NRNP 6531 Adv Practice Care of Adults Across the Lifespan Final Exam
A 65-year-old woman complains of pain and swelling in her hands. The nurse practitioner conducts an examination and interview about the patient’s ADLs and how this pain and swelling inhibits her activity. Which of the following diagnostic tests will be ordered?
| Xray of bilateral hands, urinalysis, CBC | ||
| Xray of both hands, Rheumatoid factor, Sed rate | ||
| Uric acid level, joint aspiration, CBC | ||
| Uric acid level, urinalysis, joint aspiration |
To complete hematological assessment, a diagnostic should be performed. Which of the following should be tested to assess for blood loss or blood cell destruction?
| 1. | Hemoglobin electrophoresis | |
| 2. | Reticulocyte count | |
| 3. | Vitamin B12 and folate levels | |
| 4. | Ferritin |
Mr. Jones is 70 years old and sees the nurse practitioner for a yearly checkup. He states that he needs to urinate a lot and seems to always be thirsty. He also finds himself gaining some weight. In the process of the examination, the nurse practitioner detects that he is vague in his answers. Which of the following may be the reason?
| 1. | Mr. Jones is cold and bundled in a sweater. | |
| 2. | There is no family history of diabetes. | |
| 3. | The symptoms seem to have appeared slowly. | |
| 4. | He does not want to admit to eating too much. |
Mr. Goldberg is diagnosed with late-stage Hodgkin’s lymphoma. His wife, Barbara, noticed that his attention and awareness abilities are decreasing, fluctuating during the course of the day, and worsening at night. From which of the following could Mr. Goldberg be suffering?
| 1. | Confusion | |
| 2. | Dyspnea | |
| 3. | Depression | |
| 4. | Delirium |
The nurse practitioner is working in the emergency department and is called to assist with the diagnosis of a patient who just came in. Mr. Barn is 76 years old and complains of abdominal pain, and his serum amylase and lipase are three times the normal limit. The nurse practitioner confirms pancreatitis, as this meets which criteria?
| 1. | CT severity index | |
| 2. | Atlanta classification | |
| 3. | APACHE II | |
| 4. | Ranson criteria |
Mrs. Borden is 67 years old and her primary care physician wants her to be seen by a nurse practitioner who specializes in geriatric issues. On completing the interview and examination, the nurse practitioner tells Mrs. Borden that she will order a blood laboratory specimen for thyroid function and pancreatic function. Mrs. Borden asks what the reason is. Which of the following is the nurse practitioner’s best response?
| 1. | Diabetes is more common in older patients. | |||||||||||||
| 2. | Thyroid issues are less common in older patients. | |||||||||||||
| 3. | These are common tests to be done on any new patient. | |||||||||||||
| 4. | These tests are necessary to obtain baseline information. | |||||||||||||
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Mrs. Smith is 90 years old and a frail, older woman with functional limitations, cognitive impairment, and lack of family or social support. Which type of care is best for the patient?
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Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder resulting in the loss of dopamine-producing cells in the brain. Which part of the brain is affected with PD?
| 1. | Substantia nigra | |
| 2. | Cingulate gyrus | |
| 3. | Hippocampus | |
| 4. | Hypothalamus |
A 67 year old male presents to the clinic with complaints of painful urination. He states that his brother was just diagnosed with kidney cancer and is worried that he has cancer too. Which of the following diagnostic tests should the NP order?
| 1. | CT scan of the abdomen and pelvis | |
| 2. | IV pyelogram | |
| 3. | Urinalysis and cytology | |
| 4. | Ultrasound |
Diabetes and tamoxifen intake can contribute to the development of endometrial cancer.
True
False
TRUE
Prostate cancer is the most common and leading cause of cancer death in men. Which of the following statements is true about prostate cancer?
| 1. | There is usually a sudden onset of pain in the early stages. | |
| 2. | Asian men are at highest risk for developing prostate cancer. | |
| 3. | Development of prostate cancer has been linked with prior vasectomy. | |
| 4. | There are usually no symptoms with early disease. |
Mrs. Foster reports the presence of pain in her lower and upper back. The nurse practitioner responds by doing which of the following?
| 1. | Determining where the pain is coming from. | |
| 2. | Ignoring any history of injury. | |
| 3. | Ruling out the presence of anything inflammatory. | |
| 4. | Determining that this pain does not affect activities of daily living (ADLs), as the patient came in independently. |
A 63 year old female presents to the clinic with complaints of decreased urine output. She has a history of diabetes. The nurse practitioner orders a glomerular filtration rate (GFR). Which of the following would indicate a stage 1 chronic kidney disease (CKD)?
| 1. | GFR greater than or equal to 120mL/min. | |
| 2. | GFR greater than or equal to 90 mL/min with other symptoms. | |
| 3. | GFR of 45 to 59 mL/min. | |
| 4. | GFR less than 15 mL/min. |
The nurse practitioner calls Mr. Smith to come into the examining room. As he is coming in, the nurse practitioner observes his gait to assess for musculoskeletal conditions. One abnormal sign is:
| 1. | Unbalance in gait. | |
| 2. | Lack of a lurch. | |
| 3. | Symmetrical leg movement. | |
| 4. | Ability to sit in and get out of a chair without using arms. |
According to studies, Restless Leg Syndrome (RLS) is a condition for which there is no cure. Which of the following are recommended for the management of RLS symptoms?
| Melatonin before bed | ||
| Massage and exercise | ||
| Physical therapy | ||
| Vasodilators |
Jonathan was brought in to urgent care by his mother for symptoms of pain, frequent nosebleeds, weakness, and shortness of breath. Complete blood count (CBC) with differential and platelet count and a comprehensive chemistry panel were done. From which of the following conditions may Jonathan be suffering?
| 1. | ITP | |
| 2. | CLL | |
| 3. | ALL | |
| 4. | AML |
Which of the following may be present in those suffering from delirium?
| Depression, delusions, lethargy | ||
| Delusions, lethargy, hallucinations | ||
| Delusions, hallucinations, disorientation | ||
| Disorientation, depression, memory loss |
According to studies, which of the following is true regarding cerebrovascular disease?
| 1. | The earliest symptom of cerebrovascular disease is seizures | |
| 2. | Cerebrovascular disease is not a risk factor for seizures | |
| 3. | Twenty to fifty percent of patients with a history of stroke with develop seizures | |
| 4. | Transient ischemic attacks have a relatively high incidence of seizures. |
When other symptoms are presented with atrophic vaginitis, a biopsy is used as the diagnostic test to rule out which of the following diagnoses?
| UTI, sexually transmitted infection, squamous cell hyperplasia | ||
| Sexually transmitted infection, squamous cell hyperplasia, Lichen sclerosis | ||
| squamous cell hyperplasia, Lichen sclerosis, Lichen planus | ||
| Lichen sclerosis, Lichen planus, UTI |
Neurological assessment of the older adult requires specific tools and considerations to assess patient mental status. Which of the following should be used to assess patient cognition?
| 1. | Administer SLUMS, a short dementia assessment. | |
| 2. | Administer MoCA v 7.1, a 12-item assessment to detect mild neurocognitive disorders. | |
| 3. | Administer testing of cranial nerve III. | |
| 4. | Administer Mini-Cog, a three-word recall with clock drawing capability. |
Max is a 55-year-old male who is being treated for cirrhosis of the liver. Which of the following does the nurse practitioner include in his discharge teaching?
| Avoid alcohol and over the counter medications | ||
| Eat 3 large meals with 4 to 5 mg protein/kg body weight per day | ||
| Increase your intake of vitamin A to 1.5 the normal daily recommended intake | ||
| Herbal preparations are safe since they don’t affect the liver. |
A 72 year old man is seen in the clinic complaining of chronic cough, hoarseness, and atypical chest pain. The NP suspects gastroesophageal reflux disease (GERD). All of the following should be included in the treatment plan EXCEPT:
| Avoid smoking and ingestion of fatty foods. | ||
| Avoid caffeine and acidic foods. | ||
| Raise the head of the bed 2 inches. | ||
| Avoid eating a meal for at least 30 minutes before becoming recumbent. |
Charlie is 69 years old and is recovering from a recent bout of kidney stones. This was his three episode of kidney stones which he describes as very painful. The nurse practitioner should suggest which of the following interventions to prevent future episodes of kidney stones?
| Decrease your fluid intake and increase your intake of dark chocolate and green leafy vegetables | ||
| Increase your fluid intake and limit your intake of dairy products and nuts | ||
| Prevention is difficulty since kidney stones have a hereditary trait | ||
| Medications do not contribute to the formation of kidney stones. |
A 72 year old women with a history of obesity and diabetes is seen in the clinical with complaints of pain in her abdomen. Which of the following is a definitive diagnostic test for cholecystitis?
| 1. | A flat plate of the abdomen. | |
| 2. | MRI of the abdomen with contrast | |
| 3. | Lipase, amylase, and liver function tests. | |
| 4. | Ultrasound of the RUQ |
Lucy is 65 years old and has irritable bowel syndrome-diarrhea (IBS-D) for over 10 years. She has tried various treatments with minimal effectiveness. What interventions could the nurse practitioner suggest to help control the diarrhea?
| Antispasmodics and antidiarrheal medications | ||
| Caffeinated beverages and antispasmodics | ||
| Antidiarrheals and eluxadoline | ||
| Eluxadoline and Rifaximin |
Which of the following medical providers is responsible for the early components of diagnostic work-up?
| 1. | Primary care provider (PCP) | |
| 2. | Anesthesiologist | |
| 3. | Surgeon | |
| 4. | Pulmonologist |
Insulin, glucagon, amylin, and incretin are all hormones associated with diabetes.
True
False
TRUE
A 66-year-old female complains of a painful big toe on the right foot. The nurse practitioner suspects gout. All of the following about gout is true EXCEPT:
| Gout is an inflammatory condition of joints, tissues, and kidneys | ||
| Gout is a problem with a protein called purine | ||
| Long-term use of some medications can lead to gout | ||
| Gout is more common in young people |
Steve came in for an office visit presenting complaints of difficulty speaking, gait problems, and dizziness. Which of the following should be noted as additional signs and symptoms in the focused interview?
| Paresthesias, weight gain, tobacco use | ||
| Weight gain, tobacco use, loss of conciousness | ||
| Tobacco use, loss of consciousness, paresthesias | ||
| Loss of consciousness, parasthesias, pertinent family history |
The NP is assessing a female patient for breast cancers. Which of the following symptoms are essential to assess for?
| temperature, size, symmetry | ||
| size, symmetry, dimpling | ||
| symmetry, dimpling, lumps | ||
| dimpling, lumps, temperature |
The nurse practitioner discusses vitamin and mineral supplementation with Ed, who is 75 years old. Ed wants to know why he should take calcium because he understands that calcium is for women. The nurse practitioner responds:
| 1. | As one gets older, albumin can decrease, and calcium is bound to albumin. | |
| 2. | Dietary patterns may result in low nutrient intake. | |
| 3. | An increase in lactose intolerance that comes with aging decreases the amount of calcium absorbed by the body. | |
| 4. | Aging aids the absorption of nutrients from the intestine. |
Which of the following are modifiable risk factors that may contribute to the diagnosis of breast cancer?
| Ethnicity, decreased alcohol intake, eliminate estrogen based hormone replacement therapy | ||
| Decreased alcohol intake, eliminate estrogen based hormone replacement therapy, weight loss | ||
| Eliminate estrogen based hormone replacement therapy, weight loss, increase alcohol intake | ||
| Early menarche, decreased alcohol intake, progesterone based hormone replacement therapy |
Ms. Allen, 72 years old, is being evaluated by the nurse practitioner for type 2 diabetes. Because symptoms of endocrine disorders in older adults are vague, which of the following questions is best to ask?
| 1. | Do you have any trouble carrying out your daily activities? | |
| 2. | Can you tell me what you ate yesterday? | |
| 3. | Have you seen a dentist in the last year? | |
| 4. | Have you noticed that you have less hair? |
Which of the following conditions has the presentation of increased platelet destruction by the immune system?
| 1. | ITP | |
| 2. | CLL | |
| 3. | ALL | |
| 4. | AML |
A
Factors that contribute to the development of iron deficiency anemia include inadequate iron intake, peptic ulcer disease, and malabsorption syndrome.
True
False
TRUE
Mrs. Marlin is 78 years old, is 5 feet tall, and weighs 140 pounds. The nurse practitioner tells her that her body mass index (BMI) is between 25 and 29.9, and that this BMI is considered overweight. The nurse practitioner recommends that Mrs. Marlin assess her diet and activity level. If she is sedentary, the recommended daily kcal intake is which of the following?
| 1. | 1,600 | |
| 2. | 2,000 | |
| 3. | 2,500 | |
| 4. | 3,000 |
