NR601 Midterm Exam - Questions With Practical
Insights
Body composition changes in older adult Correct Answer - decreased
water weight, increased fat
changes in brain older adult Correct Answer - weight decreases by 7%,
atrophy is normal
taste/smell changes older adult Correct Answer - taste buds reduced by
70%
cardiac function older adult Correct Answer - maximum heart rate
decreases to around 155, reduced cardiac output during stress
changes in kidney function older adult Correct Answer - renal perfusion
decreases by 50%
changes in bone mineral content older adult Correct Answer - decreased
by 10-30%
prostate gland older adult Correct Answer - increases by 100% in size
changes sexual function older adult Correct Answer - men: decreased
ability to get an erection, decreased ejaculatory flow
women: menopause, less lubrication, vaginal atrophy
the rule of fourths Correct Answer - 4 things that cause disability in the
elderly: disease, disuse, misuse, and physiologic aging
effects of polypharmacy Correct Answer - drug interactions, increased risk
of falls, and cognitive impairment
decreasing medication complexity for older adults Correct Answer -
Decreasing complexity of medication regimen will improve adherence.
When selecting a regimen, choose a medication requiring fewer doses per day.
Use combination tablets to reduce pill burden.
,When adding a new medication, consider whether any other medication could
be
discontinued, or the dose reduced
recommendations for vaccines older adults Correct Answer - shingles, flu,
pneumococcal, tdap q10 years, hepatitis A/B if at risk
prevention of polypharmacy Correct Answer - One way to reduce
polypharmacy is to try nonpharmacologic therapies first.
oDiet, exercise, stress management, and cognitive-behavioral therapy.
Be very clear of about drug use instructions and possible side effects.
screening for alcohol abuse in older adults Correct Answer - CAGE tool:
cut down, annoyed when criticized, guilty about drinking, and eye-opener
smoking cessation older adults Correct Answer - When smoking cessation
interventions are tailored to older adults, their rate of smoking
cessation equals that of a younger person.
Smoking cessation is most successful when pharmacotherapy is in
combination with
counseling
adverse effects smoking cessation drugs Correct Answer - The nicotine
patch may cause local skin irritation, gum may cause mouth
soreness or dyspepsia, nasal irritation may occur with nasal spray (or oral
irritation if used as an inhaler).
Nicotine may also cause insomnia.
Bupropion may also cause insomnia and dry mouth.
Varenicline can cause nausea, and caution is needed with persons with a
history of depression who are at risk of suicide
opioid use older adults Correct Answer - The longer the duration of opioid
use, the greater risk of developing an opioid use disorder.
Opioids should never be first-line treatment for chronic pain.
Emphasize to the patient that opioids should be taken only as prescribed and
with consistent
follow-up on the part of the clinician as to effectiveness
, alcohol effects on older adults Correct Answer - -As the body ages, there is
a decrease in total volume of body water.
-Reduces the volume of distribution of alcohol that produces a higher blood
concentration with the same amount of intake.
-Alcohol's effects are greater even when an older individual's alcohol intake
remains unchanged
recommended alcohol intake for older adults Correct Answer - For healthy
adults over age 65 years = no more than 1 drink per day (max 7 drinks in 1
week)
and never more than 3 drinks on a given day.
assessing medication adherence older adults Correct Answer - • Ask about
medication/supplement/over-the-counter use in different ways throughout
an encounter.
• Have patient demonstrate inhaler/eyedrop/topical medication use.
• Request that patient bring all medications (preferred) or at least a
medication list to all appointments.
• Explicitly inquire about missing doses and difficulties with adherence using
open-ended questions
demographic risk factors a-fib Correct Answer - age, male, European
disease risk factors a-fib Correct Answer - diabetes, hypertension, MI
history, valvular disease, heart failure, OSA
lifestyle risk factors a-fib Correct Answer - alcohol use, tobacco use, long
term endurance exercise
a-fib presentation Correct Answer - shortness of breath, palpitations,
fatigue, weakness, lightheadedness
new onset a-fib Correct Answer - thorough investigation warranted: labs,
H&P, radiography, advanced cardiac studies
diagnostic testing new onset a-fib Correct Answer - CBC, CMP, cardiac
enzymes, TSH, CXR, echo, ECG, stress testing, sleep study
Insights
Body composition changes in older adult Correct Answer - decreased
water weight, increased fat
changes in brain older adult Correct Answer - weight decreases by 7%,
atrophy is normal
taste/smell changes older adult Correct Answer - taste buds reduced by
70%
cardiac function older adult Correct Answer - maximum heart rate
decreases to around 155, reduced cardiac output during stress
changes in kidney function older adult Correct Answer - renal perfusion
decreases by 50%
changes in bone mineral content older adult Correct Answer - decreased
by 10-30%
prostate gland older adult Correct Answer - increases by 100% in size
changes sexual function older adult Correct Answer - men: decreased
ability to get an erection, decreased ejaculatory flow
women: menopause, less lubrication, vaginal atrophy
the rule of fourths Correct Answer - 4 things that cause disability in the
elderly: disease, disuse, misuse, and physiologic aging
effects of polypharmacy Correct Answer - drug interactions, increased risk
of falls, and cognitive impairment
decreasing medication complexity for older adults Correct Answer -
Decreasing complexity of medication regimen will improve adherence.
When selecting a regimen, choose a medication requiring fewer doses per day.
Use combination tablets to reduce pill burden.
,When adding a new medication, consider whether any other medication could
be
discontinued, or the dose reduced
recommendations for vaccines older adults Correct Answer - shingles, flu,
pneumococcal, tdap q10 years, hepatitis A/B if at risk
prevention of polypharmacy Correct Answer - One way to reduce
polypharmacy is to try nonpharmacologic therapies first.
oDiet, exercise, stress management, and cognitive-behavioral therapy.
Be very clear of about drug use instructions and possible side effects.
screening for alcohol abuse in older adults Correct Answer - CAGE tool:
cut down, annoyed when criticized, guilty about drinking, and eye-opener
smoking cessation older adults Correct Answer - When smoking cessation
interventions are tailored to older adults, their rate of smoking
cessation equals that of a younger person.
Smoking cessation is most successful when pharmacotherapy is in
combination with
counseling
adverse effects smoking cessation drugs Correct Answer - The nicotine
patch may cause local skin irritation, gum may cause mouth
soreness or dyspepsia, nasal irritation may occur with nasal spray (or oral
irritation if used as an inhaler).
Nicotine may also cause insomnia.
Bupropion may also cause insomnia and dry mouth.
Varenicline can cause nausea, and caution is needed with persons with a
history of depression who are at risk of suicide
opioid use older adults Correct Answer - The longer the duration of opioid
use, the greater risk of developing an opioid use disorder.
Opioids should never be first-line treatment for chronic pain.
Emphasize to the patient that opioids should be taken only as prescribed and
with consistent
follow-up on the part of the clinician as to effectiveness
, alcohol effects on older adults Correct Answer - -As the body ages, there is
a decrease in total volume of body water.
-Reduces the volume of distribution of alcohol that produces a higher blood
concentration with the same amount of intake.
-Alcohol's effects are greater even when an older individual's alcohol intake
remains unchanged
recommended alcohol intake for older adults Correct Answer - For healthy
adults over age 65 years = no more than 1 drink per day (max 7 drinks in 1
week)
and never more than 3 drinks on a given day.
assessing medication adherence older adults Correct Answer - • Ask about
medication/supplement/over-the-counter use in different ways throughout
an encounter.
• Have patient demonstrate inhaler/eyedrop/topical medication use.
• Request that patient bring all medications (preferred) or at least a
medication list to all appointments.
• Explicitly inquire about missing doses and difficulties with adherence using
open-ended questions
demographic risk factors a-fib Correct Answer - age, male, European
disease risk factors a-fib Correct Answer - diabetes, hypertension, MI
history, valvular disease, heart failure, OSA
lifestyle risk factors a-fib Correct Answer - alcohol use, tobacco use, long
term endurance exercise
a-fib presentation Correct Answer - shortness of breath, palpitations,
fatigue, weakness, lightheadedness
new onset a-fib Correct Answer - thorough investigation warranted: labs,
H&P, radiography, advanced cardiac studies
diagnostic testing new onset a-fib Correct Answer - CBC, CMP, cardiac
enzymes, TSH, CXR, echo, ECG, stress testing, sleep study
