Older Adults Ch. 1 - 11
1. 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.: 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.
2. 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: 3. Creatinine clearance
*The calculation of creatinine clearance provides an estimation of renal function.
3. 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.:
1. A test is ordered for a specific purpose.
, Older Adults Ch. 1 - 11
*The APRN should have a plan for the use of each test result value obtained.
4. 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.: 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.
5. 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: 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.
, Older Adults Ch. 1 - 11
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.
6. 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.: 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.
7. The APRN performs a thorough systemic examination of a patient who
reports melena, weight loss, intermittent confusion, and dyspepsia. The older
adult denies abdominal pain. One possible diagnosis would be:
1. Pneumonia
2. Ulcerative colitis
3. Appendicitis
4. Peptic ulcer disease: 4. Peptic ulcer disease
1. Pneumonia in the older adult may present with mild cough, tachycardia and
tachypnea, anorexia, and other atypical symptoms.
2. Diarrhea is associated with ulcerative colitis.
3. Appendicitis is more common in younger patients than in older patients. The
older adult may experience pain in the right lower abdomen that becomes
diffuse.
, Older Adults Ch. 1 - 11
4. Peptic ulcer disease is manifested differently in a bimodal pattern. It presents in
the older adults with no abdominal pain, melena, dyspepsia, anorexia,
confusion, and other atypical symptoms.
8. An older woman is being seen in the ambulatory clinic for a routine
check-up. The patient asks about results of her blood work compared to last
year's results. Which response is best for the clinician to offer?
1. They are likely to be the same if you have had no diseases since then.
2. Your results may be different because the body changes with disease and
medications you are taking.
3. Blood work is not a reliable indicator of health because many things can
affect your health that may not show up in the results of your blood work.
4. There is likely no significant difference if your body remains stable in
its functioning.: 2. Your results may be different because the body changes
with disease and medications you are taking.
1. Biochemical individuality variation is often much smaller than variation within the
larger group.
2. Disease, nutrition, and medications affect health in older adults.
3. Although abnormal laboratory findings are often attributed to old age, rarely are
they true aging changes.
4. Many factors can influence laboratory value interpretation in the older adult,
including the physiological changes with aging, the prevalence of chronic
disease, changes in nutritional and fluid intake, lifestyle (including activity), and
the medications taken.
9. For individuals over 65, the most common morbidities are related to
which of the following? Select all that apply.
1. Heart disease
2. Respiratory problems
3. Diabetes
4. Cancer
5. Stroke: Answer: 1, 2, 3, 4, 5
1. 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.: 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.
2. 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: 3. Creatinine clearance
*The calculation of creatinine clearance provides an estimation of renal function.
3. 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.:
1. A test is ordered for a specific purpose.
, Older Adults Ch. 1 - 11
*The APRN should have a plan for the use of each test result value obtained.
4. 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.: 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.
5. 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: 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.
, Older Adults Ch. 1 - 11
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.
6. 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.: 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.
7. The APRN performs a thorough systemic examination of a patient who
reports melena, weight loss, intermittent confusion, and dyspepsia. The older
adult denies abdominal pain. One possible diagnosis would be:
1. Pneumonia
2. Ulcerative colitis
3. Appendicitis
4. Peptic ulcer disease: 4. Peptic ulcer disease
1. Pneumonia in the older adult may present with mild cough, tachycardia and
tachypnea, anorexia, and other atypical symptoms.
2. Diarrhea is associated with ulcerative colitis.
3. Appendicitis is more common in younger patients than in older patients. The
older adult may experience pain in the right lower abdomen that becomes
diffuse.
, Older Adults Ch. 1 - 11
4. Peptic ulcer disease is manifested differently in a bimodal pattern. It presents in
the older adults with no abdominal pain, melena, dyspepsia, anorexia,
confusion, and other atypical symptoms.
8. An older woman is being seen in the ambulatory clinic for a routine
check-up. The patient asks about results of her blood work compared to last
year's results. Which response is best for the clinician to offer?
1. They are likely to be the same if you have had no diseases since then.
2. Your results may be different because the body changes with disease and
medications you are taking.
3. Blood work is not a reliable indicator of health because many things can
affect your health that may not show up in the results of your blood work.
4. There is likely no significant difference if your body remains stable in
its functioning.: 2. Your results may be different because the body changes
with disease and medications you are taking.
1. Biochemical individuality variation is often much smaller than variation within the
larger group.
2. Disease, nutrition, and medications affect health in older adults.
3. Although abnormal laboratory findings are often attributed to old age, rarely are
they true aging changes.
4. Many factors can influence laboratory value interpretation in the older adult,
including the physiological changes with aging, the prevalence of chronic
disease, changes in nutritional and fluid intake, lifestyle (including activity), and
the medications taken.
9. For individuals over 65, the most common morbidities are related to
which of the following? Select all that apply.
1. Heart disease
2. Respiratory problems
3. Diabetes
4. Cancer
5. Stroke: Answer: 1, 2, 3, 4, 5
