Principles of Primary Care

Question 1

1. Which one of the following is most true about the rule of fourths?

a. One-fourth of geriatric problems are iatrogenic.
b. Little can be done to prevent three-fourths of the problems of aging.
c. For every medical complaint a patient presents with, a careful assessment can identify three other diagnoses.
d. What used to be called normal aging can be largely explained by processes that are not normal.
e. A good way to conduct a geriatric assessment is to use four categories: mental, physical, psychosocial, and environmental.

Answer 1

d. What used to be called normal aging can be largely explained by processes that are not normal.

Question 2

2. Which one of the following is most true about aging changes?

a. Stage 3 and 4 sleep decreases.
b. Renal perfusion is not reduced, but renal function is reduced.
c. Hearing acuity declines beginning in middle age.
d. Prostatic enlargement occurs only in a minority of men.

Answer 2

a. Stage 3 and 4 sleep decreases.

Question 3

3. An old woman who is cared for by attentive, cautious, concerned family is particularly likely to suffer from which one of the following complications after an episode of gastroenteritis?

a. Immobility related to overconcern
b. Continued vomiting caused by too-rapid feeding
c. Diarrhea resulting from administration of milk products
d. Constipation related to overtreatment of diarrhea

Answer 3

a. Immobility related to overconcern

Question 4

4. Which one of the following is most true about psychological aging?

a. Disengagement tends to promote better psychological health than continued engagement.
b. Most older adults do not worry about memory loss.
c. Happiness declines starting in middle age.
d. Ageism can lead to isolation and depression.

Answer 4

d. Ageism can lead to isolation and depression.

Question 5

5. Of the following conditions, which one is most common and most often preventable?

a. Falls
b. Frailty
c. Cognitive impairment
d. Iatrogenic disease
e. Depression

Answer 5

d. Iatrogenic disease

Question 6

The rule of fourths

Answer 6

• “Is this a normal part of aging?”; disabilities do not equate to “normal aging”.
• Disease-related disability, for example, could manifest as decreased exercise tolerance in a chronic smoker with chronic lung disease; disuse-related disability as shortness of breath on minimal exertion in a sedentary older person; misuse-related disability as knee arthritis in a former football player; and disability related to physiologic aging as trouble reading fine print in a 50-year-old.

Treatments:
o Disease = medication.
o Disuse = activity regimen
o Misuse = cannot reverse damage but prevent deterioration to preserve function.
o Physiological aging = adapt and compensate for disability.

Question 7

Affordable care act & Older Adults

Answer 7

ACA has increased the population of insured people thru Medicaid expansion and long term facility and market place insurance. Expendatures and reimbursement rates have shown that the ACA has increased Medicaid payments in long term care for many older adults to prevent institutionalization. Utilizing and community resources may system and their family to maintain the same environment. NP must be aware of community resources to provide recommendations and direction needed.

Question 8

The Administration on Aging (AoA), a division of the U.S. Department of Health and Human Services

Answer 8

creates and funds services to assist older adults in remaining safely at home (Administration for Community Living, n. d.). The AoA divides programming into four areas of spending.

Office of Nutrition and Health Promotion Programs (ONHPP)

Office of Supportive and Caregiver Services (OSCS)

Office of Elder Justice and Adult Protective Services (OEJAPS)

Office for American Indian, Alaska Natives, and Native Hawaiian Programs (OAA)

Question 9

The services offered by the Office of Nutrition and Health Promotion Programs (ONHPP) include:

Answer 9

• health promotion and prevention
• chronic disease self-management
• diabetes self-management
• falls prevention
• human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) education
• nutrition services
• oral health promotion

Question 10

The services offered by the Office of Supportive and Caregiver Services (OSCS) include:

Answer 10

• transportation
• caregiver support
• adult daycare

Question 11

The services offered by the Office of Elder Justice and Adult Protective Services (OEJAPS) include:

Answer 11

• legal assistance
• pension counseling
• elder abuse prevention

Question 12

The services offered by the Office for American Indian, Alaska Natives, and Native Hawaiian Programs (OAA) include:

Answer 12

• nutrition
• caregiver support
• provides grants to tribal organizations

Question 13

Consider social determinants of health

Answer 13

Older adults may be reluctant to divulge inequities and the related consequences they have experienced. Asking direct and specific questions can elicit important information related to lack of housing, food insecurity, transportation concerns, or social isolation; education, income, physical activity opportunities, free from polluted air and water. They also contribute to a wide health disparities and inequities, such as people who do not have access to groceries with healthy foods are less likely to have good nutrition.

Question 14

Health promotion

Answer 14

Wellness visits
Medication reconciliation
Immunizations
Screenings