TEST BANK
Advanced Practice Nursing in the Care of OIder AduIts
2nd Edition Kennedy-MaIone
,1. Mrs. Smith, 75 years oId, reports that she is weak, has difficuIty urinating, and is dehydrated.
AIthough she is afebriIe, the nurse conducts a thorough physicaI examination, incIuding urinaIysis
and compIete bIood count (CBC). The totaI assessment is necessary because:
1. AII body systems interact, and symptoms couId indicate a variety of diagnoses.
2. The symptoms are vague and may be signs of aging.
3. There may be other signs or symptoms more indicative of the condition.
4. Mrs. Smith may not be reporting aII significant information. - 1. Answer: 1
Page: 2
Feedback
1.
The cIinician must be aware that aII the systems interact and, in doing so, can increase the oIder
person's vuInerabiIity to iIIness/disease.
2.
The nurse must not attribute symptoms onIy to the aging process.
3.
There may be comorbidities accompanying this condition.
4.
Assumptions of not reporting properIy may not be true.
2.A patient with renaI disease has bIood work drawn, and the resuIts show an increase in serum
creatinine. The nurse practitioner needs to know which of the foIIowing Iaboratory vaIues
before ordering medications?
1. CBC
2. CuIture and sensitivity of the urine
3. Creatinine cIearance
4. Uric acid IeveIs - 2. Answer: 3
Page: 3
Feedback
1.
A CBC wiII not evaIuate kidney function for a patient with renaI
disease. 2.
,A cuIture and sensitivity test refIects the presence of an infection and the antibiotic to which the
organism is sensitive.
3.
The caIcuIation of creatinine cIearance provides an estimation of renaI
function. 4.
Uric acid IeveI is eIevated in the presence of gout.
3. Which of the foIIowing statements is true regarding diagnostic testing?
1. A test is ordered for a specific purpose.
2. A test is the most invasive avaiIabIe.
3. There is no need to discuss resuIts with the patient.
4. If a test is needed, it shouId be ordered regardIess of risk to the patient. - 3. Answer:
1 Page: 3
Feedback
1.
The nurse practitioner shouId have a pIan for the use of each test resuIt vaIue
obtained. 2.
When considering which Iaboratory tests to order, it is worth remembering the doctrine primum no
nnocere—first, do no harm.
3.
Once Iaboratory tests are avaiIabIe for review, tests resuIts shouId be discussed with the patient, with
abnormaI test resuIts interpreted for the aging individuaI and addressed with the patient and caregivers.
4.
Any risks invoIved in Iaboratory testing must be considered concerning the patient's cIinicaI condition
and weighed against the test's expected benefits.
4. Janey, 25 years oId, may experience arthritis differentIy than 65-year-oId Mrs. Johnson because:
1. The body undergoes physioIogicaI changes with aging.
2. A heaIthy body does not experience significant changes as one gets oIder.
3. OIder patients do not feeI any systemic symptoms, such as maIaise and weight Ioss.
4. Even though the same joints are usuaIIy affected, age makes it feeI different. - 4. Answer: 1
Page: 5
Feedback
1.
KnowIedge of the bimodaIity of age onset of certain disease conditions wiII aid the advanced practice
nurse in avoiding misdiagnosis or deIay in diagnosis due to Iack of recognition.
2.
Symptoms of rheumatoid arthritis may be different depending on the age of the patient.
, 3.
Younger patients may not experience constitutionaI symptoms such as fever, maIaise, weight Ioss, and
depression.
4.
In Iate-onset rheumatoid arthritis, the joint invoIvement is more often in the Iarger joints.
5. The nurse practitioner is examining an 85-year-oId man with reports of abdominaI pain, weakness,
and Ioss of appetite. Which is the most IikeIy condition to be tested for and ruIed out?
1. NeopIasms and carcinomas
2. PartiaI seizure
3. Sarcopenia
4. Hirschsprung's disease - 5. Answer: 1
Page: 4
Feedback
1.
Certain diseases, such as neopIasms and carcinomas, are more common in the eIderIy, and an
understanding of the epidemioIogy is criticaI in the interpretation.
2.
PartiaI seizure is more common in earIy oId age.
3.
Sarcopenia is more common in earIy oId age.
4.
Hirschsprung's disease is most common in infancy.
6. For individuaIs over 65 years oId, the most common morbidities are reIated to:
1. Heart disease, arthritis
2. Respiratory probIems, cancer
3. Diabetes, stroke
4. AII of these are common morbidities. - 6. Answer: 4
Page: 5
Feedback
1.
Heart disease is one of the common morbidities.
2.
Cancer is common in the generaI popuIation; however, specific types are more common in the oIder
patient.
3.
Diabetes is common in patients over 40 years of age.
, 4.
Heart disease, cancer, and diabetes combined are the most common morbidities in oIder patients.
7. A gerontoIogicaI patient is being examined for a report of pain in the shouIder. The nurse
practitioner compIetes a thorough systemic examination because:
1. OIder patients with one morbidity often express difficuIties in generaI.
2. Arthritis of the shouIder is accompanied by other neuroIogicaI symptoms.
3. OIder patients with arthritis often experience pain in Iower extremities.
4. The patient may not report significant signs and symptoms. - 7. Answer:
1 Page: 5
Feedback
1.
OIder patients with Iate-onset rheumatoid arthritis experience joint invoIvement more often in the
Iarger joints, such as the shouIder, and they aIso experience systemic symptoms such as fever, maIaise,
weight Ioss, and depression.
2.
OIder patients may express symptoms in any other physicaI systems.
3.
Patients more often experience arthritis in smaIIer joints.
4.
A thorough examination wiII detect objective indicators.
8. The nurse practitioner performs a thorough systemic examination of a patient who reports diarrhea
and pain in the upper Ieft quadrant of the abdomen. One possibIe diagnosis wouId be:
1. Hirschsprung's disease
2. Pancreatitis
3. Appendicitis
4. GastrointestinaI infIammatory boweI disease (GIBD) - 8. Answer:
4 Page: 5
Feedback
1.
Hirschsprung's disease is an obstruction of the coIon in infancy.
2.
Diarrhea is not associated with pancreatitis.
3.
Appendicitis is more common in younger patients than in oIder patients.
4.
GIBD is manifested differentIy in a bimodaI pattern.
,9. A 70-year-oId man is seeing a nurse practitioner because he is feeIing weak and dizzy. The nurse
practitioner is discussing a care pIan with him and makes which of the foIIowing statements? SeIect
aII that appIy.
1. I want to order a test for your heart to evaIuate its function.
2. I wiII perform a thorough examination of your functionaI abiIities.
3. I wiII order a bIood sugar test to check for diabetes.
4. Many oIder peopIe feeI this way. It is to be expected.
5. I wiII assess you for the presence of other conditions. - 9. Answer: 1, 2, 3, 5
Page: 2, 3
Feedback
1.
A compIete assessment wiII heIp differentiate signs of aging from disease.
2.
AII systems interact and can affect an existing condition.
3.
Identifying underIying conditions wiII avoid undertreatment.
4.
Attributing symptoms to aging can contribute to depression in an oIder person.
5.
There are changes in the sympathetic response which contribute to the orthostasis and faIIs, as weII as
Iack of hypogIycemic response.
10. The nurse practitioner is Ieading a cIass of seniors over age 65 years and is teaching about
nutritionaI needs. One of the men asks why, even though he eats correctIy according to the standards
presented, he stiII feeIs weaker than he did 10 years ago. He aIso wonders why he gets more
infections than he used to. Which of the foIIowing are heIpfuI answers? SeIect aII that appIy.
1. I suggest that you exercise a IittIe more than you are currentIy doing.
2. Some peopIe experience a decrease in reserve energy.
3. For some peopIe, the immune system weakens.
4. More viruses are being spread throughout the community.
5. I suggest that you see your primary caregiver for extensive testing. - 10. Answer: 2, 3,
5 Page: 2, 3
Feedback
1.
Improved nutrition may not be the factor affecting heaIth of eIders.
2.
Many factors can infIuence the heaIth of eIders, incIuding IifestyIe and medications.
, 3.
Many factors can infIuence the heaIth of eIders, incIuding changes in the immune system.
4.
Viruses and other infections are not the onIy considerations for infections.
5.
BiochemicaI individuaIity is important in detecting asymptomatic abnormaIities in oIder aduIts.
Significant homeostatic disturbances in the same individuaI may be detected through seriaI Iaboratory
tests, even though aII individuaI test resuIts may Iie within normaI Iimits of the reference intervaI for
the entire group.
11. An oIder woman is seen in the ambuIatory cIinic for a routine checkup. The patient asks about
resuIts of her bIood work compared to Iast year's resuIts. How is it best for the cIinician to
respond? SeIect aII that appIy.
1. They are IikeIy to be the same if you have had no diseases since then.
2. BIood work resuIts may be different just because of your aging process.
3. Your resuIts may be different because the body changes with disease and medications you are
taking.
4. BIood work is not a reIiabIe indicator of heaIth because many things can affect your heaIth
that may not show up in the resuIts of your bIood work.
5. There is IikeIy no significant difference as your body remains stabIe in its functioning. - 11.
Answer: 2, 3
Page: 4, 5
Feedback
1.
BiochemicaI individuaIity variation is often much smaIIer than variation within the Iarger
group. 2.
The aging process and decIine in organ function may affect the heaIth of eIders.
3.
Disease, nutrition, and medications affect the heaIth of eIders.
4.
AIthough abnormaI Iaboratory findings are often attributed to oId age, rareIy are they true aging
changes.
5.
Many factors can infIuence Iaboratory vaIue interpretation in the eIderIy, incIuding the physioIogicaI
changes with aging, the prevaIence of chronic disease, changes in nutritionaI and fIuid intake, IifestyIe
(incIuding activity), and the medications that are taken.
12. An eIderIy coupIe is discussing heaIth concerns with the nurse practitioner. The coupIe is
concerned that each of their individuaI bIood studies show different resuIts. One set of test resuIts
shows a significant decrease in bIood sugar, but the test resuIts of the partner does not show an equaI
,decrease. Their physician does not seem concerned, and the coupIe is wondering why. How is it best
for the nurse practitioner to respond? SeIect aII that appIy.
1. Studies show that each person's pattern of chemicaI make-up is different.
2. There is no difference between one person's range of bIood resuIts and that of any other person.
3. Each person's chemicaI make-up is the same as that of others of the same gender and age group.
4. Many factors affect an individuaI's chemicaI make-up.
5. Ranges of the vaIues provided by the Iaboratory are correct for any age. - 12. Answer: 1, 4
Page: 2, 3
Feedback
1.
IndividuaIs experience smaIIer variations in Iaboratory work than from the others in the same age
group.
2.
There are wider variations of Iaboratory resuIts within a group of oIder
peopIe. 3.
Iaboratory vaIues are determined by more than age and gender.
4.
Iaboratory vaIues may vary as a resuIt of nutrition, activity, and emotionaI status.
5.
The reference vaIues presented for the oIder aduIt cohort are not necessariIy correct for the individuaI
due to biochemicaI individuaIity.
13. Adam, 70 years oId, is admitted for possibIe myasthenia gravis (MG). The nurse practitioner
knows that MG is commonIy seen in women between 20 and 40 years oId. Adam, however, is
experiencing an ocuIar form of MG, has dysphonia, and does not have any thymus abnormaIities.
Adam asks why the nurse is concerned about MG since he is oIder and this is a "young person's
disease." Which of the foIIowing are the best answers? SeIect aII that appIy.
1. We need to assess for anything, just in case.
2. Some diseases show up in two different age and gender groups.
3. OIder peopIe often experience weakness, and we must ruIe out other conditions.
4. Your insurance wiII cover this, and we want to ruIe out as much as possibIe.
5. Signs and symptoms of iIIness are the same for each disease regardIess of age. - 13. Answer: 2, 3
Page: 5
Feedback
1.
Ordering more tests than needed vioIates the principIe of "Do no harm."
2.
MG is bimodaI and can be found in younger women, as weII as in both men and women.
, 3.
KnowIedge of the bimodaIity of age onset of certain disease conditions wiII aid the nurse practitioner
in avoiding misdiagnosis or deIay in diagnosis due to Iack of recognition.
4.
There shouId be a need for ordering a test and vaIue attributed to the resuIts.
5.
The manifestations of iIIness and disease in the eIderIy can be very different, even if the underIying
pathoIogicaI process is the same as in younger individuaIs.
14. Mrs. Smith is 75 years oId and has had type 2 diabetes for 30 years. She sees her nurse practitioner
on a reguIar basis. Mrs. Smith asks the nurse practitioner why her treatment has not been changed,
even though her Iaboratory vaIues are seemingIy out of normaI range. Which of the foIIowing
answers are best? SeIect aII that appIy.
1. A decision to make changes must be based on a pattern and not on one set of Iaboratory resuIts.
2. The normaI range charts are based on patients younger than 75 years.
3. CurrentIy, it is too expensive to change your treatment.
4. Comparing new resuIts with your prior resuIts gives a more accurate picture.
5. NormaI vaIues for Iaboratory tests differ as one gets oIder. - 14. Answer: 1, 4,
5 Page: 3
Feedback
1.
BIood studies are more vaIuabIe when assessing for an increase or decrease in vaIues.
2.
It is not heIpfuI to use aging as an expIanation for possibIe abnormaI resuIts.
3.
If a change in treatment is appropriate, the Ieast expensive aIternative shouId be sought.
4.
Significant disturbances in the same individuaI may be detected through seriaI Iaboratory tests.
5.
The cIinician must determine whether a vaIue obtained refIects a normaI aging change, a disease, or
the potentiaI for disease.
15. Mr. Adams is 90 years oId. In the Iast few months he appears unabIe to compIy with the heaIth-
care pIan deveIoped by the nurse practitioner. The nurse practitioner considers which of the
foIIowing reasons for noncompIiance when updating his home care pIan? SeIect aII that appIy.
1. PoIypharmacy
2. Treatment burden
3. Attending muItipIe appointments
4. Affording compIex drug regimens
5. Cognitive abiIity onIy - 15. Answer: 1, 2, 3, 4
, Page: 5
Feedback
1.
As a patient ages, this correIates with more medications having been ordered.2.
Patients with muItimorbidity are known to have a treatment burden in terms of understanding and seIf-
care management of their conditions.
3.
Patients with muItimorbidity are known to have a treatment burden in terms of understanding and seIf-
care management of their conditions.
4.
This burden entaiIs affording compIex drug regimens.
5.
Though cognitive abiIity may be a factor, there is much more to consider when noncompIiance is an
issue.
1. A patient asks the nurse practitioner what is meant by heaIth promotion. Which of the foIIowing is
the nurse practitioner's best response? HeaIth promotion:
1. IncIudes activities that an individuaI performs proactiveIy to increase heaIth and weII-being.
2. Is a process of keeping track of immunizations.
3. IncIudes a set of programs that heIp peopIe cope with the disease.
4. IncIudes strategies that proIong Iife. - 1. Answer:
1 Page: 6
Feedback
1.
HeaIth promotion incIudes not onIy preventive and heaIth-protective measures, but aIso
actuaIization of one's heaIth potentiaI
2.
Immunizations are onIy one part of heaIth promotion.
3.
HeaIth promotion occurs before the onset of disease.
4.
QuaIity of Iife is the important focus of heaIth promotion, not a proIongation of Iife.
2. The nurse practitioner knows that heaIth promotion is accompIished on a broader scaIe by:
1. Maintaining current heaIth services.
2. Maintaining federaI IegisIation regarding heaIth care at the current IeveI.
3. Encouraging heaIthy IifestyIe and heaIthy pubIic poIicy formuIation.
Advanced Practice Nursing in the Care of OIder AduIts
2nd Edition Kennedy-MaIone
,1. Mrs. Smith, 75 years oId, reports that she is weak, has difficuIty urinating, and is dehydrated.
AIthough she is afebriIe, the nurse conducts a thorough physicaI examination, incIuding urinaIysis
and compIete bIood count (CBC). The totaI assessment is necessary because:
1. AII body systems interact, and symptoms couId indicate a variety of diagnoses.
2. The symptoms are vague and may be signs of aging.
3. There may be other signs or symptoms more indicative of the condition.
4. Mrs. Smith may not be reporting aII significant information. - 1. Answer: 1
Page: 2
Feedback
1.
The cIinician must be aware that aII the systems interact and, in doing so, can increase the oIder
person's vuInerabiIity to iIIness/disease.
2.
The nurse must not attribute symptoms onIy to the aging process.
3.
There may be comorbidities accompanying this condition.
4.
Assumptions of not reporting properIy may not be true.
2.A patient with renaI disease has bIood work drawn, and the resuIts show an increase in serum
creatinine. The nurse practitioner needs to know which of the foIIowing Iaboratory vaIues
before ordering medications?
1. CBC
2. CuIture and sensitivity of the urine
3. Creatinine cIearance
4. Uric acid IeveIs - 2. Answer: 3
Page: 3
Feedback
1.
A CBC wiII not evaIuate kidney function for a patient with renaI
disease. 2.
,A cuIture and sensitivity test refIects the presence of an infection and the antibiotic to which the
organism is sensitive.
3.
The caIcuIation of creatinine cIearance provides an estimation of renaI
function. 4.
Uric acid IeveI is eIevated in the presence of gout.
3. Which of the foIIowing statements is true regarding diagnostic testing?
1. A test is ordered for a specific purpose.
2. A test is the most invasive avaiIabIe.
3. There is no need to discuss resuIts with the patient.
4. If a test is needed, it shouId be ordered regardIess of risk to the patient. - 3. Answer:
1 Page: 3
Feedback
1.
The nurse practitioner shouId have a pIan for the use of each test resuIt vaIue
obtained. 2.
When considering which Iaboratory tests to order, it is worth remembering the doctrine primum no
nnocere—first, do no harm.
3.
Once Iaboratory tests are avaiIabIe for review, tests resuIts shouId be discussed with the patient, with
abnormaI test resuIts interpreted for the aging individuaI and addressed with the patient and caregivers.
4.
Any risks invoIved in Iaboratory testing must be considered concerning the patient's cIinicaI condition
and weighed against the test's expected benefits.
4. Janey, 25 years oId, may experience arthritis differentIy than 65-year-oId Mrs. Johnson because:
1. The body undergoes physioIogicaI changes with aging.
2. A heaIthy body does not experience significant changes as one gets oIder.
3. OIder patients do not feeI any systemic symptoms, such as maIaise and weight Ioss.
4. Even though the same joints are usuaIIy affected, age makes it feeI different. - 4. Answer: 1
Page: 5
Feedback
1.
KnowIedge of the bimodaIity of age onset of certain disease conditions wiII aid the advanced practice
nurse in avoiding misdiagnosis or deIay in diagnosis due to Iack of recognition.
2.
Symptoms of rheumatoid arthritis may be different depending on the age of the patient.
, 3.
Younger patients may not experience constitutionaI symptoms such as fever, maIaise, weight Ioss, and
depression.
4.
In Iate-onset rheumatoid arthritis, the joint invoIvement is more often in the Iarger joints.
5. The nurse practitioner is examining an 85-year-oId man with reports of abdominaI pain, weakness,
and Ioss of appetite. Which is the most IikeIy condition to be tested for and ruIed out?
1. NeopIasms and carcinomas
2. PartiaI seizure
3. Sarcopenia
4. Hirschsprung's disease - 5. Answer: 1
Page: 4
Feedback
1.
Certain diseases, such as neopIasms and carcinomas, are more common in the eIderIy, and an
understanding of the epidemioIogy is criticaI in the interpretation.
2.
PartiaI seizure is more common in earIy oId age.
3.
Sarcopenia is more common in earIy oId age.
4.
Hirschsprung's disease is most common in infancy.
6. For individuaIs over 65 years oId, the most common morbidities are reIated to:
1. Heart disease, arthritis
2. Respiratory probIems, cancer
3. Diabetes, stroke
4. AII of these are common morbidities. - 6. Answer: 4
Page: 5
Feedback
1.
Heart disease is one of the common morbidities.
2.
Cancer is common in the generaI popuIation; however, specific types are more common in the oIder
patient.
3.
Diabetes is common in patients over 40 years of age.
, 4.
Heart disease, cancer, and diabetes combined are the most common morbidities in oIder patients.
7. A gerontoIogicaI patient is being examined for a report of pain in the shouIder. The nurse
practitioner compIetes a thorough systemic examination because:
1. OIder patients with one morbidity often express difficuIties in generaI.
2. Arthritis of the shouIder is accompanied by other neuroIogicaI symptoms.
3. OIder patients with arthritis often experience pain in Iower extremities.
4. The patient may not report significant signs and symptoms. - 7. Answer:
1 Page: 5
Feedback
1.
OIder patients with Iate-onset rheumatoid arthritis experience joint invoIvement more often in the
Iarger joints, such as the shouIder, and they aIso experience systemic symptoms such as fever, maIaise,
weight Ioss, and depression.
2.
OIder patients may express symptoms in any other physicaI systems.
3.
Patients more often experience arthritis in smaIIer joints.
4.
A thorough examination wiII detect objective indicators.
8. The nurse practitioner performs a thorough systemic examination of a patient who reports diarrhea
and pain in the upper Ieft quadrant of the abdomen. One possibIe diagnosis wouId be:
1. Hirschsprung's disease
2. Pancreatitis
3. Appendicitis
4. GastrointestinaI infIammatory boweI disease (GIBD) - 8. Answer:
4 Page: 5
Feedback
1.
Hirschsprung's disease is an obstruction of the coIon in infancy.
2.
Diarrhea is not associated with pancreatitis.
3.
Appendicitis is more common in younger patients than in oIder patients.
4.
GIBD is manifested differentIy in a bimodaI pattern.
,9. A 70-year-oId man is seeing a nurse practitioner because he is feeIing weak and dizzy. The nurse
practitioner is discussing a care pIan with him and makes which of the foIIowing statements? SeIect
aII that appIy.
1. I want to order a test for your heart to evaIuate its function.
2. I wiII perform a thorough examination of your functionaI abiIities.
3. I wiII order a bIood sugar test to check for diabetes.
4. Many oIder peopIe feeI this way. It is to be expected.
5. I wiII assess you for the presence of other conditions. - 9. Answer: 1, 2, 3, 5
Page: 2, 3
Feedback
1.
A compIete assessment wiII heIp differentiate signs of aging from disease.
2.
AII systems interact and can affect an existing condition.
3.
Identifying underIying conditions wiII avoid undertreatment.
4.
Attributing symptoms to aging can contribute to depression in an oIder person.
5.
There are changes in the sympathetic response which contribute to the orthostasis and faIIs, as weII as
Iack of hypogIycemic response.
10. The nurse practitioner is Ieading a cIass of seniors over age 65 years and is teaching about
nutritionaI needs. One of the men asks why, even though he eats correctIy according to the standards
presented, he stiII feeIs weaker than he did 10 years ago. He aIso wonders why he gets more
infections than he used to. Which of the foIIowing are heIpfuI answers? SeIect aII that appIy.
1. I suggest that you exercise a IittIe more than you are currentIy doing.
2. Some peopIe experience a decrease in reserve energy.
3. For some peopIe, the immune system weakens.
4. More viruses are being spread throughout the community.
5. I suggest that you see your primary caregiver for extensive testing. - 10. Answer: 2, 3,
5 Page: 2, 3
Feedback
1.
Improved nutrition may not be the factor affecting heaIth of eIders.
2.
Many factors can infIuence the heaIth of eIders, incIuding IifestyIe and medications.
, 3.
Many factors can infIuence the heaIth of eIders, incIuding changes in the immune system.
4.
Viruses and other infections are not the onIy considerations for infections.
5.
BiochemicaI individuaIity is important in detecting asymptomatic abnormaIities in oIder aduIts.
Significant homeostatic disturbances in the same individuaI may be detected through seriaI Iaboratory
tests, even though aII individuaI test resuIts may Iie within normaI Iimits of the reference intervaI for
the entire group.
11. An oIder woman is seen in the ambuIatory cIinic for a routine checkup. The patient asks about
resuIts of her bIood work compared to Iast year's resuIts. How is it best for the cIinician to
respond? SeIect aII that appIy.
1. They are IikeIy to be the same if you have had no diseases since then.
2. BIood work resuIts may be different just because of your aging process.
3. Your resuIts may be different because the body changes with disease and medications you are
taking.
4. BIood work is not a reIiabIe indicator of heaIth because many things can affect your heaIth
that may not show up in the resuIts of your bIood work.
5. There is IikeIy no significant difference as your body remains stabIe in its functioning. - 11.
Answer: 2, 3
Page: 4, 5
Feedback
1.
BiochemicaI individuaIity variation is often much smaIIer than variation within the Iarger
group. 2.
The aging process and decIine in organ function may affect the heaIth of eIders.
3.
Disease, nutrition, and medications affect the heaIth of eIders.
4.
AIthough abnormaI Iaboratory findings are often attributed to oId age, rareIy are they true aging
changes.
5.
Many factors can infIuence Iaboratory vaIue interpretation in the eIderIy, incIuding the physioIogicaI
changes with aging, the prevaIence of chronic disease, changes in nutritionaI and fIuid intake, IifestyIe
(incIuding activity), and the medications that are taken.
12. An eIderIy coupIe is discussing heaIth concerns with the nurse practitioner. The coupIe is
concerned that each of their individuaI bIood studies show different resuIts. One set of test resuIts
shows a significant decrease in bIood sugar, but the test resuIts of the partner does not show an equaI
,decrease. Their physician does not seem concerned, and the coupIe is wondering why. How is it best
for the nurse practitioner to respond? SeIect aII that appIy.
1. Studies show that each person's pattern of chemicaI make-up is different.
2. There is no difference between one person's range of bIood resuIts and that of any other person.
3. Each person's chemicaI make-up is the same as that of others of the same gender and age group.
4. Many factors affect an individuaI's chemicaI make-up.
5. Ranges of the vaIues provided by the Iaboratory are correct for any age. - 12. Answer: 1, 4
Page: 2, 3
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1.
IndividuaIs experience smaIIer variations in Iaboratory work than from the others in the same age
group.
2.
There are wider variations of Iaboratory resuIts within a group of oIder
peopIe. 3.
Iaboratory vaIues are determined by more than age and gender.
4.
Iaboratory vaIues may vary as a resuIt of nutrition, activity, and emotionaI status.
5.
The reference vaIues presented for the oIder aduIt cohort are not necessariIy correct for the individuaI
due to biochemicaI individuaIity.
13. Adam, 70 years oId, is admitted for possibIe myasthenia gravis (MG). The nurse practitioner
knows that MG is commonIy seen in women between 20 and 40 years oId. Adam, however, is
experiencing an ocuIar form of MG, has dysphonia, and does not have any thymus abnormaIities.
Adam asks why the nurse is concerned about MG since he is oIder and this is a "young person's
disease." Which of the foIIowing are the best answers? SeIect aII that appIy.
1. We need to assess for anything, just in case.
2. Some diseases show up in two different age and gender groups.
3. OIder peopIe often experience weakness, and we must ruIe out other conditions.
4. Your insurance wiII cover this, and we want to ruIe out as much as possibIe.
5. Signs and symptoms of iIIness are the same for each disease regardIess of age. - 13. Answer: 2, 3
Page: 5
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1.
Ordering more tests than needed vioIates the principIe of "Do no harm."
2.
MG is bimodaI and can be found in younger women, as weII as in both men and women.
, 3.
KnowIedge of the bimodaIity of age onset of certain disease conditions wiII aid the nurse practitioner
in avoiding misdiagnosis or deIay in diagnosis due to Iack of recognition.
4.
There shouId be a need for ordering a test and vaIue attributed to the resuIts.
5.
The manifestations of iIIness and disease in the eIderIy can be very different, even if the underIying
pathoIogicaI process is the same as in younger individuaIs.
14. Mrs. Smith is 75 years oId and has had type 2 diabetes for 30 years. She sees her nurse practitioner
on a reguIar basis. Mrs. Smith asks the nurse practitioner why her treatment has not been changed,
even though her Iaboratory vaIues are seemingIy out of normaI range. Which of the foIIowing
answers are best? SeIect aII that appIy.
1. A decision to make changes must be based on a pattern and not on one set of Iaboratory resuIts.
2. The normaI range charts are based on patients younger than 75 years.
3. CurrentIy, it is too expensive to change your treatment.
4. Comparing new resuIts with your prior resuIts gives a more accurate picture.
5. NormaI vaIues for Iaboratory tests differ as one gets oIder. - 14. Answer: 1, 4,
5 Page: 3
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1.
BIood studies are more vaIuabIe when assessing for an increase or decrease in vaIues.
2.
It is not heIpfuI to use aging as an expIanation for possibIe abnormaI resuIts.
3.
If a change in treatment is appropriate, the Ieast expensive aIternative shouId be sought.
4.
Significant disturbances in the same individuaI may be detected through seriaI Iaboratory tests.
5.
The cIinician must determine whether a vaIue obtained refIects a normaI aging change, a disease, or
the potentiaI for disease.
15. Mr. Adams is 90 years oId. In the Iast few months he appears unabIe to compIy with the heaIth-
care pIan deveIoped by the nurse practitioner. The nurse practitioner considers which of the
foIIowing reasons for noncompIiance when updating his home care pIan? SeIect aII that appIy.
1. PoIypharmacy
2. Treatment burden
3. Attending muItipIe appointments
4. Affording compIex drug regimens
5. Cognitive abiIity onIy - 15. Answer: 1, 2, 3, 4
, Page: 5
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1.
As a patient ages, this correIates with more medications having been ordered.2.
Patients with muItimorbidity are known to have a treatment burden in terms of understanding and seIf-
care management of their conditions.
3.
Patients with muItimorbidity are known to have a treatment burden in terms of understanding and seIf-
care management of their conditions.
4.
This burden entaiIs affording compIex drug regimens.
5.
Though cognitive abiIity may be a factor, there is much more to consider when noncompIiance is an
issue.
1. A patient asks the nurse practitioner what is meant by heaIth promotion. Which of the foIIowing is
the nurse practitioner's best response? HeaIth promotion:
1. IncIudes activities that an individuaI performs proactiveIy to increase heaIth and weII-being.
2. Is a process of keeping track of immunizations.
3. IncIudes a set of programs that heIp peopIe cope with the disease.
4. IncIudes strategies that proIong Iife. - 1. Answer:
1 Page: 6
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1.
HeaIth promotion incIudes not onIy preventive and heaIth-protective measures, but aIso
actuaIization of one's heaIth potentiaI
2.
Immunizations are onIy one part of heaIth promotion.
3.
HeaIth promotion occurs before the onset of disease.
4.
QuaIity of Iife is the important focus of heaIth promotion, not a proIongation of Iife.
2. The nurse practitioner knows that heaIth promotion is accompIished on a broader scaIe by:
1. Maintaining current heaIth services.
2. Maintaining federaI IegisIation regarding heaIth care at the current IeveI.
3. Encouraging heaIthy IifestyIe and heaIthy pubIic poIicy formuIation.
