NR601 – Primary Care of the Maturing and Aged
Exam Study Guide – Midterm Exam
Exam Format: Non-cumulative
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes
Testing Timeframe: The midterm exam will be available starting on Wednesday of
week 4 at 12:01 am MT until Friday of week 4 at 11:59 pm MT.
1. Exam Coverage
Content Areas:
Week 1: The Maturing Adult Client
Week 2: Coronary and Peripheral Vascular Disease
Week 3: Cardiac Arrhythmias and Valvular Disorders
Week 4: Respiratory Disorders
Learning Objectives Covered:
Week 1: Foundations of Aging: 2,6,12,476,477
o Approaches to caring for the aging population
Tertiary prevention: Requires rapid action to prevent imminent death
in the setting of acute illness (ex: PCI for MI)
Secondary prevention: Focus on avoiding the recurrence of disease
and death in an individual who is already affected
Primary prevention: Attempts to reduce the risk of incident disease
among individuals with one or more risk factors
Primordial prevention: Focuses on prevention of the development of
risk factors for disease
Eating patterns, exercise, and environmental and social
determinants of health
o Aging theories and how they affect NP practice
Genomic instability: Integrity of DNA is vulnerable to stressors
mutations, translocations, and chromosomal abnormalities
Telomere attrition: Telomeres are shortened to a point where cell
division cannot continue
, Epigenetic alterations
Loss of proteostasis
Deregulated nutrient sensing
Mitochondrial dysfunction
Cellular senescence
Stem cell exhaustion
Altered intracellular communication and inflammation
o Anticipatory guidance – lifestyle, fall prevention
o Holistic assessment and health promotion for older adults –
screening and prevention
Holistic assessment: 5Ms Matters, mobility, mentation, medication,
multicomplexity
Screening: For older patients past a certain age, only consider
screening if they have never been screened and they are healthy
enough to undergo treatment if colon cancer is detected
Prevention:
Vaccines: Flu, pneumococcus, shingles
STIs: Education and prevention
o Polypharmacy and pain management
o Palliative Care and Hospice Care:
Begin palliative care many months before death in order to
focus on symptom relief and then switch to hospice in the
patient’s last few months
Assessment
Focus on evaluating the patient’s condition in all four domains
affected by the illness: physical, psychological, social, spiritual
PSPIKES: A structured procedure for communicating bad news
Prepare for the discussion
Set up a suitable environment
Begin the discussion by finding out what the Patient and/or
family understand
Determine how they will comprehend new Information best and
how much they want to know
, Provide needed new Knowledge accordingly
Allow for Emotional responses
Share plans for the next steps in care
Determining capacity
Determination of decision-making capacity limited to medical
circumstances should be differentiated from declaring a patient
“incompetent” to make decisions
Declaring someone incompetent is a legal definition and
usually is reserved for court settings
Tools to determine decision-making capacity
The MacArthur Competence Assessment Tool-Treatment
(MacCAT-T)
Validated tool but is lengthy and can be difficult to
administer
The Capacity to Consent to Treatment instrument (CCTI)
Validated in patients with mild-moderate
Alzheimer’s
o Advance care planning
POLST: Physician Orders for Life-Sustaining Treatment
Builds on communication between providers and patients by
including guidance for end-of-life care in a color-coordinated
form that follows the patient across treatment settings
Advanced Directives
Two main barriers to advance care planning:
Problems in raising the topic
Difficulty in structuring a succinct discussion
Advance care planning documents include 2 broad types
Living wills
These are advisory documents that describe the
types of decisions that should direct a patient’s care
Designation of a health care proxy (aka durable attorney
for health care)
Exam Study Guide – Midterm Exam
Exam Format: Non-cumulative
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes
Testing Timeframe: The midterm exam will be available starting on Wednesday of
week 4 at 12:01 am MT until Friday of week 4 at 11:59 pm MT.
1. Exam Coverage
Content Areas:
Week 1: The Maturing Adult Client
Week 2: Coronary and Peripheral Vascular Disease
Week 3: Cardiac Arrhythmias and Valvular Disorders
Week 4: Respiratory Disorders
Learning Objectives Covered:
Week 1: Foundations of Aging: 2,6,12,476,477
o Approaches to caring for the aging population
Tertiary prevention: Requires rapid action to prevent imminent death
in the setting of acute illness (ex: PCI for MI)
Secondary prevention: Focus on avoiding the recurrence of disease
and death in an individual who is already affected
Primary prevention: Attempts to reduce the risk of incident disease
among individuals with one or more risk factors
Primordial prevention: Focuses on prevention of the development of
risk factors for disease
Eating patterns, exercise, and environmental and social
determinants of health
o Aging theories and how they affect NP practice
Genomic instability: Integrity of DNA is vulnerable to stressors
mutations, translocations, and chromosomal abnormalities
Telomere attrition: Telomeres are shortened to a point where cell
division cannot continue
, Epigenetic alterations
Loss of proteostasis
Deregulated nutrient sensing
Mitochondrial dysfunction
Cellular senescence
Stem cell exhaustion
Altered intracellular communication and inflammation
o Anticipatory guidance – lifestyle, fall prevention
o Holistic assessment and health promotion for older adults –
screening and prevention
Holistic assessment: 5Ms Matters, mobility, mentation, medication,
multicomplexity
Screening: For older patients past a certain age, only consider
screening if they have never been screened and they are healthy
enough to undergo treatment if colon cancer is detected
Prevention:
Vaccines: Flu, pneumococcus, shingles
STIs: Education and prevention
o Polypharmacy and pain management
o Palliative Care and Hospice Care:
Begin palliative care many months before death in order to
focus on symptom relief and then switch to hospice in the
patient’s last few months
Assessment
Focus on evaluating the patient’s condition in all four domains
affected by the illness: physical, psychological, social, spiritual
PSPIKES: A structured procedure for communicating bad news
Prepare for the discussion
Set up a suitable environment
Begin the discussion by finding out what the Patient and/or
family understand
Determine how they will comprehend new Information best and
how much they want to know
, Provide needed new Knowledge accordingly
Allow for Emotional responses
Share plans for the next steps in care
Determining capacity
Determination of decision-making capacity limited to medical
circumstances should be differentiated from declaring a patient
“incompetent” to make decisions
Declaring someone incompetent is a legal definition and
usually is reserved for court settings
Tools to determine decision-making capacity
The MacArthur Competence Assessment Tool-Treatment
(MacCAT-T)
Validated tool but is lengthy and can be difficult to
administer
The Capacity to Consent to Treatment instrument (CCTI)
Validated in patients with mild-moderate
Alzheimer’s
o Advance care planning
POLST: Physician Orders for Life-Sustaining Treatment
Builds on communication between providers and patients by
including guidance for end-of-life care in a color-coordinated
form that follows the patient across treatment settings
Advanced Directives
Two main barriers to advance care planning:
Problems in raising the topic
Difficulty in structuring a succinct discussion
Advance care planning documents include 2 broad types
Living wills
These are advisory documents that describe the
types of decisions that should direct a patient’s care
Designation of a health care proxy (aka durable attorney
for health care)
