which of the following? Select all that apply.
- A physical activity prescription that is individualized to the patient.
- Active hobbies that the patient enjoys.
- Alternative activities such as yoga or tai chi.
- Armchair activities for the frail older adult.
- Patient's ability to pay for involvement in activities. - 10. Answer: 1, 2, 3, 4 Page: 7
- Answer: 1, 2, 3, 4 Page: 7 Feedback
Each person is unique and may not respond the same to exercise.
Hobbies are enjoyable and give pleasure, while at the same time increasing activity.
Stretching routines are done slowly and to the level of endurance.
When the frail older person cannot ambulate, they can move other parts of their body such as core, arms, head, and neck. They may also do non-weight-bearing movements of legs and feet. 5. Movement, activity, and exercise can be done anywhere, anytime the individual desires. There is no need to join a group.
- Nutrition counseling is part of health promotion. The nurse practitioner considers a teaching plan that includes which of the following information? Select all that apply.
- Level of involvement in community activities.
- Baseline information on current dietary intake.
- Current activity patterns.
- Current height and weight.
- Health status information. - 11. Answer: 2, 3, 4, 5 Page: 7, 8 Feedback
Active involvement in community activities does not reflect what the older person is eating.
The nurse practitioner needs the current state of nutrition to develop a plan for increasing or maintaining positive nutrition. 3.
Feedback
Older adults are less likely to practice safe sex and use condoms.
Older people may be at increased danger from STIs because of the decreased perception of risk.
Current sexual history may determine the need for continued screening for STIs, HPV, and cervical cancer.
Encounters may be with fellow travelers, locals, or commercial sex workers.
Using the patient's sexual history, explore patient needs, preferences, and medical or psychological obstacles to sexual expression.
- Mary, 72 years old, goes to the pharmacy to pick up her prescriptions. The pharmacist asks if she has had her immunizations. Mary replies, "I had all my childhood shots, so I do not need any now." What should the nurse practitioner teach her about senior immunizations? Select all that apply.
- Because the immune system may be weakened in older persons, immunizations are suggested.
- Persons over the age of 50 years should have a yearly influenza vaccine.
- The new Shingrix vaccine will help protect her from shingles.
- The side effects of immunizations outweigh the benefits of immunizations.
- The pneumococcal vaccine is given as a one-time dose. - 14. Answer: 1, 2, 3 Page: 12 Feedback
The older person is susceptible to organisms that cause infection due to decreased immunity, nutrition, hydration, and other factors. 2. The influenza virus mutates each year and an updated version of the vaccine is needed to provide immunity. Influenza vaccine is now recommended annually for all adults over 50 years old, unless contraindicated. 3. Recently released Shingrix has been found to be more effective than the Zostavax, which was given previously. 4. Side effects are most often mild and localized. Viruses can cause serious or even lethal conditions.
Pneumococcal vaccine is recommended as follows: Administer one-time dose to PCV13-naïve adults at age 65 years, followed by a dose of PPSV23 12 months later.
- Mr. and Mrs. Jones are preparing to take a trip to Europe. The nurse practitioner includes the following teaching about taking care of their health while gone. Select all that apply.
- Shorter airplane flights provide more chance to ambulate and relieve pressure on the back and legs.
- Generally speaking, the air in Europe is cleaner than the air in the United States, so you should have no problems with your respiratory conditions.
- Plan to fill your prescriptions when you are in a larger city.
- Depending on the specific areas you will visit, certain immunizations may be needed.
- You will most likely function as well when traveling as when at home. - 15. Answer: 1, 4 Page: 12, 13 Feedback
Long flights in cramped areas increase the risk of thromboembolic events.
Increased air pollution is a significant problem in many countries and affects pulmonary function.
The medications needed may not be available in some countries in Europe. Medicare does not cover medications filled outside of the United States. 4. Some areas of the world continue to see cases of yellow fever, malaria, and other diseases. When going to a vulnerable area, proper immunizations are required. 5. Some of the physiological and psychosocial changes that can occur with aging pose special risks during travel. How a patient functions at home may not be indicative of how well he or she will function in an unfamiliar environment.
- Mrs. Keating is a 70-year-old woman suffering from arthritis. She is seeing the nurse practitioner for her regular checkup. For a person with chronic degenerative conditions, which of the following should the nurse suggest for health promotion?
- Take herbal supplements.
- Increase physical activity.
- Take Aleve.
- Get a massage. - 1. Answer: 2 Page: 19 Feedback
Although there may be some herbal supplements that can help with arthritis, this is not the best suggestion because it does not promote increased physical activity. 2.
Barriers are things that prevent or hinder patients from exercising.
Incentive is one kind of patient facilitator, like family support. 3. Positive self-efficacy is another kind of patient facilitator, like family support.
Facilitators are things that help a patient desire exercise and health promotion, so these are facilitators.
- The American College of Sports Medicine (ACSM) has designed programs to incorporate exercise into every patient encounter. Which of the following is the correct phrase for this program?
- Back to Exercise
- Health and Wellness
- Exercise is Medicine
- Exercise is Wellness - 4. Answer: 3 Page: 20 Feedback
Back to Exercise is not the correct phrase for the program the ACSM designed.
Health and Wellness is not the correct phrase for the program the ACSM designed. 3. Exercise is Medicine is the correct phrase for the program the ACSM has designed to incorporate discussion of exercise into patient encounters. 4. Exercise is wellness is not the correct phrase for the program the ACSM designed. 5. Which of the following should nurse practitioners suggest to counter common patient excuses for not exercising? 1. Join a gym. 2. Find an exercise "buddy." 3. Take a 10-minute walk every day. 4. Go to the YMCA. - 5. Answer: 3 Page: 20 Feedback
Joining a gym is not the best suggestion to counter excuses not to exercise because having to go to the gym may become another excuse. There may also be financial and transportation issues adding to the reasons not to exercise.
Finding an exercise "buddy" may be helpful but still may impose the excuse of not being able to find one.
Taking a 10-minute walk every day is the best suggestion. With this suggestion a patient cannot make the excuse of not having time or equipment.
Going to the YMCA is not the best suggestion to counter excuses for the same reasons as joining a gym is not the best suggestion.
- Older adults who have chronic conditions and are considering an increase in their physical activity should:
- Start slowly, using lower weights with high repetitions.
- Consult with a personal trainer.
- Consult a health-care provider to help set physical activity goals that are realistic and safe.
- Start with low repetitions but heavier weights. - 6. Answer: 3 Page: 21 Feedback
Starting slowly with low weights and high repetitions may be a good start but must be monitored or initiated by an appropriate medical professional for instruction in proper use. 2. A consultation with a personal trainer is not the best option because some trainers may not be familiar with chronic conditions. 3. Consulting a health-care provider for physical activity goals that are realistic and safe is the best option. 4. Starting with low repetitions but heavier weights is not a good way to start an exercise program because it may result in injury.
- Challenges to increasing physical activity are different for everyone. For instance, some patients may be experiencing depression or loss, some may have had significant life changes, and others may be dealing with functional limitations. As relates to increasing physical activity, these are examples of what?
- Patient excuses
- Patient facilitators
- Patient ignorance regarding what to do
- Patient barriers - 7. Answer: 4 Page: 20
