Advanced Hesi

Advance Hesi   ADVANCED HESI GERIATRICS EXAM (37pgs) The nurse is providing medication instructions to an older client who is taking digoxin daily. The nurse explains to the client that decreased lean body mass and decreased glomerular filtration rate, which are age-related body changes, could place the client at risk for which complication with medication therapy? 1. Decreased absorption of digoxin 2. Increased risk for digoxin toxicity 3. Decreased therapeutic effect of digoxin 4. Increased risk for side effects related to digoxin The nurse is caring for an older client in a long-term care facility. Which action contributes to encouraging autonomy in the client? 1. Planning meals 2. Decorating the room 3. Scheduling haircut appointments 4. Allowing the client to choose social activities The nurse is providing instructions to the assistive personnel (AP) regarding care of an older client with hearing loss. What should the nurse tell the AP about older clients with hearing loss? 1. They are often distracted. 2. They have middle ear changes. 3. They respond to low-pitched tones. 4. They develop moist cerumen production. The nurse is providing an educational session to new employees, and the topic is abuse of the older client. The nurse helps the employees identify which client as most typically a victim of abuse? 1. A man who has moderate hypertension 2. A man who has newly diagnosed cataracts 3. A woman who has advanced Parkinson's disease 4. A woman who has early diagnosed Lyme disease The nurse is performing an assessment on an older client who is having difficulty sleeping at night. Which statement by the client indicates the need for further teaching regarding measures to improve sleep? 1. "I swim 3 times a week." 2. "I have stopped smoking cigars." 3. "I drink hot chocolate before bedtime." 4. "I read for 40 minutes before bedtime." The visiting nurse observes that the older male client is confined by his daughter-in-law to his room. When the nurse suggests that he walk to the den and join the family, he says, "I'm in everyone's way; my daughter-in-law needs me to stay here." Which is the most important action for the nurse to take? 1. Say to the daughter-in-law, "Confining your father-in-law to his room is inhumane." 2. Suggest to the client and daughter-in-law that they consider a nursing home for the client. 3. Say nothing, because it is best for the nurse to remain neutral and wait to be asked for help. 4. Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens center. The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin? 1. Crusting 2. Wrinkling 3. Deepening of expression lines 4. Thinning and loss of elasticity in the skin The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological changes the nurse should expect to note? Select all that apply. 1. Increased heart rate 2. Decline in visual acuity 3. Decreased respiratory rate 4. Decline in long-term memory 5. Increased susceptibility to urinary tract infections 6. Increased incidence of awakening after sleep onset An older client is admitted to the hospital with a diagnosis of malnutrition. Other than cognitive status, what other factors can increase the risk of malnutrition and dehydration? Select all that apply. 1. Past profession 2. Physical fatigue 3. Limited mobility 4. Sensory decreases 5. Inadequate dental care 6. Family history of malnutrition The nurse planning care for a military veteran should prioritize nursing interventions targeted at managing which condition, if present, that commonly occurs in this population? 1. Hypertension 2. Hyperlipidemia 3. Substance abuse disorder 4. Post-traumatic stress disorder Which action by the nurse will best facilitate adherence to the treatment regimen for a client with a chronic illness? 1. Arranging for home health care 2. Focusing on managing a single illness at a time 3. Communicating with one provider only to avoid confusion for the client 4. Allowing the client to teach a support person about their treatment regimen Which statement is true regarding falls in the elderly? A. Most falls occur in the garage. B. Hip fractures resulting from falls are a leading cause of placement in long-term care facilities. C. Fall risk decreases with addition of medications. D. Sedatives reduce the risk of falls. Appropriate nursing care for a patient with urinary incontinence is to: A. insert an indwelling Foley catheter. B. order oxybutynin chloride (Ditropan). C. encourage fluids to decrease the urine concentration so it is less irritating. D. recommend herbal approaches to reduce incontinence. A nursing intervention for a patient with constipation is to: A. avoid the urge to defecate. B. limit fluid intake. C. give prune juice with a noncarbonated drink. D. encourage bran cereal or whole-grain breads. A patient with dysphagia is: A. fed only for pleasure. B. at low risk for nutritional deficits. C. at higher risk for pneumonia. D. able to drink thin liquids. Age-related eye changes may include: A. increased visual accommodation. B. macular degeneration. C. non-preventable blindness as a result of glaucoma. D. decreased ability of pupil to respond to light changes. Nurses' knowledge of sexuality in the older adult population should include: A. Chronic illness may affect the ability to participate in sexual activity. B. Sexual response time is unchanged. C. Ability to achieve orgasm declines. D. Dryness of the vaginal walls is associated with pelvic inflammatory disease. What is the initial nursing intervention in preventing polypharmacy? A. Obtain a thorough medication history. B. Discontinue all herbal preparations. C. Refer the patient to a geriatric practitioner. D. Consult a pharmacist to review all medications. What should the nurse include in the teaching plan for self-medication practices of older adults? A. Eliminate unnecessary medications. B. Substitute herbal preparations for certain prescribed medications. C. Develop a drug reminder system and schedule. D. Pharmacy shop for the cheapest medications. Which age-related changes predispose the elderly patient to drug toxicity and extended duration of action of drugs? (Select all that apply.) A. Decreased body water B. Increased ratio of muscle to fat C. Low serum albumin D. Reduced blood flow to liver Which mental change is associated with aging? A. Confusion B. Gradual decline in cognitive skills C. Depression D. Inappropriate behavior An elderly patient has acute confusion after undergoing abdominal surgery. The patient most likely has: A. delirium. B. anxiety. C. dementia. D. depression A patient is taking a psychotropic medication for agitation associated with dementia. What is a common side effect of psychotropics? A. Accelerated hypertension B. Orthostatic hypotension C. Diarrhea D. Chest pain Alzheimer's disease may be suggested in its early stages by: A. magnetic resonance imaging (MRI). B. computed tomography (CT). C. positron emission tomography (PET). D. autopsy. Medications taken early in Alzheimer's disease to improve memory and alertness work by: A. increasing dopamine in the frontal lobe. B. decreasing dopamine in the frontal lobe. C. increasing acetylcholine in the cerebral cortex. D. decreasing acetylcholine in the cerebral cortex. A patient with dementia wanders throughout the skilled nursing facility. A nursing intervention for wandering may include: A. administering a sedative. B. maintaining a regular activity program. C. locking the patient's room from the outside. D. keeping a staff member with the patient when wandering A patient with depression may be prescribed a(n): A. phenytoin (Dilantin). B. lorazepam (Ativan). C. quetiapine (Seroquel). D. amitriptyline hydrochloride (Elavil). A patient in the middle stage of Alzheimer's disease (AD) may exhibit which characteristic or behavior? A. Mild depression B. Hallucinations C. Weight loss D. Impaired mobility Alcoholism is often overlooked in the elderly. Cues to alcoholism include: (Select all that apply.) A. delirium. B. self-neglect. C. frequent falls. D. mental confusion. An elderly patient who experiences nighttime confusion wanders from his room into the room of another patient. Which intervention will best decrease this patient's nighttime confusion? A. Administering a sedative at the hour of sleep B. Leaving a night-light on during the evening and night shifts C. Assigning a nursing assistant to sit with him until he falls asleep D. Allowing the patient to share a room with another elderly patient A patient with Alzheimer disease (AD) has been prescribed oral donepezil 10 mg. The nurse should give priority to assessing the patient for which sign of an adverse effect of this drug? A. Skin rashes B. Cardiac dysrhythmias C. Decreased blood pressure D. Gastrointestinal (GI) bleeding A 62-year-old woman is admitted to an assisted-living facility with symptoms of forgetfulness, irritability, difficulty following directions, and neglect of her personal hygiene. These would suggest which stage of AD? A. Late B. Early C. Moderate D. Moderate to severe The nurse is planning care for a patient with dementia. Which would be an appropriate intervention to include in this patient's care plan? A. Speak loudly and slowly. B. Restrain the patient for safety. C. Involve the patient in new activities. D. Increase verbal and environmental cues. A patient has been diagnosed as having dementia. Which symptom should the LPN/LVN expect? A. Patient tends to confabulate. B. Patient tends to have flight of ideas. C. Patient's speech tends to be slurred. D. Patient tends to be oriented to time, place, and person. The LPN/LVN reads on a patient's chart that the patient is exhibiting the sundowning phenomenon. Which behavior should the nurse expect? A. On sunny days, the patient is disoriented. B. On cloudy days, the patient is disoriented. C. The patient becomes disoriented in the evening. D. The patient is very disoriented in the morning only. The patient with dementia presents to the clinic for a routine examination. The patient's daughter, who is her full-time caregiver, states to the nurse, "I just don't know how much longer I can go on caring for Mom full time. My kids feel neglected, my marriage is suffering, and I feel so run down." What is the best response by the nurse? A. "You must stay strong for your mother. You are all she has." B."Your mother's dementia will improve once we correct the cause." C. "You should discuss the many medications available for treating and reversing dementia." D. "As your mother's condition continues to deteriorate, we should discuss alternative care resources." The nurse administers an emergent dose of intravenous (IV) haloperidol to a patient with delirium who is combative and is putting herself and others at risk. Which priority instruction should she give the unlicensed assistive personnel immediately? A. "Please get a telemetry monitor and attach it to this patient." B. "Let's put a bed alarm under the patient's sheets right away." C. "Move everything away from the patient's bed, including the patient's phone and bedside table. D. "Please apply restraints to the patient's wrists and ankles and secure them to the immobile parts of the bed." The nurse is caring for a patient recently diagnosed with AD. The nurse knows this patient's symptoms are caused by which changes in the brain? (select all that apply) A. Neurofibrillary tangles B. Development of gumma C. Formation of aneurysms D. Neuron loss in frontal and temporal lobes E. Decreased production of neurotransmitters The nurse is planning care for a patient with early AD. Interventions for which patient problems are appropriate for this patient's care plan? (select all that apply) A. Pain B. Airway patency issues C. Nutritional deficiencies D. Reduced cardiac output E. Caregiver stress and fatigue The nurse is setting up an education session with an 85-year-old patient who will be going home on anticoagulant therapy. Which strategy would reflect consideration of aging changes that may exist with this patient? A. Show a colorful video about anticoagulation therapy. B. Present all the information in one session just before discharge. C. Give the patient pamphlets about the medications to read at home. D. Develop large-print handouts that reflect the verbal information presented. When developing the plan of care for an older adult who is hospitalized for an acute illness, the nurse should A. use a standardized geriatric nursing care plan. B. plan for likely long-term-care transfer to allow additional time for recovery. C. consider the preadmission functional abilities when setting patient goals. D. minimize activity level during hospitalization. Which information obtained by the home health nurse when making a visit to an 88-year-old with mild forgetfulness is of the most concern? A. The patient's son uses a marked pillbox to set up the patient's medications weekly. B. The patient has lost 10 pounds (4.5 kg) during the last month. C. The patient is cared for by a daughter during the day and stays with a son at night. D. The patient tells the nurse that a close friend recently died. A 70-year-old client asks the nurse to explain to her about hypertension. An appropriate response by the nurse as to why older clients often have hypertension is due to: A. Myocardial muscle damage B. Reduction in physical activity C. Ingestion of foods high in sodium D. Accumulation of plaque on arterial walls In reviewing changes in the older adult, the nurse recognizes that which of the following statements related to cognitive functioning in the older client is true? A. Delirium is usually easily distinguished from irreversible dementia. B. Therapeutic drug intoxication is a common cause of senile dementia. C. Reversible systemic disorders are often implicated as a cause of delirium. D. Cognitive deterioration is an inevitable outcome of the human aging process. Which of the following interventions should be taken to help an older client to prevent osteoporosis? A. Decrease dietary calcium intake. B. Increase sedentary lifestyles C. Increase dietary protein intake. D. Encourage regular exercise. Which of the following statements accurately reflects data that the nurse should use in planning care to meet the needs of the older adult? A. 50% of older adults have two chronic health problems. B. Cancer is the most common cause of death among older adults. C. Nutritional needs for both younger and older adults are essentially the same. D. Adults older than 65 years of age are the greatest users of prescription medications. The nurse is aware that the majority of older adults: A. Live alone B. Live in institutional settings C. Are unable to care for themselves D. Are actively involved in their community The nurse works with elderly clients in a wellness screening clinic on a weekly basis. Which of the following statements made by the nurse is the most therapeutic regarding their mobility? A. "Your shoulder pain is normal for your age." B. "Continue to exercise your joints regularly to your tolerance level." C. "Why don't you begin walking 3 to 4 miles a day, and we'll evaluate how you feel next week." D. "Don't worry about taking that combination of medications since your doctor has prescribed them." A long-term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. The nurse responds most appropriately by saying: A. "Don't worry about the medication's name if you can identify it by its color and shape." B. "Unless you have severe side affects, don't worry about the minor changes in the way you feel." C. "Feel free to ask your physician why you are receiving the medications that are prescribed for you." D. "Remember that the hepatic system is primarily responsible for the pharmacotherapeutics of your medications." In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging? A. Increased perspiration B. Increased airway resistance C. Increased salivary secretions D. Increased pitch discrimination There are factors that influence the musculoskeletal system associated with aging. The nurse recognizes that with age: A. Men have the greatest incidence of osteoporosis B. Muscle fibers increase in size and become tighter C. Weight-bearing exercise reduces the loss of bone mass D. Muscle strength does not diminish as much as muscle mass Which of the following statements, made by the daughter of an older adult client concerning bringing her mother home to live with her family, presents the greatest concern for the nurse? A. "If this doesn't work out, she can always go to live with my sister." B. "I don't think she will react very well to me making decisions for her." C. "I'm afraid that mom will be depressed and miss her home." D. "My children will just have to adjust to having their grandmother with us." The nurse, preparing to discharge an 81-year-old client from the hospital, recognizes that the majority of older adults: A. Require institutional care B. Have no social or family support C. Are unable to afford any medical treatment D. Are capable of taking charge of their own lives Which of the following responses by an older-adult client is most reflective of a need for further education by the nurse regarding the physiological changes associated with the older adult? A. "I call a cab if I want to go out after dark." B. "I can't help worrying about becoming forgetful." C. "I have my eyes checked regularly. Can't afford to fall." D. "I really enjoy eating good vanilla ice cream, but I have cut way down." 0% Which of the following statements made by a family member of a client recently diagnosed with early stages of Alzheimer's disease is most reflective of an understanding of this disease process? A. "Dad has always been a fighter; he'll fight this too. He won't give up." B. "We have an appointment with his care provider to see about medication therapy." C. "Good thing we found out about this early so we can prevent this from getting worse." D. "We have a made arrangements to discuss nursing home placement for dad." The nurse is planning client education for an older adult being prepared for discharge home after hospitalization for a cardiac problem. Which nursing action addresses the most commonly determined need for this age-group? A. Suggest that he purchase an emergency in-home alert system. B. Arrange for the client to receive meals delivered to his home daily. C. Encourage the client to use a compartmentalized pill storage container for his daily medications. D. Provide only written document describing the medications the client is currently prescribed. An assisted living facility has provided its clients with an educational program on safe administration of prescribed medications. Which statement made by an older-adult client reflects the best understanding of safe self-administration of medications? A. "I don't seem to have problems with side effects, but I'll let my doctor know if something happens." B. "I'm lucky since my daughter is really good about keeping up with my medications." C. "I'll be sure to read the inserts and ask the pharmacist if I don't understand something." D. "It shouldn't be too hard to keep it straight since I don't have any really serious health issues." Which of the following client statements regarding self-medication administration by an older-adult client requires follow-up teaching by the nurse? A. "I take all the pills ordered once a day at bedtime, so I'm less likely to forget them." B. "I have one pill that needs cut in half. I am going to ask the pharmacist to do that for me." C. "The pharmacist said to keep my pills away from the sunlight, so I put them inside the kitchen cabinet." D. "My daughter comes over each morning and puts my pills into a container that sorts them by the time they are due." Which of the following statements made by an older-adult client poses the greatest concern for the nurse conducting an assessment regarding the clients adjustment to the aging process? A. "I use to enjoy dancing and jogging so much, but now I have arthritis in my knees so that it's hard to even walk." B. "I've given my grandchildren money for college so they can live a better life than I had." C. "Growing old certainly presents all sorts of challenges. I wish I knew then what I know now." D. "As I age I've found its harder to do the things I love doing, but I guess it will all be over soon enough." Of the following options, which is the greatest barrier to providing quality health care to the older-adult client? A. Poor client compliance resulting from generalized diminished capacity B. Inadequate health insurance coverage for the group as a whole C. Insufficient research to provide a basis for effective geriatric health care D. Preconceived assumptions regarding the lifestyles and attitudes of this group A patient is taking delayed-release omeprazole (Prilosec) capsules for the treatment of gastroesophageal reflux disease (GERD). Which statement will the nurse include in the teaching plan about this medication? A. "Take this medication once a day after breakfast." B. "You will only have to be on this medication for 2 weeks for a life long treatment of the reflux disease." C. "The medication may be dissolved in a liquid for better absorption." D. "The entire capsule should be taken whole, not crushed, chewed, or opened." The nurse defines ageism most accurately as: A. The undervaluing of individuals based on their age. B. Perception of a person's worth based on productivity C. Biases directed towards individuals considered aged D. Discrimination based on an individual's increasing age A nurse is caring for an older adult client preparing for discharge to a nursing center after having hip surgery. Which of the following nursing responses is most therapeutic with a client's concern that she, will never go back home? A. "What makes you think that this transfer to the nursing center will be permanent?" B. "The reason for this transfer is only to support you while you continue to recuperate." C. "The decision to stay in the nursing center is yours to make. When you want to leave no one will stop you." D. "The nursing center is a lovely place with a wonderful staff of caring people. Just give it a chance. You may like it." A nurse caring for older adults in an assistive living facility recognizes that a clients quality of life needs are best determined by: A. Excellent physical, social, and emotional nursing assessments B. A working knowledge of this age-group's developmental needs C. A therapeutic nurse-client relationship that facilitates communication D. The client's need for complete physical, emotional, and cognitive care Which of the following statements made by a nurse reflects the best understanding of the health value of conducting a blood pressure (BP) screening at a senior citizens centers health fair? A. "This is a high risk group, so assessing BP allows us to identify clients at risk and send them for treatment." B. "Older adults enjoy health fairs, so it's a good place to screen substantial numbers of clients for hypertension." C. "Hypertension doesn't present symptoms early on, so screening elder adults is a wonderful preventive measure." D. "Blood pressure problems are common among this group, so it's a good way to monitor the effectiveness of their medications." The three common conditions affecting cognition in the older adults are: A. Stroke, MI, Cancer B. Cancer, Alzheimer's disease, Stroke C. Delirium, Depression, Dementia D. Blindness, Hearing loss, Stroke A client has been recently diagnosed with Alzheimer's disease. When teaching the family about the prognosis, the nurse must explain that: A. Diet and exercise can slow the process considerably B. It usually progresses gradually with a deterioration of function C. Many individuals can be cured if the diagnosis is made early D. Few clients live more than 3 years after the diagnosis An overall, general assessment of an older adult patient is best performed in which setting? A. During a meal. B. During assessment of vital signs. C. While assisting a patient with a bath. D. When assisting a patient during a walk. When caring for the older adult, it is important to: A. Repeat oneself often because older adults are forgetful. B. Treat the client as an individual with a unique history of his or her own. C. Be aware that older adults are no longer interested in sex. D. Disregard the older adult's experiences because older people are too old-fashioned to be of value today. When administering a mental status examination to a patient with delirium, the nurse should A. give the examination when the patient is well-rested. B. choose a place without distracting environmental stimuli. C. reorient the patient as needed during the examination. D. medicate the patient first to reduce anxiety. When performing a comprehensive geriatric assessment of an older adult, focus of the nursing assessment is on the patient's: A. Physical signs of aging. B. Immunological function. C. Functional abilities. D. Chronic illness. Of the following, which describes dementia? A. Quick onset, irreversible B. Slow onset, chronic C. Acute onset, reversible D. Progressive, terminal When a fall results in injury and hospitalization, a cycle of disuse may occur over time. When establishing a care plan for the patient and family to prevent this, it is important to remember disuse is most likely a result of: A. Decreasing muscle strength. B. Decreased joint mobility. C. Fear of repeated falls. D. Changes in sensory perception. What is the best resource (of those listed below) for identifying information regarding an older adult's current functional ability? A. Psychological tests and related exams B. Diagnostic x-rays and lab tests C. Family members who visit occasionally and call weekly D. Neighbor who visits daily and helps the person to the store weekly. When caring for an older adult patient, the nurse uses the following interventions to accommodate visual changes with age: A. Eye glasses in the bedside table. B. Adequate lighting and uncluttered walkways. C. Draw drapes in room to prevent glare. D. Keep bedside rails down. The primary reason an older adult client is more likely to develop a pressure ulcer on the elbow as compared to a middle-age adult is: A. A reduced skin elasticity is common in the older adult B. The attachment between the epidermis and dermis is weaker C. The older client has less subcutaneous padding on the elbows D. Older adults have a poor diet that increases risk for pressure ulcers While bathing an elderly client who has limited abilities for self-care, the nurse notices several patches of dry skin on the clients heels, elbows, and coccyx. The nurse cleans and dries all the areas well and applies a moisturizing lotion. The most appropriate immediate follow-up by the nurse to ensure appropriate nursing care for this clients skin is to: A. Revise the client's care plan to show the need for the application of moisturizing lotion B. Assume personal responsibility to apply the moisturizing lotion daily to the client's skin C. Encourage the client to tell whomever bathes her to apply the moisturizing lotion to her areas of dry skin D. Inform the staff that the client's skin is showing signs of breakdown and moisturizing lotion needs to be applied daily A 76-year-old adult female is brought to a neighborhood client after being found wandering around the local park. The client appears disheveled and reports being hungry. Which of the following assessment and interview findings would cause the nurse to suspect elder abuse? (Select all that apply.) A. Falls asleep in the examination room B. Repeatedly states, "Don't hurt me." C. Chafing around wrists and ankles D. Bruises in various stages of healing One reason for medication problems in the elderly is that 1. Regular use of laxatives increases absorption of medications 2. Decreased renal function slows excretion of drugs 3. Enhanced sense of taste of medications 4. Increased perception of pain from injections You are caring for a 78 year-old female cardiac patient. In preconference, your clinical instructor asks you what is an age-related change in the cardiac system of the older adult? Your best response would be 1. Decreased blood pressure 2. Decreased cardiac output 3. Increase ability to respond to stress 4. Increased heart recovery rate The most common affective or mood disorder of old age is 1. dementia. 2. depression. 3. delirium. 4. Alzheimer's. Your patient assigned to you has pneumonia. You are reviewing the age-related changed involved with the older adult. Select all age-related changes of the respiratory system that apply. 1. Decreased in residual lung volume 2. Decreased gas exchange 3. Decreased cough efficiency 4. Increased gas exchange The leading cause of injury and preventable source of mortality and morbidity in older adults is 1. presbycusis. 2. car accidents. 3. pneumonia. 4. falls. Which medication prevents the breakdown of a brain chemical important for memory and thinking and may slow the progress of Alzheimer's disease. 1. memantine (Namenda) 2. ozazepam (Serax) 3. donepezil (Aricept) 4. citalopram (Celexa) HESI 100 QUESTIONS The cleansing of the stomach with solution delivered through a nasogastric tube is known as what? Gavage Emesis Lavage Stomach pumping Gastric lavage is used to cleanse the stomach of a poison, overdose of medication, or other toxic substance. It is delivered through a nasogastric tube You are providing care to a patient who has recently begun dialysis. Her daughter, with whom she lives and who prepares many of her meals, asks what types of foods she should incorporate into her diet and which she should avoid. Which of the following is NOT a food that this patient should be advised to avoid? Avocado. Lean red meat. Dried fruit. Bananas. Dialysis patients are encouraged to eat lean meat, including red meat. High quality proteins produce less waste and help the body heal and maintain regular processes. Dialysis patients should avoid foods high in potassium, including avocado, banana, and dried fruit, and should eat other potassium-containing foods in moderation. Your 89-year-old patient presents with dyspepsia and nausea. After testing, you determine she is positive for Peptic Ulcer Disease. Of the following, which would LEAST likely be a differential diagnosis for Peptic Ulcer Disease? Cholecystitis. Migraines. Gastric carcinoma. Cardiovascular disease. Peptic Ulcer Disease is a gastrointestinal disorder. Other differential diagnoses of the condition are pancreatitis and biliary tract disease. There are a good many diseases affecting the elderly that are the result of smoking. Counseling regarding smoking cessation is part of the GNP's job. The components of brief intervention for treating tobacco use are: Counsel, Document, Caution, Describe, Demonstrate Advise, Confer, Describe, Document, Prescribe Advise, Counsel, Intervene, Prescribe, Follow-up Ask, Advise, Assess, Assist, Arrange Ask about tobacco use, Advise to quit, Assess willingness to make an attempt to quit, Assist in this quit attempt. Arrange a follow-up. Mrs. Frasier, an 50-year-old patient, presents with a mosquito bite that she is concerned about. How do you diagnose this? Cyst. Bulla. Wheal. Plaques. Cyst: encapsulated, fluid-filled mass that varies in size. Bulla: fluid-filled, elevated, circumscribed lesion that's larger than 5mm. Wheal: circumscribed, reddening with transient elevation lesion that's 0.5 to 10mm diameter. Plaques: usually a grouping of papules; elevated and a variety of shapes; larger than 5mm. Which of the following groups should be tested for abdominal aortic aneurysm? males aged 65-75 who have ever smoked females aged 65-75 who have hypertension males and females over 75 females over 75 Abdominal aortic aneurysm (AAA) is more prevalent in males than in females. The American Heart Association recommends screening males once between ages 65-75 if they have ever smoked since that increases the risk of AAA. With a giardia lamblia diagnosis, the NP would MOST likely prescribe what medication? Metronidazole. Erythromycin. Ampicillin. Trimethoprim-sulfamethoxazole. The preceding drugs are typically used in treating the following: - Campylobacter jejuni: Erythromycin - Salmonella: Ampicillin - Shigella: Trimethoprim-sulfamethoxazole - Giardia lamblia: Metronidazole A 65-year-old Caucasian male calls your office. He tells you he just came in from the woods and discovered a tick on his upper right thigh. He reports self removal of the tick and now the area is slightly red. What should you advise him to do? He should come to the office for a ceftriaxone (Rocephin) injection. He should be prescribed doxycycline. He needs no treatment. He needs a topical scrub to prevent Lyme Disease. To develop Lyme Disease from a tick bite, many factors must be present. The tick must belong to Ixodes species and must have been attached for at least 48 hours before the disease can spread. There is no need for prophylactic treatment in this case because the tick has not been present long enough. As part of the treatment plan for your elderly patient, you recommend he see an Ophthalmologist. What body part(s) will this doctor evaluate? Brain / nerves. Eyes. Bones / Joints / Muscles. Ears / Throat. Neurologist - Brain / nerves Ophthalmologist - Eyes Orthopedist - Bones / Joints / Muscles Otolaryngologist - Ears / Throat As a GNP you understand that due to physiological changes of aging, some laboratory test results will have age-related changes. Which of the following values would be the least likely to be affected? red blood cell values white blood cell counts platelet range hemoglobin values platelet range Due to the physiological changes of aging, red blood cell values tend to decrease, white blood cell counts tend to decrease slightly, hemoglobin values slightly decrease, but platelet range does not vary. The family of a patient with dementia has asked you to tell them more about this condition. You would tell them all of the following except: Dementia is the leading reason for institutionalization of older adults. Some persons diagnosed with dementia have reversible pseudodementia. Irreversible dementia has a gradual onset and a progressive downward course. 50% of the older adult population suffer from some form of dementia. This statement is not true. It is estimated that between 10 and 20% of the older adult population suffer from some form of dementia. There are 1.2 million cases in the United States in people over the age of 65. What is true regarding deep vein thrombosis (DVT)? Contrast venography is the most commonly used test to diagnose this. Because the presentation of DVT varies, making the diagnosis from clinical presentation alone is problematic. Hypocoagulation state presents a considerable risk for DVT. Therapy for patients with DVT is aimed at easing the pain. Because the presentation of DVT varies, making the diagnosis from clinical presentation alone is problematic. Choice B is the right answer. Contrast venography has the greatest sensitivity and specificity for the condition but due to the cost and nature of the test, ultrasound is more common as first-line diagnostic technique (choice A). A hypercoagulation state presents a considerable risk for DVT (choice C). Therapy for patients with DVT is aimed at minimizing the risk of pulmonary embolism and extension of peripheral thrombus (choice D). It has been determined that an elderly patient is suffering from long term insomnia. Which of the following is LESS likely to be considered a long term cause of the condition? Nocturia. Environmental changes. Congestive heart failure. Alcohol and substance abuse. There are various causes of insomnia in the elderly. While some may be the cause of short term insomnia and others long term insomnia, long term insomnia is more common in the elderly than short term. In terms of the elderly which of the following is NOT true of hypothyroidism? Symptoms are often similar to normal aging changes making it difficult to detect in older adults. Symptoms usually have an insidious onset. It usually occurs before age 50. There is a greater risk for developing myxedema coma, which is life-threatening. Hypothyroidism usually occurs after age 50. It is often diagnosed as depression. You must use caution against abruptly discontinuing medication. When treating a patient with oral Vitamin B12, which drug interaction will result in decreased absorption of vitamin B12? aminoglycosides colchicine potassium supplements all of the above In addition to the drugs listed in the first three choices, ascorbic acid may destroy the vitamin B12 supplement within one hour of ingestion. These drugs should not be taken concomitantly with oral vitamin B12. You are counseling a 72-year-old woman about nutrition. In the course of counseling you tell her that older adults are at increased risk of Vitamin D deficiency. Which of the following is NOT a factor that contributes to a Vitamin D deficiency? too much exposure to sunlight decreased exercise diminished renal function decreased body mass In actuality lack of sun exposure decreases synthesis of Vitamin D. An 88-year-old female patient comes into the clinic with her heart "racing and feeling funny." The ECG confirms atrial fibrillation. The GNP understands that this condition is managed by all of the following except: treating the underlying disease electrical cardioversion heparin as the drug of choice with antithrombotic therapy IV management with digoxin as first line therapy The antithrombotic drug of choice for atrial fibrillation is warfarin (Coumadin). A patient you diagnosed with hypothyroidism was started on levothyroixine. At what interval should the GNP reassess her TSH? 1 to 2 weeks 2 to 4 weeks 4 to 6 weeks 6 to 8 weeks In the treatment of hypothyroidism, T4 replacement is needed in the form of levothyroixine (Synthroid or Levoxyl). The initial dosages for an adult is 75 to 125 mcg. For an elderly person, the dose is 75% less than the adult dosage. Because of the long half-life of levothyroxine, the effects of a dosage adjustment or initiation would not cause a change in TSH for approximately five to six drug half-lives, or about 6 to 8 weeks. A 67-year-old diabetic has been taking oral anti-hypoglycemics and is still having poor glycemic control. You make the decision to start insulin therapy. He weighs 60 kg. What should you order as an initial starting dose? 6 units short-acting insulin at breakfast, continue oral medication 6 units intermediate insulin at bedtime, stop oral medication 6 units long-acting before breakfast, stop oral medication 6 units long-acting insulin at bedtime, continue oral medication The American Diabetic Association algorithm for initiation and adjustment of therapy (2006) suggests an intermediate or long-acting insulin to be started at bedtime or morning as a once daily dose. The starting dose is either 10 units or 0.2 units per kilogram. Oral medication should be continued except for discontinuing sulfonylureas or meglitinides. A 65 year patient has sub-occipital and posterior cranial head pain following a fall. The GNP conducts a musculoskeletal assessment by: Palpating the acromioclavicular joint. Assessing the gleno-humeral range of motion. Palpating the cervical vertebrae. Palpating anterior the thoracic muscles. The patient who is complaining of sub-occipital, posterior head pain should have the cervical vertebrae assessed. Additionally, the GNP will palpate the posterior neck muscles and assess the neck for range of motion. A 67-year-old female is in the office with cataracts. She is asking what she needs to do about this. The GNP understands that all of the following are management for this except: Surgery may be necessary if the cataract markedly decreases visual acuity. No drugs are available that will halt the progression of the aging process of the eye. Vision correction with corrective lenses are available if the cataracts are in the early stages. Ophthalmic steroids that decrease the severity are available by prescription from an ophthalmologist. No topical or oral medications exists that will cure or treat this condition. However, there are surgical options. You are providing patient education to a patient who has recently been diagnosed with shingles. Which of the following is NOT true of the way this patient should care for his rash? He should leave the rash uncovered to speed healing. He should keep the rash covered. OJO He should keep the rash clean and dry. He should use only nonadhesive bandages on the rash. Patients with herpes zoster - shingles - should keep their rashes clean, dry, and covered. The adhesive in bandages can irritate the shingles, so only nonadhesive bandages should be used. You are providing care for a patient who has been admitted to the hospital after a fall. Which of the following is NOT appropriate when providing patient education for when the patient returns home? The patient should resume regular activities as soon as possible. The patient should avoid returning to full activity until he is fully recovered. The patient should take extra care of his feet. The patient should engage in some type of regular exercise. Patients who have suffered a fall should return to normal activity as soon as possible. Avoiding routine activities may increase fear of falling and actually increase the risk of falling. Regular exercise and foot care can also help reduce the risk of falls. Which of the following is true when performing a functional assessment with a geriatric patient? It may be necessary to allow more time for the assessment if the patient has impaired mobility. It is not necessary to perform the assessment if the patient uses a wheelchair. It may be necessary to bring in someone to assist the patient with the assessment. It is only necessary when the patient returns for follow-up after treatment. Functional assessments may take longer with geriatric patients due to impaired mobility. Allow for extra time to conduct the functional assessment if you are working with a geriatric patient whose mobility is limited. You are managing a patient who has irritable bowel syndrome (IBS). Altering the gut pain threshold in IBS is a possible therapeutic outcome with the use of: amitriptyline (Elavil) loperamide (Immodium) dicyclomine (Bentyl) metrodionazole (Flagyl) Low dose tricyclic antidepressant or selective serotonin reuptake inhibitor use can be helpful in altering the gut pain threshold, resulting in less abdominal pain. Imodium and Bentyl are prescribed to treat diarrhea. Flagyl is not used in IBS, but is used to treat certain types of infectious colitis. Which of the following is NOT a sign of depression in an older adult? She neglects personal grooming. She has difficulty concentrating. She often becomes lost even in familiar places. She worries about lapses in memory. Older adults who are depressed may have trouble concentrating or may have memory lapses. They often express concern about these lapses. Depression may lead to neglect of personal grooming as well. Depression does not lead to patients being disoriented or becoming easily lost. These symptoms are more often associated with dementia. Change can be scary to anyone, but may be especially hard to deal with in the elderly population. According to the Lewin Theory of Change, which of the following is the second step? Freezing. Resisting. Unfreezing Change. The Lewin Theory of Change represents three steps with regard to change. These are: Unfreezing - During this step, the individual realizes change is necessary and mentally prepares himself to do so. Change - Self-explanatory. Freezing (or refreezing) - Once the change has taken place, the individual regains a sense of stability or normalcy. Which medication can cause urinary incontinence by relaxing the internal urethral sphincter and is used to treat BPH for this reason? librium, a benzodiazepine furosemide, a diuretic prazosin, an alpha-adrenergic antagonist amitripylline, a tricyclic antidepressant This is not a good medication to use with a woman who has continence issues. These medication s potentially increase the risk of postural hypotension in the older adult, as well. Benzodiazepines cause alteration in sensorium and can lead to functional urinary incontinence. Diuretics increase frequency of voiding and volume of urine. Tricyclic antidepressants cause urinary retention, overflow incontinence, and alteration in sensorium A 65-year-old patient that has transferred into your care from another provider presents with a history of migraine headaches. She is on Tylenol with codeine for treatment of these headaches but nothing for abortive therapy. The GNP understands that a good agent to prescribe for her for abortive therapy is: ketorolac (toradol) 100 mg IM amitriptyline (Elavil) 100 mg PO sumatriptan (Imitrex) 6 mg IM ergotamine (Ergostat) 2 mg SL Ergotamine sublinginal at 2 mg is the correct dose of abortive therapy for migraine headaches. Ketorolac is give 30-60mg IM for pain, but does not help with abortive therapy. Sumatriptan is given subcutaneously (SC) or PO, not IM and is a good medication for abortive migraine therapy. Amitriptyline is not used in abortive therapy. Of the following, which is the body system that is responsible for protecting the organs as well as allowing the body to move? Nervous. Skeletal. Muscular. Circulatory. The human body is made up of 11 major body systems. These are Nervous, Skeletal, Muscular, Circulatory, Respiratory, Digestive, Endocrine, Reproductive, Excretory, Integumentary, and Immune. The Nervous System receives and sends messages to the body. The Skeletal System protects the body's organs and helps with functions such as moving around. The Muscular System consists of bones and the tissues that bring them together. It helps with functions such as walking. The Circulatory System includes the heart and blood vessels and helps with the flow of blood throughout the body. Ms. Villa asks the GNP the minimum number she can have for her LDL Cholesterol level to be considered "high". What answer does she give her? 81 mg/dL. 113 mg/dL. 160 mg/dL. 134 mg/dL. The following LDL cholesterol guidelines are outlined by the American Heart Association: Less than 100 mg/dL = Optimal 100-129 mg/dL = Near or above optimal 130-159 mg/dL = Borderline high 160-189 mg/dL = High 190 mg/dL and above = Very high Which of the following diseases can be described as the inability of the heart to pump out all the blood returned to it from the veins resulting in the organs of the body not receiving an adequate supply of blood? artherosclerosis hypertension congestive heart failure arteriosclerosis Congestive heart failure is the inability of the heart to pump out all the blood returned to it from the veins. As a result of vital organs not receiving an adequate supply of blood fluid backs up into the lungs and body. Signs and symptoms include: congestion in the lungs, difficulty breathing, restlessness, anxiety and edema of the legs, feet, hands, face, and buttocks. A retired businessman, age 71, is in the office today with complaints of pain over the inner aspect of the lower humerus of the arm. He reports that the pain is aggravated by wrist flexion and gripping. No swelling is noted upon examination. He is an avid golfer and works around the house doing carpentry work. What does the Geriatric Nurse Practitioner suspect is the cause of his ailment? medial epicondylitis lateral epicondylitis olecranon bursitis elbow strain Choice A is the right answer. This is often called golfers' elbow because it results from repetitive activity such as lifting, tooling, and sports that require a tight grip. The patient will complain of pan over the medial epicondyle or inner aspect of the lower humerus. With lateral epicondylitis (choice B) the patient has pain over the outer aspect of the lower humerus. Olecranon bursitis (choice C) results in pain and swelling behind the elbow and a noticeable ball or sac hanging from the elbow. An elbow strain (choice D) is not likely to cause aggravated pain with wrist flexion and decreased grip. An adult male patient with iron deficiency anemia presents in the office and gastrointestinal (GI) bleeding has been ruled out. The GNP determines that the next step is: Prescribe ferrous sufate 300 mg PO tid and schedule patient to return in 1 month for a repeat CBC, serum iron, and TIBC. Administer iron dextran 50 mg IM weekly for 4 weeks. Schedule the patient to return in 6 months for additional stool guaiac testing. Refer patient to a hematologist. To replenish the depleted body iron stores, treatment with iron orally for at least 6 months is necessary to correct the anemia. The patient should have hemoglobin/hematocrit, iron, and TIBC rechecked after 1 month of therapy. The patient should be referred to a hematologist if treatment shows no improvement and referral to a GI specialist or repeat of stool guaiac is unnecessary because there is no indication that the condition is related to bleeding. When screening for alcohol abuse in the elderly, which test has been validated for this population? CUT Screen CAGE Screen MINE Screen LIST Screen This is a screen for alcohol abuse that is validated in adults and the geriatric population.The C stands for "have you ever felt like you should CUT down". The A stands for "does other's criticism of your drinking ANNOY you". The G stands for "have you ever felt GUILTY about your drinking". The E stands for "have you ever had an EYE opener". You are assessing the pulse of an elderly patient. The reading is normal. Which of the following does NOT fit the "normal" range. 50 beats per minute. 72 beats per minute. 89 beats per minute. 65 beats per minute. A normal pulse falls within the range of 60 to 100 beats per minute. It should be noted when a patient has irregular rhythms. An electrocardiogram may also be necessary. When providing care for an adult female patient who has a history of prescription benzodiazepine dependence, you consider that: The preferred method of treatment for this problem is rapid detoxification. She is at significant risk for drug-induced hepatitis. She is unlikely to have a problem with misuse of other drugs or alcohol. She probably has an underlying untreated or under-treated mood disorder. The misuse and overuse of various mood-altering products is referred to as substance abuse and it affects 10-15% of primary care patients. Women have higher rates of misuse of prescription medications and are more likely to have mood disorders, including anxiety and depression. Your patient, a 72 year old man, indicates that he is not urinating very often because is it painful and difficult to do so. He reports a burning sensation when he urinates as well. This patient should be further assessed for which of the following? Enlarged prostate. Bladder cancer. Urinary tract infection. STIs. This patient's symptoms are consistent with urinary tract infection. Geriatric patients may be more prone to UTIs. Further assess this patient for a UTI by ordering urinalysis on a clean catch specimen. All but which of the following increase a geriatric patient's risk of abuse or mistreatment? Taking multiple medications. Impaired mobility. Risk for fall. Being male. Geriatric patients may be at risk for elder abuse or mistreatment. Several factors increase the risk, especially those that contribute to overall frailty. Taking multiple medications, having decreased strength or factors that increase fall risk, cognitive impairment, and dependency on others all increase a patient's risk. Female patients are at greater risk than male patients. In order for effective teaching to take place, it is crucial that the GNP use the proper teaching style for each patient. What teaching style would BEST suit a patient with an "Interested Learner" style? Facilitator. Delegator. Authority, expert. Salesperson, motivator. Matching teaching style (TS) to learning style (LS) is crucial for effective communication. The following are the BEST matches: TS LS Authority Dependent Motivator Interested Facilitator Involved Delegator Self-directed You are providing care for a patient who is hearing impaired. The patient's chart notes that she was born with total hearing loss. You notice that the patient and her family members use American Sign Language when communicating among themselves. Which of the following is the MOST appropriate strategy when communicating with this patient about her care? Speak directly to a family member and have him or her translate into ASL. Communicate with the patient only in writing. Attempt to communicate with the patient in ASL. Engage a medical interpreter fluent in ASL. As is the case when working with any patient whose primary language is not your own, the use of a medical interpreter is the best course of action. A medical interpreter will know how to communicate complex concepts related to care that family members, though fluent, may not have the words for. Communicating with the patient in writing is a useful strategy, but it should not be the only strategy. Communicating directly with the patient (even through an interpreter) is key to helping maintain the patient's dignity and agency. An elderly patient presents with fever, left lower quadrant abdominal pain and diarrhea. Which of the following BEST describes the symptoms the patient is experiencing? Acute hepatitis. Iron deficiency anemia. Testicular cancer. Diverticulitis. Diverticulitis. Diverticulitis is when the colon secondary consists of pouchlike hernias. These hernias are caused by the lack of dietary fiber. A 65-year-old male comes to the clinic complaining of severe abdominal pain, fever, and nausea with a change in his bowel habits. You diagnose diverticulitis. In educating him about this condition you tell him all but which of the following? It occurs when one or more small bulging pouches in the digestive tract become inflamed or infected. It is common, particularly in persons over 40. Some cases of diverticulitis can be treated with rest, changes in the diet and antibiotics. OJO Diverticulitis may be the result of too much fiber in the diet. Diverticulitis is rare in countries where people eat a high-fiber diet that helps keep stools soft. But in the USA where the average diet is high in refined carbohydrates and low in fiber it is more common. Diverticulitis may be the result of too little fiber in the diet. A 68 year female patient has frequent migraine headaches. Besides checking for possible triggers and the patient's family history, the GNP should also assess the extent at which headaches limit all of the following except for: Job performance. Activities of daily living. Medication absorption. Social interaction. The incidence of new onset migraine headaches reduces with age, but after age 65 the risk of headaches involving a serious medical condition increases significantly. The GNP should check for other co-existing conditions and medications the patient is taking. While the GNP cannot determine how well medications are being absorbed into the patient's system without further diagnostics, the GNP should recognize during initial assessment that some medications may induce migraines. A patient with folliculitis is given Isotretinoin. Of the following, which would be the correct dosage? Apply tid before antibiotic ointment. 2%, apply bid X 10 days and cover with DSD. Apply to area bid-tid. 0.5 to 1 mg/kg/day PO in divided doses. The preceding medications should be administered at the following dosages: Mupirocin ointment - 2%, apply bid X 10 days and cover with DSD. Gentamicin Sulfate cream or ointment - Apply to area bid-tid. Isotretinoin - 0.5 to 1 mg/kg/day PO in divided doses. Anhydrous ethyl alcohol with 6.25% aluminum chloride - Apply tid before antibiotic ointment. You have diagnosed a 74-year-old patient with angle-closure glaucoma. Which of these MOST likely caused the condition? Sudden increase in intraocular pressure. Hardening of the lens. Lens clouding. Gradual onset of increased intraocular pressure. Presbyopia is caused by the hardening of the lens. Senile cataracts is caused by lens clouding. Open-angle glaucoma is caused by the gradual onset of increased intraocular pressure. Angle-closure glaucoma is caused by the sudden increase in intraocular pressure. Which disease is NOT going to impact the older adult's ability to eat? stroke dyphagia Parkinson's disease hypertension Choice D is the right answer. Many diseases impact the older adult's ability to eat. About 50% of patients who have had a stroke have impaired ability to eat (choice A). Parkinson's disease and other neurological conditions involve the muscle movement that is necessary for chewing and swallowing (choice C). Dysphagia is difficulty swallowing (choice B) and has significant impact on feeding. Which theory holds that a person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior? Family Systems Theory Systems Theory Health Belief Theory Self-Efficacy Theory The Family Systems Theory holds that families develop at different rate and if one member is dysfunctional, the rest are affected negatively. The Systems Theory holds that all parts of a system are interrelated and dependent on each other. The Health Belief Theory holds that the person who feels susceptible to the disease and believes that he will benefit from changing his behavior is more likely to perform the healthier behavior. A patient who has been prescribed Keflex for pneumonia should be advised to seek immediate medical attention if she experiences which of the following? Vaginal itching. Easy bruising. Joint pain. Nausea. This is the sign of a potentially serious side effect. Patients taking Keflex may also experience vaginal discharge and itching, nausea, and joint pain. These are not usually considered serious. Because older adults may already be more prone to bruising than younger patients, they should pay special attention to any bruising that occurs while taking Keflex. Your 76-year-old male patient has had a cardiovascular asessment and you found that he has a systolic heart murmur. In terms of this assessment which of the following statements is correct? The patient most likely has some underlying heart disease and should undergo further tests. He is a candidate for valve replacement. He has the first signs of congestive heart failure. This abnormality is common in older persons and is related to calcification and stiffening of the heart valves. A GNP understands that there are many skin changes as adults grow older. Which of the following would NOT be a typical skin change in the older adult? thinner epidermis, dermis and subcutaneous layers seborrheic keratoses presbycusis senile purpura Presbycusis is sensorineural hearing loss. It is not a skin change. All of the other choices are changes that you might see in the skin of older adults along with less fat, less elasticity, slower wound healing and sebaceous glands hypertrophy. A patient may be prescribed Prinivil for which of the following conditions? Excessive blood clotting. Hypertension. Nerve pain associated with shingles. Bacterial pneumonia. Prinivil (lisinopril) is prescribed for the treatment of hypertension. It may be prescribed to protect the kidneys from damage resulting from diabetes. Prinivil is an ACE inhibitor. When discussing Human Immunodeficiency virus (HIV) testing with a patient, the GNP knows: Sexually active homosexual men are the only ones at risk for HIV. Receiving blood products from 1985 to 1995 is a risk factor for HIV. The screening ELISA test (enzyme-linked immunosorbent assay) detects antibodies and is 99% sensitive and specific. There is no need to recheck the ELISA if negative on the first test. The screening ELISA test (enzyme-linked immunosorbent assay) detects antibodies and is 99% sensitive and specific. At what age is a person initially considered an older adult? 70 65 60 75 Nurses need to be familiar with the stages of life. Older adults at the age of 65 onward experience development changes. A decline in health and mobility affects life and function. The "pill-rolling" tremor that is typical in patients with Parkinson's disease is: usually unilateral worse when the patient sleeps present at rest of and with movement a late manifestation of the disease Choice A is the right answer. The "pill-rolling" tremor is the earliest manifestation of the disease. It occurs at rest but not with movement. The tremor is worse with emotional stress and gets better decreases with sleep. The United States Preventive Services Task Force recommends screening older patients for depression: at each visit only if symptoms exist if they are at high risk annually Depression is very common among older adults. Recommendations are to screen every adult patient annually in the primary care setting. Untreated depression often leads to higher rates of mortality when other co-morbid conditions exist, especially heart disease. You are assessing your aged patient and determine that he has Presbyopia. What causes Presbyopia? Sudden increase in intraocular pressure. Hardening of the lens. Lens clouding. Gradual onset of increased intraocular pressure. Presbyopia is caused by the hardening of the lens. Senile cataracts is caused by lens clouding. Open-angle glaucoma is caused by the gradual onset of increased intraocular pressure. Angle-closure glaucoma is caused by the sudden increase in intraocular pressure. Which statement is true regarding the Varicella vaccine? The Varicella vaccine is administered only to adults over 50. The Varicella vaccine provides temporary passive immunity to infection. Women who do not have immunity should receive the first dose upon completion or termination of pregnancy and before discharge from the health-care facility. The vaccine provides minimal protection against invasive Varicella. As we age, skin disorders are common. Which of the following statements about skin problems in older adults is false? Intertrigo disorder is a painful inflammation in the skin folds and skin discoloration that occurs in older people. Fungal infections are common skin disorders seen in older people. Erysipelas is a condition involving large blisters that are usually found on the trunk of the body. Bacterial in