WALDEN UNIVERSITY NRNP6645 PSYCHOTHERAPY WITH
MULTIPLE MODALITIES MIDTERM EXAM (I)
Mrs. Smith, who is 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:
1. All body systems interact, and symptoms could indicate a
variety of diagnoses.
2. The symptoms are vague and may be signs of aging.
3. There may be other signs or symptoms more indicative of the
condition.
4. Mrs. Smith may not be reporting all significant information. -
ANSWER ->1. All body systems interact, and symptoms could
indicate a variety of diagnoses.
*The clinician must be aware that all the systems interact and,
in doing so, can increase the older adult's vulnerability to
illness/disease.
A patient with renal disease has blood work drawn, and the
results show an increase in serum creatinine. Which of the
following laboratory values does the advanced practice
registered nurse (APRN) need to know before ordering
medications?
1. Complete blood count
,2. Culture and sensitivity of the urine
3. Creatinine clearance
4. Uric acid levels - ANSWER ->3. Creatinine clearance
*The calculation of creatinine clearance provides an estimation
of renal function.
Which of the following statements is true regarding diagnostic
testing?
1. A test is ordered for a specific purpose.
2. More invasive tests are the best option.
3. There is no need to discuss results with the patient.
4. If a test is needed, it should be ordered regardless of risk to
the patient. - ANSWER ->1. A test is ordered for a specific
purpose.
*The APRN should have a plan for the use of each test result
value obtained.
Janey, who is 25 years old, may experience arthritis differently
than 65-year-old Mrs. Johnson because:
1. The body undergoes physiological changes with aging, which
changes how diseases present.
2. A healthy body does not experience significant changes as
one gets older.
3. Older adults do not feel any constitutional symptoms, such
as malaise and weight loss.
,4. Even though the same joints are usually affected, age makes
arthritis pain feel different. - ANSWER ->1. The body undergoes
physiological changes with aging, which changes how diseases
present.
*Knowledge of the bimodality of age onset of certain disease
conditions, such as knowing that the same disease may present
differently in a 25 year old versus a 65 year old, will aid the
APRN in avoiding misdiagnosis or delay in diagnosis due to lack
of recognition.
The APRN is examining an 85-year-old man with reports of
vague abdominal symptoms, new onset constipation, and
somatic complaints. These symptoms may be an atypical
presentation of which illness?
1. Depression
2. Heart failure
3. Hypothyroidism
4. Malignancy - ANSWER ->1. Depression
1. The older adult may have atypical presentations of some
conditions. These symptoms may be atypical presentation of
depression.
2. Atypical presentation of heart failure in the older adult may
include anorexia, confusion, and nocturia.
3. Atypical presentation of hypothyroidism may include
confusion and agitation, new onset of anorexia, and ataxia.
, 4. Atypical presentation of malignancies may be new or
worsening back pain secondary to metastases from slow
growing breast masses or silent masses of the bowel.
A gerontological patient is being examined for a report of pain
in the shoulder. The APRN completes a thorough systemic
examination because:
1. Older adults with one morbidity often express difficulties in
general.
2. Arthritis of the shoulders can be accompanied by other
neurological symptoms.
3. Older adults with arthritis often experience pain in the lower
extremities.
4. The older adult may not report significant signs and
symptoms. - ANSWER ->1. Older adults with one morbidity
often express difficulties in general.
1. Older patients with late-onset RA 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 adults may express symptoms in any other physical
systems.
3. Patients more often experience arthritis in smaller joints.
4. A thorough examination will detect objective indicators.
The APRN performs a thorough systemic examination of a
patient who reports melena, weight loss, intermittent
MULTIPLE MODALITIES MIDTERM EXAM (I)
Mrs. Smith, who is 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:
1. All body systems interact, and symptoms could indicate a
variety of diagnoses.
2. The symptoms are vague and may be signs of aging.
3. There may be other signs or symptoms more indicative of the
condition.
4. Mrs. Smith may not be reporting all significant information. -
ANSWER ->1. All body systems interact, and symptoms could
indicate a variety of diagnoses.
*The clinician must be aware that all the systems interact and,
in doing so, can increase the older adult's vulnerability to
illness/disease.
A patient with renal disease has blood work drawn, and the
results show an increase in serum creatinine. Which of the
following laboratory values does the advanced practice
registered nurse (APRN) need to know before ordering
medications?
1. Complete blood count
,2. Culture and sensitivity of the urine
3. Creatinine clearance
4. Uric acid levels - ANSWER ->3. Creatinine clearance
*The calculation of creatinine clearance provides an estimation
of renal function.
Which of the following statements is true regarding diagnostic
testing?
1. A test is ordered for a specific purpose.
2. More invasive tests are the best option.
3. There is no need to discuss results with the patient.
4. If a test is needed, it should be ordered regardless of risk to
the patient. - ANSWER ->1. A test is ordered for a specific
purpose.
*The APRN should have a plan for the use of each test result
value obtained.
Janey, who is 25 years old, may experience arthritis differently
than 65-year-old Mrs. Johnson because:
1. The body undergoes physiological changes with aging, which
changes how diseases present.
2. A healthy body does not experience significant changes as
one gets older.
3. Older adults do not feel any constitutional symptoms, such
as malaise and weight loss.
,4. Even though the same joints are usually affected, age makes
arthritis pain feel different. - ANSWER ->1. The body undergoes
physiological changes with aging, which changes how diseases
present.
*Knowledge of the bimodality of age onset of certain disease
conditions, such as knowing that the same disease may present
differently in a 25 year old versus a 65 year old, will aid the
APRN in avoiding misdiagnosis or delay in diagnosis due to lack
of recognition.
The APRN is examining an 85-year-old man with reports of
vague abdominal symptoms, new onset constipation, and
somatic complaints. These symptoms may be an atypical
presentation of which illness?
1. Depression
2. Heart failure
3. Hypothyroidism
4. Malignancy - ANSWER ->1. Depression
1. The older adult may have atypical presentations of some
conditions. These symptoms may be atypical presentation of
depression.
2. Atypical presentation of heart failure in the older adult may
include anorexia, confusion, and nocturia.
3. Atypical presentation of hypothyroidism may include
confusion and agitation, new onset of anorexia, and ataxia.
, 4. Atypical presentation of malignancies may be new or
worsening back pain secondary to metastases from slow
growing breast masses or silent masses of the bowel.
A gerontological patient is being examined for a report of pain
in the shoulder. The APRN completes a thorough systemic
examination because:
1. Older adults with one morbidity often express difficulties in
general.
2. Arthritis of the shoulders can be accompanied by other
neurological symptoms.
3. Older adults with arthritis often experience pain in the lower
extremities.
4. The older adult may not report significant signs and
symptoms. - ANSWER ->1. Older adults with one morbidity
often express difficulties in general.
1. Older patients with late-onset RA 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 adults may express symptoms in any other physical
systems.
3. Patients more often experience arthritis in smaller joints.
4. A thorough examination will detect objective indicators.
The APRN performs a thorough systemic examination of a
patient who reports melena, weight loss, intermittent
