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Part 2 Lens of Wholeness Final

Terms in this set (134)

1. The genitourinary and reproductive systems undergo many age-related changes. Which of the
following statements is true about these changes?

1. The older male patient undergoes more gradual changes than does the older female patient.
2. The older female patient undergoes more gradual changes than does the older male patient.
3. Older male and female patients undergo the same changes.
4. The older male patient undergoes less gradual changes than those of the older female patient.
1
2. Lucy is a 56-year-old woman experiencing itching, discomfort, and bleeding after intercourse.
Which of the following conditions may be developing in the patient?

1. Atrophic vaginitis
2. Vaginal cancer
3. Fibroadenoma
4. Cystitis
1
3. Which of the following is the single most signal symptom for possible breast cancer?

1. Nipple retraction
2. Breast discharge
3. Breast mass
4. Breast redness
3
4. Which of the following conditions presents nonproliferating lesions and does not affect future
cancer risk?

1. Atypical lobular hyperplasia
2. Fat necrosis
3. Radial scar
4. Papilloma
2
5. Mr. Angulo is an 89-year-old patient who was recently an inpatient for pneumonia and was
bedridden for 1 week. He is now presenting dysuria, suprapubic tenderness accompanied by
fever, and increased confusion. Based on his recent history, which of the following conditions may be developing?

1. Cystitis
2. Distended bladder
3. Prostate stones
4.Subacute prostatitis
1
6. Which of the following statements is true for untreated symptomatic cystitis?

1. Untreated symptomatic cystitis can lead to pneumonia.
2. Untreated symptomatic cystitis can resolve on its own.
3. Untreated symptomatic cystitis can lead to pyelonephritis, sepsis, shock, and death.
4. Untreated symptomatic cystitis can lead to prostatic cancer, vaginitis, and sepsis.
3
7. Women developing ovarian cancer may be asymptomatic, making it hard to detect until the
condition has worsened. Which of the following is the best initial diagnostic tool for suspected
ovarian cancer?

1. Transvaginal ultrasonography
2. Pelvic examination
3. Laparoscopy
4. Complete blood count (CBC)
1
8. 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.
4
9. A nurse practitioner is performing an annual checkup for a female patient. In the physical
examination of the breast, for which of the following should the nurse practitioner assess? Select
all that apply.

1. Temperature
2. Symmetry
3. Dimpling
4. Lumps
5. Size
2, 3, 4
10. During a breast examination, the patient should be asked if she has which of the following?
Select all that apply.

1. Breast pain
2. Breast atrophy
3. Breast rash
4. Breast trauma
5. Proper support
1, 3, 4
11. When other symptoms are presented with atrophic vaginitis, a biopsy is used as the diagnostic
test to rule out which of the following diagnoses? Select all that apply.

1. Urinary tract infection (UTI)
2. Sexually transmitted infection (STI)
3. Squamous cell hyperplasia
4. Lichen sclerosis
5. Lichen planus
3, 4, 5
12. Jessie is a 54-year-old patient with a history of atrophic vaginitis. Which of the following
should be included in her patient education? Select all that apply.

1. Use of over-the-counter (OTC) medications for pain and discomfort.
2. Use of water-soluble lubricants.
3. Benefits of regular sexual activity.
4. Identifying and addressing age-related changes.
5. Benefits of sexual-aid stimulators.
2, 3, 4
13. Breast cancer is more prevalent in the female gender, with a median age of 61 years. Which
of the following are modifiable risk factors that may contribute to the diagnosis of breast cancer?
Select all that apply.

1. Postmenopausal obesity
2. Alcohol intake
3. Early menarche
4. Menopause hormone therapy
5. Ethnicity
1, 2, 4
14. Which of the following are the main laboratory clinical manifestations of cystitis? Select all
that apply.

1. White blood cell (WBC) count
2. Bacteriuria
3. Pyuria
4. Fungi
5. E. coli
2, 3
15. Marie, 63 years old, is presenting with symptoms of postmenopausal bleeding and is diagnosed with endometrial cancer. Other than gender and age, which of the following can be contributing factors in the development of endometrial cancer? Select all that apply.

1. Diabetes
2. Use of tamoxifen
3. Use of hormonal contraception
4. Obesity
5. Lynch syndrome
1, 2, 4, 5
1. The nurse practitioner is serving in a clinic dedicated to patients over age 65 years. The nurse practitioner observes several common characteristics in the posture of elderly patients. Which of the following is common?

1. Increase in the length of the trunk in relationship to the upper extremities.
2. Head tips backward.
3. Disappearance of bony prominences.
4. Increase in the range of motion (ROM).
2
2. While conducting a thorough examination of the musculoskeletal system, the patient asks why such detail is necessary. Which of the following is the nurse practitioner's best response?

1. I don't want to miss any signs of something serious.
2. The purpose of conducting this examination is to regulate your medications.
3. I am looking for symptoms that form a pattern.
4. This is routine for all patients over 65 years of age.
3
3. Mrs. Wilbur 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.
1
4. When assessing a patient with a possible musculoskeletal condition, it is important to:

1. Know how much sleep the patient gets per night.
2. Be aware that older patients report any and all pains.
3. Determine ROM in all limbs.
4. Not refer to past injuries or conditions.
3
5. Mr. Cummins, a 69-year-old Caucasian male, presents with an inability to move his right arm sufficiently. The nurse practitioner tells him that she will perform a physical examination and order tests to rule out which of the following?

1. Gout
2. Rheumatoid arthritis (RA)
3. Muscle weakness from a systemic condition
4. Osteoarthritis (OA)
3
6. Mrs. Cameron is a 72-year-old woman who comes to see her nurse practitioner for pain in her right thigh. The nurse practitioner assesses that Mrs. Smith has bruises on her thigh and muscle weakness distally, near the knee. The nurse practitioner suspects which of the following?

1. Musculoskeletal lesions
2. Tendon rupture
3. Gout
4. Arthritis
2
7. 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.
1
8. Mr. Weisner is a 65-year-old male who is experiencing pain in his joints. The nurse practitioner assesses which of the following? Select all that apply.

1. Movement of the joint in a relaxed position.
2. Movement of the joint in flexion.
3. Movement of the joint in extension.
4. Appearance of the limb being normal for his age.
5. Absence of any curvatures in the limb.
1, 2, 3, 4, 5
9. Tom Brown is 62 years old and plays golf twice a week. He experiences pain in his shoulder and goes to the urgent care center to be seen by his nurse practitioner. The nurse practitioner asks which of the following questions? Select all that apply.

1. Does the shoulder hurt when you are not playing golf?
2. Is there any swelling, redness, or pain?
3. Is there any family history of arthritis?
4. Is there a history of taking ibuprofen?
5. Does your pain affect your golf game?
1, 2, 5
10. Mrs. Rivets is an 80-year-old female who comes to the emergency department with complaints of a low-grade fever and pain in her lower leg that is aggravated by movement. Which early treatment does the nurse practitioner implement? Select all that apply.

1. Protection of the lower leg, rest, and application of an ice pack.
2. Salt compresses and an antibiotic.
3. Compression dressing and an antibiotic.
4. Compression dressing and warm compresses.
5. Elevation of the leg and pain medication.
1, 5
11. Mr. Jamison, a 67-year-old male, is being seen in the clinic for complaints of pain in his thigh. There is swelling in the soft tissue, dislocation, altered ROM, bruising, local tenderness, and pain with any motion. The nurse practitioner suspects a femoral neck fracture. What could have contributed to this fracture? Select all that apply.

1. Direct injury to the femur.
2. Sleeping on his side.
3. Osteoporosis.
4. Heavy lifting.
5. Bending over at the waist.
1, 3
12. Miss Benton is a 65-year-old female who complains of a painful big toe on the right foot. She asks the nurse practitioner if this is normal for older people. The nurse practitioner explains that this appears to be gout, and gives her what information? Select all that apply.

1. Gout is an inflammatory condition of joints, tissues, and kidneys.
2. Gout is a problem with a protein called purine.
3. Gout is rare in older people.
4. Gout is localized to the big toe.
5. Long-term use of some medications can lead to gout.
1, 2, 5
13. A 65-year-old woman seeks relief from pain and swelling in her hands. She consults with a nurse practitioner for diagnosis and treatment. 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? Select all that apply.

1. Radiology of both hands.
2. Blood tests for conditions such as rheumatic factor.
3. Anti-cyclic citrullinated peptide (anti-CCP) antibodies.
4. Urinalysis.
5. Abdominal ultrasound.
1, 2, 3
14. The nurse practitioner is asked to order medication for pain and disease control for a 60-year-old patient who has suffered with RA for years. Which is the most common treatment? Select all that apply.

1. Corticosteroids
2. NSAIDs
3. Analgesics
4. Biological disease-modifying antirheumatic drugs (DMARDs)
5. Tumor necrosis factor (TNF) receptor antagonists
1, 2, 3, 4, 5
15. Mrs. Owen, 70 years old, is being discharged from the rehabilitation center to go home. Her RA pain is under currently control. What does the nurse practitioner include in the follow-up instructions? Select all that apply.

1. Get plenty of rest during the day.
2. Exercise and move throughout the day.
3. Learn about the side effects of your medication.
4. Read literature for antidotes that cure RA.
5. Keep your regular health-care visits, as there are no support organizations for RA.
1, 2, 3
1. 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.
4
2. A clinician is performing sensory assessment on a patient presenting signs and symptoms of
neurological disease. During the assessment, the clinician notices that the patient has a decreased sense of both pain and temperature. Which of the following may be affected?

1. Spinothalamic tract
2. Cranial nerve VII
3. Posterior column
4. Posterior horn
1
3. Gayle is a 55-year-old woman who is suspected of having a brain tumor. The clinician orders
diagnostic testing for thyroid-stimulating hormone (TSH) and magnetic resonance imaging (MRI) to confirm this. Which of the following statements is true regarding a brain tumor?

1. The symptom of headache is rare.
2. A brain tumor can be a malignant or benign neoplasm.
3. The etiology of brain tumors is often known.
4. Brain tumors occur more commonly in females than males.
2
4. 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
1
5. Which of the following is a neurological disorder characterized by leg cramping, pulling,
and tugging sensations, and may have a genetic component?

1. Radiculopathy
2. Nerve compression
3. Restless legs syndrome (RLS)
4. Sleep impairment
3
6. According to studies, which of the following is true regarding cerebrovascular disease?

1. It accounts for 20% to 50% of seizures in older adults.
2. It accounts for 10% of seizures in older adults.
3. Sixty percent of patients with stroke are at risk of developing seizures within 5 years.
4. Transient ischemic attacks have a relatively high incidence of seizures.
1
7. Mr. Fitzgerald has seizure conditions due to a recent accident causing traumatic brain injury (TBI). A nurse practitioner is tasked with giving the patient and his family information on home care. Which of the following should be included in the patient/family education?

1. Referral to an internist.
2. Lifestyle considerations.
3. Use of protective gear.
4. Referral for group therapy.
2
8. Mr. Newman developed a sudden onset of severe headache, weakness on one side of his body, difficulty speaking, and loss of balance. He was immediately admitted to the hospital with the diagnosis of hemorrhagic stroke. Which of the following is the manifestation of a hemorrhagic stroke?

1. Leak or rupture in an artery wall.
2. Leak or rupture in a venous wall.
3. Blockage in the heart.
4. Blockage of an artery.
1
9. 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? Select all that apply.

1. Paresthesias
2. Weight gain
3. Pertinent family history
4. Loss of consciousness
5. Use of tobacco
1, 3, 4
10. To rule out age-related benign symptoms, motor functions should be inspected for body
position and involuntary movements. Which of the following should be included in the
assessment of motor function? Select all that apply.

1. Reflexes
2. Hypersensitivity
3. Muscle tone
4. Muscle strength
5. Sensory loss
3, 4
11. A patient is being assessed for symptoms of headaches, changes in mental function, language deficits, and visual problems. Diagnostic testing reveals that he does not have a brain tumor. Which of the following may be the differential diagnosis for the patient's symptoms? Select all that apply.

1. Stroke
2. Subdural hematoma
3. Meningitis
4. Venous insufficiency
5. Diabetes mellitus
1, 2, 3
12. Which of the following statements is true relating the diagnosis of Parkinson's disease (PD)? Select all that apply.

1. The disease should be addressed aggressively using all medications to minimize progression.
2. Drug therapy focuses on correcting the imbalance of dopamine and acetylcholine.
3. Exercise is a contraindication to avoid falls.
4. Depression is common in PD and can contribute to worsening of symptoms.
5. PD is accompanied by symptoms of radiculopathy.
2, 4
13. Peripheral neuropathy is a disorder of the peripheral nervous system resulting in sensory,
motor, and autonomic dysfunction. Which of the following conditions are the treatable causes of
peripheral neuropathy? Select all that apply.

1. Radiculopathy
2. Alcohol use
3. Diabetes mellitus
4. Hypnic jerks
5. TBI
2, 3
14. Mrs. Pope presents with twitching and burning sensations in her right leg that cause
difficulty in walking. Initial suspicion is peripheral neuropathy. The proper diagnosis of
peripheral neuropathy begins with a detailed history and physical examination. Which of the following information in her social history may be a cause of her symptoms? Select all that apply.

1. Substance abuse.
2. Use of supplements.
3. Use of shoes with good support.
4. Current occupation.
5. Going out to dinner.
1, 2, 4
15. According to studies, RLS is a condition for which there is no cure. Which of the following are recommended for the management of RLS symptoms? Select all that apply.

1. Glass of wine every night to fall asleep
2. Massage
3. Exercise
4. Group therapy
5. New bed
2, 3, 4
1. 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.
1
2. 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.
3
3. 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?
1
4. Mrs. Smith, 80 years old, has been vomiting and having bouts of loose stools for several days. She is taking several medications that are prescribed. The nurse practitioner conducts a medication review because:

1. An accounting of all prescribed and over-the-counter (OTC) medications may uncover reasons for her symptoms.
2. There could be drug-drug interactions leading to her symptoms.
3. Side effects of the gastrointestinal tract are not seen in many medications.
4. The administration of some of her medications may be appropriate.
2
5. Mr. Jameson, 75 years old, comes to the clinic with complaints of severe sharp epigastric pain that radiates to his back. He has been nauseous and has vomited three times today. The nurse practitioner suspects which of the following?

1. Appendicitis
2. Gastrointestinal influenza
3. Acute pancreatitis
4. Insulin shock
3
6. 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
3
7. Ms. Jenny is 72 years old and has managed her type 2 diabetes for 30 years. This condition is costly to her in more than one way. Which complications are common?

1. Financial challenges.
2. Good visual acuity.
3. Good renal functioning.
4. Increased circulation to lower extremities.
1
8. The nurse practitioner is ordering laboratory testing to confirm her suspicion of acute pancreatitis. Which of the following findings would confirm her suspicions? Select all that apply.

1. Trypsinogen activation peptide (TAP).
2. Blood urea nitrogen (BUN), creatinine, glucose.
3. An abdominal x-ray.
4. Amylase and lipase amount three times the normal.
5. Stool culture.
1, 2, 3, 4, 5
9. John Brown, 60 years old, asks the nurse practitioner if a lack of functioning insulin is the only cause of diabetes. Which of the following is the nurse practitioner's reply? Select all that apply.

1. More recently, other hormones have been found to be part of diabetes.
2. Besides insulin, glucagon, amylin, and incretin are involved.
3. Finding other factors of diabetes has resulted in new treatments.
4. The pancreas is not the only organ involved in diabetes.
1, 2, 3, 4, 5
10. Mr. Ed, 46 years old, experienced a mild stroke and was hospitalized through the emergency room. The general work-up showed that his blood glucose was 300 mg/dl. He denied knowing that his sugar was so high. He did report frequency of urination and polyphagia. On further examination, the nurse practitioner asked about family history, and he identified that his mother and grandfather both had adult-onset diabetes. Although he is under 65 years old, the nurse practitioner teaches him which of the following? Select all that apply.

1. A urine sample that shows ketones in the urine, his age, and his body mass index (BMI) will tell if he is a type 1 or type 2 diabetic.
2. Having the mild stroke is connected to having diabetes.
3. Medications could be associated with diabetes.
4. Because he had a family history of type 2 diabetes, he should have been screened every year.
5. Screening would not have identified him as a risk.
1, 2, 3
11. The nurse practitioner is preparing home-going instructions for a 66-year-old man with newly diagnosed type 2 diabetes. The goals include which of the following? Select all that apply.

1. Maintenance of weight at present status
2. Glycemic control
3. Good nutritional status
4. More rest
5. Exercise
2, 3, 5
12. Mr. John has recently been given a diagnosis of diabetes. He asks the nurse practitioner if can try something nonpharmacological to control his diabetes. Which of the following would the nurse practitioner propose? Select all that apply.

1. Weight loss and exercise.
2. Self-monitoring blood glucose.
3. A moderate increase in activity.
4. Frequent follow-up appointments with the nurse practitioner.
5. Enrolling in a high-intensity physical activity program.
1, 2, 3, 4
13. Annie is 89 years old and appears apathetic, unwilling to eat and drink, and shows functional decline. The nurse practitioner discusses with the family the possibility that Annie is experiencing a failure to thrive (FTT). The family asks how this happened. The nurse practitioner replies with which of the following statements? Select all that apply.

1. Adult FTT is a part of aging.
2. FTT can be associated with increased infections and diminished immunity.
3. FTT patients have often experienced multiple hospitalizations and several comorbidities.
4. FTT is complex, with many components.
5. The goal of early assessment is to prevent a decline in health.
2, 3, 4
14. Bob is 85 years old and is suspected of experiencing adult FTT. His family asks the nurse practitioner to evaluate what exactly is going on with him. The nurse practitioner knows to order which of the following? Select all that apply.

1. Complete blood count (CBC), serum albumin level, and thyroid-stimulating hormone (TSH).
2. Cholesterol levels and comprehensive metabolic panel.
3. Blood cultures.
4. A nutritional assessment.
5. Depression screening with Beck's PP depression scale.
1, 2, 3, 4
15. Mr. Waterson is 76 years old and involved in a weight-loss program. He weighs 250 pounds and is 5 feet and 5 inches tall. He asks his nurse practitioner what he should do for exercise to enhance his modified eating style. The nurse practitioner advises him with which of the following statements? Select all that apply.

1. Anything you do is better than nothing.
2. Try moderate walking for 2 ½ hours a week.
3. Try to increase your moderate activity to 600 minutes a week.
4. Perform muscle-strengthening activities that are moderate or high intensity on 4 or more days a week.
5. Do exercises that improve balance, which may prevent falls.
1, 2, 5
1. Hematological and immune systems disorders are sometimes complicated because the
manifestations may appear in different organ systems. A complete detailed history, diagnostic testing, and which of the following must be performed for diagnosis?

1. Cognitive assessment
2. Ethnicity assessment
3. Patient education
4. Physical examination
4
2. 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
2
3. Ellen is a 57-year-old woman diagnosed with iron-deficiency anemia (IDA). Her physician orders further diagnostic tests to rule out which of the following?

1. HIV
2. Malignancy
3. Gastritis
4. Stroke
2
4. Which of the following conditions has the presentation of increased platelet destruction by the
immune system?

1. ITP
2. CLL
3. ALL
4. AML
1
5. 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
3
6. The treatment of acute lymphoblastic leukemia (ALL) consists of the control of bone marrow
and systemic disease. Which of the following therapies eliminates any leukemic cells that may remain?

1. Consolidation therapy
2. Maintenance therapy
3. Induction remission
4. Central nervous system (CNS) prophylaxis
1
7. Acute myeloid leukemia (AML) is a rare and diverse group of diseases. Which of the
following statements is true regarding AML?

1. AML has no CNS involvement.
2. Laboratory evaluation includes urinalysis.
3. Initial work-up is to assess and characterize the disease based on prior exposure.
4. Comorbidities do not apply in the diagnosis of AML.
3
8. 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
1
9. IDA is multifactorial and is common in men 65 years and older. Patients
present symptoms of nonspecific fatigue and/or weakness, dizziness, and shortness of breath. Which of the following are the contributing factors for IDA in older adults? Select all that apply.

1. Inadequate diet
2. Peptic ulcer disease
3. Malabsorption syndromes
4. Podiatric surgery
5. Weight gain
1,3, 5
10. Tanya came in for an office visit due to recurrent epistaxis. She also has a diagnosis of
systemic lupus erythematosus. CBC with peripheral blood smear was performed and confirmed that she has idiopathic thrombocytopenic purpura (ITP). Which of the following is true relating to the condition of ITP? Select all that apply.

1. ITP affects women more than men.
2. ITP is more common in children.
3. ITP etiology is known.
4. Patients 65 years or older have a higher risk of bleeding and mortality.
5. Asians are at higher risk for developing ITP.
1, 4
11. Which of the following are contributing factors for ALL? Select all that apply.

1. Cancer
2. Chronic inflammation
3. Radiation exposure
4. Inherited syndromes
5. Smoking
3, 4
12. Signs and symptoms of ALL are nonspecific. Patients with ALL may also present with which of these additional symptoms? Select all that apply.

1. Joint stiffness
2. Enlarged lymph nodes
3. Joint pain
4. Swelling in the abdomen
5. Impaired speech
2, 3, 4
13. AML is a condition more common in older adults age 67 years and older. Which of the following contributing factors increases the risk of the development of AML? Select all that apply.

1. Smoking
2. Blood disorder
3. African American ethnicity
4. Traumatic brain injury (TBI)
5. Genetic syndromes
1, 2, 5
14. Which of the following conditions may be a possible differential diagnosis for AML? Select all that apply.

1. Anemia
2. Myelophthisis
3. Meningitis
4. Bone marrow failure
5. Subdural hematoma
1, 2, 4
15. Martin is a 75-year-old patient diagnosed with chronic lymphatic leukemia (CLL). Which of
the following statements is true relating to CLL? Select all that apply.

1. CLL is a rare type of adult leukemia in the Western world.
2. CLL is a disease of the older adult.
3. CLL manifests symptoms of fatigue, feeling of fullness in the abdomen, and weight loss.
4. CLL is more likely to be found in men than in women.
5. CLL treatment is divided into induction and post-remission or consolidation therapy.
2, 3, 4
1. Mrs. James is 78 years old and comes to the clinic for an annual checkup. The nurse practitioner addresses the psychosocial needs of older adults and specifically the need for which of the following?

1. Dependence.
2. Dignity, credibility, and respect.
3. Being alone.
4. Not being touched.
2
2. Mr. Slobinsky, 80 years old, is unable to leave his home due to mobility problems. The nurse practitioner conducts a social support assessment because Mr. Slobinsky:

1. May not want to see anyone.
2. Is not missing the cultural traditions of community activities.
3. Has made frequent appointments for consultation with the practitioner.
4. Looks forward to sharing his loneliness with the nurse practitioner.
3
3. Mrs. Khan is 89 years old and is reported to have bouts of agitation. The nurse practitioner is counseling her family that these periods of agitation can be triggered by which of the following?

1. Silence and soft music.
2. Dim lights.
3. Approaches from other people.
4. A feeling of appetite satiety.
3
4. The nurse practitioner is considering ordering medications to help control an older patient's agitation. She chooses which of the following?

1. Psychotropic medications
2. Seizure medications
3. Stimulants
4. Depressants
1
5. The nurse practitioner is conducting an admitting assessment of a 69-year-old man. He has diminished ability to ambulate and has difficulty with activities of daily living (ADLs). In the interview, the nurse practitioner asks him if he drinks alcohol. He says, "Yes." The practitioner follows up with a psycho-social evaluation because:

1. Physiological dynamics need to be ruled out as a possible contribution.
2. His drinking may be a function of the environment where he lives.
3. Criteria from the DSM-V is the same for people of any age.
4. His condition could be related to a long-term usage of alcohol or a new occurrence.
4
6. The daughter of a 70-year-old woman asks the nurse practitioner why her mother has had a change in functional ability recently. The mother has regularly been drinking for 40 years, however, her behavior is changing. The nurse practitioner replies that:

1. The concentration of alcohol in her body remains the same as she ages.
2. Her change in behavior has nothing to do with any drugs she is taking.
3. There are different types of alcoholism in older adults, and the change in behavior is related to the specific type.
4. Physical changes due to aging affect the body's metabolism of alcohol differently.
4
7. The son of a 72-year-old man brings his father into the practitioner to plan for treatment of the patient's alcoholism. The nurse practitioner has several options available. Which is the first choice?
1. Treat for anxiety.
2. Begin with higher doses of anti-anxiety medications.
3. The last choice for medication is serotonin uptake inhibitors.
4. Buspirone and gabapentin are used as first-line choices.
1
8. Elisabeth, 67 years old, comes to the practitioner with her daughter, who is her caregiver. The nurse practitioner notices that Elizabeth is very busy and always moving and placing things in order within the waiting room. Along with this increase in energy, which of the following suggest bipolar with mania or hypomania? Select all that apply.

1. Ability to focus on a task
2. Flight of ideas
3. Rapid speech
4. Impulsivity
5. Thoughtfulness
2, 3, 4
9. The nurse practitioner is assessing a 69-year-old man for possible bipolar disorder. Which of the following will contribute to diagnosing this patient? Select all that apply.

1. Complete blood count (CBC) and comprehensive metabolic panel, toxicology screen, urinalysis, thyroid function tests.
2. Electroencephalogram (EEG) and magnetic resonance imaging (MRI).
3. Mini-Mental State Examination.
4. Saint Louis University Mental Status (SLUMS).
5. Total body computed tomography (CT) scan.
3, 4
10. Mark, 82 years old, is in a rehabilitation center for therapy post-knee replacement. The nurse practitioner is visiting Mark and finds him confused, disoriented, and with speech difficulty. The staff nurse says that his condition changed quickly over the last few hours. The nurse practitioner orders which of the following? Select all that apply.

1. Pulse oximetry
2. Evaluation for infections
3. Assessment of change in medications
4. Brain scan
5. Radiology
1, 2, 3, 4
11. Larry is 69 years old and beginning to experience a cognitive decline. His son brings him to the practitioner asking for an evaluation. The nurse practitioner assesses for which of the following signs or symptoms? Select all that apply.

1. Cognitive decline in complex attention, executive function, learning, and memory.
2. Gradual onset and the course of illness and progression are typically slow.
3. Impaired ability to care for oneself.
4. Total or partial loss of the ability to recognize familiar people.
5. Improvement in symptoms in time.
1, 2, 3, 4
12. Mr. Dan is 75 years old and suffering from depression. He tells the nurse practitioner that he is tired of feeling so low. He asks if depression is a normal part of aging. The nurse practitioner tells him that depression is which of the following? Select all that apply.

1. Not a normal part of aging.
2. Related to nutritional deficiencies, especially vitamin B12 and vitamin D.
3. Triggered by one life event.
4. Learned helplessness, loss, and bereavement
5. A state of balanced neurotransmitters in the brain.
1, 2, 3
13. Ms. Smith, 70 years old, is being treated for geriatric depression. What choices does the nurse practitioner have to order? Select all that apply.

1. Evaluate the present medication regimen.
2. Treat any comorbidity.
3. Maintain basic daily needs.
4. Order a selective serotonin reuptake inhibitor (SSRI).
5. Order Abilify.
1, 2, 3, 4, 5
14. Mrs. Smith is 90 years old and has a daytime caregiver. Her daughter stays with her during the evening and nighttime. The daughter suspects her mother is being abused. Which of the following statements would confirm this for the nurse practitioner? Select all that apply.

1. My mother complains of physical pain and has bruises on her arm.
2. My mother is losing weight and is always hungry in the evening.
3. My mother has lost her wallet and funds are going out of her bank account.
4. My mother has been withdrawing from others.
5. My mother has burn marks on her body in the shape of a cigarette.
1, 2, 4, 5
15. Mr. Hupp, 84 years old, lost his wife 2 months ago. He goes to his nurse practitioner and complains of the same symptoms that his wife had before she died. Possible treatment options available to the nurse practitioner include which of the following? Select all that apply.

1. Educate him on normal signs of grieving.
2. Take time to remember his wife and discuss memories.
3. Provide emotional support.
4. Monitor current chronic medical conditions.
5. Encourage him to stay quiet at home and decrease his physical activity.
1, 2, 3, 4
1. Polypharmacy is a primary predictor for any undesired or unwanted consequences that can occur because of taking medications. Which is of the following is the correct term for these undesired or unwanted consequences?

1. Adverse drug reaction (ADR)
2. Prototype drug
3. Adverse drug event
4. Schedule II drugs
1
2. Which of the following is related to the incidence of gastric acidity declining with age
because of decreased intestinal blood flow?

1. Drug metabolism
2. Drug distribution
3. Drug absorption
4. Drug elimination
3
3. Biotransformation means chemical alteration of things such as nutrients, amino acids, toxins, and drugs in the body. In which organ does biotransformation occurs?

1. Intestines
2. Liver
3. Pancreas
4. Bile
2
4. Which of the following is most affected by pharmacokinetic change?

1. Distribution of drugs.
2. Elimination of drugs.
3. Absorption of drugs.
4. Metabolism of drugs.
2
5. A patient is started on a low dose of a drug for safety but is never advanced to a therapeutic
dose while another drug is added. Which of the following does this describe?

1. Preferences of care.
2. Risk-benefit ratio of drug.
3. Narrow therapeutic index of drug.
4. Clinical inertia.
4
6. There are over 35 assessment tools currently available to assist providers with the prescribing
of medications. Which of the following consists of a list of potentially inappropriate medications (PIMs) to be avoided in older adults?

1. STOPP
2. START
3. Beers criteria
4. ADRs
3
7. After consultation with the patient, which of the following is prevented by prescribing only
necessary drugs?

1. Pharmacodynamics
2. Polypharmacy
3. Pharmacokinetics
4. Pharmacy
2
8. Initial and ongoing assessment should be the protocol when prescribing medications.
Designating and training office staff to do the initial medication review can save time but still
requires review by the provider. Which of the following terms refers to a patient bringing in all
current medications for review?

1. Brown bag
2. OTC
3. Rational polypharmacy
4. Magic bag
1
9. The aging process may alter the dynamic processes that drugs undergo to produce therapeutic
effects. Which of the following are terms that refer to these changes? Select all that apply.

1. Pharmacodynamics
2. Prophylaxis
3. Pharmacology
4. Pharmacokinetics
5. Pharmacist
1, 4
10. Which of the following factors affect drug absorption? Select all that apply.

1. Metabolic diseases
2. Esophageal erosion
3. Kidney diseases
4. Drug-food interactions
5. Huntington's disease
1, 2, 4
11. Drug distribution in the body is affected by aging and higher body fat. Which of the
following is true regarding drugs distributed in fat? Select all that apply.

1. There is a wider effect in drugs distributed in fat.
2. The effect of drugs is less when distributed in fat.
3. There is prolonged action in drugs distributed in fat.
4. There is a more intense effect of drugs distributed in fat.
5. There is a shorter effect of drugs distributed in fat.
1, 2, 3
12. One of the things affecting drug distribution is the bioavailability of the drug. Which of the
following factors may affect the amount of a drug that reaches the systemic circulation? Select
all that apply.

1. Handling of the drug.
2. Dosage of the drug.
3. Solubility of the drug.
4. Route of administration.
5. Generic drug.
3, 4
13. It is important to know the pharmacodynamic influences of the drug. Which of the following
statements are true regarding pharmacodynamics? Select all that apply.

1. A drug's pharmacodynamics describes the effect at the site of action.
2. Pharmacodynamics is concerned with the movement of drugs within the body.
3. A drug's pharmacodynamics describes the time and intensity of the drug effect.
4. Pharmacodynamics describes the rate and pathways by which drugs are eliminated from the
body by metabolism and excretion.
5. Pharmacodynamics' fundamental concept is drug clearance.
1, 3
14. A patient sees the nurse practitioner for a post-hospitalization follow-up and presents new
complaints with change in functional status. Which of the following should the nurse practitioner do? Select all that apply.

1. Evaluate for ADR.
2. Prescribe patient medications for the new symptoms.
3. Consult current resources for precautions before prescribing.
4. Prescribe antibiotics for the patient.
5. Leave as status quo.
1, 3
15. Which of the following is true regarding STOPP/START criteria for prescribing
medications? Select all that apply.

1. Lists potential alternative drugs that can safely be used in older adults.
2. Valuable tool for prescribers, but they are not meant to be mandates for prescribing.
3. Screening tool to alert doctors to correct treatment.
4. Screening tool of older persons' potentially inappropriate prescriptions.
5. It is the Beers criteria that mandates prescribing.
2, 3, 4
1. The nurse practitioner is conducting a health of older adults in-service with a group of older adults at a community center. The first concept she presents is a definition of chronic illness.
Which of the following is the best definition?

1. A situation that considers the meaning of the more than one long-term illness on the patient,
family, and provider.
2. A condition that requires medical attention for at least 6 months.
3. Any condition that requires time-limited adjustments.
4. There is only one definition of chronic illness.
...
2. The nurse practitioner is speaking to a group of student nurses about the causes of death of older adults. Which of the following statements is true regarding mortality and morbidity of people older than 65 years?

1. Seventy percent of the cohort older than 65 years dies of chronic conditions.
2. Conditions that contribute to significant chronic illness include fractures.
3. The number one cause of death of both older men and women is heart disease.
4. Dyslipidemia is the leading cause of mortality of people over 65 years of age.
1
3. While teaching a family about the risks of chronic illness for James, who is 69 years old and the patriarch of the family, the nurse practitioner includes which of the following information?

1. The American Heart Association reports that there is an increase in cardiovascular disease
with low levels of smoking, excluding second-hand smoke.
2. Drinking high levels of alcohol contributes to an increase in chronic obstructive lung disease.
3. Obesity is correlated with a higher risk for type 2 diabetes.
4. The lower the body mass index (BMI) the lower the risk of chronic illness.
3
4. The U.S. health-care system functions by managing and paying for illness by focusing on one problem at a time. The nurse practitioner analyzes this system and concludes it is ineffective because:

1. As the number of comorbidities increases, so do the risks.
2. Unintended outcomes of the one disease model include the collaboration of medical advice.
3. There is no knowledge gap regarding people with multiple chronic conditions (MCCs).
4. One in ten Medicare recipients has more than one chronic illness.
1
5. The nurse practitioner whose practice consists of geriatric-aged patients must consider which of the following when working with patients who experience multiple chronic illnesses?

1. Addictions in older adults are predicted to decline in the next 20 years.
2. Mental illness or behavior problems must be included as chronic conditions.
3. Fragility and disability typically have multiple chronic conditions.
4. Co-occurrence of mental and medical conditions is not necessarily disabling.
2
6. Mrs. Jones, 80 years old, comes to the clinic for management of heart failure, diabetes, and depression. The nurse practitioner assesses that this patient is not compliant with the medication plan and has missed a couple of recent appointments. The nurse practitioner analyzes this information and concludes that perhaps Mrs. Jones is experiencing treatment burden because:

1. At the age of 80 years, she may not understand the workload she is carrying daily.
2. The comorbidities Mrs. Jones is dealing with are similar and do not necessitate many different
specific tasks.
3. She is supposed to deal with several activities regarding her health daily.
4. The depression may inhibit her from proper self-care.
3
7. Mr. Smith, 82 years old, is seen by a nurse practitioner and is potentially diagnosed with treatment burden. The nurse practitioner recommends the Chronic Disease Self-Management Program (CDSMP). This program addresses which of the following skills? Select all that apply.

1. Techniques to deal with problems.
2. Decision making.
3. Using resources available.
4. Patient-practitioner relationship.
5. Taking action.
1, 2, 3, 4, 5
8. Mrs. Hupp, 91 years old, lives with her daughter, Kim. Kim loves her mother and does everything she can to assist in providing a good quality life for her mother. Recently, Kim has been telling her nurse practitioner that she is experiencing lack of sleep, higher blood sugars, and anxiety. The nurse practitioner discusses which of the following with Kim? Select all that apply.

1. The mother's treatment burden.
2. Caregiver burden.
3. The possibilityof referring the mother to a long-term facility.
4. The possibility of the caregiver not practicing self-care and not experiencing good health.
5. Caregivers experience varying degrees of burden in caring for their parents.
2, 3, 5
9. The nurse practitioner has conducted a thorough health assessment for Mr. York, who is 83 years old. As the nurse practitioner synthesizes the information and creates the discharge instructions, consideration must be given to which of the following? Select all that apply.

1. His level of understanding of his health condition.
2. His ability to provide self-care.
3. His willingness to obtain preventive services.
4. His number of medication errors.
5. His basic reading level.
1, 2, 4, 5
10. Mrs. Morrison is 85 years old and on Medicare with supplemental insurance. She is obese and has diabetes and heart failure. The nurse practitioner collaborates with a social worker and with a representative from Medicare about the cost of her treatment choices. The nurse practitioner analyzes treatment burden and the costs of care to develop a practical and cost-effective plan of care. Which of the following puts Mrs. Morrison at risk for a financial burden for health care? Select all that apply.

1. Chronic medical conditions.
2. Obesity and diabetes.
3. No history of hospitalization in the last 5 years.
4. Higher costs of prescriptions.
5. Lower total out-of-pocket expenses.
1, 2, 4
11. The nurse practitioner is conducting an initial history and physical examination, along with a health assessment on a new patient. Mr. Carter is African American and 68 years old. He presents with complaints of dizziness, unstable gait, and polyuria. This combination of symptoms is blamed for his frequent falling at home. The nurse practitioner analyzes the findings of the examination and suggests which of the following diagnostics? Select all that apply.

1. Blood pressure measurements, including measuring for hypostatic hypertension to rule out hypertension.
2. Fasting blood sugar and a glucose tolerance test to rule our diabetes.
3. Testing for chronic kidney disease (CKD).
4. Measurement of BMI.
5. Definitive testing for Alzheimer's disease.
1, 2, 3
12. Mrs. Kesler, 91 years old, is considered frail and yet she is active and lives alone with supervision from her daughter. Her frailty is based on which of the following? Select all that apply.

1. A 10-pound weight gain in the last month.
2. Self-reported exhaustion.
3. Strength based on grip.
4. Low walking speed.
5. Decreased physical activity.
2, 4, 5
13. Mrs. Koslowski, 95 years old, comes to the nurse practitioner with her daughter to discuss her medical regime. She complains that she thinks some of the therapies are doing more harm than good. Mrs. Koslowski wants to discontinue some of the medical orders. The nurse practitioner reviews her medical plan and discusses a new model of care called minimally disruptive medicine (MDM). She explains to the daughter and to Mrs. Koslowski that this model does which of the following? Select all that apply.

1. Recognizes the difference between patient-centered and disease-centered treatment.
2. May suggest limitations on some traditional therapies for the frail patient with MCCs.
3. Revises clinical practice guidelines to consider minimally disruptive medicine.
4. Recognizes that older adults have improved results when treated with disease-specific orders.
5. Has clinicians use approaches that include patient values so that better decisions are made.
1, 2, 3, 5
14. The family of Mr. Moore, 90 years old, meets with the nurse practitioner to discuss a change in the care of Mr. Moore. He appears to be less comfortable, more irritable, and has less appetite. He has diabetes, chronic obstructive pulmonary disease (COPD), kidney disease, and chronic colitis. The family and practitioner agree that Mr. Moore is not near end of life, and yet there is not an apparent cure for his conditions. The nurse practitioner discusses palliative care for Mr. Moore. Why might palliative care be a good option? Select all that apply.

1. It will provide relief from his symptoms.
2. It can manage symptoms until treatment is found to provide a cure.
3. Nearly half of Medicare patients can qualify for palliative care when they have two to four
chronic care conditions.
4. The health-care providers are aware of updated treatment that can alleviate his symptoms.
5. It may provide a better quality of life and mood enhancement.
1, 2, 5
1. Jean is a breast cancer patient given 2 to 3 years of survival. Her condition is up and down.
Which of the following types of care is indicated for the patient?

1. Naturopathic care
2. Complementary care
3. Maintenance care
4. Palliative care
4
2. 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?

1. Hospice care
2. Palliative care
3. Skilled nursing care
4. Physical therapy care
2
3. Geriatric patients in end-of-life conditions suffer from many symptoms. The most prevalent
symptoms include delirium, dyspnea, and pain. Which of the following is a common additional symptom for patients in end-of-life conditions?

1. Insomnia
2. Speech impairment
3. Hearing impairment
4. Tremors
1
4. 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
4
5. Which of the following is the best statement regarding dyspnea?

1. Smoking causes dyspnea.
2. Dyspnea is one of the most common reasons for visits to the emergency room for individuals with advanced disease.
3. Dyspnea is a rare symptom as patients approach the end of life.
4. Females are more likely to develop symptoms of dyspnea.
2
6. Pain is categorized into different types. Which of the following type of pain originates in the
thoracic, abdominal, and pelvic viscera and presents diffused pain that often radiates?

1. Neuropathic pain
2. Somatic pain
3. Visceral pain
4. Mixed pain
3
7. Marie is a fibromyalgia sufferer. Her treatment program includes pain relief, antidepressant
medications, and an exercise program. From which of the following types of pain might she be
suffering?

1. Neuropathic pain
2. Somatic pain
3. Visceral pain
4. Mixed pain
2
8. Physiological changes of aging and multiple comorbidities influence the dying process. The
growing acceptance of hospice and palliative care is creating a more natural dying experience.
Which of the following is true regarding the process of death?

1. Urinalysis is usually performed as a diagnostic test for further infection.
2. Age has no bearing on the risk of death.
3. The meaning and experience of death are often influenced by society.
4. The meaning and experience of death are often influenced by one's culture and ethnicity.
4
9. In a life-threatening illness, which of the following are tools to help minimize and relieve
suffering? Select all that apply.

1. Establish an exercise program to keep the patient active.
2. Offer a support system to help patients live as actively as possible until death.
3. Provide relief from pain and other distressing symptoms.
4. Integrate psychological and spiritual aspects of patient care.
5. State that everything will be okay.
2, 3, 4
10. Hospice services are an option for patients with end-stage life-threatening illness. These
services are covered by Medicare, Medicaid, and most private insurance providers. According to studies, which of the following are the current leading causes of death? Select all that apply.

1. Elective surgeries
2. Falls and accidents
3. Malignant neoplasms
4. Cerebrovascular accidents
5. Diverticulitis
3, 4
11. Which of the following statements is true regarding palliative care and hospice care? Select all that apply.

1. Palliative care can begin at diagnosis, and at the same time as treatment.
2. Palliative care may be offered by hospitals, home care agencies, cancer centers, and long-term
care facilities.
3. Hospice care begins after treatment of the disease is stopped and when it is clear that the
person is not going to survive the illness.
4. Only hospice care provides comfort.
5. Only a patient's family can give the best care.
1, 2, 3
12. Which of the following may be present in those suffering from delirium? Select all that apply.

1. Cognitive changes involving memory impairment, disorientation, and language disturbance.
2. Perceptual disturbances, including delusions and hallucinations.
3. Marked lethargy.
4. Disturbance of consciousness with impaired ability to focus.
5. Depression.
1, 2, 4
13. Dyspnea derives from interactions of physiological, psychological, social, and environmental factors that may induce secondary physiological and behavioral responses. Which of the following are layman's terms for dyspnea? Select all that apply.

1. Shortness of breath
2. Breathlessness
3. Sobbing
4. Asthma
5. Hyperventilation
1, 2
14. Pain is an unpleasant sensory and emotional experience associated with actual or potential
tissue damage. Which of following is true regarding pain? Select all that apply.

1. Pain is mostly perceived by the individual and often not real.
2. Pain is always treatable.
3. The patient's own report is the best indicator of pain.
4. Pain is a common end-of-life symptom in the older adult.
5. Pain is not an indicator of an illness.
3, 4
15. Bereavement is the process of experiencing the death of a loved one and adjusting to a world without the deceased. Bereavement can be expressed in many ways. Which of the following relates to bereavement and grief? Select all that apply.

1. Normal grieving is only presented through emotional responses.
2. Medical providers should instruct those involved regarding normal grief reactions and
bereavement resources in the community.
3. Memory loss and impaired concentration are common grief reactions.
4. Risk for self-harm is only present when loved ones left behind have a prior diagnosis of major
depressive disorder.
5. Bereavement care should include questioning of spiritual and religious beliefs.
2, 3, 5
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