NR 601 midterm Exam 2024-verified
NR 601 Midterm Study Guide
Developmental changes
o Review Kennedy and Dunphy readings for age related changes:
o Physiological:
1. Limited chest wall expansion
2. Cilia atrophy
3. Immune system alterations
4. Cardiac, respiratory and renal reduced physiological reserve
5. Reduced homeostatic mechanisms that fail to adjust regulatory systems such as temperature
control and fluid and electrolyte balance.
6. Changes in the sympathetic response which contributes to orthostasis and falls, as well as lack
of hypoglycemic response.
7. Impaired immunological function: infection risk is greater and auto-immune diseases are
more prevalent.
o Lab results- Dunphy Table 77.2- PAGE
1. Protein: rises slightly- kidney changes with age, UTI, renal pathology
2. Specific gravity: lower maximum in elderly- the decline in nephrons impairs the ability
to concentrate urine.
3. ESR: significant increase- neither sensitive nor specific in aged.
4. Iron Binding: slight decrease
5. HGB: men slight decrease, women no change- anemia common in elderly.
6. HCT: slight decrease speculated: decline in hematopoiesis.
7. Leukocytes: slight decrease due to drugs or sepsis and should not be attributed immediately to age.
8. Lymphocytes: T-CELL AND B-CELL levels fall- therefore infection risk is higher and
immunizations should be encouraged.
9. Platelets: no change
,NR 601 midterm Exam 2024-verified
10. Albumin: decline- related to a decrease in liver size and enzymes: protein-energy
malnutrition, infection, and liver disease.
11. BUN: increases significantly up to 69mg/100 ml.- decline in GFR; decreased cardiac output.
12. Creatinine: increases to 1.9 mg/100 ml- related to lean body mass decrease.
13. Creatinine clearance: decreases 10%/decade after 30 years of age- used for prescribing
meds excreted by kidneys.
14. Glucose tolerance: slight increase of 10mg/DL per decade after 30 years of age-
diabetes increasingly prevalent; drugs may cause glucose intolerance.
o Atypical disease presentations- PG. 4
1. Acute abdomen: absence of symptoms or vague symptoms, acute confusion, mild discomfort
and constipation, some tachypnea and possibly vague respiratory symptoms, appendicitis
pain may begin in right lower quadrant and become diffuse.
2. Depression: anorexia, vague abdominal complaints, new onset of confusion,
insomnia, hyperactivity, lack of sadness.
3. Hyperthyroidism: Hyperthyroidism presenting as “apathetic thyrotoxicosis,” i.e., fatigue
and weakness; weight loss may result instead of weight gain; patients report palpitations,
tachycardia, new onset of atrial fibrillation, and heart failure may occur with undiagnosed
hyperthyroidism .
4. Hypothyroidism: confusion, agitation, new onset anorexia, weight loss, and arthralgias
may occur.
5. Malignancy: new or worsening back pain secondary to metastasis from slow growing
breast masses. Silent masses of the bowel.
6. Myocardial infarction: absence of chest pain. Vague symptoms of fatigue, nausea, and a
decrease in functional and cognitive status. Classic presentations include dyspnea,
epigastric discomfort, weakness, vomiting, history of previous cardiac failure. Higher
prevalence in females versus males. Non-Q- WAVE MI.
7. Overall infectious disease processes: absence of fever or low-grade fever, malaise, sepsis
without usual leukocytosis and fever. Falls, anorexia, new onset of confusion and/or
alteration and change in mental status, decrease in usual functional status.
8. Peptic ulcer disease: absence of abdominal pain, dyspepsia, early satiety, painless,
bloodless, new onset of confusion, unexplained tachycardia, and/or hypotension.
,NR 601 midterm Exam 2024-verified
9. Pneumonia: absence of fever, mild coughing without copious sputum, especially in dehydrated
patients, tachycardia and tachypnea, anorexia and malaise are common, alteration in
cognition.
10. Pulmonary edema: lack of proximal nocturnal dyspnea or coughing, insidious onset
with changes in function, food or fluid intake, or confusion.
11. Tuberculosis: hepatosplenomegaly, abnormalities in liver function test, and anemia.
12. UTI: absence of fever, worsening mental or functional status, dizziness, anorexia, fatigue,
and weakness.
o Geriatric syndromes: focus should be on maintaining function, dignity, and individual control
to promote health and quality of life. Early detection and correction of problems such as
sensory deficits, confusion, and gait and balance issues can increase independence and
longevity among this group.
1. SPICES geriatric syndrome markers:
S: sleep disturbances
P: problems with eating or
feeding. I: incontinence
C: confusion- often caused by delirium and dementia. (PAGE 1291-
• Delirium is a state of mental confusion that develops suddenly and can fluctuate
over time. Symptoms include hallucinations, delusions, and a dream like state of
incoherent and mental confusion. Common causes of delirium include infection
often urinary tract infection, anticholinergic medications, sedatives,
antidepressant drugs, steroids, dehydration and electrolyte in balance, metabolic
and encephalopathy, vitamin deficiencies, or diabetes and thyroid disease.
• Dementia has a gradual onset over months or even years. Evidence that regular
physical exercise reduces the risk of dementia. This occurs when there is too much
of a breakdown of acetylcholine. Defined as a chronic organic disorder of mental
processes with symptoms of memory loss, personality changes, and impaired
reasoning. The most common type of dementia is Alzheimer’s disease. A standard
diagnosis requires two of the following impairments to be present;
• A. memory impairment
• B. communication and language impairment
• C. inability to focus or pay attention
• D. reasoning and judgment impairment
, NR 601 midterm Exam 2024-verified
• E. visual perception impairment.
E: evidence of falls- identified as the leading cause of older adult injury related visits to the
emergency department in the United States. One person every 11 seconds falls. Risk factors
include previous falls, increasing age, medications, and cognitive deficits. The most
common injury includes a head or hip fracture. RITUAL is the free falls risk assessment tool.
The patient should be asked if they have fallen in the past year, if they feel unsteady when
standing or walking, or if they worry about falling. Key interventions to reduce falls include
patient education, enhancing strength and balance, modification of medications,
management of hypotension, vitamin D and calcium supplement, addressing foot in
footwear issues, assessment of vision, and implementing home safety precautions.
S: skin breakdown.
o Categories of aging- know age ranges for old, young old, old-old, etc. (page 1282)
young-old: 65-74
old: 75-84
oldest- old: 85 and older.
Exercise in older adults (Kennedy)- chapter 3 starts on page 19. Recommended amount of exercise 30
minutes per day for five days a week of moderate exercise. If weight management is part of this 60 minutes
per day as advised.
o Recommended exercises for sleep and flexibility: recommended activities include: tai chi, walking,
aqua therapy, and biking. Provider should assess balance and risk for falls before beginning, and explain
the importance of starting low intensity and going slow.
o Exercise recommendations for specific diagnoses (Kennedy): a lot of the conditions include
walking, aquatic activities, tai chi, cycling, stationary bike, and recreational activities.
o Recommended testing prior to exercise initiation: clinician judgment should be exercised in assessing
the patient and prescribing an exercise routine.
• Adults who do not have symptoms and have no diagnosis chronic health conditions do not need
to consult with a healthcare professional about increasing physical activity.
• Patients with chronic conditions should consult a healthcare provider for physical activity goals that
are realistic and safe.
NR 601 Midterm Study Guide
Developmental changes
o Review Kennedy and Dunphy readings for age related changes:
o Physiological:
1. Limited chest wall expansion
2. Cilia atrophy
3. Immune system alterations
4. Cardiac, respiratory and renal reduced physiological reserve
5. Reduced homeostatic mechanisms that fail to adjust regulatory systems such as temperature
control and fluid and electrolyte balance.
6. Changes in the sympathetic response which contributes to orthostasis and falls, as well as lack
of hypoglycemic response.
7. Impaired immunological function: infection risk is greater and auto-immune diseases are
more prevalent.
o Lab results- Dunphy Table 77.2- PAGE
1. Protein: rises slightly- kidney changes with age, UTI, renal pathology
2. Specific gravity: lower maximum in elderly- the decline in nephrons impairs the ability
to concentrate urine.
3. ESR: significant increase- neither sensitive nor specific in aged.
4. Iron Binding: slight decrease
5. HGB: men slight decrease, women no change- anemia common in elderly.
6. HCT: slight decrease speculated: decline in hematopoiesis.
7. Leukocytes: slight decrease due to drugs or sepsis and should not be attributed immediately to age.
8. Lymphocytes: T-CELL AND B-CELL levels fall- therefore infection risk is higher and
immunizations should be encouraged.
9. Platelets: no change
,NR 601 midterm Exam 2024-verified
10. Albumin: decline- related to a decrease in liver size and enzymes: protein-energy
malnutrition, infection, and liver disease.
11. BUN: increases significantly up to 69mg/100 ml.- decline in GFR; decreased cardiac output.
12. Creatinine: increases to 1.9 mg/100 ml- related to lean body mass decrease.
13. Creatinine clearance: decreases 10%/decade after 30 years of age- used for prescribing
meds excreted by kidneys.
14. Glucose tolerance: slight increase of 10mg/DL per decade after 30 years of age-
diabetes increasingly prevalent; drugs may cause glucose intolerance.
o Atypical disease presentations- PG. 4
1. Acute abdomen: absence of symptoms or vague symptoms, acute confusion, mild discomfort
and constipation, some tachypnea and possibly vague respiratory symptoms, appendicitis
pain may begin in right lower quadrant and become diffuse.
2. Depression: anorexia, vague abdominal complaints, new onset of confusion,
insomnia, hyperactivity, lack of sadness.
3. Hyperthyroidism: Hyperthyroidism presenting as “apathetic thyrotoxicosis,” i.e., fatigue
and weakness; weight loss may result instead of weight gain; patients report palpitations,
tachycardia, new onset of atrial fibrillation, and heart failure may occur with undiagnosed
hyperthyroidism .
4. Hypothyroidism: confusion, agitation, new onset anorexia, weight loss, and arthralgias
may occur.
5. Malignancy: new or worsening back pain secondary to metastasis from slow growing
breast masses. Silent masses of the bowel.
6. Myocardial infarction: absence of chest pain. Vague symptoms of fatigue, nausea, and a
decrease in functional and cognitive status. Classic presentations include dyspnea,
epigastric discomfort, weakness, vomiting, history of previous cardiac failure. Higher
prevalence in females versus males. Non-Q- WAVE MI.
7. Overall infectious disease processes: absence of fever or low-grade fever, malaise, sepsis
without usual leukocytosis and fever. Falls, anorexia, new onset of confusion and/or
alteration and change in mental status, decrease in usual functional status.
8. Peptic ulcer disease: absence of abdominal pain, dyspepsia, early satiety, painless,
bloodless, new onset of confusion, unexplained tachycardia, and/or hypotension.
,NR 601 midterm Exam 2024-verified
9. Pneumonia: absence of fever, mild coughing without copious sputum, especially in dehydrated
patients, tachycardia and tachypnea, anorexia and malaise are common, alteration in
cognition.
10. Pulmonary edema: lack of proximal nocturnal dyspnea or coughing, insidious onset
with changes in function, food or fluid intake, or confusion.
11. Tuberculosis: hepatosplenomegaly, abnormalities in liver function test, and anemia.
12. UTI: absence of fever, worsening mental or functional status, dizziness, anorexia, fatigue,
and weakness.
o Geriatric syndromes: focus should be on maintaining function, dignity, and individual control
to promote health and quality of life. Early detection and correction of problems such as
sensory deficits, confusion, and gait and balance issues can increase independence and
longevity among this group.
1. SPICES geriatric syndrome markers:
S: sleep disturbances
P: problems with eating or
feeding. I: incontinence
C: confusion- often caused by delirium and dementia. (PAGE 1291-
• Delirium is a state of mental confusion that develops suddenly and can fluctuate
over time. Symptoms include hallucinations, delusions, and a dream like state of
incoherent and mental confusion. Common causes of delirium include infection
often urinary tract infection, anticholinergic medications, sedatives,
antidepressant drugs, steroids, dehydration and electrolyte in balance, metabolic
and encephalopathy, vitamin deficiencies, or diabetes and thyroid disease.
• Dementia has a gradual onset over months or even years. Evidence that regular
physical exercise reduces the risk of dementia. This occurs when there is too much
of a breakdown of acetylcholine. Defined as a chronic organic disorder of mental
processes with symptoms of memory loss, personality changes, and impaired
reasoning. The most common type of dementia is Alzheimer’s disease. A standard
diagnosis requires two of the following impairments to be present;
• A. memory impairment
• B. communication and language impairment
• C. inability to focus or pay attention
• D. reasoning and judgment impairment
, NR 601 midterm Exam 2024-verified
• E. visual perception impairment.
E: evidence of falls- identified as the leading cause of older adult injury related visits to the
emergency department in the United States. One person every 11 seconds falls. Risk factors
include previous falls, increasing age, medications, and cognitive deficits. The most
common injury includes a head or hip fracture. RITUAL is the free falls risk assessment tool.
The patient should be asked if they have fallen in the past year, if they feel unsteady when
standing or walking, or if they worry about falling. Key interventions to reduce falls include
patient education, enhancing strength and balance, modification of medications,
management of hypotension, vitamin D and calcium supplement, addressing foot in
footwear issues, assessment of vision, and implementing home safety precautions.
S: skin breakdown.
o Categories of aging- know age ranges for old, young old, old-old, etc. (page 1282)
young-old: 65-74
old: 75-84
oldest- old: 85 and older.
Exercise in older adults (Kennedy)- chapter 3 starts on page 19. Recommended amount of exercise 30
minutes per day for five days a week of moderate exercise. If weight management is part of this 60 minutes
per day as advised.
o Recommended exercises for sleep and flexibility: recommended activities include: tai chi, walking,
aqua therapy, and biking. Provider should assess balance and risk for falls before beginning, and explain
the importance of starting low intensity and going slow.
o Exercise recommendations for specific diagnoses (Kennedy): a lot of the conditions include
walking, aquatic activities, tai chi, cycling, stationary bike, and recreational activities.
o Recommended testing prior to exercise initiation: clinician judgment should be exercised in assessing
the patient and prescribing an exercise routine.
• Adults who do not have symptoms and have no diagnosis chronic health conditions do not need
to consult with a healthcare professional about increasing physical activity.
• Patients with chronic conditions should consult a healthcare provider for physical activity goals that
are realistic and safe.
