NRNP 6540 Didactic Terms in this set (280) There are benign and lethal murmurs. Which of the following are true of lethal murmurs hospitalization is required when arrhythmias result from hemodynamic compromise Cardioversion pre hospitalization may be

NRNP 6540 Didactic Terms in this set (280) There are benign and lethal murmurs. Which of the following are true of lethal murmurs hospitalization is required when arrhythmias result from hemodynamic compromise Cardioversion pre hospitalization may be needed Aggressive therapeutic treatment is needed when symptomatic Underlying cardiac problems need to be discovered What are the classes of BMI for obesity Class 1 30-35 Class II 35-39.9 Class morbid >40 What is the screening tool for alcohol Cage It is positive if they answer yes to two or more and then perform a SMAST-G screening tool What are the hypertension guidelines for patients greater than 60 years of age 150/90 for patients without DM or CKD 140/90 for patients with DM or CKD Why would you initiate statins on elderly patients 1-cvd 2 - LDL >190 3-in patients age 40-75, LDL of 70-189 Was what is a positive malnutrition score Greater than 10 lb weight loss in 6 months Use the MUST tool Elderly population should you screen for hyperlipidemia Patients that have known hypertension, smoking, or diabetes What is the scales nutrition screening tool S-sadness, C-cholesterol, A-albumin, L- loss of weight E- eating problems, S - shopping problems What are the vision screening requirements of patients > 65 Snelling chart - annually Patients with hypertension or diabetes must have a dilated exam annually What are the hearing screening requirements of patients > 65 Asking questions about whether people say they appear to have problems with turning the volume up NRNP 6540 Didactic When should you screen for osteoporosis Women >65 Men > 70 You must use a dual energy dxa x-ray And perform at-score What is the T score for osteoporosis? Normal 1.0 Osteopenia -1 to -2.5 Osteoporosis -2.5 Severe osteoporosis < 2.5 and fragility fracture What are the mammogram screening requirements Age greater than 40-74 What are the colon cancer screening recommendations All patients over the age of 50 Colonoscopy every 10 years Sigmoidoscopy every 5 years Occult blood yearly What are the cervical cancer screening recommendations Age 21-65 > age 65 is not required What are the requirements for counseling patients > 65 Exercise, nutrition, tobacco, alcohol What are the requirements of exercise for patients 65 Aerobic exercise for 30 minutes three times a week Strength exercise two times a week What are the alcohol recommendations for an adult one per day for women Per day for men What are the pneumonia immunization recommendations for patients >65 Pcv13 first PPS 23 one year later What are the zoster immunization recommendations All patients over the age of 60-regardless if they have had shingles or chicken pox in the past Contraindications-allergy to neomycin or gelatin Bone marrow cancer - such as lymphoma Current chemotherapy or steroids AIDS patients the major impact of the physiological changes that occur with aging is Reduced physiological Reserve-Particularly the cardiac, respiratory, and renal systems Reduced homeostatic mechanisms-That fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance Changes in the sympathetic response-which contribute to orthostasis and Falls as well as a lack of hypoglycemic response Impaired immunologic response the strongest evidence regarding normal physiological aging is available through Longitudinal studies the following statements are true about laboratory values in older adults Reference ranges are preferable Normal ranges may not be applicable for older adults Reference ranges are not necessarily acceptable values biochemical individuality is best described as Each individual's variation is often much smaller than that of a larger group polypharmacy is best described as Even a single med if there is not a clear indication for its use pharmacokinetic changes with aging is reflective of What the body does to the drug All of the following statements are false about drug absorption except Underlying chronic disease has little impact on drug absorption all of the following statements are true about drug distribution in the elderly drugs distributed in fat have less intense, more prolonged effect drugs highly protein bound have greater potential to cause an adverse drug reaction the fastest way to deliver a drug to the action site is by inhalation men have faster and more efficient biotransformation of drugs and this is thought to be due to testosterone the cytochrome P system involves enzymes that are generally Inhibited or induced by drugs a statement not shown to be true about pharmacodynamics changes with aging and hand sensitivity to central nervous system drugs drug responsiveness can be influenced by patients activity level decreased sensitivity to beta blockers they do not have a decrease sensitivity to oral anticoagulants a typical presentation of disease in the elderly is reflected by all of the following infection without fever depression without dysphoric mood cardiac manifestations of thyroid disease functional abilities are best assessed by Observed assessment of function What is a reference range in laboratory values How age or sexcan attribute to The leading cause of death in elderly Travelers worldwide Accidents What should be avoided in countries where food and water precautions are to be observed Salad buffet What insect precautions are not necessary to prevent insect-born diseases in the tropics Using 100% DEET on skin to prevent bites What is an example of a secondary prevention you could recommend order for older adults Check for a fecal occult blood Ali is a 72-year-old man who recently came to the US from Nigeria. He reports having BCG vaccination as a child. Which of the following is correct regarding a TB skin test Vaccination history is irrelevant, read as usual A 72-year-old woman and her husband are on a cross country driving Vacation. After a long day of driving, they stopped for dinner. Midway through the meal the woman becomes very short of breath, with chest pain and a feeling of panic which of the problems is most likely Pulmonary embolism Ivan is a 65-year-old man who is new to your practice. He is a history of COPD, CID, hypertension, and type 2 diabetes. He has no immunization since his discharge from the military at age 25. Childhood diseases include chicken pox, measles, mom's, and German Measles. He prevents for a disease management visit. Which of the following immunizations would you recommend for Ivan Tdap, pneumococcal, influenza, zostovax Personal health history includes smoking one pack per day, consuming a case of beer every weekend and working as an assembler for the past 10 years. Family history is first grew relatives include hypertension, high cholesterol, heart attack, and type 2 diabetes. Leo's BMI is 32, BP today is 1:30 over 86 you order a fasting glucose, lipid profile of Secondary prevention A local chapter of a nurse practitioner organization has begun planning a community-based screening for hypertension at a local congregate living facility. This population was selected on the basis of A recognized element of high risk within this group Performing range of motion exercises on a client who has had a stroke is an example of which level of prevention Tertiary prevention The nurse practitioner demonstrates an understanding of primary prevention of Falls among the elderly through which management plan Provide information about medications, side effects, and interactions An example of an active strategy of health promotion for an individual to accomplish would be Beginning a Stress Management program You are working with an older male adult with a long history of alcohol abuse and a 30-year history of smoking. In recommending an intervention for this client you're responsibility is to Chest x-ray at the same time of PPD test What is primary prevention measures to decrease the incidence of disease What is secondary prevention? treating or controlling a disease or condition after it occurs NRNP 6540 Didactic What are some recommendations not to use with dementia patients Do not use antipsychotics as first line drug Do not recommend percutaneous feeding tubes Only use metformin in patients with Hemoglobin A1c of less than 7.5 What trip details are considered high risk in the elderly patient Longer than 3 weeks Mission, medical tourism, volunteerism, visiting friends or relatives Traveling alone Adventure-backpacking scuba diving Hostile, Budget Hotel, camp What is malaria chemoprophylaxis Subtropical areas in Africa South America, and South Asia What is travelers diarrhea -bacterial or parasitic -usually lasts 2-3 days -self limiting usually -only treat if severely ill, high fever, or lasts >7 days Treat with fluoroquinolones What are the exercise recommendations for older adults Strengthen muscles The best recommendation for a patient who states they have no equipment to exercise would be Improvise with recommended objects at home that can be used When the nurse practitioner recommends exercise for sedentary older adult, which of the following pieces of advice should be considered for all types of exercise Start low and go slow The evidence reflects that comprehensive geriatric assessment should be conducted Targeting the vulnerable and frail elderly Evidence-based geriatric assessment instruments available to the clinician Include screening, evaluation, and measurement instruments in multiple domains When interviewing the older adult with the suspected dementia, it is most important that The Examiner should use short simple questionand recognize nonverbal signs of discomfort What are dimensions of symptomology Onset, location, absence of associated symptoms What is the best approach to taking a health history Start with open-ended questions A review of The Evidence relative to screening of the elderly reveals the highest evidence rating for Hearing screening Assessment of vital signs in the elderly reflect Older adults can be septic with the temperature within normal limits What is true about nutrition intake in the elderly The serum albumin is a good reflection of protein stores NRNP 6540 Didactic What is reflective of functional decline in older adults A functional decline is synonymous with Advanced staged The leading cause of traumatic death in the elderly Falls Timing of the get and go test enhances its sensitivity the process should take less than 16 seconds A validated tool for assessing cognitive function specific to dementia Confusion assessment method The medical outcome study short form 36 Remains the gold standard of quality of life instruments it measures Physical, mental, and social domains What is the half-life of albumin 21 days What is the average lifespan of pre-albumin 1 to 2 days Short-term malnutrition level Pre-albumen of less than 10 A complex syndrome characterized by loss of weight, mostly due to loss of muscle mass resulting from metabolic abnormalities due to disease cachexia What are the domains of comprehensive geriatric assessment Physical health Functional Health Psychological health Socioeconomic support Quality of life measures what is the 4Ms Framework in geriatric assessment what matters, medication, mentation, mobility The term geriatric syndrome is best described as Condition that has multiple underlying factors and involves multiple systems The anal wink reflex is used to test Sensation and Prudential nerve function Atypical presentation of acute coronary syndrome is More common in females What disease can mimic an often coexist with myocardial infarctions in elderly with coronary artery disease Esophageal disease Thoracic aortic dissection presents typically as Severe retrosternal CP that radiates to the back and both arms Medications known to contribute to constipation include Stimulant laxatives Anticholinergic drugs Iron Bordetella pertussis is best described as Subacute cough lasting greater than 2 weeks The routine testing of tuberculosis should occur in all of the following vulnerable populations Nursing home residents Prison inmates Immunocompromised patients What is true about fluid balance in the elderly Thirst response decreases as a person ages Total body water decreases with age NRNP 6540 Didactic Distinguishing delirium from dementia can be problematic since they may coexist the primary consideration in the differential is Rapid change and fluctuating course of cognitive function Presbystasis age-related decline in equilibrium or dynamic balance If dizziness has a predictable pattern associated with it common the clinician should first consider Hypoglycemia What are contributing factors to dysphagia Anticholinergics Drugs that increase reflux Inadequate intake of fluids with medication and meals Evidence shows that the most important predictor of a fall is A prior history of Falls The most cost-effective intervention used to prevent Falls Home modifications and Vitamin D supplements Chronic fatigue syndrome is best described as Fatigue lasting longer than 6 months and not relieved by rest Which form of headache is bilateral Tension Microscopic hematuria is defined as 3 or more RBCs on 3 or more samples of urine What are the associated risk factors of finding malignancy in a patient with hemoptysis Male sex Smoking history Over the age of 40 Recent weight loss is defined as A loss of greater than 10 lb over the past 3 to 6 months The most common cause of disability in the elderly is due to Arthritis Lipedema is best described as Bilateral distribution of fat in the lower extremities