NR 601 Midterm Complete Solution and resources for the exam

NR 601 Midterm Complete Solution and resources for the exam A client is newly diagnosed with type 2 diabetes mellitus. Which diagnostic test will best evaluate the management plan prescribed for this client? Quarterly hemoglobin A1C After first managing the pain being experienced by the client with gout, the treatment focuses on: Preventing systemic involvement by altering the client's diet The abrupt onset of symptoms of stress or urge incontinence is most often due to a urinary tract infection True A 60-year-old woman presents with a chief complaint of uncomfortable breathing on exertion. She has had a minimally productive cough for several years that does not bother her. On further questioning, she states that her breathing gets much worse when she lies down. The most likely cause of her dyspnea is: Cardiac Which of the following drugs do not trigger or aggravate a cough? Hydrochlorothiazide Based on current demographic data, which statement identifies a predictive trend regarding the health care needs of society? More nursing services will be required to serve the needs of the population 85 years of age and older. Which diagnostic laboratory test would the nurse practitioner typically not order for the purpose of evaluating an individual's acute, unexplained weight loss? Serum Potassium It has been projected that the cultural group presenting the greatest growth rate among the older adult population will be the: Hispanic Americans Which statement made by a client recently diagnosed with diverticular disease would indicate that she needs additional teaching regarding dietary considerations? "I'll have to give up eating right before I go to bed." Ethnocentrism is defined as: a belief that one's ethnic group is superior to that of another true When diagnosed with diverticulosis, a client asks how this problem occurred. Which assessment data identifies a risk factor for diverticulosis? Maintains a diet low in fiber. A 77-year-old client being treated for glaucoma asks the nurse practitioner what causes glaucoma. The nurse bases the response on the knowledge that the increase in intraocular pressure is a result of: a breakdown in the absorption process Weight loss is frequently caused by ingestion of one or more of the following drugs. Antibiotics Digoxin Nonsteroidal anti-inflammatory drugs (NSAIDs) Theophylline A, B, and C All of the above Answer: All of the above Which of the following culturally diverse male clients will most benefit from educational material related to "Staying Healthy into your 80s" Japanese The following are true statements about bipolar disorders in older adults except "Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults." Which assessment data would not be of particular concern when attempting to manage an older adult's risk for dehydration? Chronic constipation When educating the older adult population about the risks to physical health that chronic alcohol abuse presents, the nurse practitioner is especially careful to include the: Identification of the signs and symptoms of gastrointestinal bleeding Which of the following drugs does not typically cause constipation? Magnesium-containing antacid An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging? Assessing the client for both depression and anxiety The greatest risk for injury for a client with progressed Parkinson's disease is: Falls An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that aging may cause this change due to the: Slower ability of the pupil to adjust to changes in lighting. The nurse practitioner educates that client that Healthy People 2010: offers direction for the achievement of improved quality of life across the life span Which of the following is not a common cause of constipation? hypercalcemia The nurse is teaching a health promotion class at a senior center. Which of the following statements demonstrate that the participant does not understand the topic: "We need to use caustic soaps and scrub aggressively with a wash cloth bathing to minimize bacteria on the skin." The nurse practitioner shows an understanding of appropriate influenza vaccination guidelines for a client over the age of 65 when stating: "Regardless of your physical health you really should get a yearly flu shot." The nurse shows understanding of the need to promote healthy skin in the older adult when encouraging the client to all of the following except : clean the skin with a moisturizing soap What is osteoporosis? Skeletal disorder characterized by impaired bone strength that predisposes to increased risk of fracture. Can occur from not only bone loss but also from failure earlier in life to make sufficient bone. Primary: due to aging (increased bone resorption/reduced new bone formation) Secondary: consequence of underlying medical condition/drug What are s/s of osteoporosis? Sometimes not seen until fracture sustained spontaneously or after minimal trauma, usually in thoracic/lumbar vertebrae, hip, wrist, humerus, pelvis. With each fracture, risk of another increases exponentially. Loss of height, kyphosis development. XR: bones appear osteopenic (at least 30% loss in bone mass); spine shows loss of horizontal vertebral trabeculae, accentuating end plates, producing biconcave "codfish" vertebrae; maybe compression fracture. What are diagnostic tests for osteoporosis? XR DEXA (screen all women 65yo, hip/spine; test earlier if major risk factors present; repeat every 3-5yrs depending on degree) What is T-score of -2.5 or lower indicative of? Osteoporosis What is a T-score of -1.0 to -2.5 indicative of? Osteopenia What is a T-score of -1.0 or higher indicative of? Normal bone density What is a Z-score of -1.5 indicative of? Secondary cause of osteoporosis What are the risk factors for osteoporosis? Previous fracture Advanced age Low body wt/BMI Maternal h/o fracture Current smoking Physical inactivity Excessive exercise resulting in amenorrhea Poor lifetime intake of calcium Endocrine disorders GI dz Chronic systemic illnesses Nutritional deficiencies Meds (steroids, anticonvulsants, thyroid hormone, SSRI, aromatase inhibitors for breast CA) Alcoholism What is the treatment for osteoporosis? Aim to prevent those that are at risk Combine diet, exercise, meds Dietary Ca/vit D Wt-bearing/strength exercises Bisphosphonates Selective estrogen receptor modulators Calcitonin PTH Denosumab Fall prevention How does chronic pain differ from acute pain? Chronic pain tends to be more multifactorial, less amenable to cure, more influenced by psychological/social factors. Typically requires continuous long-term/multidisciplenary management. Can be triggered with seemingly minor biologic stimulus or persist long after injury is healed. What is the principle goal of chronic pain treatment? Improvement in QOL/function, rather than complete elimination of pain. What is nociceptive pain? Pain from nociceptive fibers in periphery triggered by actual or potential tissue damage. Typically attributed to specific anatomic location of tissue injury. Pain is well-localized, stabbing, throbbing, achy. What is neuropathic pain? Direct neuronal injury. Burning, tingling, lancinating. Often occurs in dermatomal pattern What are treatments for nociceptive pain? Nonopioid (APAP, ibuprofen) Weak opioids (Tramadol, tapentadol) Antidepressants (TCAs, SNRIs) Opioids What are treatments for neuropathic pain? Characteristically more resistant to opioids and to pharm interventions in general than nociceptive pain. Antidepressants (TCAs, SNRIs) Anticonvulsants (gabapentin, pregabalin, carbamazepine, oxcarbazepine) Opioids Topical agents 1. The percentage of the FVC expired in one second is: a. FEV1/FVC ratio 2. The aging process causes what normal physiological changes in the heart? a. The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis. 3. A 55yo Caucasian male follows up after referral to cardiologist. He thinks his med is causing a cough and sometimes he has difficulty breathing. Which med was most likely prescribed? a. Lisinopril 4. JM is a 68yo man who presents for a physical. He has T2DM x5yrs, smokes 1/2 PPD, BMI is 30. No other previous medical dx, no current complaints. According to the AHA/ACC guidelines, JM is stage A HF. Treatment goals for him include: a. Heart healthy lifestyle 5. MJ presents with h/o structural damage with current s/s of HF. Treatment will be based on his stage of HF, which is: a. Stage C 6. 65yo Caucasian female presents with mitral valve stenosis, physical exam unremarkable. You know her stage of HF is: a. B 7. DG, 65yo man, presents for eval of CP and L-sided shoulder pain, beginning after strenuous activity, including walking. Pain is dull, aching, 8/10 during activity, otherwise 0/10. Began few mo ago, intermittent, aggravated by exercise, relieved by rest. Occasional nausea. Pain is retrosternal, radiating to L shoulder, affects QOL by limiting activity. Pain is worse today, did not go away after stopped walking. BP 120/80, HR 72 and regular. Normal heart sounds, no murmur, S1, S2. Which differential dx would be most likely? a. Coronary artery dz w/angina pectoris 8. The best way to dx structural heart dz/dysfunction non- invasively is: a. Echocardiogram 9. Chronic pain can have major impact on pt's ability to function and have profound impact on overall QOL. Ongoing pain may be linked to: a. Depression, sleep disturbance, decreased socialization 10. The Beers criteria are appropriate for use in evaluating use of certain meds in pts: a. 65yo 11. Pt presents with c/o increasing SOB, cough w/occasional white sputum, fatigue. As part of the plan you order labs. You know the likelihood of HF is low if the BNP is: a. 100 12. All of the following statements are true about lab values in older adults except: a. Normal ranges may not be applicable to older adults b. Abnormal findings are often due to physiological aging c. Reference ranges are preferable d. References values are not necessarily acceptable values a. B 13. According to the 2017 ACC HTN guidelines, the recommended BP goal for a 65yo African American woman w/a h/o HTN and DM and no h/o CKD is: a. 140/80 14. The pathophysiology of HF is due to: a. Inadequate cardiac output to meet the metabolic and O2 demands of the body 15. A 60yo woman w/30 pack yr hx, presents for eval of persistent, daily cough w/increased sputum, worse in the AM, occurring over past 3 months. She tells you, "I have the same thing year after year." Which of the following choices would you consider strongly in your critical thinking process? a. Chronic bronchitis 16. JM is a 68yo man who presents for a physical. He has T2DM x5yrs, diet controlled. His BMI is 32. He has HTN, smoker (10 cigs/day x20yrs). He denies other medical problems. Fam hx includes CAD, CABG x4 for dad, now deceased; CHF, T2DM, HTN for mom. He is asymptomatic today, exam is normal, EKG NSR. According to AHA/ACC guidelines, JM is at risk for what stage of HF? a. Stage A 17. The volume of air a pt is able to exhale for total duration of the test during maximal effort is: a. FVC 18. According to the 2017 ACC HTN guidelines, normal BP is: a. 120/80 19. Functional abilities are best assessed by: a. Observed assessment of function 20. LB is a 77yo pt w/chronic poorly controlled HTN. You know that goals include prevention of target organ damage. During your eval you will assess for evidence of: a. L ventricular hypertrophy 21. Aortic regurgitation requires medical treatment for early signs of HF with: a. ACEi 22. The volume of air in the lungs at max inflation is: a. TLC (total lung capacity) 23. Preferred amount of exercise for older adults is: a. 30min/day of aerobic activity 5 days/wk 24. The total volume of air a pt is able to exhale in the first second during max effort is: a. FEV1 25. You know the following statements regarding the pain of acute coronary syndrome are true except: a. Present atypically more often in men than women b. May be retrosternal or poorly localized c. May last longer than 20min d. May radiate to arms, back, neck, jaw a. A 26. Elderly pt presents w/new onset of feeling heart race, fatigue. EKG reveals afib w/rate 100. Pt also has a new tremor in both hands. Which of the following would you suspect? a. Hyperthyroidism 27. 62yo female c/o fatigue, lack of energy. Constipation increased, pt gained 10lbs in past 3mo. Depression is denied although pt reports lack of interest in usual hobbies. VS are WNL, skin is dry/cool. Which of the following must be included in the DD? a. Hypothyroidism 28. Mrs. Black, 87yo, has been taking 100mcg Synthroid x10yrs. She comes for routine follow-up, feeling well. HR is 90. Your first response is to: a. Order TSH 29. Which pt is most likely to have osteoporosis? 30. 80yo underweight male who smokes and has been on steroids for psoriasis 31. When evaluating the expected outcome for hypothyroid elderly pt on levothyroxine, you will: a. Assess TSH in 4-6wks 32. Postmenopausal woman w/osteoporosis is taking bisphosphonate daily PO. What action info statement would indicate she understood your instructions regarding this med? a. Take med w/full glass of water when up in the AM 30min before other food and meds 33. Primary reason levothyroxine sodium is initiated at low dose in elderly pt w/hypothyroidism is to prevent which of the following untoward effects? a. Angina and arrhythmia 34. 6mo ago an elderly pt was dx'd w/subclinical hypothyroidism. Today the pt returns and has TSH of 11 and c/o fatigue. He has taken Synthroid 25mcg daily as prescribed. What is the best course of action? a. Double the dose 35. A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should you teach him regarding this med? a. Its effectiveness is decreased by antacids, iron, or caffeine 36. Pt has been rx'd metformin (Glucophage). One wk later, he returns w/lowered BGL but c/o loose stools during the week. How should you respond? a. Reassure him that this is an anticipated SE 37. Which of the following s/s of hyperthyroidism commonly manifest in younger populations, but is notably lacking in elderly? a. Exopthalmos 38. 60yo obese male has T2DM and lipid panel of TC = 250, HDL = 32, LDL = 165. You teach him about his modifiable cardiac risk factors, which include: a. DM, obesity, hyperlipidemia 39. Diabetic pt presents w/R foot pain but denies any recent known injury. He states it has gotten progressively worse over past few months. On exam, vibratory sense, as well as sensation tested w/monofilament, was abnormal. Pt's foot is warm, edematous, misshapen. You suspect Charcot foot. What intervention is indicated? a. Referral to orthopedist 40. What is a s/s of insulin resistance that can present in African Americans? a. Acanthosis Nigricans 41. During routine exam of 62yo female, you ID xanthelasma around both eyes. What is the significance of this? a. Abnormal lipid metabolism requiring medical management 42. Mr. White is 62yo, had CKD that has been relatively stable. He also has h/o hyperlipidemia, OA, HTN. He is compliant w/meds, BP has been well controlled on CCB. Last lipids showed: TC = 201, HDL = 40, TG = 180, LDL = 98. He currently takes Crestor 20mg daily. Today his BP is 188/90 and urine dip shows significant proteinuria. He denies changes in dietary habits or med regimen. What would be the best med change at this point? a. Change CCB to ACEi 43. You are working as NP in Fast Track of ER. 76yo male presents w/LUQ pain. There can be many conditions that present as LUQ pain, but which of the following is least likely to cause pain here? a. Acute pancreatitis 44. Which is cardinal feature of failure to thrive? a. Poor nutritional status 45. Feeding gastrostomy tubes at end-of-life Alzheimer's pt's have been associated with: a. Aspiration pna 46. Which of the following nutritional indicators is not an indication of poor nutritional status in elderly? a. BMI 25 47. OA of cervical and lumbar spine causes pain related to all of the following except: a. Crystal deposition 48. In differentiating OA from chronic gout, pseudogout, or septic arthritis, the most valuable diagnostic study would be: a. Synovial fluid analysis 49. Pt's w/OA of hip and knee often have distinguishable gait described as: a. Antalgic 50. Which of the following best describes pain associated w/OA? a. Begins upon arising and after prolonged wt bearing and/or use of the joint 51. Joint effusions typically occur later in the course of OA, especially in the: 52. Knee 53. You ordered CBC for your pt you suspect has polymyalgia rheumatica (PMR). Which 2 clinical findings are common in pt's w/PMR? a. Normochromic, normocytic anemia and thrombocytosis 54. You suspect your pt has PMR and now are concerned that they may have Giant Cell Arteritis (GCA) too. Which of the following 2 symptoms are most indicative of GCA and PMR? a. Scalp tenderness and aching in shoulder and pelvic girdle 55. 63yo Caucasian pt w/PMR will begin Tx w/corticosteroids until the condition has resolved. You look over her records and it has been 2yrs since her last physical exam and any labs or diagnostic tests as she relocated and had not yet ID'd a provider. In prioritizing your management plan, your first orders should include: a. Duel-energy x-ray (DEXA) scan and updating immunizations 56. Which of the following DD for pt's presenting w/PMR can be ruled out w/a muscle biopsy? a. Polymyositis 57. In reviewing lab results for pt's w/suspected PMR, you realize there is no definitive test to dx PMR, rather clinical response to Tx. Results you would expect to see include: a. Elevated erythrocyte sed rate (ESR) 50 58. Which of the following is the most appropriate lab test for monitoring gout therapy over the long-term? a. Serum urate level 59. In providing health teaching related to dietary restrictions, you should advise a pt w/gout to avoid which of the following dietary items: a. Beer, sausage, fried seafood 60. The best method of verifying gout dx in a joint is which of the following: 61. Joint aspiration and polarized-light microscopy 62. The most appropriate first-line Tx for acute gout flare is (assuming no kidney dz or elevated bleeding risk): a. Indomethacin 50mg TID x2 days, then 25mg TID x3 days 63. You order bilat wrist XR on 69yo man c/o pain both wrists x6 wks no related to any known trauma. You suspect early onset RA. The initial XR finding in a pt w/elderly onset RA would be: a. Soft tissue swelling 64. You examine the hands of a 55yo woman w/RA and note bilat spindle shaped deformities on middle interphalangeal joints. These are known as: a. Haygarth's nodes 65. A 72yo female has been dx'd w/gout. She also has h/o chronic HF. The most likely contributing factor to development of gout in this older female is: a. Thiazide diuretics 66. Which of the following statements about OA is true? 67. It affects primarily wt-bearing joints 68. In considering the specificity of lab data, the most reliable diagnostic test listed below would be: a. Synovial fluid analysis to differentiate between infectious versus inflammatory infusion 69. When examining the spine of an older adult you notice a curvature w/a sharp angle. This is referred to as a: a. Gibbus 70. The prevalence of depression in nursing home residents is greater than adults living in the community. a. 3-4 times 71. The majority of depressed older adults remain untreated because of: a. Misdiagnosis, social stigma, environmental barriers 72. Symptoms of depression distinct to the elderly include: a. Lack of emotions 73. The justification for ordering CBC, TSH, serum B12 for a pt you may suspect have clinical depression is: a. Because of overlapping symptoms w/anemia, thyroid dysfunction, and nutritional deficiencies 74. One major difference that is useful in the DD of dementia versus delirium is that: a. Dementia develops slowly and delirium develops quickly 75. Which of the following is the most appropriate screening tool for delirium? a. Confusion Assessment Method 76. The proposed mechanism by which diphenhydramine causes delirium is: a. Anticholinergic effects 77. The elderly are at high risk for delirium because of: a. Multisensory declines, polypharmacy, multiple medical problems 78. A consistent finding in delirium, regardless of cause, is: a. Reduction in regional cerebral perfusion 79. Older adults w/dementia sometimes suffer from agnosia, which is defined as the inability to: a. Recognize objects 80. In late stages of dementia, a phenomenon called sun downing occurs, in which cognitive disturbances tend to: a. Become worse in the evening 81. Of the following, which one is the most useful clinical eval tool to assist in the dx of dementia? a. St. Louis University Mental Status Exam (SLUMS) 82. The cornerstone of pharmacotherapy in treating Alzheimer's is: a. Cholinesterase inhibitors 83. The comorbid psych problem w/the highest frequency in dementia is: a. Anxiety 84. When treating depression associated w/dementia, which of the following would be a poor choice and should not be prescribed? a. Amitriptyline 85. The leading COD in elderly travelers worldwide is: a. Accidents 86. Which of the following should be avoided in countries where food and water precautions are to be observed? a. Salad buffet 87. What insect precautions are not necessary to prevent insect-borne dz's in the tropics? a. Using 100% DEET on skin to prevent bites 88. An example of secondary prevention you could recommend/order for older adults would be to: a. Check for fecal occult blood 89. Ali is a 72yo man who recently came to US from Nigeria. He reports having BCG (bacille Calmette-Guerin) vax as a child. Which of the following is correct regarding a TB skin test? a. Vax hx is irrelevant; read as usual 90. Ivan is 65yo man who is new to your practice. He has h/o COPD, CAD, HTN, T2DM. He has had no immunizations since his d/c from military at 25yo. Childhood dz's include chickenpox, measles, mumps, and German measles. He presents for a dz management visit. Which of the following immunizations would you recommend for Ivan? a. Tdap, pneumococcal, influenza, Zostavax 91. Leo is a 62yo African American male who comes in for an initial visit. Personal health hx includes smoking 1 PPD since 11yo, consuming a case of beer (24 bottles) every weekend, and working as an assembler (sedentary job) for the past 10yrs. Fam Hx in first-degree relatives includes HTN, high cholesterol, MI, T2DM. Leo's BMI is 32. BP is 130/86. You order fasting glucose, lipid profile, and return visit for BP check. This is an example of: a. Secondary prevention 92. A local chapter of NP organization has begun planning a community-based screening for HTN at a local congregate living facility. This population was selected on the basis of: a. A recognized element of high risk within this group. 93. Performing ROM exercises on a pt who has had a CVA is an example of which level of prevention? a. Tertiary 94. You demonstrate an understanding of primary prevention of falling among the elderly through which management plan? a. Provide info about meds, SE, interactions 95. An example of an active strategy of health promotion for an individual to accomplish would be: a. Beginning stress management program 96. You are working w/an older adult male w/a long h/o ETOH abuse and a 30yr h/o smoking. In recommending an intervention, your responsibility is to: a. Promote positive change in lifestyle choices 97. The 4 main domains of clinical preventive services that you will provide are: a. Counseling interventions, screening tests, immunizations, chemoprophylaxis 98. Which organism that can be prevented by immunization is most often responsible for an infectious "outbreak" in the nursing home setting? a. Influenza A 99. What is the appropriate method for TB screening of an older adult entering a nursing home? a. 5 TBU intradermal PPD injection and if negative, repeat w/same dose one week later 100. Meds known to contribute to constipation include all of the following except: a. Broad-spectrum abx 101. All of the following are considered contributors to dysphagia except: a. Smooth muscle relaxants 102. The term "geriatric syndrome" is best described as: a. Condition that has multiple underlying factors and involves multiple systems 103. The anal wink reflex is used to test: a. Sensation and pudental nerve function 104. Atypical presentation of acute coronary syndrome is: a. More common in females 105. What dz can mimic and often co-exists w/MI in elderly w/CAD? a. Esophageal dz 106. Thoracic aortic dissection presents typically as: a. Severe retrosternal CP that radiates to the back and both arms 107. Bordetella pertussis is best characterized by: a. Sub-acute cough lasting 2wks 108. Routine testing of TB should occur in all of the following vulnerable populations except: a. Hospitalized elderly 109. Which of the following statements about fluid balance in elderly is false? a. Assessment of skin turgor at the sternum is a reliable indicator of dehydration in elderly. 110. Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the DD is: a. Rapid change and fluctuating course of cognitive function 111. Presbystasis is best described as: a. Age-related disequilibrium of unknown pathology characterized by gradual onset of difficulty walking 112. If dizziness has a predictable pattern associated w/it, you should first consider: a. Hypoglycemia 113. Evidence shows that the most important predictor of a fall is: a. Prior h/o a fall 114. The most cost-effective interventions used to prevent falls are: 115. Home modifications and vit D supplements 116. Chronic fatigue syndrome is best described as: 117. Fatigue lasting longer than 6mo and not relieved by rest 118. Which form of HA is bilat? 119. Tension 120. Microscopic hematuria is defined as: 121. 3 or more RBCs on 3 or mor samples of urine 122. Risk factors associated with the finding of a malignancy in a pt w/hemoptysis include all of the following except: a. Childhood asthma 123. Recent wt loss is defined as: a. Loss of 10lbs over the past 3-6mo 124. The most common cause of disability in elderly is due to: a. Arthritis 125. Lipedema is best described as: a. Bilat distribution of fat in lower extremities 126. Drug-induced pruritis is distinguished because it: a. May occur right after drug is taken or months later 127. A form of syncope that is more common in elderly than in younger adults is: a. Orthostatic hypotension 128. All of the following statements about tremor are true except: a. The most common tremor is the Parkinson tremor 129. Overflow incontinence is usually associated with: a. Bladder outlet obstruction 130. Wandering is best described as: a. Purposeful excessive ambulatory behavior 131. A key symptom of ischemic heart dz is CP. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: a. Women w/ischemic heart dz many times don't present w/CP. Some pt's may have no symptoms or atypical symptoms so dx may only be made at the time of the actual MI. 132. Which test is clinical standard for assessment of aortic stenosis? a. Echocardiogram 133. Ischemic heart dz is: a. Defined as an imbalance between O2 supply and demand. Frequently manifested as angina. Leading COD in elderly. 134. Preceding a stress test, the following lab work might include: a. CBC w/diff to differentiate ischemic heart dz from anemia. Thyroid studies to rule out hyperthyroidism. 135. On exam, what type of murmur can be auscultated w/aortic regurg? a. Austin flint 136. Which of the following statements is true regarding anti- arrhythmic drugs? a. Most anti-arrhythmics have low toxic/therapeutic ratio and some are exceedingly toxic. 137. In mitral stenosis, p waves may suggest: a. L atrial enlargement 138. Aortic regurg requires medical tx for early signs of CHF with: a. ACEi 139. The best evidence rating drugs in a post-MI pt include: a. ASA, ACEi/ARB, BB, aldosterone blockade 140. 55yo post-menopausal woman with h/o HTN c/o jaw pain on heavy exertion. No c/o CP. EKG is NSR w/out ST segment abnormalities. Your plan may include: a. Exercise stress test 141. What is the most common valvular heart dz in elderly? a. Aortic stenosis 142. Elderly may present with atypical clinical signs of pna. You need to be aware that clustering of all of the following s/s may indicate pna in the elderly except for: a. Bradycardia 143. A common auscultatory finding in CHF is: a. S3 144. The most common organism responsible for CAP in the elderly is: a. Strep pneumoniae 145. 72yo woman and her husband are driving cross- country. After a long day of driving, they stop to eat. Midway through the meal, the woman becomes very SOB w/CP and a sense of panic. Which problem is most likely? a. Pulmonary embolism 146. Exercise recommended for elderly should include activities that: a. Strengthen muscles 147. Preferred amount of exercise for elderly is: a. 30min of aerobic activity a day 5 days a week 148. Which of the following medical conditions is not considered restrictive for engaging in physical activity? a. Depression 149. The best recommendation for a pt who says they have no equipment to exercise is: a. Improvise w/recommended objects at home that can be used 150. When you recommend exercise for elderly, which of the following pieces of advice should be considered for all types of exercise? a. Start low and go slow 151. All of the following statements are true about lab values in the elderly except: a. Abnormal findings are often due to physiological aging 152. Biochemical individuality is best described as: a. Each individual's variation is often much smaller than that of a larger group 153. All the following statements about drug absorption are false except: a. Underlying chronic dz has little impact on drug absorption 154. The cytochrome p system involves enzymes that are generally: a. Inhibited or induced by drugs 155. A statement not shown to be true about pharmacodynamic changes with aging is: a. Decreased sensitivity to oral anticoagulants 156. The major impact of the physiological changes that occur w/aging is: a. Reduced physiological reserve Reduced homeostatic mechanisms Impaired immunolgoical response 157. The strongest evidence regarding normal physiological aging is available through: a. Longitudinal studies 158. Pharmacokinetic changes w/aging is reflective of: a. What the body does to the drug 159. All of the following statements are true about drug distribution in the elderly except: a. Drugs distributed in water have lower concentration 160. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: a. Testosterone 161. Atypical presentation of dz in elderly is reflected by all the following except: a. MI w/CP and diaphoresis 162. Polypharmacy is best described as taking: a. Even a single med if there is not a clear indication for its use