1
NR 601 Midterm Exam Review Questions With
Correct Detailed Answers
● 75 questions- one at a time/1 minute per question
● Assess, diagnose, treat, who is at risk, what are the risk factors
● Define, prioritize, diagnose, treat, or plan
● Principles of Primary Care of Older Adults
Rule of fourths- ¼-disease, ¼ disuse, ¼ Misuse, ¼ Physiological aging -knowing which one can
help to decide how will treat.
● Developmental changes
No developmental norms for later ages- protocols less valuable, and care must be
individualized.
● Age-related changes -
Decreased functional
reserve-
Eyesight decreases, average age needs reading glasses 50
Fertility peaks and declines.
The amount of sway with the eye closed increases the older one gets.
Reduced stamina and fatigue
Categories of aging
● Incontinence- Common chronic conditions, underrecognized and underreported.
○ Symptoms- pain, bloating, and gas
○ Definition of constipation- infrequent passage of stool. May have straining
to defecate or feelings of incomplete stool,
■ Rome IV criteria- 2 or more- straining, hard lumpy stool, the
sensation of incomplete stool, using digital maneuvers to remove
stool, the sensation of blockage with 25% BM, decrease in stool
frequency.
■ Types of constipation- Slow transit, dyssynergia constipation, IBS-C
○ Definition of incontinence- involuntary loss of liquid or solid stool that is a
social or hygienic problem.
■ Types of incontinence-
● Urgency FI- strong urgency followed by inability to hold stool
in.
● Passive FI- Bowel blockage without sensation, cannot
differential passing gas vs FI. May have seepage after BM
● Overflow FI- More common in older adults with impaired
, 2
mobility and functional impairments. Associated with
constipation, treating constipation can help improve this.
○ Treatment
■ Nonpharmacologic- diet modifications- including increasing fiber and
fluids, exercise, Bowel habit training, probiotics
, 3
■ Pharmacologic- bulk-forming laxatives, stool softeners, osmotic
laxatives, stimulant laxatives.
○ Treatment of fecal impaction- digital rectal exam is necessary. The large
amount of stool in the rectum. KUB can help to quantify this. Disimpaction
and colon evacuation are necessary to resolve this. A warm water enema
can help. In rare cases colonoscopy is necessary.
● SKIN-Pressure wounds.
○ Intrinsic factors- those that alter skin integrity. They include limited
mobility; medical comorbidities such as diabetes, COPD, congestive heart
failure, or other medical conditions affecting perfusion and oxygenation,
malignancy, and renal dysfunction; poor nutrition; and aging skin
changes.
○ Extrinsic factors- those external factors that can damage the skin.
They include pressure, friction, shear, and moisture.
● Health promotion for older adults
○ vaccines: Tetanus every ten years,
Diphtheria once after age 65
Pneumococcal 1 Dose PPSV-23, high-risk 2nd shot PCB 13 Flu
yearly
shingles two doses 2-5 months apart
Hep A/B only if high risk one time
● Screenings: USPSTF
Bone health osteoarthritis- Bone density test- At least once in women over 65.
○ Colorectal 50-75 yearly fecal occult blood, every 5 yrs CT, every 10 years
colonoscopy age 76-85 only selectively based on individual
○ Breast cancer: biennial 50-74 Breast exam inconclusive
○ Lung: 50-80 with 20+ pack history and quit within the last 15 years
○ Cervical cancer: every three years starting at 21, stop at age 65
○ Prostate: 50 to 64 years - hard to determine if benefits outweigh the
risks. This could lead to the potential harm of false positives and people
receiving treatment who did not need it. Over the age of 70, PSA is not
needed.
● Education:
○ Smoking cessation- Lower risk of cancer, heart attack, breathing, and lowers
blood pressure. Regardless of age can have positive results. Use both behavioral
approach and pharmacology. 5 A’s assess, advise, agree, assist, and arrange
○ Aerobic exercise and strength training, essential for healthy aging, 150 minutes
a week recommended. Tailor the amount of exercise to patient
○ Write exercise prescription- 150 minutes/week goal for older adults
● BEERS criteria and polypharmacy
NR 601 Midterm Exam Review Questions With
Correct Detailed Answers
● 75 questions- one at a time/1 minute per question
● Assess, diagnose, treat, who is at risk, what are the risk factors
● Define, prioritize, diagnose, treat, or plan
● Principles of Primary Care of Older Adults
Rule of fourths- ¼-disease, ¼ disuse, ¼ Misuse, ¼ Physiological aging -knowing which one can
help to decide how will treat.
● Developmental changes
No developmental norms for later ages- protocols less valuable, and care must be
individualized.
● Age-related changes -
Decreased functional
reserve-
Eyesight decreases, average age needs reading glasses 50
Fertility peaks and declines.
The amount of sway with the eye closed increases the older one gets.
Reduced stamina and fatigue
Categories of aging
● Incontinence- Common chronic conditions, underrecognized and underreported.
○ Symptoms- pain, bloating, and gas
○ Definition of constipation- infrequent passage of stool. May have straining
to defecate or feelings of incomplete stool,
■ Rome IV criteria- 2 or more- straining, hard lumpy stool, the
sensation of incomplete stool, using digital maneuvers to remove
stool, the sensation of blockage with 25% BM, decrease in stool
frequency.
■ Types of constipation- Slow transit, dyssynergia constipation, IBS-C
○ Definition of incontinence- involuntary loss of liquid or solid stool that is a
social or hygienic problem.
■ Types of incontinence-
● Urgency FI- strong urgency followed by inability to hold stool
in.
● Passive FI- Bowel blockage without sensation, cannot
differential passing gas vs FI. May have seepage after BM
● Overflow FI- More common in older adults with impaired
, 2
mobility and functional impairments. Associated with
constipation, treating constipation can help improve this.
○ Treatment
■ Nonpharmacologic- diet modifications- including increasing fiber and
fluids, exercise, Bowel habit training, probiotics
, 3
■ Pharmacologic- bulk-forming laxatives, stool softeners, osmotic
laxatives, stimulant laxatives.
○ Treatment of fecal impaction- digital rectal exam is necessary. The large
amount of stool in the rectum. KUB can help to quantify this. Disimpaction
and colon evacuation are necessary to resolve this. A warm water enema
can help. In rare cases colonoscopy is necessary.
● SKIN-Pressure wounds.
○ Intrinsic factors- those that alter skin integrity. They include limited
mobility; medical comorbidities such as diabetes, COPD, congestive heart
failure, or other medical conditions affecting perfusion and oxygenation,
malignancy, and renal dysfunction; poor nutrition; and aging skin
changes.
○ Extrinsic factors- those external factors that can damage the skin.
They include pressure, friction, shear, and moisture.
● Health promotion for older adults
○ vaccines: Tetanus every ten years,
Diphtheria once after age 65
Pneumococcal 1 Dose PPSV-23, high-risk 2nd shot PCB 13 Flu
yearly
shingles two doses 2-5 months apart
Hep A/B only if high risk one time
● Screenings: USPSTF
Bone health osteoarthritis- Bone density test- At least once in women over 65.
○ Colorectal 50-75 yearly fecal occult blood, every 5 yrs CT, every 10 years
colonoscopy age 76-85 only selectively based on individual
○ Breast cancer: biennial 50-74 Breast exam inconclusive
○ Lung: 50-80 with 20+ pack history and quit within the last 15 years
○ Cervical cancer: every three years starting at 21, stop at age 65
○ Prostate: 50 to 64 years - hard to determine if benefits outweigh the
risks. This could lead to the potential harm of false positives and people
receiving treatment who did not need it. Over the age of 70, PSA is not
needed.
● Education:
○ Smoking cessation- Lower risk of cancer, heart attack, breathing, and lowers
blood pressure. Regardless of age can have positive results. Use both behavioral
approach and pharmacology. 5 A’s assess, advise, agree, assist, and arrange
○ Aerobic exercise and strength training, essential for healthy aging, 150 minutes
a week recommended. Tailor the amount of exercise to patient
○ Write exercise prescription- 150 minutes/week goal for older adults
● BEERS criteria and polypharmacy
