NS431 Final Exam Questions with
Correct Answers Latest Update
Aging in place - Answer-Housing designs and renovations that allow elderly citizens to
remain in their homes longer
Chronic care rehab goal - Answer-To achieve the highest level of independence
possible.
education for older adults - Answer-Eye contact
LISTEN, Speak clearly.
Supplement verbal instruction with clear, written instructions.
Paraphrase
Use pictures and drawings to enhance written message
Consider "elder culture"
Patient must participate actively in goal setting
Reduce environmental distractions
Age related changes - Answer-Senses may be diminished
Thinner, frail skin
Auditory: hearing loss (more hair growth in the ears) → hard time hearing
Integumentary: wrinkling, easy bruising, dry/flaky skin, thin, tears easily
Respiratory: diminished lung sounds in the bases, barrel chest
Hematological: decreased immune (more likely to get infections)
Cardiovascular: arterial stiffening, slower to recover from exercise
GI: indigestion food intolerances
Urinary: incontinence, decreased kidney function (CAREFUL with meds
Musculoskeletal: decreased strength/agility
Delirium - Answer-Temporary state of mental confusion
Dementia - Answer-degenerative disorder of the mental processes marked by memory
disorders, personality changes, and impaired reasoning.
Primary dementia - Answer-it happened on its own, no other diseases that caused it.
With primary, you cannot fix it
two types: Vascular Dementia (VD) and Neurodegenerative
Vascular dementia - Answer-20% of pt with primary dementia
blood flow to the brain is impaired. A stroke could cause this
abrupt onset, one step forward, two steps back pattern (goes from normal to confused
back to normal)
Neurodegenerative Dementia - Answer-60%-80% - Alzheimer's
,slow, progressive loss of function
Secondary Dementia - Answer-happens because of a disease or other illness. Typically
treatable and reversible
AIDS dementia complex
Korsakoff's syndrome
Delirium clinical manifestations - Answer-onset: 2-3 days; duration: 1-7 days
Early: restlessness, insomnia, loss of appetite, confusion
Late: agitation, hallucinations
Nursing management delirium - Answer-Nursing management
3 major nursing roles (PET) - Prevention, Early recognition, Treatment
Focus → protect the patient from harm
Reorient patient and environment modifications
Drug therapy: Pay attention to # of meds, drug-to-drug interactions, how a particular
drug affects that patient (can have opposite effect sometimes)
Diagnostic studies delirium - Answer-Medical history, physical exam, medications (>4 =
higher risk)
Diagnostic studies dementia - Answer-MMSE: reliable assessment/screening tool
Depression screening
Sundowning - Answer-Disruption of a circadian rhythm with symptoms in the evening or
late afternoon
Nursing intervention sundowning - Answer-Remain calm, avoid confrontation. Keep a
calm environment and help correct sleep patterns, evaluate meds, limit daytime naps
maximize exposure to daylight, and caffeine, familiar attendants: family can help
Mild stage of dementia - Answer-a bit forgetful, can't seem to remember certain words
or remember numbers.
Easy to miss because not a ton of symptoms
Losing interest in hobbies
Moderate stage of dementia - Answer-start to forget family members, pace a lot, and
get agitated/easily argumentative
delusions
Long term memory starts to fade away
they can get lost easily
Still mostly mobile
Severe stage of dementia - Answer-can't take care of themselves or form new
memories/ process new info
Don't know who they ar/ recognize themselves in mirror or what is going on.
, ROUTINE Is very important.
Difficulty eating, swallowing, immobile, incontinent, word repetition
diagnostic for dementia - Answer-Assessments: mini cog is a test that can be
administered for cognition
Diagnosis of exclusion
Comprehensive patient evaluation: MSE, lab tests, physical exam, history
Overall goals for pt with dementia - Answer-1. Maintain a safe environment
2. Maintain cognitive function for as long as possible
3. Personal care needs met
4. Dignity maintained
5. Evaluate burden on family→ connect to resources (daycare centers/long-term
facilities)
6. COMMUNICATION is huge with these patients/families
What is important when we sense a burden? - Answer-Reduce caregiver stress and
connect them to resources like daycares for the adults and other interventions to
provide relief
Rheumatoid Arthritis - Answer-Chronic, systemic autoimmune disease
Inflammation of connective tissue in diarthrodial (synovial) joints
Periods of remission and exacerbation
Frequently accompanied by extra-articular manifestations (outside the affected joint)
Osteoarthiritis (OA) - Answer-Slowly progressive non inflammatory disorder of the
diarthrodial joints
Cartilage is lost making bone rub against each other
Osteoporosis - Answer-Chronic, progressive metabolic bone disease characterized by:
Low bone mass
Increased bone fragility (which leads to fractures)
When reabsorption >deposit = osteoporosis
Complications of osteoporosis - Answer-Often silent or asymptomatic
Back pain
Fractures easily
Getting shorter over time
Spinal deformity (kyphosis- humpback, curvature)
Risk factors of osteoporosis - Answer-age > 50, family history, white or asian ethnicity,
small stature, females (less calcium intake, smaller frame, live longer), early
menopause, breastfeeding without adequate supplementation, excess alcohol
(insufficient nutrients), cigarette smoking, anorexia, sedentary lifestyle, excessive
caffeine intake, low testosterone levels (men), long term corticosteroid use
Correct Answers Latest Update
Aging in place - Answer-Housing designs and renovations that allow elderly citizens to
remain in their homes longer
Chronic care rehab goal - Answer-To achieve the highest level of independence
possible.
education for older adults - Answer-Eye contact
LISTEN, Speak clearly.
Supplement verbal instruction with clear, written instructions.
Paraphrase
Use pictures and drawings to enhance written message
Consider "elder culture"
Patient must participate actively in goal setting
Reduce environmental distractions
Age related changes - Answer-Senses may be diminished
Thinner, frail skin
Auditory: hearing loss (more hair growth in the ears) → hard time hearing
Integumentary: wrinkling, easy bruising, dry/flaky skin, thin, tears easily
Respiratory: diminished lung sounds in the bases, barrel chest
Hematological: decreased immune (more likely to get infections)
Cardiovascular: arterial stiffening, slower to recover from exercise
GI: indigestion food intolerances
Urinary: incontinence, decreased kidney function (CAREFUL with meds
Musculoskeletal: decreased strength/agility
Delirium - Answer-Temporary state of mental confusion
Dementia - Answer-degenerative disorder of the mental processes marked by memory
disorders, personality changes, and impaired reasoning.
Primary dementia - Answer-it happened on its own, no other diseases that caused it.
With primary, you cannot fix it
two types: Vascular Dementia (VD) and Neurodegenerative
Vascular dementia - Answer-20% of pt with primary dementia
blood flow to the brain is impaired. A stroke could cause this
abrupt onset, one step forward, two steps back pattern (goes from normal to confused
back to normal)
Neurodegenerative Dementia - Answer-60%-80% - Alzheimer's
,slow, progressive loss of function
Secondary Dementia - Answer-happens because of a disease or other illness. Typically
treatable and reversible
AIDS dementia complex
Korsakoff's syndrome
Delirium clinical manifestations - Answer-onset: 2-3 days; duration: 1-7 days
Early: restlessness, insomnia, loss of appetite, confusion
Late: agitation, hallucinations
Nursing management delirium - Answer-Nursing management
3 major nursing roles (PET) - Prevention, Early recognition, Treatment
Focus → protect the patient from harm
Reorient patient and environment modifications
Drug therapy: Pay attention to # of meds, drug-to-drug interactions, how a particular
drug affects that patient (can have opposite effect sometimes)
Diagnostic studies delirium - Answer-Medical history, physical exam, medications (>4 =
higher risk)
Diagnostic studies dementia - Answer-MMSE: reliable assessment/screening tool
Depression screening
Sundowning - Answer-Disruption of a circadian rhythm with symptoms in the evening or
late afternoon
Nursing intervention sundowning - Answer-Remain calm, avoid confrontation. Keep a
calm environment and help correct sleep patterns, evaluate meds, limit daytime naps
maximize exposure to daylight, and caffeine, familiar attendants: family can help
Mild stage of dementia - Answer-a bit forgetful, can't seem to remember certain words
or remember numbers.
Easy to miss because not a ton of symptoms
Losing interest in hobbies
Moderate stage of dementia - Answer-start to forget family members, pace a lot, and
get agitated/easily argumentative
delusions
Long term memory starts to fade away
they can get lost easily
Still mostly mobile
Severe stage of dementia - Answer-can't take care of themselves or form new
memories/ process new info
Don't know who they ar/ recognize themselves in mirror or what is going on.
, ROUTINE Is very important.
Difficulty eating, swallowing, immobile, incontinent, word repetition
diagnostic for dementia - Answer-Assessments: mini cog is a test that can be
administered for cognition
Diagnosis of exclusion
Comprehensive patient evaluation: MSE, lab tests, physical exam, history
Overall goals for pt with dementia - Answer-1. Maintain a safe environment
2. Maintain cognitive function for as long as possible
3. Personal care needs met
4. Dignity maintained
5. Evaluate burden on family→ connect to resources (daycare centers/long-term
facilities)
6. COMMUNICATION is huge with these patients/families
What is important when we sense a burden? - Answer-Reduce caregiver stress and
connect them to resources like daycares for the adults and other interventions to
provide relief
Rheumatoid Arthritis - Answer-Chronic, systemic autoimmune disease
Inflammation of connective tissue in diarthrodial (synovial) joints
Periods of remission and exacerbation
Frequently accompanied by extra-articular manifestations (outside the affected joint)
Osteoarthiritis (OA) - Answer-Slowly progressive non inflammatory disorder of the
diarthrodial joints
Cartilage is lost making bone rub against each other
Osteoporosis - Answer-Chronic, progressive metabolic bone disease characterized by:
Low bone mass
Increased bone fragility (which leads to fractures)
When reabsorption >deposit = osteoporosis
Complications of osteoporosis - Answer-Often silent or asymptomatic
Back pain
Fractures easily
Getting shorter over time
Spinal deformity (kyphosis- humpback, curvature)
Risk factors of osteoporosis - Answer-age > 50, family history, white or asian ethnicity,
small stature, females (less calcium intake, smaller frame, live longer), early
menopause, breastfeeding without adequate supplementation, excess alcohol
(insufficient nutrients), cigarette smoking, anorexia, sedentary lifestyle, excessive
caffeine intake, low testosterone levels (men), long term corticosteroid use
