Final exam questions 3 Flashcards
- An elderly male patient fell at the golf course and was rushed to the ER by his grandson. He has a confirmed broken hip. The NP is talking to the patient and grandson about the plan. Which response by the NP is incorrect?
a. Surgery should happen within 24 hours
b. The elderly is at greater risk of complications such as pneumonia and blood clots
c. Waiting for surgery is best for now and the bone needs to settle first
d. He can expect a slow return of activities for the next 4-6 months
c. Waiting for surgery is best for now and the bone needs to settle first
Rationale: The patient should be admitted for pain control and surgery should be done within the first 24
hours.
Waiting is not recommended for a hip fracture due to the doubled increase of DVT and other complications.
- A 68 y/o female presents to your clinic with her daughter who reports her mother has had progressive decline in memory with difficulty performing daily tasks. You perform a SLUMS exam that resulted in a score of 18. All of the following should be included in her treatment plan EXCEPT:
a. Prescribe Aricept (donepezil)
b. Counsel to stop driving
c. Check a VitB12 and TSH level
d. Prescribe Seroquel (quetiapine)
d. Prescribe Seroquel (quetiapine)
Rationale: A decline in short term memory, decreased ability to perform ADLs, and a score of 18 on the SLUMS exam all indicate a diagnosis of dementia.
This patient has no indication for antipsychotic use. Quetiapine (Seroquel) is an antipsychotic that is prescribed for hallucinations, aggressive behavior, or agitation. These medications are prescribed after secondary causes such as UTI, PNA, thyroid disorder, depression, and anxiety are ruled out first.
- Visual hallucinations are a hallmark sign of which type of dementia?
a. Alzheimer’s dementia
b. Vascular dementia
c. Dementia with Lewy bodies
d. Parkinson’s disease dementia
c. Dementia with Lewy bodies
Rationale: Visual hallucinations often occur early in Lewy body dementia and is a hallmark symptom.
- In the elderly population, what assessment is used to test gait and balance that is readily accessible?
a. Up and Go Test
b. Physical therapy evaluation
c. Heel and toe walk
d. Assessing full range of motion
a. Up and Go Test
Rationale: Up and Go Test can be readily assessed with limited supplies. This is assessed by asking the
patient to stand up without use of hands, walking 10 feet, turning around, and sitting back down. If it takes
longer than 13.5 seconds, they are at greater risk of falling. This is when further PT evaluation and
strengthening/ exercise would be used to improve gait/balance and prevent falls.
- Detrusor overactivity is the most common cause of incontinence in geriatrics. A common symptom is leakage after the sensation to urinate which can’t be stopped. Which type of incontinence is being described?
a. Stress incontinence
b. Overflow incontinence
c. Functional incontinence
d. Urge incontinence
d. Urge incontinence
Rational: Leakage with sudden urge to urinate is urge incontinence and is caused by detrusor overactivity.
Stress incontinence occurs after stress maneuvers, like coughing.
Overflow incontinence is due from lower
sacral motor never dysfunction.
Functional incontinence is when they have limited mobility and they become incontinent when trying to get to bathroom.
- An 80-year-old woman and her daughter present in the primary care office for a consult. The daughter states her mother is becoming more forgetful and she speaks to people and animals that do not exist. After a physical exam, what would be the presumptive diagnosis for this patient?
a. Frontotemporal dementia
b. Lewy body dementia
c. Vascular dementia
d. Alzheimer’s disease
b. Lewy body dementia
Rationale: 4-04 complex visual hallucinations- typically of people or animals may be an early feature that
can help distinguish Lewy body dementia from Alzheimer disease.
- An 87-year-old patient with type two diabetes presents to the office with complaints of intermittent severe, cramping in his bilateral calves. The pain is worse with activity and generally is relieved with rest. The pain the patient is complaining of is consistent with which diagnosis?
a. Deep vein thrombosis.
b. Intermittent Claudication related to Peripheral Artery Disease
c. Chronic Venous Insufficiency
d. Lymphedema
b. Intermittent Claudication related to Peripheral Artery Disease
Rationale: Peripheral artery disease is seen in patients greater than 50 years old and more often in diabetic
patients. Patients with PAD can be asymptomatic or have the classic symptoms that are related to
intermittent claudication. The pain is usually severe, cramping, occurs primarily in the calf muscles, and is
relieved with rest and exacerbated with activity.
- A 78-year-old patient with moderate dementia comes into the clinic and the daughter of the patient asks the nurse practitioner what would be the best form of medical treatment. Which medication would be the best option for treatment based on the stage of dementia the patient is currently at?
a. Memantine
b. Donepezil
c. Risperidone
d. Quetiapine
b. Donepezil
Rationale: Donepezil is an acetylcholinesterase inhibitor that many experts recommend for the mainstay treatment of mild to moderate dementia.
Clinical trials have shown memantine to be better for the use of dementia that’s more advanced.
Risperidone and Quetiapine are atypical antipsychotics, and they are used to treat behavioral disturbances associated with dementia.
- An 80-year-old patient presents to the clinic and expresses concerns about falling and getting injured. What advice would you give the patient as a nurse practitioner that has shown to have the most impact on decreasing the risk of falls in the elderly?
a. Spending more time resting in the bed
b. Taking high dose vitamin D supplements to strengthen the bones
c. Using a cane and a walker in the home at all times
d. Engaging in exercises such as tai chi and strength training
d. Engaging in exercises such as tai chi and strength training
Rationale: Exercise is the intervention most consistently reported to decrease the risk of falls. Balance-focused
exercises such as tai chi, gait, and strength training are more effective for fall prevention than general
exercise programs.
High-dose vitamin D supplements (60,000 units per month) have been shown to increase the incidence of falls.
Assistive devices such as canes and walkers are useful but many older adults use them incorrectly.
Physical therapists are really useful in assessing the needs for an assistive device, choosing the best one for the patient, and showing them how to properly use the device.
- An elderly female presents to your clinic with her daughter. The daughter is concerned about her mother’s memory decline over the past several months. She reports that her mom has left the stove on several times, and her mom can’t seem to find the words she wants to say at times. Testing reveals the diagnosis of mild Alzheimer disease. What medication would you initiate first?
a. Donepezil
b. Memantine
c. Citalopram
d. Risperidone
a. Donepezil
Rationale: McPhee et al. (2020) discusses treatment options of donepezil, galantamine, or rivastigmine as
treatment options for mild to moderate Alzheimer disease.
It recommends Memantine as a treatment
option for more advanced Alzheimer disease.
The options of citalopram and risperidone may be used when the individual has behavioral issues alongside their dementia.
- An elderly male presents to your clinic with his caregiver. The caregiver reports that the patient spends most of his time in bed, and he rarely changes position without a “fuss”. On assessment you note a pressure injury to coccyx area. The area has non blanchable redness surrounding an open area with dermis exposed. What stage is the pressure injury?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
b. Stage 2
Rationale: McPhee et al. (2020) describes pressure injuries as follows:
stage 1- non blanchable redness that
has skin intact,
stage 2- partial thickness skin loss with dermis exposed,
stage 3 as full thickness skin loss,
stage 4 as full thickness skin loss with tissue loss.
Unstageable is when the view of the wound is
impacted by eschar or slough and a deep tissue injury is suspected with continued non- blanchable red or
purple discoloration. Elderly is at risk for pressure injuries with immobility. Elderly should be encouraged to use pressure reduction items and change position at least every two hours.
- You are the provider caring for a 2-year-old who has very limited vocabulary and suffers from metastatic osteosarcoma. Which pain scale will you use to help determine pain management efficacy?
a. Wong-Baker pain scale
b. Bieri Faces Scale
c. FLACC scale
d. Numeric scale
c. FLACC scale
Rationale: The FLACC scale is used for nonverbal children >1yo. It looks at five categories to determine pain scale of 1-10: face, legs, activity, cry and consolability. But you still always heavily weigh parent’s opinion of child’s pain level.
- The nurse practitioner is reviewing the CBC of a female patient that complains of fatigue, pallor and tachycardia. The hemoglobin is 10.2 and the MCV is low at 72. Based on these initial findings, the nurse practitioner considers all of the following diagnoses except:
a. Iron deficiency
b. Thalassemia
c. Vitamin B12 deficiency
d. Anemia of Chronic Disease
c. Vitamin B12 deficiency
Rationale: Iron deficiency anemia, Thalassemia, and Anemia of Chronic disease are all considered
microcytic anemias that would present with either normal MVCs or low MVCs.
Vitamin B12 deficiency is a macrocytic anemias that would present with high MVCs.
The nurse practitioner would run further tests such as a Ferritin, TIBC, transferrin, reticulocyte count etc.
- A patient presents for prenatal counseling prior to becoming pregnant. She knows that she is a carrier for the sickle cell trait. She asks the APRN if this means that her child will have sickle cell anemia. The APRN correctly responds:
a. Sickle cell anemia is an autosomal recessive trait. We will refer you and your partner for genetic counseling to assess the risks of your child having sickle cell anemia.
b. Sickle cell anemia is not a hereditary genetic condition. You do not need to worry about having a child with sickle cell anemia.
c. Sickle cell anemia is autosomal dominant. There is a 50% chance your child will have sickle cell anemia.
d. There is a strong genetic suspicion that you will pass this trait to your child. You should consider adoption.
a. Sickle cell anemia is an autosomal recessive trait. We will refer you and your partner for genetic counseling to assess the risks of your child having sickle cell anemia.
Rationale: The patient is aware that she is a carrier for the sickle cell trait and if her partner is a carrier as
well, they will have a 25% chance of bearing a child that has a phenotype of sickle cell. All partners should
be referred for genetic counseling prior to becoming pregnant.
- All of the following are true pertaining to Lymphedema except:
a. Excision of lymph nodes in the groin can result in Lymphedema
b. Antibiotics are useful in treating Lymphedema
c. Lymphedema has no cure
d. Consistent use of compression stockings is helpful
b. Antibiotics are useful in treating Lymphedema
Rationale:
Antibiotics as a prophylaxis in Lymphedema is of no benefit to the patient.
The use of diuretics is not helpful either.
Educating the patient about ways to control the symptoms of Lymphedema through the use of compression stockings, pneumatic pressure devices to promote lymphatic flow, and elevation of extremities will promote function and movement.
