NR601 Primary Care of The Maturing and Aged Family QUESTIONS & ANSWERS STUDY FINAL EXAM For a guaranteed pass

NR 601: Primary Care of The Maturing and Aged Family QUESTIONS & ANSWERS STUDY FINAL EXAM 1. According to the Sexually presentation, atrophic vaginitis a. The symptoms are the same for each woman b. Creates a more acidic vaginal environment c. Is a contributing factor for frequent urinary tract infections d. Is not treated with vaginal lubricants ANSWER: C 2. Which of the following is the most appropriate screening tool for delirium? a. St Louis University Mental Status Exam (SLUMS) b. Montreal cognitive assessment c. Lawton scale of instrumental activities of daily living d. Confusion assessment model ( question) ANSWER: D 3. A drug that can be used to treat two very common symptoms in a dying patient (pain and dyspnea_ is: a. Lorazepam b. Gabapentin c. Methadone d. Morphine ANSWER: D 4. Which of the following would you recommend annually for the elderly type 2 diabetic? a. Periodic visits to a gastroenterologist b. Colonoscopy c. Follow up with a urologist d. Eye exam with an ophthalmologist ANSWER: D 5. Which characteristic of delerium helps to distinguish it from dementia? a. short term memory impairment b. Personality changes c. Acute onset d. Impaired attention ANSWER: C 6. The majority of patients enrolled in hospice care die: a. In the hospital b. In an inpatient hospice facility c. In a nursing home d. At home ANSWER: D 7. Which of the following is a role of the advanced practice nurse in palliative cancer care? a. Detecting cancer in asymptomatic patients or those with specific symptoms b. Arranging for follow up including patients c. Identifying and managing complications of care d. All of the above ANSWER: D 8. The elderly are at high risk for delerium because of: a. Multiple medical problems b. Multisensory deficits c. Polypharmacy d. All of the above ANSWER D 9. A 68 year old woman presents with a complaint of urine leakage whenever she sneezes, laughs or strains for the past 4 months. She denies dysuria, frequency and nocturia. US dipstick is negative for RBC's leukocyte esterase, nitrates, ketones and urobilinogen. What is the diagnosis? a. Stress incontinence b. Urinary incontinence c. Urge incontinence d. Overflow incontninence ANSWER A 10. Which of the following signs or symptoms are not characteristics of delirium a. Patient is coherent b. Short duration c. Sudden onset d. Symptoms are worse in the evenings ANSWER A 11. A 52 year old female patient screened for diabetes has a fasting plasma glucose level of 123 mg/dl. The nurse practitioners plan includes: a. Repeat fasting glucose in 1 month b. Prescribe memformin 500mg bid po c. Repeat fasting plasma glucose in one year (not sure) d. Repeat fasting glucose in three years ANSWER: C 12. According to the palliative care presentation, most elderly patients die: a. Alone b. At home c. In institutions d. In pain ANSWER: C 13. Older adults with dementia sometimes suffer from agnosia, which is defined as the inability to a. Remember events and places b. Understand language c. Use language d. Recognize objects ANSWER: D 14. When treating depression associated with dementia, which of the following would be a poor choice and not be prescribed a. Desimpramine b. Amitryptyline c. Fluoxitine d. Mirtazapine ANSWER: B 15. Male patient presents with a BMI of 30 presents to the office for an annual exam. You are reviewing the lab results. You ordered a CMP as part of routine labs. The fasting glucose was 130. Your next action is: a. Repeat the fasting glucose b. Start metformin 500mg bid c. Repeat fasting glucose in 1 year d. Call the patient and report lab results as normal ANSWER: A 16. The task of grieving include all of the following except a. Begin to disengage b. Acknowledge the reality of death c. Work through the pain of grief d. Restructure relationships ANNSWE: A 17. All of the following are true statements regarding elder abuse except: a. A new STI in an elderly patient can be a sign of abuse b. Persons over 80 years of age are at highest risk for abuse c. Missing scheduled appointments and delays in medical care are common d. Common signs of abuse include decreased anxiety and depression ANSWER: D 18. Hospice care differs from palliative care in that: a. It cannot be provided in the nursing home b. The majority of those admitted to hospice die within 7 days c. It is not covered by insurance d. It is designed for the last six months of life ANSWER: D 19. How dies woman’s anatomy make them more susceptible to UTI's a. The female urethra is shorter b. Asymptomatic uti's do not resolve themselves without treatment c. Women tend to get uti's when they are pregnant d. There is a longer distance between the urethra and anus ANSWER: A 20. Mrs. Smith, a 64 year old woman presents to the 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 87 years of age. The patient’s most recent mammogram was 7 years ago and no known family history of breast cancer. She is not taking any medications. Her physical exam is unremarkable except for findings consistent with atrophic vaginitis. You prescribed topical hormone replacement therapy today. Which of the following evaluations should also be ordered today? Mammogram 21. All of the following patients should be screened for diabetes except: a. A 44 year old caucasian male with hypertension b. A 42 year old femal on disability from back injury from back injury who is unable to exercise c. An overweight middle aged african american woman with a family history of type 2 diabetes mellitus d. An obese hispanic man ANSWER: A 22. A 60 year old obese male client has type 2 diabetes mellitus and a lipid panel of TC=250 HDL=32 LDL=165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include: a. Diabetes, obesity and hyperlipidemia b. Advancing age, diabetes, hyperlipidemia, and male gender c. Hyperlipidemia, smoking and family history of heart disease d. Male with age >45, diabetes mellitys and hyperlipidemia ANSWER: A 23. A 65 year old Hispanic woman who presents to the office for routine follow up of her type 2 diabetes mellitus. Her routine UA results are as follows: few epithelial cells, negative leukocytes, negative nitrates, negative protein, no ketones. Which of the following tests should also be ordered annually for diabetic patients: a. Result is normal, no further testing is necessary b. Urine for culture and sensitivity c. Recommend a screening intravenous pyelogram (ivp) d. Microalbumin ANSWER: D 24. A male patient with a BMI of 33 presents to the office with complaints of fatigue, excessive hunger and excessive thirst. You ordered a CMP and a Hgb A1C. The results are a fasting glucose 99, Hbg AIC 5.7. The nurse practitioner diagnosis is: a. Type 2 diagnosis mellitus b. Prediabetes c. Euglycemia d. Type 1 diabetes mellitus ANSWER: B 25. All of the following patients have a risk of adverse reactions from Metformin except: a. Patients with renal disease b. Patients with bmi >30 c. Patients with alcoholic disorder d. Patients with hypoxia ANSWER: B 26. The first step in treating delriuim is to: a. Use side rails and/or wrist restraints to keep the patients safe b. Give low dose haldol if the patient has psychosis c. Identify the cause d. Provide reality orientation ANSWER: C 27. A 65 caucasian female presents for her yearly physical. She is 5"1 tall and weighs 102 lbs. A review of her chart reveals she smokes 1 pack of cigarettes a day, and drinks 2 beers every evening since she retired. She has taken synthroid and simvastatin for 10 years. She does not exercise, she likes to sit and knit. The NP knows the non-modifiable risk factor for osteoporosis for this patient include: a. Activity level b. Age c. Tobacco use d. Medications ANSWER: B 28. According to the genitourinary presentation, the number 1 risk factor for urinary incontinence is: a. Smoking and caffeine levles b. Uncontrolled diabetes c. Aging (not sure) d. Obesity ANSWER: C 29. The cornerstone of pharmacotherapy in treating Alzheimer's disease is: a. NMDA receptor antagonist b. Psychotropic medications c. Cholinesterase inhibitors d. Anxiolytics ANSWER: C 30. An 80 year old female widow asks her nurse practitioner about her end of life options. Her diagnosis include congestive heart failure, hypertension and type 2 diabetes mellitus. She has noticed that in the last month she has lower extremity edema and she if finding it difficult to walk to the grocery store and chrch. She does not use oxygen. She is able to maintain her home but requires more frequent rests after vacuuming. She does not wish to be admitted to the hospital again in the future but if admitted wants to maintain full code status. How should the NP address this patients concerns today? a. Start her on a medication for depression B provide her with information for senior day care services C. Offer the patient a palliative care referral ANSWER: C 31. Hospice services and palliative care services are underutilized due to a. Denial of impending death b. Confusion remains over when it is appropriate to consult palliative care c. Services are not understood d. All options are appropriate ANSWER: D 32. Delirium is typically characterized by all of the following except: a. Altered level of consciousness b. Insidious onset c. Inattention ANSWER: B 33. Mrs. G has returned to your office for a follow up visit for urinary incontinence (UI). Mrs G has followed your 1st line recommendations. She has quit smoking, drinks plenty of fluids, and has eliminated caffeine and spicy foods. Despite all these changes, she still experiences UI. You decide to initiate second line treatement. You recommend: a. Bladder control training b. Keagels c. Antimuscarinic medications d. Alpha 1 adrenergic receptor antagonists ANSWER: C 34. Which of the following diagnoses should be considered in a patient presenting with erectile dysfunction? a. Diabetes mellitus b. Artherosclerosis c. Depression d. All options are appropriate ANSWER: D 35. A patient has been prescribed metformin (Glucophage). One week later he returns with complaints of some loose stools during the week. How should the nurse practitioner respond? a. Double the dosage of medication and have patient return in one week b. Order a chem. 7 to check for lactic acidosis c. Discontinue the medication immediately d. Reassure the patient that this is an anticipated side effect ANSWER: D 36. A 48 year old male patient screened for diabetes has a fasting plasma glucose level of 120mg/dl (6.7mmol/L). The nurse practitioner plan includes: a. Prescribe metformin 500mg po BID b. Educate the patient on lifestyle changes to lower blood glucose c. Initiate self monitoring of blood glucose d. Review the effects of oral hypoglycemic medications ANSWER: B 37. Which of the listed conditions is most likely to cause delirium? a. Acute infection b. Multiple brain infarcts c. Malnutrition d. Fluid overload ANSWER: A 38. Age-related changes in the bladder, urethra and ureters include all of the following in older women except: a. Decline in ureteral resistance pressure b. Increased estrogen production’s influence on the bladder and ureter c. Laxity of the pelvic muscle d. Decline in bladder outlet function. ANSWER: B 39. Mrs R is a 68 year old woman with a BMI of 26. She is on Medicare, has a 20 year history of primary hypertension and has been well controlled on furosemide 30 mg BID for years. During this follow up visit Mrs. R reports that for the last 2 months she is always thirsty, she drinks at least 8 glasses of water a day. Upon chart review the NP notes that the last two fasting blood glucose levels have been 102mg/dl and 108mg/dl. What action should the nurse practitioner perform next? a. Plan to recheck glucose as scheduled at the yearly physical exam next month b. Order a fasting blood glucose c. Check a poc glucose now, she is not fasting d. Educate that the diuretic is causing thirst ANSWER: B 40. The proposed mechanism by which diphenhydramine caused delerium is: a. Anticholinergic effects b. Dopaminergic effects c. Gabanergic effectis d. Serotinergic effects ANSWER:: A 41. According to the Palliative Care Presentation, palliative care may be provided to a. Only cancer patients b. Anyone regardless of their life expectancy or disease progression c. Those with a life expectancy > 6 months d. Those with a life expectancy< 6 months ANSWER: B 42. The highest level of evidence with the use of adjuvant analgesics is with a. Therapeutic trials before discontinuing drugs b. Patients with fibromyalgia are candidates for adjuvant analgesics c. Tricyclic antidepressants avoided due to high adverse affects d. Neuropathic pain patients are candidates for adjuvant analgesia ANSWER: D 43. According to the Sexuality presentation, the biggest barrier to appropriate sexual evaluation in the older patient a. Older people don’t talk about sex b. Most elderly patients are not interested in sex c. Ageist attitudes d. Female post menopausal changes ANSWER: C 44. The highest level of evidence to support interventions at the end of life is with a. Hycosamine for respiratory secretions b. Stimulant laxatives for treating constipation c. Opioids for pain control d. Opioids for dyspnea ANSWER: D 45. The comorbid psychiatric problem with the highest frequency in dementia is: a. Depression b. Agitation and aggression c. Psychosis d. Anxiety ANSWER: A 46. According to the 2017 Guideline for High Blood pressure in adults, patients with stage 1 or 2 CKD with albuminuria should be started on the following medication to slow progression of kidney disease a. ACE inhibitors b. CCP c. ARNI d. thiazide diruetic ANSWER: A