Fitzgerald ACNP review- Questions and
Answers
Erik Erikson's theory of development Correct Ans-Erik Erikson- the 8 stages of development
framed as conflicts.
Infancy: trust vs mistrust: success = hope
Toddler (1-3): autonomy vs shame: success = will
Preschool (3-6): initiative vs guilt: success = purpose
School age (6-11): industry vs inferiority-
success = competence
Teenagers: identity vs role confusion: success = fidelity
18-34: intimacy vs isolation: success = love
35-64: generativity vs stagnation: success = care
65+: ego integrity vs despair: success = wisdom
Peck's Theory of Aging Correct Ans-Takes Erikson's "ego integrity vs despair" and breaks it
down into 3 categories.
1) Ego differentiation vs workplace preoccupation- who are you when you've left your job?
2) Body transcendance vs body preoccupation- recognizing the emotional/intellectual benefits of
age instead of just seeing the physical declines
,3) Ego transcendance vs ego preoccupation- can you accept yourself and your
life/accomplishments?
Levinson's Seasons of Life Correct Ans-The 'midlife crisis' guy who saw aging as a series of
transitions and crisises. Had different sets of 'seasons' for men and women. For men in the
midlife crisis, identified 4 main conflicts
-being young vs being old
-being destructive vs constructive
-being masculine vs feminine
-being attached to others vs separated.
For the elderly, he focused on the relationship between physical changes and personality changes
and believed that older adults had to make peace with the inevitability of death.
Legal definition of competency Correct Ans-The law presumes that all adults are competent
to make their own medical decisions. Only a court can take away someone's competency and
appoint them a guardian. Impaired judgement is NOT enough to make someone incompetent. For
instance, someone who is temporarily delirious
But informed consent is a different thing- it's your job as a provider to determine in the patient
can give informed consent. If someone is temporarily impaired, you can have a family member
give informed consent, but it doesn't make the patient incompetent.
Criteria for informed consent Correct Ans-The patient must:
,Know the diagnosis
Understand the nature and purpose of the procedure
Understands the risks, benefits, and side effects
Knows about the reasonable alternatives.
Definition of Elder Abuse Correct Ans-When an elderly person is abused, mistreated, or
neglected by another person OR by themselves.
Elder abuse rates are estimated at 4-10% of elderly adults.
Includes physical, sexual, emotional, financial abuse as well as neglect.
End of Life Approaches Correct Ans-Advanced directives are the best option if we have one.
If not:
An appointed person, typically the child of the patient, makes decisions based on their
understanding of the patient's values.
Rational approach: make decisions based on what a "rational person" would want.
Substituted judgment: You, as the provider, make your best guess at what the patient would want.
, Living will vs advanced directives vs durable power of attorney Correct Ans-Advanced
directives is relative vague term, including living wills, healthcare proxies, values statements-
they may not be considered legally binding.
Living will is meant specifically for terminal illness. Laws about living wills vary by state.
Durable PoA is designating a specific person to make healthcare decisions.
a DNR order is not the same thing as a living will.
POLST (Physician Orders for Life-Sustaining Treatment)- a document that helps clarify vague
terms used by the patients such as "life support" or "heroic measures"
Normal age-related changes on physical exam Correct Ans-Increased A-P diameter
Corneal ring
Decreased skin turgor
Dementia vs delirium vs depression Correct Ans-Dementia is characterized by its
stable/progressive nature and deterioration of mental/behavioral/emotional function without a
decline in LOC.
Delirium is an acute event with global cognitive impairment, changes in sleep-wake cycle and
psychomotor behavior. Typically due to non-CNS causes.
Answers
Erik Erikson's theory of development Correct Ans-Erik Erikson- the 8 stages of development
framed as conflicts.
Infancy: trust vs mistrust: success = hope
Toddler (1-3): autonomy vs shame: success = will
Preschool (3-6): initiative vs guilt: success = purpose
School age (6-11): industry vs inferiority-
success = competence
Teenagers: identity vs role confusion: success = fidelity
18-34: intimacy vs isolation: success = love
35-64: generativity vs stagnation: success = care
65+: ego integrity vs despair: success = wisdom
Peck's Theory of Aging Correct Ans-Takes Erikson's "ego integrity vs despair" and breaks it
down into 3 categories.
1) Ego differentiation vs workplace preoccupation- who are you when you've left your job?
2) Body transcendance vs body preoccupation- recognizing the emotional/intellectual benefits of
age instead of just seeing the physical declines
,3) Ego transcendance vs ego preoccupation- can you accept yourself and your
life/accomplishments?
Levinson's Seasons of Life Correct Ans-The 'midlife crisis' guy who saw aging as a series of
transitions and crisises. Had different sets of 'seasons' for men and women. For men in the
midlife crisis, identified 4 main conflicts
-being young vs being old
-being destructive vs constructive
-being masculine vs feminine
-being attached to others vs separated.
For the elderly, he focused on the relationship between physical changes and personality changes
and believed that older adults had to make peace with the inevitability of death.
Legal definition of competency Correct Ans-The law presumes that all adults are competent
to make their own medical decisions. Only a court can take away someone's competency and
appoint them a guardian. Impaired judgement is NOT enough to make someone incompetent. For
instance, someone who is temporarily delirious
But informed consent is a different thing- it's your job as a provider to determine in the patient
can give informed consent. If someone is temporarily impaired, you can have a family member
give informed consent, but it doesn't make the patient incompetent.
Criteria for informed consent Correct Ans-The patient must:
,Know the diagnosis
Understand the nature and purpose of the procedure
Understands the risks, benefits, and side effects
Knows about the reasonable alternatives.
Definition of Elder Abuse Correct Ans-When an elderly person is abused, mistreated, or
neglected by another person OR by themselves.
Elder abuse rates are estimated at 4-10% of elderly adults.
Includes physical, sexual, emotional, financial abuse as well as neglect.
End of Life Approaches Correct Ans-Advanced directives are the best option if we have one.
If not:
An appointed person, typically the child of the patient, makes decisions based on their
understanding of the patient's values.
Rational approach: make decisions based on what a "rational person" would want.
Substituted judgment: You, as the provider, make your best guess at what the patient would want.
, Living will vs advanced directives vs durable power of attorney Correct Ans-Advanced
directives is relative vague term, including living wills, healthcare proxies, values statements-
they may not be considered legally binding.
Living will is meant specifically for terminal illness. Laws about living wills vary by state.
Durable PoA is designating a specific person to make healthcare decisions.
a DNR order is not the same thing as a living will.
POLST (Physician Orders for Life-Sustaining Treatment)- a document that helps clarify vague
terms used by the patients such as "life support" or "heroic measures"
Normal age-related changes on physical exam Correct Ans-Increased A-P diameter
Corneal ring
Decreased skin turgor
Dementia vs delirium vs depression Correct Ans-Dementia is characterized by its
stable/progressive nature and deterioration of mental/behavioral/emotional function without a
decline in LOC.
Delirium is an acute event with global cognitive impairment, changes in sleep-wake cycle and
psychomotor behavior. Typically due to non-CNS causes.
