GERONTOLOGY HESI TEST WITH 100
QUESTIONS AND ANSWERS.
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 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.
~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.
~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 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.
~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 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.
, ~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 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.
~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 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
QUESTIONS AND ANSWERS.
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 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.
~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.
~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 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.
~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 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.
, ~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 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.
~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 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
