NR601

NR601 ____ 1. An elderly client presents with a new onset of feeling her heart race and fatigue. An EKG reveals atrial fibrillation with rate 110. The patient also has a new fine tremor of both hands. Which of the following would the nurse practitioner suspect? A. Hypothyroidism B. Hyperthyroidism C. Congestive heart failure D. Type 2 diabetes mellitus - CORRECT ANSWER-B ____ 2. A 62-year-old female complains of fatigue and lack of energy. Constipation has increased and the patient has gained ten pounds in the past 3 months. Depression is denied although the patient reports a lack of interest in usual hobbies. Vital signs are within normal limits and the patient's skin is dry and cool. Which of the following must be included in the differential? A. Hyperthyroidism B. Hypothyroidism C. Hyperparathyroidism D. Grave's disease - CORRECT ANSWER-B ____ 3. Mrs. Black, an 87-year-old patient, has been taking 100 mcg of Synthroid for 10 years. She comes to your office for a routine follow-up, feeling well. Her heart rate is 90. Your first response is to: A. Increase the Synthroid B. Order TSH C. Start a beta-blocker D. Order thyroid scan - CORRECT ANSWER-B ____ 4. Which patient is most likely to have osteoporosis? A. An 80-year-old underweight male who smokes and has been on steroids for psoriasis B. A 90-year-old female with no family history of osteoporosis who is on hormone replacement therapy C. A 68-year-old overweight female who drinks 1-2 drinks alcohol/day D. An 82-year-old female with a normal BMI takes calcium and performs weightbearing exercise daily - CORRECT ANSWER-A ____ 5. When evaluating the expected outcome for a hypothyroid elderly patient placed on levothyroxine, the nurse practitioner will: A. Assess a weekly TSH B. Assess the TSH in 4-6 weeks C. Ask the patient if the symptoms have subsided and adjust dosage accordingly D. Decrease the dosage should a cardiac event occur - CORRECT ANSWER-5. ANS: B PTS: 1 ____ 6. A postmenopausal woman with osteoporosis is taking a bisphosphonate daily by mouth. What action information statement would indicate the patient understood the nurse practitioner's instructions regarding this medication? A. Takes medication at bedtime with a full glass of water B. Takes medication with a full glass of water when up in a.m. 30 minutes prior to other food and medications C. Takes medication when up in a.m. with a glass of orange juice to increase absorption D. Takes medica - CORRECT ANSWER-6. ANS: B PTS: 1 ____ 7. The primary reason levothyroxine sodium is initiated at a low dose in an elderly patient with hypothyroidism is to prevent which of the following untoward effects? A. Angina and arrhythmia B. Nausea and diarrhea C. Confusion and delirium D. Osteoporosis and muscle weakness - CORRECT ANSWER-7. ANS: A PTS: 1 ____ 8. Six months ago an elderly patient was diagnosed with subclinical hypothyroidism. Today the patient returns and has a TSH of 11.0 and complains of fatigue. He has taken Synthroid 25 mcg daily as prescribed. What is the best course of action for the nurse practitioner? A. Assess further for a cause of fatigue B. Double the dose of Synthroid C. Discontinue the Synthroid D. Prescribe Liotrix (T3 & T4 combination) - CORRECT ANSWER-8. ANS: B PTS: 1 ____ 9. A fluoroquinolone (Ciprofloxin) is prescribed for a male patient with a UTI. What should the nurse practitioner teach the patient regarding taking this medication? A. It must be taken on an empty stomach B. Its effectiveness is decreased by antacids, iron, or caffeine ingestion C. It may cause a metallic aftertaste D. Its effectiveness is not a concern and it can be taken with any medications - CORRECT ANSWER-9. ANS: B PTS: 1 ____ 10. A patient has been prescribed metformin (Glucophage). One week later he returns with lowered blood sugars but complains of some loose stools during the week. How should the nurse practitioner respond? A. Discontinue the medication immediately B. Reassure the patient that this is an anticipated side effect C. Double the dosage of medication and have patient return in 1 week D. Order a chem. 7 to check for lactic acidosis - CORRECT ANSWER-10. ANS: B PTS: 1 ____ 11. Which of the following signs of hyperthyroidism commonly manifest in younger populations, but is notably lacking in the elderly? A. Weight gain B. Constipation C. Bradycardia D. Exophthalmos - CORRECT ANSWER-11. ANS: D PTS: 1 ____ 12. A 60-year-old obese male client has type 2 diabetes mellitus and a lipid panel of TC = 250, HDL = 32, LDL = 165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include: A. Advancing age, diabetes, hyperlipidemia, and male gender B. Diabetes, obesity, and hyperlipidemia C. Hyperlipidemia, smoking, and family history of heart disease D. Male with age 45, diabetes mellitus, and hyperlipidemia - CORRECT ANSWER-B ____ 13. A diabetic patient presents with the complaint of right foot pain but denies any recent known injury. He states it has gotten progressively worse over the past few months. On exam, vibratory sense, as well as sensation tested with a monofilament, was abnormal. The patient's foot is warm, edematous, and misshapen. The nurse practitioner suspects Charcot foot. What intervention is indicated? A. Warm soaks and return for follow-up in 1 week B. Referral to a pain management clinic C. Refer - CORRECT ANSWER-C ____ 14. What is a sign of insulin resistance that can present in African American patients? A. Acanthosis Nigricans B. Psoriasis Nigricans C. Seborrheic Nigricans D. Bullemic Nigricans - CORRECT ANSWER-A ____ 15. During a routine physical examination of a 62-year-old female patient, the nurse practitioner identifies xanthelasma around both his eyes. What is the significance of this finding? A. High potential for future blindness and requires immediate referral B. None, normal variant of aging process C. Abnormal lipid metabolism requiring medical management D. Hereditary variant that is of no consequence but requires watchful waiting - CORRECT ANSWER-C ____ 16. Mr. White is 62 years old and has chronic kidney disease that has been relatively stable. He also has a history of hyperlipidemia, osteoarthritis, and hypertension. He is compliant with his medications, and his BP has been well controlled on a calcium channel blocker. His last lipid panel showed: TC = 201, HDL = 40, TG = 180, LDL = 98. He currently takes Crestor 20 mg daily. In the office today, his BP is 188/90, and his urine dip now shows significant proteinuria. He denies any changes - CORRECT ANSWER-C ____ 17. You are working as a nurse practitioner in the Fast Track of the emergency room. A 76-year-old male presents with left upper quadrant abdominal pain. There can be many conditions that present as left upper quadrant pain, but which of the following is least likely to cause pain in the left upper quadrant? A. Splenic abscess B. Left pyelonephritis C. Splenic rupture D. Acute pancreatitis - CORRECT ANSWER-D ____ 18. Which is a "cardinal feature" of failure to thrive? A. Decline in toileting ability B. Gait disturbance C. Poor nutritional status D. Spiritual distress - CORRECT ANSWER-C ____ 19. Feeding gastrostomy tubes at end-of-life Alzheimer's disease patients have been associated with: A. Prolongation of life B. Aspirational pneumonia C. Increase in skin infections D. Reversal of any clinical signs of failure to thrive - CORRECT ANSWER-B ____ 20. Which of the following nutritional indicators is not an indication of poor nutritional status in an older person? A. Albumin of 3.5 g/dl B. Body mass index of 25 C. Total cholesterol 150 mg/dl D. Loss of 10% body weight in 180 days - CORRECT ANSWER-B ____ 1. The term "geriatric syndrome" is best described as: A. A condition that has multiple underlying factors and involves multiple systems B. A condition that has a discreet etiology that is difficult to pinpoint C. Significant progress has been made in understanding geriatric syndromes, especially falls and delirium D. Therapeutic management of a geriatric syndrome can be accomplished once a specific diagnosis is made - CORRECT ANSWER-A ____ 2. The anal wink reflex is used to test: A. Rectal prolapse B. Sensation and pudental nerve function C. Baseline and squeeze sphincter tone D. Fissures and fistulas - CORRECT ANSWER-B ____ 3. Atypical presentation of acute coronary syndrome is: A. Most common in Hispanic females B. More common in men C. Most common in African American men D. More common in females - CORRECT ANSWER-D ____ 4. What disease can mimic and often co-exists with myocardial infarctions in elders with coronary artery disease? A. Hypertension B. Esophageal disease C. Diabetic gastroparesis D. Vascular disease - CORRECT ANSWER-B ____ 5. Thoracic aortic dissection presents typically as: A. Sharp stabbing pain in the mid thorax B. Pleuretic chest pain and dyspnea C. Severe retrosternal chest pain that radiates to the back and both arms D. Unilateral pleuretic chest pain and dyspnea - CORRECT ANSWER-C ____ 6. Medications known to contribute to constipation include all of the following except: A. Stimulant laxatives B. Anticholinergic drugs C. Broad-spectrum antibiotics D. Iron - CORRECT ANSWER-C ____ 7. Bordetella pertussis is best characterized by: A. Sub-acute cough lasting greater than two weeks B. Acute cough associated with a coryzal symptom C. Chronic cough with post-nasal drip D. Non-productive acute cough - CORRECT ANSWER-A ____ 8. The routine testing of tuberculosis should occur in all of the following vulnerable populations except: A. Nursing home residents B. Prison inmates C. Hospitalized elderly D. Immune-compromised patients - CORRECT ANSWER-C ____ 9. Which of the following statements about fluid balance in the elderly is false? A. Total body water decreases with age. B. Thirst response decreases as a person ages. C. African Americans have higher rates of dehydration than white Americans. D. Assessment of skin turgor at the sternum is a reliable indicator of dehydration in the elderly. - CORRECT ANSWER-D ____ 10. Distinguishing delirium from dementia can be problematic since they may coexist. The primary consideration in the differential is: A. Performance on the Mini Mental Status Exam B. The Confusion Assessment is negative C. Rapid change and fluctuating course of cognitive function D. The presence of behavioral symptoms with cognitive impairment - CORRECT ANSWER-C ____ 11. Presbystasis is best described as: A. Impairment in vestibular apparatus that causes dizziness B. Age-related disequilibrium of unknown pathology characterized by a gradual onset of difficulty walking C. The loss of high frequency tones with aging that can impair sensation D. A disorder of the inner ear characterized by vertigo - CORRECT ANSWER-B ____ 12. If dizziness has a predictable pattern associated with it, the clinician should first consider: A. Hypoglycemia B. Psychogenic etiology C. Cardiovascular cause D. Neurogenic cause - CORRECT ANSWER-A ____ 13. All of the following are considered as contributors to dysphagia except: A. Anticholinergics B. Drugs that increase reflux symptoms C. Inadequate intake of fluids with medications and meals D. Smooth muscle relaxants - CORRECT ANSWER-D ____ 14. Evidence shows that the most important predictor of a fall is: A. Prior history of a fall B. Cognitive impairment C. Gait and balance disturbance D. Proximal muscle weakness - CORRECT ANSWER-A ____ 15. The most cost-effective interventions used to prevent falls are: A. Use of sitters B. Use of alarms (bed, chair, monitors) C. Tai Chi exercises D. Home modifications and vitamin D supplements - CORRECT ANSWER-D ____ 16. Chronic fatigue syndrome is best described as: A. Fatigue that is constant, lasting more than three months B. Fatigue lasting longer than six months and not relieved by rest C. Fatigue that waxes and wanes over a period of three months D. Total exhaustion with inability to get out of bed - CORRECT ANSWER-B ____ 17. Which form of headache is bilateral? A. Cluster B. Tension C. Migraine D. Acute angle closure glaucoma - CORRECT ANSWER-B ____ 18. Microscopic hematuria is defined as: A. Twenty or more RBCs on a urine sample B. Three or more RBCs on a urine sample C. Twenty or more RBCs on three or more samples of urine D. Three or more RBCs on three or more samples of urine - CORRECT ANSWER-D ____ 19. Risk factors associated with the finding of a malignancy in a patient with hemoptysis include all of the following except: A. Male sex B. Smoking history C. Over age 40 D. Childhood asthma - CORRECT ANSWER-D ____ 20. Recent weight loss is defined as: A. loss of 10 pounds over the past 3-6 months B. loss of 2 pounds a week C. 5% weight loss in three months D. 10% weight loss in one year - CORRECT ANSWER-A ____ 21. The most common cause of disability in the elderly is due to: A. Diabetes B. Arthritis C. Heart disease D. Chronic obstructive pulmonary disease - CORRECT ANSWER-B ____ 22. Lipedema is best described as: A. Bilateral accumulation of interstitial fluid B. Bilateral distribution of fat in the lower extremities C. Fluid retention caused by a compromised lymphatic system D. Lipid molecules that break down and cause fluid retention - CORRECT ANSWER-B ____ 23. Drug-induced pruritus is distinguished because it: A. Occurs soon after a new drug is taken B. Usually is a generalized rash C. May occur right after the drug is taken or months later D. Usually involves localized circumscribed lesions - CORRECT ANSWER-C ____ 24. A form of syncope that is more common in the elderly than younger adults is: A. Vasovagal B. Carotid sinus sensitivity C. Orthostatic hypotension D. Arrhythmias - CORRECT ANSWER-C ____ 25. All of the following statements about tremor are true except: A. The most common tremor is the Parkinson tremor B. Most individuals with tremor do not seek medical attention C. Psychogenic tremor is uncommon D. Tremor is more prevalent in whites than blacks - CORRECT ANSWER-A ____ 26. Overflow incontinence is usually associated with: A. Loss of urine that occurs with urgency B. Cognitive impairment C. Weak pelvic floor muscles D. Bladder outlet obstruction - CORRECT ANSWER-D ____ 27. Wandering is best described as: A. Aimless excessive ambulatory behavior B. Purposeful excessive ambulatory behavior C. Risk-seeking behavior in the cognitively impaired D. A result of boredom in those with dementia - CORRECT ANSWER-B ____ 1. Which ethnic group has the highest incidence of prostate cancer? A. Asians B. Hispanics C. African Americans D. American Indians - CORRECT ANSWER-C ____ 2. Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what intervals? A. Every 6 months B. Yearly C. Every 2 years D. Every 2 to 4 years - CORRECT ANSWER-C ____ 3. All of the following may be reasons associated with an elevated PSA besides prostate cancer except: A. Prostatitis B. Urinary tract infection C. Perineal trauma D. Digital rectal exam - CORRECT ANSWER-B ____ 4. In the diagnosis of acute bacterial prostatitis, a midstream urine culture is of benefit. To be diagnostic, the specimen should reveal how many white blood cells per high-power field? A. Five B. Ten C. Fifteen D. Twenty - CORRECT ANSWER-B ____ 5. In chronic bacterial prostatitis, what is the organism most commonly associated with the disease? A. Klebsiella B. Proteus C. Pseudomonas D. Escherichia coli - CORRECT ANSWER-D ____ 6. In acute prostatitis, an exam of the prostate may find the gland to be: A. Nodular B. Cool and pliable C. Swollen and tender D. Asymmetrical - CORRECT ANSWER-C ____ 7. All of the following antimicrobials may be indicated in chronic bacterial prostatitis except: A. Ciprofloxacin B. Levofloxacin C. Trimethoprim D. Azithromycin - CORRECT ANSWER-D ____ 8. Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: A. Increased estrogen production's influence on the bladder and ureter B. Decline in bladder outlet function C. Decline in ureteral resistance pressure D. Laxity of the pelvic muscle - CORRECT ANSWER-A ____ 9. Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the past week. He has never had a surgical procedure in his life and seeks clarification on the availability of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is NOT a potential side effect of this procedure? A. Urinary incontinence B. Impotence C. Dribbling urine D. Selected low back pain - CORRECT ANSWER-D ____ 10. The nurse practitioner is evaluating a patient's pelvic muscle strength by digital examination. This is performed when: A. A male patient complains of nocturia and dribbling B. The nurse practitioner needs to confirm a cystocele or stress incontinence C. The patient reports sudden loss of large amounts of urine or urge incontinence D. The nurse practitioner suspects overflow incontinence - CORRECT ANSWER-B ____ 11. A pelvic mass in a postmenopausal woman: A. is most commonly due to uterine fibroids. B. is always symptomatic. C. is highly suspicious for ovarian cancer. D. should be monitored over a period of time. - CORRECT ANSWER-C ____ 12. A 79-year-old man is being evaluated for frequent urinary dribbling without burning. Physical examination reveals a smooth but slightly enlarged prostate gland. His PSA level is 3.3 ng/mL. The patient undergoes formal urodynamic studies, and findings are as follows: a decreased bladder capacity of 370 mL; a few involuntary detrusor contractions at a low bladder volume of 246 mL; an increased postvoid residual urine volume of 225 mL; and a slightly decreased urinary flow rate. Which of t - CORRECT ANSWER-D ____ 13. Mrs. Smith, a 65-year-old woman presents to clinic for the first time and complains of urinary incontinence and dyspareunia. She went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 82 years of age. The patient's most recent mammogram was 5 years ago and no known family history of breast cancer. She is not taking any medications. Her physical examination is unremarkable except for findings cons - CORRECT ANSWER-A ____ 14. Mrs. L. Billings is a 77-year-old Caucasian female who has a history of breast cancer. She has been in remission for 6 years. As her primary care provider, you are seeing her for follow-up of her recent complaint of intermittent abdominal pain of a 3-month duration and some general malaise. Given the brief history above, what will you direct your assessment at during physical examination? A. Examination of her thyroid to rule out thyroid nodules that may contribute to her feeling fatigu - CORRECT ANSWER-C ____ 15. A 78-year-old female comes to the office because she has pain when she urinates. She has been seen three times for this problem in the last 3 months. Each time she was told she had a UTI and was given antibiotics. She carefully followed the instructions but has had no relief of symptoms. Last UA: WBCs: 2-3/high-power field RBCs: 0-2/high-power field Epithelial cells: Few Nitrite: Negative Leuckocyte esterase: Negative Which of the following should be done next? A. Obtain a clean catch u - CORRECT ANSWER-B ____ 1. The prevalence of depression in nursing home residents is ____ greater than adults living in the community. A. 1-2 times B. 2-3 times C. 3-4 times D. 5 times - CORRECT ANSWER-C ____ 2. The majority of depressed older adults remain untreated because of: A. Misdiagnosis B. Social stigma C. Environmental barriers D. All of the above - CORRECT ANSWER-D ____ 3. Symptoms of depression distinct to the elderly include: A. Flat affect B. Loss of pleasure in usual activities C. Appetite and weight disturbances D. Lack of emotions - CORRECT ANSWER-D ____ 4. The justification for ordering a CBC, TSH, and serum B12 for a patient you suspect may haveclinical depression is: A. To determine the cause of sadness B. Because of overlapping symptoms with anemia, thyroid dysfunction, and nutritional deficiencies C. To differentiate between depression and metabolic disorders D. To rule out vascular disease - CORRECT ANSWER-B ____ 5. One major difference that is useful in the differential diagnosis of dementia versus delirium is that: A. Dementia develops slowly and delirium develops quickly B. The initial symptoms of dementia are more severe than the symptoms of delirium C. Dementia symptoms are not associated with underlying medical conditions and delirium symptoms usually result from underlying medical conditions D. Symptoms of delirium involve memory and attention and symptoms of dementia involve only memory - CORRECT ANSWER-A ____ 6. Which of the following is the most appropriate screening tool for delirium? A. Lawton Scale of Instrumental Activities of Daily Living B. Confusion Assessment Method C. Folstein's Mini-Mental Status Examination D. Montreal Cognitive Assessment - CORRECT ANSWER-B ____ 7. The proposed mechanism by which diphenhydramine causes delirium is: A. Serotinergic effects B. Dopaminergic effects C. Gabanergic effects D. Anticholinergic effects - CORRECT ANSWER-D ____ 8. The elderly are at high risk for delirium because of: A. Multisensory declines B. Polypharmacy C. Multiple medical problems D. All of the above - CORRECT ANSWER-D ____ 9. A consistent finding in delirium, regardless of cause, is: A. Dopamine deficiency B. Serotinergic toxicity C. Acetylcholine deficiency D. Reduction in regional cerebral perfusion - CORRECT ANSWER-D ____ 10. Older adults with dementia sometimes suffer from agnosia, which is defined as the inability to: A. Use language B. Understand language C. Recognize objects D. Remember events and places - CORRECT ANSWER-C ____ 11. In late stages of dementia, a phenomenon called "sun downing" occurs, in which cognitive disturbances tend to: A. Improve as the day goes on B. Become worse toward the evening C. Fluctuate during the course of the day D. Peak mid-day - CORRECT ANSWER-B ____ 12. Of the following, which one is the most useful clinical evaluation tool to assist in the diagnosis of dementia? A. Folstein's Mini-Mental Status Exam (MMSE) B. St. Louis University Mental Status Exam (SLUMS) C. Montreal Cognitive Assessment (MoCA) D. Geriatric Depression Scale (GDS) - CORRECT ANSWER-B ____ 13. The cornerstone of pharmacotherapy in treating Alzheimer's disease is: A. Cholinesterase inhibitors B. NMDA receptor antagonist C. Psychotropic medications D. Anxiolytics - CORRECT ANSWER-A ____ 14. The comorbid psychiatric problem with the highest frequency in dementia is: A. Anxiety B. Depression C. Agitation and aggression D. Psychosis - CORRECT ANSWER-A ____ 15. When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed? A. Fluoxetine B. Desipramine C. Amitriptyline D. Mirtazapine - CORRECT ANSWER-C ____ 1. Hospice care differs from palliative care in that: A. It is not covered by insurance B. Supports patients and families through both the dying and the bereavement process C. It cannot be provided in the nursing home D. The majority of those admitted to hospice die within 7 days - CORRECT ANSWER-B ____ 2. Evidence reflects the primary obstacle to implementing palliative care in the long-term care setting include all of the following except: A. Inadequate communication between decision makers B. Failure to recognize futile treatments C. Lack of advance directives D. Lack of sufficient staff - CORRECT ANSWER-D ____ 3. The most prevalent symptom in end-of-life care includes all of the following except: A. Lower extremity weakness B. Pain C. Dyspnea D. Delirium - CORRECT ANSWER-A ____ 4. Pain at the end of life is most often due to all of the following except: A. Musculoskeletal disorders B. Headache C. Cancer pain D. Neuropathic pain - CORRECT ANSWER-B