NR 601 Midterm Exam Comprehensive
StudyGuide (Weeks 1-4) Content. MOST
RELIABLE FOR BEST SCORES 2023/2025
The rules of fourths
clarifies that changes often attributed to normal aging by the general
public (and sometimes by medical professionals) are caused by disease,
disuse, misuse, and physiology—about one-fourth of the time for each.
Normal physiologic changes
• The age at which reading glasses are needed because of reduced lens
elasticity is between 42 and 50 years.
• Vestibular sensitivity gradually increases until about age 60 years, which
is one of the reasons why adults have increasing trouble on amusement
park rides as they age.
• Fertility in women peaks between 15 and 25 years and declines
thereafter, with menopause typically occurring about age 50 years.
• Reaction time tends to increase with age (which explains why teenagers
are usually far better at games of speed—including many video games—
than older persons).
• The amount of sway a person will experience if asked to stand still with
eyes closed is high in early childhood, is minimized between about ages
15 and 16 years, and then gradually increases beyond age 60 years.
• Ankle jerk reflexes are increasingly diminished or absent with older age,
in the absence of detectable musculoskeletal pathology.
• Bone density plateaus between ages 20 and 50 years, then gradually
declines, with the slope of decline being more rapid in women than in
men.
Iatrogenic disease
,Illness caused by medical interventions, known as iatrogenic illness, is
one of the most common medical problems of older persons.
Which one of the following is most true about the rule of fourths?
a. One-fourth of geriatric problems are iatrogenic.
b. Little can be done to prevent three-fourths of the problems of aging.
c. For every medical complaint a patient presents with, a careful
assessment can identify three other diagnoses.
d. What used to be called normal aging can be largely explained by
processes that are not normal.
e. A good way to conduct a geriatric assessment is to use four
categories: mental, physical, psychosocial, and environmental
D
Which one of the following is most true about aging changes?
a. Stage 3 and 4 sleep decreases.
b. Renal perfusion is not reduced, but renal function is reduced.
c. Hearing acuity declines beginning in middle age.
d. Prostatic enlargement occurs only in a minority of men.
A
An old woman who is cared for by attentive, cautious, concerned family
is particularly likely to suffer from which one of the following
complications after an episode of gastroenteritis?
a. Immobility related to overconcern
b. Continued vomiting caused by too-rapid feeding
c. Diarrhea resulting from administration of milk products
d. Constipation related to overtreatment of diarrhea
A
Which one of the following is most true about psychological aging?
a. Disengagement tends to promote better psychological health than
continued engagement.
b. Most older adults do not worry about memory loss.
c. Happiness declines starting in middle age.
d. Ageism can lead to isolation and depression.
D
,Of the following conditions, which one is most common and most often
preventable?
a. Falls
b. Frailty
c. Cognitive impairment
d. Iatrogenic disease
e. Depression
D
Immunizations recommended for older Adults
Influenza inactive (IIV), or recombinant (RIV): 1 dose annually
Tetanus, diphtheria, pertussis (TDAP): 1 dose after age 65 years then Td
every 10 years
Varicella recombinant (Shingrix): 2 doses 2-5 months apart. Give to those
who had zoster
Pneumococcal: 1 dose of PPSV23 (Polysaccharide, Pneumovax);
consider 1 dose PCV 13 in high-risk patients
Hepatitis A/hepatitis B: Only if high risk, and at least once
Vaccine costs
Medicare Part B covers vaccines to prevent influenza and pneumonia, as
well as hepatitis B if the patient is at medium to high risk for this disease.
No copay is associated with these vaccines. All other vaccines are
covered under Medicare Part D; this includes the vaccine for zoster.
Zostavax
can be used when there is a Shingrix allergy, if a patient prefers the
Zostavax, or the patient wishes an immediate vaccination and Shingrix is
unavailable. The vaccination is recommended even if a patient is unsure
about having chickenpox in the past
The Five A's
Assess
Ask about behavioral health risks and other factors that affect health goal
change.
Advise
, Provide clear, targeted behavior change advice, along with information as
to potential harms/benefits.
Agree
Work together on selection of appropriate, achievable treatment goals,
and methods, based on patient’s buy-in and willingness to change.
Assist
Guide the patient to achieve the agreed-upon goals by fostering self-
confidence, along with providing additional medical treatments when
needed. Help the patient with social/environmental supports for behavior
change.
Arrange
Schedule follow-up visits or phone conversations to provide ongoing
support, and adjust treatment plan as needed. Include any referrals for
more specialized treatment.
Pharmacological interventions for smoking cessation
bupropion SR; nicotine replacement therapy (NRT) with gum, inhaler,
lozenge, nasal spray, or patch; and varenicline (Chantix).
Polypharmacy
is the use of more medications than are clinically needed or indicated.
Older adults are at particular risk for polypharmacy because of multiple
comorbidities and because they see multiple healthcare providers. One
way to reduce polypharmacy is to try nonpharmacologic therapies first.
Interventions may include diet, exercise, stress management, and
cognitive-behavioral therapy. Moreover, combining behavioral
interventions with medications may reduce the drug dosages needed for
effect. Clinicians should also make certain to be very clear about drug use
instructions and possible side effects. Always provide both verbal and
written instructions on how to use the medication. Drug regimens should
be as simple as possible and medications need thorough review and
updating at each provider-patient interaction
Classes of medications that interact with alcohol
Antibiotics
Nonnarcotic pain relievers
StudyGuide (Weeks 1-4) Content. MOST
RELIABLE FOR BEST SCORES 2023/2025
The rules of fourths
clarifies that changes often attributed to normal aging by the general
public (and sometimes by medical professionals) are caused by disease,
disuse, misuse, and physiology—about one-fourth of the time for each.
Normal physiologic changes
• The age at which reading glasses are needed because of reduced lens
elasticity is between 42 and 50 years.
• Vestibular sensitivity gradually increases until about age 60 years, which
is one of the reasons why adults have increasing trouble on amusement
park rides as they age.
• Fertility in women peaks between 15 and 25 years and declines
thereafter, with menopause typically occurring about age 50 years.
• Reaction time tends to increase with age (which explains why teenagers
are usually far better at games of speed—including many video games—
than older persons).
• The amount of sway a person will experience if asked to stand still with
eyes closed is high in early childhood, is minimized between about ages
15 and 16 years, and then gradually increases beyond age 60 years.
• Ankle jerk reflexes are increasingly diminished or absent with older age,
in the absence of detectable musculoskeletal pathology.
• Bone density plateaus between ages 20 and 50 years, then gradually
declines, with the slope of decline being more rapid in women than in
men.
Iatrogenic disease
,Illness caused by medical interventions, known as iatrogenic illness, is
one of the most common medical problems of older persons.
Which one of the following is most true about the rule of fourths?
a. One-fourth of geriatric problems are iatrogenic.
b. Little can be done to prevent three-fourths of the problems of aging.
c. For every medical complaint a patient presents with, a careful
assessment can identify three other diagnoses.
d. What used to be called normal aging can be largely explained by
processes that are not normal.
e. A good way to conduct a geriatric assessment is to use four
categories: mental, physical, psychosocial, and environmental
D
Which one of the following is most true about aging changes?
a. Stage 3 and 4 sleep decreases.
b. Renal perfusion is not reduced, but renal function is reduced.
c. Hearing acuity declines beginning in middle age.
d. Prostatic enlargement occurs only in a minority of men.
A
An old woman who is cared for by attentive, cautious, concerned family
is particularly likely to suffer from which one of the following
complications after an episode of gastroenteritis?
a. Immobility related to overconcern
b. Continued vomiting caused by too-rapid feeding
c. Diarrhea resulting from administration of milk products
d. Constipation related to overtreatment of diarrhea
A
Which one of the following is most true about psychological aging?
a. Disengagement tends to promote better psychological health than
continued engagement.
b. Most older adults do not worry about memory loss.
c. Happiness declines starting in middle age.
d. Ageism can lead to isolation and depression.
D
,Of the following conditions, which one is most common and most often
preventable?
a. Falls
b. Frailty
c. Cognitive impairment
d. Iatrogenic disease
e. Depression
D
Immunizations recommended for older Adults
Influenza inactive (IIV), or recombinant (RIV): 1 dose annually
Tetanus, diphtheria, pertussis (TDAP): 1 dose after age 65 years then Td
every 10 years
Varicella recombinant (Shingrix): 2 doses 2-5 months apart. Give to those
who had zoster
Pneumococcal: 1 dose of PPSV23 (Polysaccharide, Pneumovax);
consider 1 dose PCV 13 in high-risk patients
Hepatitis A/hepatitis B: Only if high risk, and at least once
Vaccine costs
Medicare Part B covers vaccines to prevent influenza and pneumonia, as
well as hepatitis B if the patient is at medium to high risk for this disease.
No copay is associated with these vaccines. All other vaccines are
covered under Medicare Part D; this includes the vaccine for zoster.
Zostavax
can be used when there is a Shingrix allergy, if a patient prefers the
Zostavax, or the patient wishes an immediate vaccination and Shingrix is
unavailable. The vaccination is recommended even if a patient is unsure
about having chickenpox in the past
The Five A's
Assess
Ask about behavioral health risks and other factors that affect health goal
change.
Advise
, Provide clear, targeted behavior change advice, along with information as
to potential harms/benefits.
Agree
Work together on selection of appropriate, achievable treatment goals,
and methods, based on patient’s buy-in and willingness to change.
Assist
Guide the patient to achieve the agreed-upon goals by fostering self-
confidence, along with providing additional medical treatments when
needed. Help the patient with social/environmental supports for behavior
change.
Arrange
Schedule follow-up visits or phone conversations to provide ongoing
support, and adjust treatment plan as needed. Include any referrals for
more specialized treatment.
Pharmacological interventions for smoking cessation
bupropion SR; nicotine replacement therapy (NRT) with gum, inhaler,
lozenge, nasal spray, or patch; and varenicline (Chantix).
Polypharmacy
is the use of more medications than are clinically needed or indicated.
Older adults are at particular risk for polypharmacy because of multiple
comorbidities and because they see multiple healthcare providers. One
way to reduce polypharmacy is to try nonpharmacologic therapies first.
Interventions may include diet, exercise, stress management, and
cognitive-behavioral therapy. Moreover, combining behavioral
interventions with medications may reduce the drug dosages needed for
effect. Clinicians should also make certain to be very clear about drug use
instructions and possible side effects. Always provide both verbal and
written instructions on how to use the medication. Drug regimens should
be as simple as possible and medications need thorough review and
updating at each provider-patient interaction
Classes of medications that interact with alcohol
Antibiotics
Nonnarcotic pain relievers
