TEST BANK FOR ADVANCED PRACTICE NURSING IN THE CARE OF OLDER ADULTS 2ND EDITION BY KENNEDY-MALONE (Newly Updated, All answers highlighted, Easy to Download and Print)

TEST BANK FOR ADVANCED PRACTICE NURSING IN THE CARE OF OLDER ADULTS 2ND EDITION BY KENNEDY-MALONE (Newly Updated, All answers highlighted, Easy to Download and Print) Advanced Practice Nursing in the Care ofOlder Adults / Edition 2 TESTBANK Answers highlighted Newly updated Chapter 1. Changes With Aging Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The major impact of the physiological changes that occur with aging is: A. Reduced physiological reserve B. Reduced homeostatic mechanisms C. Impaired immunological response D. All of the above 2. The strongest evidence regarding normal physiological aging is available through: A. Randomized controlled clinical trials B. Cross-sectional studies C. Longitudinal studies D. Case-control studies 3. All of the following statements are true about laboratory values in older adults except: A. Reference ranges are preferable B. Abnormal findings are often due to physiological aging C. Normal ranges may not be applicable for older adults D. Reference values are not necessarily acceptable values 4. Biochemical individuality is best described as: A. Each individual’s variation is often much greater than that of a larger group B. The unique biochemical profile of a selected population C. The truly “normal” individual—falling within average range D. Each individual’s variation is often much smaller than that of a larger group 5. Polypharmacy is best described as taking: A. More than nine medications per day B. More than five medications per day C. Even a single medication if there is not a clear indication for its use D. When a drug is given to treat the side effect of another drug 6. Pharmacokinetic changes with aging are reflective of: A. What the drug does to the body B. What the body does to the drug C. The effect at the site of action and the time and intensity of the drug D. D. The side effects commonly associated with the drug 7. All the following statements are false about drug absorption except: A. Antacids increase the bioavailability of digitalis B. Gastric acidity decreases with age C. Anticholinergics increase colonic motility D. Underlying chronic disease has little impact on drug absorption 8. All of the following statements are true about drug distribution in the elderly except: A. Drugs distributed in water have lower concentration B. Drugs distributed in fat have less intense, more prolonged effect C. Drugs highly protein bound have greater potential to cause an adverse drug reaction D. The fastest way to deliver a drug to the action site is by inhalation 9. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: A. Less obesity rates than women B. Prostate enlargement C. Testosterone D. Less estrogen than women 10. The cytochrome p system involves enzymes that are generally: A. Inhibited by drugs B. Induced by drugs C. Inhibited or induced by drugs D. Associated with decreased liver perfusion 11. A statement not shown to be true about pharmacodynamics changes with aging is: A. Decreased sensitivity to oral anticoagulants B. Enhanced sensitivity to central nervous system drugs C. Drug responsiveness can be influenced by patient activity level D. There is a decreased sensitivity to beta blockers 12. Atypical presentation of disease in the elderly is reflected by all the following except: A. Infection without fever B. Depression without dysphoric mood C. Myocardial infarction with chest pain and diaphoresis D. Cardiac manifestations of thyroid disease 13. Functional abilities are best assessed by: A. Self-report of function B. Observed assessment of function C. A comprehensive head-to-toe examination D. Family report of function Chapter 2. Health Promotion Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The leading cause of death in elderly travelers worldwide is: A.Cardiovascular disease B.Infect ions C.Accid ents D.Malar ia 2. Which of the following should be avoided in countries where food and water precautions are tobe observed? A. Hot coffee B. Bottled water D.Unpeeled bananas 3. What insect precautions are not necessary to prevent insect-borne diseases in the tropics? B. Treating clothes with permethrin C. Covering up exposed skin to lessen biting surface D. Taking malaria pills as directed for areas at risk for malaria 4. An example of secondary prevention you could recommend/order for older adults would be to: A. Check for fecal occult blood B. Wear seat belts in the car C. Provide foot care for a diabetic patient D. Administer a tetanus shot 5. Ali is a 72-year-old man who recently came to the U.S. from Nigeria. He reports having BCG(bacille Calmette-Guerin) vaccination as a child. Which of the following is correct regarding a tuberculin skin test? A. It should not be done at all. B. It should be read as smaller than it really is. C. Vaccination history is irrelevant; read as usual. D. It should be read as larger than it really is. 6. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long dayof driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? A. Pulmonary edema B. Heart failure C. Pulmonary embolism D. Pneumonia 7. Ivan W. is a 65-year-old man who is new to your practice. He has a history of COPD, CAD, hypertension, and type 2 diabetes mellitus. He has had no immunizations since his discharge from the military at age 25. Childhood diseases included chickenpox, measles, mumps, and “German measles.” He presents for a disease management visit. Which of the following immunizations would yourecommend for Ivan? A. MMR, influenza, pneumococcal, Zostavax B. Influenza, pneumococcal, PPD, Hepatitis B C. Tdap, pneumococcal, influenza, Zostavax D. Hepatitis B, influenza, pneumococcal, Hepatitis A 8. Leo L. is a 62-year-old African American male who comes for an initial visit to your practice.Personal health history includes smoking 1 pack/day since age 11, consuming a case of beer (24 bottles) every weekend, and working as an assembler (sedentary job) for the past 10 years. Family history in first-degree relatives includes hypertension, high cholesterol, heart attack, and type 2 diabetes mellitus. Leo’s BMI is 32; BP today is 130/86. You order a fasting glucose, lipid profile, and return visit for BP check. This is an example of: A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Health profiling 9. A local chapter of a nurse practitioner organization has begun planning a community-basedscreening for hypertension at a local congregate living facility. This population was selected on the basis of: A. A predicted decreased incidence of high blood pressure in this population B. A recognized element of high risk within this group C. Readily available treatment measures D. Achieving an administrative goal for the congregate living facility 10. Performing range of motion exercises on a client who has had a stroke is an example of whichlevel of prevention? A. Primary prevention B. Tertiary prevention C. Secondary prevention D. Rehabilitation prevention 11. The nurse practitioner demonstrates an understanding of primary prevention of falling amongthe elderly through which management plan? A. Evaluate a need for assistive devices for ambulation after the client has been injured from afall. B. Provide resources to correct hazards contributing to falls in the home environment. C. Reinforce the need to use prescribed eyeglasses to prevent further injury from falls. D. Provide information about medications, side effects, and interactions. 12. An example of an active strategy of health promotion for an individual to accomplish would be: A. Maintaining clean water in the local environment B. Introducing fluoride into the water C. Beginning a stress management program D. Maintaining a sanitary sewage system 13. You are working with an older male adult with a long history of alcohol abuse and a 30-yearhistory of smoking. In recommending an intervention for this client, your responsibility is to: A. Make the individual abandon his own health practices and follow your recommendations B. Register the patient for a local intervention program and secure payments C. Promote positive change in lifestyle choices D. Identify the barriers that the client will encounter 14. The four main domains of clinical preventive services that the practitioner will provide are: A. Counseling interventions, screening tests, immunizations, and chemoprophylaxis B. Counseling intervention, screening tests, immunizations, and education C. Counseling interventions, transportation, screening tests, and immunizations D. Screening tests, brief psychotherapy, immunizations, and chemoprophylaxis 15. Which organism that can be prevented by immunization is most often responsible for aninfectious “outbreak” in the nursing home setting? A. Haemophilus influenza B. Streptococcus C. Influenza A D. Mycobacterium tuberculosis 16. What is the appropriate method for tuberculosis screening of an older adult entering a nursinghome? A. 5 tuberculin units intramuscular PPD injection and if negative repeat with same dose one week later B. 5 tuberculin units intradermal PPD injection and if negative repeat with same dose one weeklater C. Chest x-ray at the same time of PPD testing D. 5 tuberculin units intradermal PPD injection and if positive repeat same dose in one week Chapter 3. Exercise in Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Exercise recommended for older adults should include activities that: A. Conserve energy B. Restrict flexibility C. Strengthen muscles D. Are anaerobic in nature 2. Preferred amount of exercise for older adults is: A. 10 minutes of physical activity each morning B. 30 minutes per day of aerobic activity five times a week C. Any increase in physical activity over a sedentary lifestyle D. 60 minutes per day that includes 30 minutes of aerobic activity and 30 minutes of weighttraining five times a week 3. Which of the following medical conditions is not considered restrictive for engaging in physicalactivity? A. A.Unstable angina B. Dehydration C. Depression D. Uncontrolled tachycardia 4. The best recommendation for a patient who states they have no equipment to exercise wouldbe: A. Sign a contract for a year’s membership to a local gym B. Borrow free weights from grandchildren C. Have a personal trainer come to the home three times a week D. Improvise with recommended objects at home that can be used 5. When the nurse practitioner recommends exercise for a sedentary older adult, which of thefollowing pieces of advice should be considered for all types of exercise? A. Only use equipment recommended by physical trainers B. Start low and go slow C. Only group exercise is beneficial to someone who has not been active in a long A. time D. Focus only on one type of exercise for the first few months Chapter 4. Comprehensive Geriatric AssessmentMultiple Choice Identify the choice that best completes the statement or answers the question. 1. The evidence reflects that comprehensive geriatric assessment should be conducted: A. On all individuals 65 and older B. On all individuals 75 and older C. By an inter-disciplinary team of professionals D. Targeting the vulnerable and frail elderly 2. Evidence-based geriatric assessment instruments available to the clinician: A. Are largely screening instruments to detect a condition B. Largely do not exist and if they do they have limited clinical utility C. Include screening, evaluation, and measurement instruments in multiple domains D. Have applicability in the outpatient but not the inpatient setting 3. When interviewing the older adult with a suspected dementia, it is most important that: A. Mental status be evaluated first in order to determine if the patient is a reliable historian B. The examiner use short simple questions and recognize non- verbal signs of discomfort C. Postpone the mental status evaluation for the following visit and establish a rapport first D. The clinician get in contact with a family member to obtain the history 4. Which is not considered a dimension of symptomatology? A. Onset B. Physical signs C. Location D. Absence of associated symptoms 5. The best approach to taking the health history is to: A. Start with an open-ended question B. Start with the review of systems C. Focus on the chief complaint D. Complete the history before conducting the examination 6. A review of the evidence relative to screening of the elderly reveals the highest evidence ratingfor: A. Vision screening B. Mammography screening C. Hearing screening D. Dementia screening 7. Assessment of vital signs in the elderly reflect: A. Errors in blood pressure measurement are rare with automated recording devices B. Shortness of breath in the elderly is rare in the older, deconditioned, and immobile patient C. Older adults prefer a 0-10 pain rating scale D. Older adults could be septic with a temperature within normal limits 8. What statement is true about nutrition intake in the elderly? A. Deficiencies in protein intake are common with aging. B. Malnutrition is the most common nutritional disorder among the elderly living in thecommunity. C. Increased caloric consumption is needed as one ages. D. The serum albumin is a good reflection of protein stores. 9. What is reflective of functional decline in older adults? A. Functional decline is synonymous with advanced age. B. Some individuals die of “old age” but have maintained an active and healthy lifestyle. C. Instrumental activities of daily living are preserved longer than activities of daily living. D. It is always possible to prevent functional deterioration. 10. The leading cause of traumatic death in the elderly is due to: A. Motor vehicle accidents B. Pedestrian injuries C. Falls D. Burns 11. Timing of the get-and-go test enhances its sensitivity. The process should take less than: A. Thirty seconds B. Sixteen seconds C. Sixty seconds D. Ten seconds 12. A validated tool for assessing cognitive function specific to dementia is: A. Mini-cog B. Confusion assessment method C. Yesavage GDS scale D. NuDesc 13. The medical outcome study short form 36 remains the gold standard of quality of lifeinstruments. It measures: A. Mental and social domains B. Social domain C. Physical, mental, and social domains D. Physical domain Chapter 5. Symptoms and Syndromes Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The term “geriatric syndrome” is best described as: A. A condition that has multiple underlying factors and involves multiple systems B. A condition that has a discreet etiology that is difficult to pinpoint C. Significant progress has been made in understanding geriatric syndromes, especially falls anddelirium D. Therapeutic management of a geriatric syndrome can be accomplished once a specificdiagnosis is made 2. The anal wink reflex is used to test: A. Rectal prolapse B. Sensation and pudental nerve function C. Baseline and squeeze sphincter tone D. Fissures and fistulas 3. Atypical presentation of acute coronary syndrome is: A. Most common in Hispanic females B. More common in men C. Most common in African American men D. More common in females 4. What disease can mimic and often co-exists with myocardial infarctions in elders with coronaryartery disease? A. Hypertension B. Esophageal disease C. Diabetic gastroparesis D. Vascular disease 5. Thoracic aortic dissection presents typically as: A. Sharp stabbing pain in the mid thorax B. Pleuretic chest pain and dyspnea C. Severe retrosternal chest pain that radiates to the back and both arms D. Unilateral pleuretic chest pain and dyspnea 6. Medications known to contribute to constipation include all of the following except: A. Stimulant laxatives B. Anticholinergic drugs C. Broad-spectrum antibiotics D. Iron 7. Bordetella pertussis is best characterized by: A. Sub-acute cough lasting greater than two weeks B. Acute cough associated with a coryzal symptom C. Chronic cough with post-nasal drip D. Non-productive acute cough 8. The routine testing of tuberculosis should occur in all of the following vulnerable populationsexcept: A. Nursing home residents B. Prison inmates C. Hospitalized elderly D. Immune-compromised patients 9. Which of the following statements about fluid balance in the elderly is false? A. Total body water decreases with age. B. Thirst response decreases as a person ages. C. African Americans have higher rates of dehydration than white Americans. D. Assessment of skin turgor at the sternum is a reliable indicator of dehydration in the elderly. 10. Distinguishing delirium from dementia can be problematic since they may co-exist. The primaryconsideration in the differential is: A. Performance on the Mini Mental Status Exam B. The Confusion Assessment is negative C. Rapid change and fluctuating course of cognitive function D. The presence of behavioral symptoms with cognitive impairment 11. Presbystasis is best described as: A. Impairment in vestibular apparatus that causes dizziness C. The loss of high frequency tones with aging that can impair sensation D. A disorder of the inner ear characterized by vertigo 12. If dizziness has a predictable pattern associated with it, the clinician should first consider: A. Hypoglycemia B. Psychogenic etiology C. Cardiovascular cause D. Neurogenic cause 13. All of the following are considered as contributors to dysphagia except: A. Anticholinergics B. Drugs that increase reflux symptoms C. Inadequate intake of fluids with medications and meals D. Smooth muscle relaxants 14. Evidence shows that the most important predictor of a fall is: A. Prior history of a fall B. Cognitive impairment C. Gait and balance disturbance D. Proximal muscle weakness 15. The most cost-effective interventions used to prevent falls are: A. Use of sitters B. Use of alarms (bed, chair, monitors) C. Tai Chi exercises D. Home modifications and vitamin D supplements 16. Chronic fatigue syndrome is best described as: A. Fatigue that is constant, lasting more than three months B. Fatigue lasting longer than six months and not relieved by rest C. Fatigue that waxes and wanes over a period of three months D. Total exhaustion with inability to get out of bed 17. Which form of headache is bilateral? A. Cluster B. Tension C. Migraine D. Acute angle closure glaucoma 18. Microscopic hematuria is defined as: A. Twenty or more RBCs on a urine sample B. Three or more RBCs on a urine sample C. Twenty or more RBCs on three or more samples of urine D. Three or more RBCs on three or more samples of urine 19. Risk factors associated with the finding of a malignancy in a patient with hemoptysis include allof the following except: A. Male sex B. Smoking history C. Over age 40 D. Childhood asthma 20. Recent weight loss is defined as: A. loss of >10 pounds over the past 3-6 months B. loss of >2 pounds a week C. 5% weight loss in three months D. 10% weight loss in one year 21. The most common cause of disability in the elderly is due to: A. Diabetes B. Arthritis C. Heart disease D. Chronic obstructive pulmonary disease 22. Lipedema is best described as: A. Bilateral accumulation of interstitial fluid B. Bilateral distribution of fat in the lower extremities C. Fluid retention caused by a compromised lymphatic system D. Lipid molecules that break down and cause fluid retention 23. Drug-induced pruritus is distinguished because it: A. Occurs soon after a new drug is taken B. Usually is a generalized rash C. May occur right after the drug is taken or months later D. Usually involves localized circumscribed lesions 24. A form of syncope that is more common in the elderly than younger adults is: A. Vasovagal B. Carotid sinus sensitivity C. Orthostatic hypotension D. Arrhythmias 25. All of the following statements about tremor are true except: A. The most common tremor is the Parkinson tremor B. Most individuals with tremor do not seek medical attention C. Psychogenic tremor is uncommon D. Tremor is more prevalent in whites than blacks 26. Overflow incontinence is usually associated with: A. Loss of urine that occurs with urgency B. Cognitive impairment C. Weak pelvic floor muscles D. Bladder outlet obstruction 27. Wandering is best described as: A. Aimless excessive ambulatory behavior B. B. Purposeful excessive ambulatory behavior C. C. Risk-seeking behavior in the cognitively impaired D. D. A result of boredom in those with dementia Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which of the following dermatological conditions results from reactivation of the dormantvaricella virus? A. Tinea versicolor B. Seborrheic keratosis C. Verruca D. Herpes zoster 2. An older adult male presents with pain in his right chest wall for the past 48 hours. Upon examination, the nurse practitioner notices a vesicular eruption along the dermatome and identifies thisas herpes zoster. The NP informs the gentleman that: A. All symptoms should disappear within three days B. Oral medications can dramatically reduce the duration and intensity of his symptoms C. He has chickenpox and can be contagious to his grandchildren D. He has a sexually transmitted disease 3. A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot ruleout other lesions. What recommendation would you give him? A. Ignore the lesion, as it is associated with aging. B. Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion. C. Perform a biopsy or refer to a dermatologist. D. Advise him to use a dandruff shampoo and return in one month if the lesion has not goneaway. 4. The immunofluorescent antibody (IFA) is a laboratory test used to diagnose which of thefollowing disorders? A. Tinea versicolor B. Herpes zoster C. Squamous cell carcinoma D. Human papilloma virus 5. A wound with drainage and foul odor should be cleansed with: A. Normal saline B. Hydrogen peroxide C. 20% acetic acid D. Betadine 6. A full-thickness pressure ulcer is partially covered with eschar and the surrounding tissue isreddened. Which of the following is the most appropriate treatment for this condition? A. Apply an occlusive dressing B. Debride mechanically or chemically C. Saline moistened gauze dressings D. Vacuum-assisted wound closure 7. In examining the skin of your nursing home patient, you note a “stained glass” brownish mark onthe face. Which of the following lesions best describes a stained glass brownish mark? A. Actinic keratosis B. Seborrhea keratosis C. Lentigo maligna D. Superficial spreading malignant melanoma 8. Patients who have an underlying tinea infection to the cellulitis should also be treated withwhich one of the following? A. An anti-fungal medication B. Topical steroids C. Oral steroids D. Zinc oxide 9. Identify the type of malignant melanoma that is associated with the Hutchinson’s sign of thecuticle of the finger. A. Lentigo maligna B. Acral lentiginous C. Nodular D. Superficial spreading malignant melanoma 10. A smooth round nodule with a pearly gray border and central induration best describe whichskin lesion? A. Seborrheic keratosis B. Malignant melanoma C. Herpes zoster D. Basal cell carcinoma 11. Cellulitis is a deep skin infection involving the dermis and subcutaneous tissues. The nurse practitioner suspects cellulitis in a 70- year-old Asian diabetic male presenting with reddened edematousskin around his nares. Which statement below will the nurse practitioner use in her decision-making process for the differential diagnosis pertaining to reddened edematous skin? A. Cellulitis is two times more common in women B. Facial cellulitis is more common in people >55 C. There is low incidence of cellulitis in patients with diabetes D. Cellulitis is only a disease of the lower extremities of patients with known arterialinsufficiency 12. An 82-year-old female has a “pimple” on his nose that occasionally bleeds and may have increased in size in the past year. The lesion is a 0.7-cm, dome-shaped, umbilicated papule with pearly translucence. There is also a hemorrhagic crust covering the central portion. Which of the following isthe most likely diagnosis? A. Squamous cell carcinoma B. Basal cell carcinoma C. Keratoacanthoma D. Sebaceous hyperplasia 13. Which of the following is generally not a first-line treatment for post herpetic neuralgia? A. Intrathecal methylprednisolone B. Gabapentin C. 5% lidocaine patch D. Topical capsaicin 14. A nursing home resident with a Stage 4 pressure ulcer that extends to the muscle layer and hassignificant undermining with heavy exudate should be treated with: A. Dry gauze dressings B. Duoderm C. Chemical debridement D. Calcium alginate dressings 15. Which of the following descriptions accurately documents cellulitis? A. Cool, erythematous, shiny hairless extremity with decreased pulse B. Scattered, erythematous ring-like lesions with clear centers C. Clearly demarcated, raised erythematous area of face D. Diffusely inflamed skin that is warm and tender to palpation 16. Asymmetrical bi-color lesion with irregular border measuring 8 mm is found on the right lowerarm of an adult patient. This assessment finding is consistent with: A. Melanoma B. Basal cell carcinoma C. Leukoplakia D. Senile lentigines 17. Which of the following descriptions best illustrates assessment findings consistent with tineacapitis? A. Circular erythematous patches with papular, scaly annular borders and clear centers B. Inflamed scaly dry patches with broken hairs C. Web lesions with erythema and scaling borders D. Scaly pruritic erythematous lesions on inguinal creases 18. A hyperkeratotic nodule formed as the result of exposure of the foot to moisture fromperspiration is called: A. Hard corn B. Tinea pedis C. Soft corn D. Plantar warts (verrucae) 19. A 64-year-old male presents with an exacerbation of psoriasis. His social history includes 50-year two packs a day of cigarettes and a six-pack a week of beer. He states he had a recent sore throat, which he attributes to minding his young grandson. He reports that until recently the pruritis was only minimal. His BMI is 37. Which of the following factors most likely contributed to the acute presentation of psoriasis? A. Alcohol abuse B. Smoking C. Streptococcal infection D. Obesity 20. Treatment of complicated cellulitis of the lower extremity resulting from an anaerobe requiresall of the following except: A. Extended antibiotic medication lasting at least 7-10 days B. Topical antifungal medication C. Inquiry when last tetanus toxoid booster was given D. Elevation of limb and consideration of compression bandaging Chapter 7. Head, Neck, and Face DisordersMultiple Choice Identify the choice that best completes the statement or answers the question. 1. A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? A. Bacterium B. Allergen C. Virus D. Fungi 2. One of the first-line treatments in patients with allergic rhinitis is the use of nasal corticosteroid sprays. What is the anticipated onset of symptom relief with the use of these medications? A. Two weeks or more B. Immediate C. 1 to 2 days D. A minimum of one week 3. The nurse practitioner knows that antihistamines work primarily through which of the followingmechanisms? A. Vasodilatation B. Blocking leukotriene effects C. Inhibiting histamine receptor sites D. Vasoconstriction 4. Cromolyn sodium may also be used in the treatment of allergic rhinitis. What is the mechanismof action of this medication? A. Mast cell stabilization B. Blocking the effects of IgE C. Leukotriene inhibition D. Histamine blockade 5. Patients that have atopic disorders are mediated by the production of IGE will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? A. Sinus pain, increased vascular permeability, and bronchodilation B. Bronchospasm, vascular permeability, and vasodilatation C. Contraction of smooth muscle decreased vascular permeability and vasoconstriction D. Vasodilatation, bronchodilation, and increased vascular permeability 6. Which of the following maneuvers is used to induce symptoms of benign paroxysmal positionalvertigo? A. The Fukuda stepping test B. The Dix-Hallpike maneuver C. Forced hyperventilation D. The head thrust test 7. You have a patient complaining of vertigo and want to know what could be the cause. Knowingthere are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? A. Ménière’s disease B. Benign paroxysmal positional vertigo C. TIA D. Migraine 8. Sensory impairment (vision and hearing) in the elderly is associated with: A. Impaired quality of life B. Decreased function C. Increased mortality D. All of the above 9. Which of the following conditions is the leading cause of blindness in the United States? A. Macular degeneration B. Diabetic retinopathy C. Glaucoma D. Cataracts 10. A slightly elevated elastic tissue deposit in the conjunctiva that may extend to the cornea butdoes not cover it is known as a: A. Pterygium B. Pinguecula C. Xanthelsma D. Limbal nodule 11. A nonmodifiable risk factor for the development of cataracts is: A. Long-term exposure to ultraviolet B radiation B. High alcohol intake C. Strong family history D. Diabetes mellitus 12. Causes of sensorineural hearing loss include: A. Ototoxicity B. Ménière’s disease C. Otosclerosis D. Inner ear fistula 13. Clinical findings in patients with nonproliferation retinopathy include: A. Cotton wool spots B. Microaneursyms C. Deep hemorrhages D. Neovascularization 14. In examining the mouth of an older adult with a history of smoking, the nurse practitioner findsa suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is themost common oral precancerous lesion? A. Fictional keratosis B. Keratoacanthoma C. Lichen planus D. Leukoplakia 15. A gross screening for hearing is the whisper tests. Which cranial nerve is being tested when thenurse practitioner conducts this test? A. Cranial nerve V B. Cranial nerve VII C. Cranial nerve VIII D. Cranial nerve IV Chapter 8. Chest Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. In mitral stenosis, p waves may suggest: A. Left atrial enlargement B. Right atrial enlargement C. Left ventricle enlargement D. Right ventricle enlargement 2. Aortic regurgitation requires medical treatment for early signs of CHF with: A. Beta blockers B. ACE inhibitors C. Surgery D. Hospitalization 3. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may includeexertional dyspnea. Angina equivalents are important because: A. Women with ischemic heart disease many times do not present with chest pain B. Some patients may have no symptoms or atypical symptoms. Diagnosis may only be made atthe time of an actual myocardial infarction C. Elderly patients have the most severe symptoms D. A & B only 4. The best evidence rating drugs to consider in a post myocardial infarction patient include: A. ASA, ACE/ARB, beta-blocker, aldosterone blockade B. Ace, ARB, Calcium channel blocker, ASA C. Long-acting nitrates, warfarin, ACE, and ARB D. ASA, clopidogrel, nitrates 5. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm withoutST-segment abnormalities. Your plan may include: A. Echocardiogram B. Exercise stress test C. Cardiac catheterization D. Myocardial perfusion imaging 6. Preceding a stress test, the following lab work might include: A. CBC and differential to differentiate ischemic heart disease from anemia B. Liver enzymes to rule out underlying gall bladder disease C. Thyroid studies to rule out hyperthyroidism D. A & C only 7. Which test is the clinical standard for the assessment of aortic stenosis? A. Cardiac catheterization B. Stress test C. Chest x-ray D. Echocardiography 8. What is the most common valvular heart disease in an older adult? A. Aortic regurgitation B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis 9. On examination, what type of murmur can be auscultated with aortic regurgitation? A. Austin flint B. Systolic ejection C. Soft S1 and a Loud S2 D. Loud S1 10. Ischemic heart disease is: A. Defined as imbalance between oxygen supply and demand. B. Frequently is manifested as angina. C. Leading cause of death in the elderly. D. All of the above. 11. Which test is the clinical standard for the assessment of aortic stenosis? A. Cardiac catheterization B. Stress test C. Chest x-ray D. Echocardiography 12. The aging process causes what normal physiological changes in the heart? A. The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis B. Cardiology occurs along with prolapse of the mitral valve and regurgitation C. Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves D. Hypertrophy of the right ventricle 13. An older adult may present with atypical clinical signs of pneumonia. The nurse practitioner needs to be aware that the clustering of all of the following signs and symptoms may be indicative ofpneumonia in an older person except: A. Bradycardia B. Malaise C. Anorexia D. Confusion 14. Which of the following statements is true concerning anti- arrhythmic drugs? A. Amiodarone is the only one not associated with increased mortality and it has a veryfavorable side effect profile. B. Both long-acting and short-acting calcium channel blockers are associated with an increasedrisk of cardiovascular morbidity and mortality. C. Most antiarrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic. D. Anti-arrhythmic therapy should be initiated in the hospital for all patients. 15. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest painand left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stoppedwalking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? A. Musculoskeletal chest wall syndrome with radiation B. Esophageal motor disorder with radiation C. Acute cholecystitis with cholelithiasis D. Coronary artery disease with angina pectoris 16. Jose M. is a 68-year-old man who presents to your primary care practice for a physical. Jose hashad type 2 diabetes mellitus for 5 years, diet controlled. His BMI is 32. Smoker, pack per day for 25 years. He denies other medical problems. Family history includes CAD, CABG x4 for father, now deceased; CHF, type 2 diabetes mellitus, HT for mother. According to the AHA/ACC guidelines, what stage is Jose? A. Stage A B. Stage B C. Stage C D. Stage D 17. Susan P., a 60-year-old woman with a 30 pack-year history, presents to your primary care practice for evaluation of persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? A. Seasonal allergies B. Acute bronchitis C. Bronchial asthma D. Chronic bronchitis 18. The best way to diagnose structural heart disease/dysfunction non-invasively is: A. Chest x-ray B. EKG C. Echocardiogram D. Heart catheterization 19. A common auscultatory finding in advanced CHF is: A. Systolic ejection murmur B. S3 gallop rhythm C. Friction rub D. Bradycardia 20. The organism most commonly responsible for community- acquired pneumonia in older adultsis: A. Pseudomonas aeruginosa B. Staphylococcus aureus C. Proteus mirabilis D. Streptococcus pneumonia 21. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long dayof driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? A. Pulmonary edema B. Heart failure C. Pulmonary embolism D. Pneumonia Chapter 9: Peripheral Vascular DisordersMultiple Choice Identify the choice that best completes the statement or answers the question. 1. The clinician should begin the peripheral vascular exam with: A. Auscultation of the carotid arteries B. Checking for peripheral edema C. Auscultation of the heart D. Palpation of the upper extremity arteries 2. Inspection of the distal nails and nail beds should be evaluated for signs of decreased perfusion.Signs include: A. Clubbing B. Cyanosis C. Petechiae D. All of the above 3. A thorough vascular exam includes all of the following except: A. Cardiac exam B. Reproductive organ exam C. Peripheral vascular exam D. Cranial nerve exam 4. The majority of abdominal aortic aneurysms are due to: A. Trauma B. Infection C. Inflammation D. Atherosclerosis 5. The best initial screening test for abdominal aortic aneurysm is: A. Angiography B. CT scan with IV contrast C. Abdominal ultrasound D. MRI 6. The initial treatment for symptomatic abdominal aortic aneurysm involves: A. Emergency surgery B. Aggressive blood pressure control C. watch-and-wait approach D. Cardiology consult 7. The major cause of death after an abdominal aortic aneurysm repair is: A. AAA rupture B. Hemorrhage C. Renal failure D. Myocardial infarction 8. An early symptom of peripheral artery disease is: A. Painful cramping of muscles during walking B. Pain is worse when the legs are dependent below the level of the heart C. Pain intensifies after vigorous walking is stopped D. Ulceration or gangrene occurs at the sight of minor injury 9. The hallmark of venous stasis ulcers include all of the following except: A. Lower extremity edema B. Hyperpigmentation of the lower extremities C. Ulcers on the medial or lateral malleolus D. Copious draining ulcers 10. Exercise is an essential element of peripheral arterial disease management primarily because: A. It encourages weight loss, as being overweight is a contributing factor to PAD B. Evidence shows exercise reduces smoking C. Collateral vessels are strengthened D. It improves aerobic capacity 11. Home exercise programs for peripheral arterial disease focus on: A. Walk until pain develops then stop B. Walk through the pain then stop C. Begin at a slow speed with 10 minutes a day and build up to 30 minutes D. Walk through the pain, rest until it goes away, then resume walking 12. When should surgical options for peripheral arterial disease be considered? A. Immediately after the diagnosis since the prognosis without revascularization is poor B. After two weeks of pentoxifylline (Trental) therapy C. Pain is not relieved with rest D. Pain limits the patient’s lifestyle or ulceration occurs 13. All of the following are classic signs of venous insufficiency except: A. Pain B. Dependent edema C. Hemosiderosis D. Dermatitis 14. Lower leg edema associated with pain is characteristic of: A. Venous insufficiency B. Heart failure C. Deep venous thrombosis D. Diabetes 15. The most common cause of secondary lymphedema is: A. Surgery B. Cancer treatment C. Infection D. Trauma 16. The imaging gold standard for lymphedema is: A. Lymphosonogram B. Lymphoscintigraphy C. Lymphoangiogram D. CT scan 17. Known risk factors for lymphedema include all of the following except: A. Osteoarthritis B. Rheumatoid arthritis C. Obesity D. Venous ulcer disease 18. Complete decongestive physiotherapy (CDP) works by: A. Stimulating the lymph vessels B. Breaking up subcutaneous fibrous tissue C. Redirecting lymph flow D. All of the above Chapter 10. Abdominal Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Your 70-year-old patient has gastroesophageal reflux disease (GERD). After a trial of lifestyle modifications and antacids, the patient continues to have occasional mild heartburn after occasional meals and at night. The most appropriate next action is: A. Prokinetic agents B. H2 antagonists C. Proton pump inhibitors D. Sucralfate 2. An older patient reports burning pain after ingestion of many foods and large meals. Whatassessment would assist the nurse practitioner in making a diagnosis of GERD? A. Identification of a fluid wave B. Positive Murphy’s sign C. Palpable spleen D. Midepigastric pain that is not reproducible with palpation 3. The nurse practitioner is examining a 62-year-old female who has been complaining of lower abdominal pain. Upon auscultation, bowel sounds are high pitched and tinkling. Which of the following terms describes this finding? A. Succession splash B. Borborygmi C. Tenesmus D. Puddle sign 4. In teaching an older adult female client with end-stage renal disease her medication regimen, the nurse practitioner must include which of the following pieces of information in the treatment plan? A. Report any changes in the color of her stool B. Take iron supplement and elemental calcium with each meal C. Take iron supplement before meals and the calcium after meals D. Take calcium with a high phosphorus meal 5. A 62-year-old client presents with a complaint of fever, pain, and burning on urination. Difficultyurinating with dribbling has been increasing in the past few days. He has a feeling of pressure in his groin. On examination, his prostate is tender, boggy, and warm. A stat urinalysis reveals the presence ofleukocytes and bacteria. He is allergic to sulfa drugs. His weight is 70 kg and his last serum creatinine was 1.0. While awaiting the culture and sensitivity, the nurse practitioner begins empiric treatment withwhich of the following? A. Trimethoprim/sulfamethoxazole DS bid x 2 weeks B. Ampicillin 250 mg PO q day for 10 days C. Nitrofurantoin 100 mg Q 12 hours for 7 days D. Ciprofloxacin 500 mg Q 12 hours for 14 days 6. A 62-year-old woman presents with a recurrent urinary tract infection. She now has a fever of104°F and severe costovertebral tenderness with pyuria. What is the appropriate diagnosis and intervention forthis patient? A. Septic arthritis and oral prednisolone is indicated B. Pyelonephritis and hospitalization is required C. Recurrent cystitis and 10 days of antibiotics are needed D. Pelvic inflammatory disease and 7 days of antibiotics are indicated 7. Which of the following drugs would be useful for the nurse practitioner to prescribe for an olderadult to prevent gastric ulcers when a nonsteroidal anti-inflammatory drug is used for chronic pain management? A. Misoprostol (Cytotec) B. Cimetidine (Tagamet) C. Metronidazole (Flagyl) D. Bismuth subsalicylate (Pepto bismol) 8. A 68-year-old male reports painless rectal bleeding occasionally noted with thin pencil-like stools, but no pain with defection. He has a history of colon polyp removal 10 years ago but was lost tofollow-up. The nurse practitioner’s appropriate intervention is: A. A digital rectal exam and send home with 3 hemoccult to return B. Immediate referral to gastroenterologist and colonoscopy C. Order a screening sigmoidoscopy D. Order a colonoscopy and barium enema and refer based on results 9. Asymptomatic 1+ bacteruria is found in a nursing home resident with an indwelling catheter. Thenurse practitioner’s initial intervention includes: A. Assessing resident’s cognitive status and last change of the catheter/bag B. Prescribing prophylactic Bactrim 1 tablet at bedtime C. Ordering a urine culture and sensitivity and prescribing empiric treatment until resultsobtained D. Ordering an x-ray of the kidney, urine, and bladder 10. When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti-diarrheal and Kaopectate, the nurse practitioner advises patients to: A. Use all the medication B. Do not use for possible infectious diarrhea C. Use should exceed one week for effectiveness D. These drugs provide exactly the same pharmaceutical effects 11. When teaching a group of older adults regarding prevention of gastroesophageal reflux diseasesymptoms, the nurse practitioner will include which of the following instructions? A. Raise the head of the bed with pillows at night and chew peppermints when symptoms ofheartburn begins B. Raise the head of the bed on blocks and take the proton pump inhibitor medication atbedtime C. Sit up for an hour after taking any medication and restrict fluid intake D. Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitorbefore a meal 12. A clinical clue for suspected renal artery stenosis would be: A. Decreased urine output B. Development of resistant hypertension in a previously well- controlled patient C. Retroperitoneal pain on the affected side D. Rising BUN level with normal creatinine level 13. Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastriculcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? A. It is highly contagious and a mask should be worn at home. B. The treatment regimen is multiple lifetime medications. C. The treatment regimen is multiple medications taken daily for a few weeks. D. The treatment regimen is complicated and is not indicated unless the patient issymptomatic. 14. An obese middle-aged client presents with a month of nonproductive irritating cough withoutfever. He also reports occasional morning hoarseness. What should the differential include? A. Atypical pneumonia B. Peptic ulcer disease C. Gastroesophageal reflux D. Mononucleosis (Epstein-Barr) 15. Which of the following findings would indicate a need for another endoscopy in clients withpeptic ulcer disease? A. Cases of dyspepsia with constipation B. Symptoms persisting after 6-8 weeks of therapy C. All clients with dyspepsia who smoke and drink alcohol D. When a therapeutic response to empiric treatment is obtained 16. A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she also experiences bouts of constipation. She has no known allergies and experienced no unintentionalweight loss. What is the most likely condition? A. Inflammatory bowel disease B. Irritable bowel syndrome C. Giardiasis D. Lactose intolerance 17. The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal reflux. What are the nonpharmacological management interventions that should be included? A. Weight reduction and rest 30 minutes after each meal in the supine position B. Elevation of head of the bed 4-6 inches on blocks and weight reduction C. Encouraged to wear restrictive clothing to add support for diaphragmatic breathing D. Using oral mints to relieve gastric distress 18. In differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer canpresent with distinct signs and symptoms. Which of the following pieces of information from the patient’s history is the least useful for you to determine that the patient has a duodenal ulcer? A. Pain occurs on an empty stomach B. Diffuse epigastric pain C. Rarely associated with non-steroidal use D. Occurs in patients under 40 years of age 19. A 74-year-old obese female presents complaining of persistent right upper quadrant pain. Shereports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis? A. C-reactive protein level of 3 mg B. White blood cell count of 11,000 C. Direct serum bilirubin level of 0.3 mg/dL D. Serum amylase level of 145 U/L 20. Which of the following is not a contributing factor to the development of esophagitis in olderadults? A. Increased gastric emptying time B. Regular ingestion of NSAIDs C. Decreased salivation D. Fungal infections such as Candida Chapter 11. Urological and Gynecologic Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which ethnic group has the highest incidence of prostate cancer? A. Asians B. Hispanics C. African Americans D. American Indians 2. Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to whatintervals? A. Every 6 months B. Yearly C. Every 2 years D. Every 2 to 4 years 3. All of the following may be reasons associated with an elevated PSA besides prostate cancerexcept: A. Prostatitis B. Urinary tract infection C. Perineal trauma D. Digital rectal exam 4. In the diagnosis of acute bacterial prostatitis, a midstream urine culture is of benefit. To bediagnostic, the specimen should reveal how many white blood cells per high-power field? A. Five B. Ten C. Fifteen D. Twenty 5. In chronic bacterial prostatitis, what is the organism most commonly associated with thedisease? A. Klebsiella B. Proteus C. Pseudomonas D. Escherichia coli 6. In acute prostatitis, an exam of the prostate may find the gland to be: A. Nodular B. Cool and pliable C. Swollen and tender D. Asymmetrical 7. All of the following antimicrobials may be indicated in chronic bacterial prostatitis except: A. Ciprofloxacin B. Levofloxacin C. Trimethoprim D. Azithromycin 8. Age-related changes in the bladder, urethra, and ureters include all of the following in olderwomen except: A. Increased estrogen production’s influence on the bladder and ureter B. Decline in bladder outlet function C. Decline in ureteral resistance pressure D. Laxity of the pelvic muscle 9. Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer inthe past week. He has never had a surgical procedure in his life and seeks clarification on the availabilityof treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is NOT a potential side effect of this procedure? A. Urinary incontinence B. Impotence C. Dribbling urine D. Selected low back pain 10. The nurse practitioner is evaluating a patient’s pelvic muscle strength by digital examination. This is performed when: A. A male patient complains of nocturia and dribbling B. The nurse practitioner needs to confirm a cystocele or stress incontinence C. The patient reports sudden loss of large amounts of urine or urge incontinence D. The nurse practitioner suspects overflow incontinence 11. A pelvic mass in a postmenopausal woman: A. is most commonly due to uterine fibroids. B. is always symptomatic. C. is highly suspicious for ovarian cancer. D. should be monitored over a period of time. 12. A 79-year-old man is being evaluated for frequent urinary dribbling without burning. Physical examination reveals a smooth but slightly enlarged prostate gland. His PSA level is 3.3 ng/mL. The patient undergoes formal urodynamic studies, and findings are as follows: a decreased bladder capacityof 370 mL; a few involuntary detrusor contractions at a low bladder volume of 246 mL; an increased postvoid residual urine volume of 225 mL; and a slightly decreased urinary flow rate. Which of the following is not consistent with a normal age- associated change? A. PSA level of 3.3 ng/mL B. Decreased bladder capacity C. Involuntary detrusor contradictions D. Increased postvoid residual urine volume 13. Mrs. Smith, a 65-year-old woman presents to clinic for the first time and complains of urinary incontinence and dyspareunia. She went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 82 years ofage. The patient’s most recent mammogram was 5 years ago and no known family history of breast cancer. She is not taking any medications. Her physical examination is unremarkable except for findings consistent with atrophic vaginitis. You decide to begin topical hormone replacement therapy. Which ofthe following evaluations would be necessary prior to initiating hormone replacement therapy? A. Mammogram B. Endometrial biopsy C. Bone mineral density measurement D. Papanicolaou smear 14. Mrs. L. Billings is a 77-year-old Caucasian female who has a history of breast cancer. She has been in remission for 6 years. As her primary care provider, you are seeing her for follow-up of her recent complaint of intermittent abdominal pain of a 3-month duration and some general malaise. Given the brief history above, what will you direct your assessment at during physical examination? A. Examination of her thyroid to rule out thyroid nodules that may contribute to her feelingfatigued. B. Auscultation of her abdomen for abnormal bowel sounds to rule out peritonitis. C. Thorough abdominal and gynecological exam to rule out masses and identify anytenderness. D. A rectal examination to rule out colon cancer as a secondary site for breast cancer. 15. A 78-year-old female comes to the office because she has pain when she urinates. She has beenseen three times for this problem in the last 3 months. Each time she was told she had a UTI and was given antibiotics. She carefully followed the instructions but has had no relief of symptoms. Last UA: WBCs: 2-3/high-power field RBCs: 0-2/high- power field Epithelial cells: Few Nitrite: Negative Leuckocyte esterase: Negative Which of the following should be done next? A. Obtain a clean catch urine for UA and urine for C&S B. Perform a pelvic examination C. Reassure the patient that she has asymptomatic bacteriuria and does not need A. antibiotics D. Order a pelvic ultrasound Chapter 12. Musculoskeletal Disorders Multiple Choice Identify the choice that best completes the statement or answers the question 1 Osteoarthritis of the cervical and lumbar spine causes pain that is related to all of the followingexcept: A. Bone spur formation B. Pressure of the ligaments C. Reactive muscle spasm D. Crystal deposition 2. In differentiating osteoarthritis from chronic gout, pseudogout, or septic arthritis, the mostvaluable the diagnostic study would be: A. Erythrocyte sedimentation rate (ESR) B. Synovial fluid analysis C. C-reactive protein analysis D. Complete blood cell count 3. Patients with osteoarthritis of the hip and knee often have a distinguishable gait described as: A. Ataxic B. Festinating C. Antalgic D. Steppage 4. Which of the following best describes the pain associated with osteoarthritis? A. Constant, burning, and throbbing with an acute onset? B. Dull and primarily affected by exposure to cold and barometric pressure C. Begins upon arising and after prolonged weight-bearing and/or use of the joint D. Begins in the morning but decreases with activity 5. Joint effusions typically occur later in the course of OA, especially in the: A. Knee B. Elbow C. DIP joints D. Hips 6. You have ordered a CBC for your patient you suspect has polymyalgia rheumatica (PMR). Whichtwo clinical findings are common in patients with PMR? A. Neutropenia and hypochromic, normocytic anemia B. Normochromic, normocytic anemia and thrombocytosis C. Microcytic, hypochromic anemia and reticulocytopenia D. Macrocytic, hyperchromic anemia and leukocytopenia 7. You suspect that your patient has polymyalgia rheumatica and now are concerned that thepatient may also have Giant Cell Arteritis (GCA). Which of the following two symptoms are most indicative of GCA and PMR? A. Jaw pain and heart murmur B. Joint swelling and sudden loss of central vision bilaterally C. Hoarseness and the total inability to grasp small objects D. Scalp tenderness and aching in shoulder and pelvic girdle 8. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 yearssince her last physical examination and any laboratory or diagnostic tests as she relocated and had notyet identified a health- care provider. In prioritizing your management plan, your first orders should include: A. Recommending she increase her dietary intake of Calcium and Vitamin D B. Ordering once a year bisphosphonate and a proton pump inhibitor C. Participate in a fall prevention program D. Dual-energy x-ray (DEXA) scan and updating immunizations 9. Which of the following differential diagnosis for patients presenting with polymyalgia rheumatica(PMR) can be ruled out with a muscle biopsy? A. Parkinson’s disease B. Polymyositis C. Late-onset rheumatoid arthritis D. Giant Cell Arteritis 10. In reviewing laboratory results for patients suspected with polymyalgia rheumatica (PMR), you realize that there is no definitive test to diagnosis PRM, rather clinical response to treatment. Results you would expect to see include: A. Elevated erythrocyte sedimentation rate (ESR) greater than 50mm per hour B. Elevated rheumatoid factor and anti-citrullinated protein antibodies (RF and ACPA) C. Decreased C-reactive protein level (CR-P) D. Elevated thyroid stimulating hormone (TSH) 11. Which of the following is the most appropriate laboratory test for monitoring gout therapy overthe long-term? A. Erythrocyte sedimentation rate (ESR) B. Completer blood count (CBC) C. Serum urate level D. Serum albumin 12. In providing health teaching related to dietary restrictions, the nurse practitioner should advisea patient with gout to avoid which of the following dietary items: A. Green leafy vegetables B. Beer, sausage, fried seafood C. Sugar D. Gluten and bread items 13. The best method of verifying a diagnosis of gout in a joint is which of the following: A. Radiographic examination of the joint with two views B. Ultrasound C. Palpation D. Joint aspiration and polarized-light microscopy 14. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney diseaseor elevated bleeding risk): A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days B. Doxycycline 100 mg BID for 5 days C. Prednisolone 35 mg QD for 5 days D. Ice therapy 15. The nurse practitioner orders bilateral wrist X-rays on a 69- year-old gentleman complaining ofpain in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be: A. Symmetric joint space narrowing B. Soft tissue swelling C. Subluxations of the joints D. Joint erosions 16. The nurse practitioner is examining the hands of a 55-year-old woman with rheumatoid arthritis and notes bilateral spindle shaped deformities on the middle interphalangeal joints. These are known as: A. Haygarth’s nodes B. Heberden’s nodes C. Bouchard’s nodes D. Benediction hands 17. A 72-year-old female patient has been diagnosed with gout. She also has a long history of chronic congestive heart failure. The most likely contributing factor to the development of gout in this older female is: A. Lead intoxication B. Illegal whiskey C. Binge-eating D. Thiazide diuretics 18. Which of the following statements about osteoarthritis is true? A. It affects primarily weight-bearing joints B. It is a systemic inflammatory illness C. The metacarpal phalangeal joints are commonly involved D. Prolonged morning stiffness is common 19. In considering the specificity of laboratory data, the most reliable diagnostic test listed belowwould be: A. Elevated erythrocyte sedimentation rate (ESR) to rule out inflammation B. CBC to rule out infection C. Antinuclear Antibody (ANA) test to rule out a collagen disease D. Synovial fluid analysis to differentiate between an infectious versus an inflammatory infusion 20. When examining the spine of an older adult you notice a curvature with a sharp angle. This isreferred to as a: A. Gibbus B. Scoliosis C. Kyphosis D. Lordosis Chapter 13. Central and Peripheral Nervous System DisordersMultiple Choice Identify the choice that best completes the statement or answers the question. 1. An older adult patient is being evaluated following a stroke, which affected the anterior cerebralcirculatory system. Which of the following signs/symptoms would be positive in the assessment of this patient? A. Bilateral vision disturbance and/or diplopia B. Dysarthria and speech difficulties C. Disorders in behavior and in cognition D. Motor and sensory problems on both sides of the body 2. When assessing a patient who complains of a tremor, the nurse practitioner must differentiate essential tremor from the tremor of Parkinson’s disease. Which of the following findings are consistentwith essential tremor? A. The handwriting is not affected by the tremor B. The tremor occurs with purposeful movements C. The tremor occurs at rest D. The tremor gets worse with alcohol ingestion 3. Which of the following assessments are commonly noted in a client with Parkinson’s disease? A. Macrographia and bradycardia B. Micrographia and bradykinesia C. Exaggeration of rapid successive movements D. Increased arm swing 4. An older adult client with a history of a seizure disorder comes into the clinic for a routine check- up. Although seizure-free, the client continues on long-term phenytoin treatment. The nurse practitioner would assess for which of the following long-term effects? A. Lid lag and nystagmus B. Gingival hyperplasia and nystagmus C. Nystagmus and microcytic anemia D. Gingival hyperplasia and iron deficiency anemia 5. An elderly nursing home resident is maintained on phenytoin therapy for a history of a seizuredisorder. In addition to periodic serum drug concentrations, which of the following are needed for annual evaluation? A. Complete blood count, liver function tests, and renal function tests B. Complete blood count, liver function tests, and platelet count C. Renal function and calculated creatinine clearance D. Serum albumin, liver function tests, and renal function tests 6. A 78-year-old female presents with a seizure that occurred over the weekend. In selecting themost important diagnostics for this presentation, it is important to know that the least common site of seizures in the elderly is: A. Cerebellum B. Frontal lobe C. Temporal lobe D. Parietal lobe 7. An elderly patient has had a CVA in the anterior cerebral circulatory system (frontal lobe). Whatsymptoms are most likely expressed? A. Neglect of body and difficulty organizing space B. Wernicke’s aphasia (difficulty understanding speech) C. Disorders of behavior and cognition D. Bilateral motor and sensory problem 8. The most common neurological cause of seizures in an o