NR601 Midterm Questions And Answers With
Verified Study Solutions
Body composition changes in older adult ANS decreased water weight, increased fat
changes in brain older adult ANS weight decreases by 7%, atrophy is normal
taste/smell changes older adult ANS taste buds reduced by 70%
cardiac function older adult ANS maximum heart rate decreases to around 155, reduced cardiac output
during stress
changes in kidney function older adult ANS renal perfusion decreases by 50%
changes in bone mineral content older adult ANS decreased by 10-30%
prostate gland older adult ANS increases by 100% in size
changes sexual function older adult ANS men: decreased ability to get an erection, decreased ejaculatory
flow
women: menopause, less lubrication, vaginal atrophy
the rule of fourths ANS 4 things that cause disability in the elderly: disease, disuse, misuse, and
physiologic aging
effects of polypharmacy ANS drug interactions, increased risk of falls, and cognitive impairment
decreasing medication complexity for older adults ANS 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 ANS shingles, flu, pneumococcal, tdap q10 years, hepatitis A/B
if at risk
prevention of polypharmacy ANS 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 ANS CAGE tool:
cut down, annoyed when criticized, guilty about drinking, and eye-opener
smoking cessation older adults ANS 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 ANS 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 ANS 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 ANS -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 ANS 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 ANS • 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 ANS age, male, European
disease risk factors a-fib ANS diabetes, hypertension, MI history, valvular disease, heart failure, OSA
lifestyle risk factors a-fib ANS alcohol use, tobacco use, long term endurance exercise
a-fib presentation ANS shortness of breath, palpitations, fatigue, weakness, lightheadedness
new onset a-fib ANS thorough investigation warranted: labs, H&P, radiography, advanced cardiac studies
diagnostic testing new onset a-fib ANS CBC, CMP, cardiac enzymes, TSH, CXR, echo, ECG, stress
testing, sleep study
Verified Study Solutions
Body composition changes in older adult ANS decreased water weight, increased fat
changes in brain older adult ANS weight decreases by 7%, atrophy is normal
taste/smell changes older adult ANS taste buds reduced by 70%
cardiac function older adult ANS maximum heart rate decreases to around 155, reduced cardiac output
during stress
changes in kidney function older adult ANS renal perfusion decreases by 50%
changes in bone mineral content older adult ANS decreased by 10-30%
prostate gland older adult ANS increases by 100% in size
changes sexual function older adult ANS men: decreased ability to get an erection, decreased ejaculatory
flow
women: menopause, less lubrication, vaginal atrophy
the rule of fourths ANS 4 things that cause disability in the elderly: disease, disuse, misuse, and
physiologic aging
effects of polypharmacy ANS drug interactions, increased risk of falls, and cognitive impairment
decreasing medication complexity for older adults ANS 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 ANS shingles, flu, pneumococcal, tdap q10 years, hepatitis A/B
if at risk
prevention of polypharmacy ANS 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 ANS CAGE tool:
cut down, annoyed when criticized, guilty about drinking, and eye-opener
smoking cessation older adults ANS 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 ANS 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 ANS 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 ANS -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 ANS 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 ANS • 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 ANS age, male, European
disease risk factors a-fib ANS diabetes, hypertension, MI history, valvular disease, heart failure, OSA
lifestyle risk factors a-fib ANS alcohol use, tobacco use, long term endurance exercise
a-fib presentation ANS shortness of breath, palpitations, fatigue, weakness, lightheadedness
new onset a-fib ANS thorough investigation warranted: labs, H&P, radiography, advanced cardiac studies
diagnostic testing new onset a-fib ANS CBC, CMP, cardiac enzymes, TSH, CXR, echo, ECG, stress
testing, sleep study
