NR601 Midterm Exam (Version-1, New-2023) / NR 601 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A|
NR601 Midterm Exam / NR 601 Midterm ... [Show More] Exam (Latest): Chamberlain College Of Nursing
1. The percentage of the FVC expired in one second is:
2. The aging process causes what normal physiological changes in the heart?
3. A 55yo Caucasian male follows up after referral to cardiologist. He thinks his med is causing a cough and sometimes he has difficulty breathing. Which med was most likely prescribed?
4. JM is a 68yo man who presents for a physical. He has T2DM x5yrs, smokes 1/2 PPD, BMI is 30. No other previous medical dx, no current complaints. According to the AHA/ACC guidelines, JM is stage A HF. Treatment goals for him include:
5. MJ presents with h/o structural damage with current s/s of HF. Treatment will be based on his stage of HF, which is:
6. 65yo Caucasian female presents with mitral valve stenosis, physical exam unremarkable. You know her stage of HF is:
7. DG, 65yo man, presents for eval of CP and L-sided shoulder pain, beginning after strenuous activity, including walking. Pain is dull, aching, 8/10 during activity, otherwise 0/10. Began few mo ago, intermittent, aggravated by exercise, relieved by rest. Occasional nausea. Pain is retrosternal, radiating to L shoulder, affects QOL by limiting activity. Pain is worse today, did not go away after stopped walking. BP 120/80, HR 72 and regular. Normal heart sounds, no murmur, S1, S2. Which differential dx would be most likely?
8. The best way to dx structural heart dz/dysfunction non-invasively is:
9. Chronic pain can have major impact on pt's ability to function and have profound impact on overall QOL. Ongoing pain may be linked to:
10. The Beers criteria are appropriate for use in evaluating use of certain meds in pts:
11. Pt presents with c/o increasing SOB, cough w/occasional white sputum, fatigue. As part of the plan you order labs. You know the likelihood of HF is low if the BNP is:
12. All of the following statements are true about lab values in older adults except:
a. Normal ranges may not be applicable to older adults
b. Abnormal findings are often due to physiological aging
c. Reference ranges are preferable
d. References values are not necessarily acceptable values
13. According to the 2017 ACC HTN guidelines, the recommended BP goal for a 65yo African American woman w/a h/o HTN and DM and no h/o CKD is:
14. The pathophysiology of HF is due to:
15. A 60yo woman w/30 pack yr hx, presents for eval of persistent, daily cough w/increased sputum, worse in the AM, occurring over past 3 months. She tells you, "I have the same thing year after year." Which of the following choices would you consider strongly in your critical thinking process?
16. JM is a 68yo man who presents for a physical. He has T2DM x5yrs, diet controlled. His BMI is 32. He has HTN, smoker (10 cigs/day x20yrs). He denies other medical problems. Fam hx includes CAD, CABG x4 for dad, now deceased; CHF, T2DM, HTN for mom. He is asymptomatic today, exam is normal, EKG NSR. According to AHA/ACC guidelines, JM is at risk for what stage of HF?
17. The volume of air a pt is able to exhale for total duration of the test during maximal effort is:
18. According to the 2017 ACC HTN guidelines, normal BP is:
19. Functional abilities are best assessed by:
20. LB is a 77yo pt w/chronic poorly controlled HTN. You know that goals include prevention of target organ damage. During your eval you will assess for evidence of:
21. Aortic regurgitation requires medical treatment for early signs of HF with:
a. ACEi
22. The volume of air in the lungs at max inflation is:
a. TLC (total lung capacity)
23. Preferred amount of exercise for older adults is:
a. 30min/day of aerobic activity 5 days/wk
24. The total volume of air a pt is able to exhale in the first second during max effort is:
a. FEV1
25. You know the following statements regarding the pain of acute coronary syndrome are true except:
a. Present atypically more often in men than women
b. May be retrosternal or poorly localized
c. May last longer than 20min
d. May radiate to arms, back, neck, jaw
a. A
26. Elderly pt presents w/new onset of feeling heart race, fatigue. EKG reveals afib w/rate >100. Pt also has a new tremor in both hands. Which of the following would you suspect?
a. Hyperthyroidism
27. 62yo female c/o fatigue, lack of energy. Constipation increased, pt gained 10lbs in past 3mo. Depression is denied although pt reports lack of interest in usual hobbies. VS are WNL, skin is dry/cool. Which of the following must be included in the DD?
a. Hypothyroidism
28. Mrs. Black, 87yo, has been taking 100mcg Synthroid x10yrs. She comes for routine follow-up, feeling well. HR is 90. Your first response is to:
a. Order TSH
29. Which pt is most likely to have osteoporosis?
30. 80yo underweight male who smokes and has been on steroids for psoriasis
31. When evaluating the expected outcome for hypothyroid elderly pt on levothyroxine, you will:
a. Assess TSH in 4-6wks
32. Postmenopausal woman w/osteoporosis is taking bisphosphonate daily PO. What action info statement would indicate she understood your instructions regarding this med?
a. Take med w/full glass of water when up in the AM 30min before other food and meds
33. Primary reason levothyroxine sodium is initiated at low dose in elderly pt w/hypothyroidism is to prevent which of the following untoward effects?
a. Angina and arrhythmia
34. 6mo ago an elderly pt was dx'd w/subclinical hypothyroidism. Today the pt returns and has TSH of 11 and c/o fatigue. He has taken Synthroid 25mcg daily as prescribed. What is the best course of action?
a. Double the dose
35. A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should you teach him regarding this med?
a. Its effectiveness is decreased by antacids, iron, or caffeine
36. Pt has been rx'd metformin (Glucophage). One wk later, he returns w/lowered BGL but c/o loose stools during the week. How should you respond?
a. Reassure him that this is an anticipated SE
37. Which of the following s/s of hyperthyroidism commonly manifest in younger populations, but is notably lacking in elderly?
a. Exopthalmos
38. 60yo obese male has T2DM and lipid panel of TC = 250, HDL = 32, LDL = 165. You teach him about his modifiable cardiac risk factors, which include:
a. DM, obesity, hyperlipidemia
39. Diabetic pt presents w/R foot pain but denies any recent known injury. He states it has gotten progressively worse over past few months. On exam, vibratory sense, as well as sensation tested w/monofilament, was abnormal. Pt's foot is warm, edematous, misshapen. You suspect Charcot foot. What intervention is indicated?
a. Referral to orthopedist
40. What is a s/s of insulin resistance that can present in African Americans?
a. Acanthosis Nigricans
41. During routine exam of 62yo female, you ID xanthelasma around both eyes. What is the significance of this?
a. Abnormal lipid metabolism requiring medical management
42. Mr. White is 62yo, had CKD that has been relatively stable. He also has h/o hyperlipidemia, OA, HTN. He is compliant w/meds, BP has been well controlled on CCB. Last lipids showed: TC = 201, HDL = 40, TG = 180, LDL = 98. He currently takes Crestor 20mg daily. Today his BP is 188/90 and urine dip shows significant proteinuria. He denies changes in dietary habits or med regimen. What would be the best med change at this point?
a. Change CCB to ACEi
43. You are working as NP in Fast Track of ER. 76yo male presents w/LUQ pain. There can be many conditions that present as LUQ pain, but which of the following is least likely to cause pain here?
a. Acute pancreatitis
44. Which is cardinal feature of failure to thrive?
a. Poor nutritional status
45. Feeding gastrostomy tubes at end-of-life Alzheimer's pt's have been associated with:
a. Aspiration pna
46. Which of the following nutritional indicators is not an indication of poor nutritional status in elderly?
a. BMI 25
47. OA of cervical and lumbar spine causes pain related to all of the following except:
a. Crystal deposition
48. In differentiating OA from chronic gout, pseudogout, or septic arthritis, the most valuable diagnostic study would be:
a. Synovial fluid analysis
49. Pt's w/OA of hip and knee often have distinguishable gait described as:
a. Antalgic
50. Which of the following best describes pain associated w/OA?
a. Begins upon arising and after prolonged wt bearing and/or use of the joint
51. Joint effusions typically occur later in the course of OA, especially in the:
52. Knee
53. You ordered CBC for your pt you suspect has polymyalgia rheumatica (PMR). Which 2 clinical findings are common in pt's w/PMR?
a. Normochromic, normocytic anemia and thrombocytosis
54. You suspect your pt has PMR and now are concerned that they may have Giant Cell Arteritis (GCA) too. Which of the following 2 symptoms are most indicative of GCA and PMR?
a. Scalp tenderness and aching in shoulder and pelvic girdle
55. 63yo Caucasian pt w/PMR will begin Tx w/corticosteroids until the condition has resolved. You look over her records and it has been 2yrs since her last physical exam and any labs or diagnostic tests as she relocated and had not yet ID'd a provider. In prioritizing your management plan, your first orders should include:
a. Duel-energy x-ray (DEXA) scan and updating immunizations
56. Which of the following DD for pt's presenting w/PMR can be ruled out w/a muscle biopsy?
a. Polymyositis
57. In reviewing lab results for pt's w/suspected PMR, you realize there is no definitive test to dx PMR, rather clinical response to Tx. Results you would expect to see include:
a. Elevated erythrocyte sed rate (ESR) >50
58. Which of the following is the most appropriate lab test for monitoring gout therapy over the long-term?
a. Serum urate level
59. In providing health teaching related to dietary restrictions, you should advise a pt w/gout to avoid which of the following dietary items:
a. Beer, sausage, fried seafood
60. The best method of verifying gout dx in a joint is which of the following:
61. Joint aspiration and polarized-light microscopy
62. The most appropriate first-line Tx for acute gout flare is (assuming no kidney dz or elevated bleeding risk):
a. Indomethacin 50mg TID x2 days, then 25mg TID x3 days
63. You order bilat wrist XR on 69yo man c/o pain both wrists x6 wks no related to any known trauma. You suspect early onset RA. The initial XR finding in a pt w/elderly onset RA would be:
a. Soft tissue swelling
64. You examine the hands of a 55yo woman w/RA and note bilat spindle shaped deformities on middle interphalangeal joints. These are known as:
a. Haygarth's nodes
65. A 72yo female has been dx'd w/gout. She also has h/o chronic HF. The most likely contributing factor to development of gout in this older female is:
a. Thiazide diuretics
66. Which of the following statements about OA is true?
67. It affects primarily wt-bearing joints
68. In considering the specificity of lab data, the most reliable diagnostic test listed below would be:
a. Synovial fluid analysis to differentiate between infectious versus inflammatory infusion
69. When examining the spine of an older adult you notice a curvature w/a sharp angle. This is referred to as a:
a. Gibbus
70. The prevalence of depression in nursing home residents is ___________ greater than adults living in the community.
a. 3-4 times
71. The majority of depressed older adults remain untreated because of:
a. Misdiagnosis, social stigma, environmental barriers
72. Symptoms of depression distinct to the elderly include:
a. Lack of emotions
73. The justification for ordering CBC, TSH, serum B12 for a pt you may suspect have clinical depression is:
a. Because of overlapping symptoms w/anemia, thyroid dysfunction, and nutritional deficiencies
74. One major difference that is useful in the DD of dementia versus delirium is that:
a. Dementia develops slowly and delirium develops quickly
75. Which of the following is the most appropriate screening tool for delirium?
a. Confusion Assessment Method
76. The proposed mechanism by which diphenhydramine causes delirium is:
a. Anticholinergic effects
77. The elderly are at high risk for delirium because of:
a. Multisensory declines, polypharmacy, multiple medical problems
78. A consistent finding in delirium, regardless of cause, is:
a. Reduction in regional cerebral perfusion
79. Older adults w/dementia sometimes suffer from agnosia, which is defined as the inability to:
a. Recognize objects
80. In late stages of dementia, a phenomenon called sun downing occurs, in which cognitive disturbances tend to:
a. Become worse in the evening
81. Of the following, which one is the most useful clinical eval tool to assist in the dx of dementia?
a. St. Louis University Mental Status Exam (SLUMS)
82. The cornerstone of pharmacotherapy in treating Alzheimer's is:
a. Cholinesterase inhibitors
83. The comorbid psych problem w/the highest frequency in dementia is:
a. Anxiety
84. When treating depression associated w/dementia, which of the following would be a poor choice and should not be prescribed?
a. Amitriptyline
85. The leading COD in elderly travelers worldwide is:
a. Accidents
86. Which of the following should be avoided in countries where food and water precautions are to be observed?
a. Salad buffet
87. What insect precautions are not necessary to prevent insect-borne dz's in the tropics?
a. Using 100% DEET on skin to prevent bites
88. An example of secondary prevention you could recommend/order for older adults would be to:
a. Check for fecal occult blood
89. Ali is a 72yo man who recently came to US from Nigeria. He reports having BCG (bacille Calmette-Guerin) vax as a child. Which of the following is correct regarding a TB skin test?
a. Vax hx is irrelevant; read as usual
90. Ivan is 65yo man who is new to your practice. He has h/o COPD, CAD, HTN, T2DM. He has had no immunizations since his d/c from military at 25yo. Childhood dz's include chickenpox, measles, mumps, and German measles. He presents for a dz management visit. Which of the following immunizations would you recommend for Ivan?
a. Tdap, pneumococcal, influenza, Zostavax
91. Leo is a 62yo African American male who comes in for an initial visit. Personal health hx includes smoking 1 PPD since 11yo, consuming a case of beer (24 bottles) every weekend, and working as an assembler (sedentary job) for the past 10yrs. Fam Hx in first-degree relatives includes HTN, high cholesterol, MI, T2DM. Leo's BMI is 32. BP is 130/86. You order fasting glucose, lipid profile, and return visit for BP check. This is an example of:
a. Secondary prevention
92. A local chapter of NP organization has begun planning a community-based screening for HTN at a local congregate living facility. This population was selected on the basis of:
a. A recognized element of high risk within this group.
93. Performing ROM exercises on a pt who has had a CVA is an example of which level of prevention?
a. Tertiary
94. You demonstrate an understanding of primary prevention of falling among the elderly through which management plan?
a. Provide info about meds, SE, interactions
95. An example of an active strategy of health promotion for an individual to accomplish would be:
a. Beginning stress management program
96. You are working w/an older adult male w/a long h/o ETOH abuse and a 30yr h/o smoking. In recommending an intervention, your responsibility is to:
a. Promote positive change in lifestyle choices
97. The 4 main domains of clinical preventive services that you will provide are:
a. Counseling interventions, screening tests, immunizations, chemoprophylaxis
98. Which organism that can be prevented by immunization is most often responsible for an infectious "outbreak" in the nursing home setting?
a. Influenza A
99. What is the appropriate method for TB screening of an older adult entering a nursing home?
a. 5 TBU intradermal PPD injection and if negative, repeat w/same dose one week later
100. Meds known to contribute to constipation include all of the following except:
a. Broad-spectrum abx
101. All of the following are considered contributors to dysphagia except:
a. Smooth muscle relaxants
102. The term "geriatric syndrome" is best described as:
a. Condition that has multiple underlying factors and involves multiple systems
103. The anal wink reflex is used to test:
a. Sensation and pudental nerve function
104. Atypical presentation of acute coronary syndrome is:
a. More common in females
105. What dz can mimic and often co-exists w/MI in elderly w/CAD?
a. Esophageal dz
106. Thoracic aortic dissection presents typically as:
a. Severe retrosternal CP that radiates to the back and both arms
107. Bordetella pertussis is best characterized by:
a. Sub-acute cough lasting >2wks
108. Routine testing of TB should occur in all of the following vulnerable populations except:
a. Hospitalized elderly
109. Which of the following statements about fluid balance in elderly is false?
a. Assessment of skin turgor at the sternum is a reliable indicator of dehydration in elderly.
110. Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the DD is:
a. Rapid change and fluctuating course of cognitive function
111. Presbystasis is best described as:
a. Age-related disequilibrium of unknown pathology characterized by gradual onset of difficulty walking
112. If dizziness has a predictable pattern associated w/it, you should first consider:
a. Hypoglycemia
113. Evidence shows that the most important predictor of a fall is:
a. Prior h/o a fall
114. The most cost-effective interventions used to prevent falls are:
115. Home modifications and vit D supplements
116. Chronic fatigue syndrome is best described as:
117. Fatigue lasting longer than 6mo and not relieved by rest
118. Which form of HA is bilat?
119. Tension
120. Microscopic hematuria is defined as:
121. 3 or more RBCs on 3 or mor samples of urine
122. Risk factors associated with the finding of a malignancy in a pt w/hemoptysis include all of the following except:
a. Childhood asthma
123. Recent wt loss is defined as:
a. Loss of >10lbs over the past 3-6mo
124. The most common cause of disability in elderly is due to:
a. Arthritis
125. Lipedema is best described as:
a. Bilat distribution of fat in lower extremities
126. Drug-induced pruritis is distinguished because it:
a. May occur right after drug is taken or months later
127. A form of syncope that is more common in elderly than in younger adults is:
a. Orthostatic hypotension
128. All of the following statements about tremor are true except:
a. The most common tremor is the Parkinson tremor
129. Overflow incontinence is usually associated with:
a. Bladder outlet obstruction
130. Wandering is best described as:
a. Purposeful excessive ambulatory behavior
131. A key symptom of ischemic heart dz is CP. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:
a. Women w/ischemic heart dz many times don't present w/CP.
Some pt's may have no symptoms or atypical symptoms so dx may only be made at the time of the actual MI.
132. Which test is clinical standard for assessment of aortic stenosis?
a. Echocardiogram
133. Ischemic heart dz is:
a. Defined as an imbalance between O2 supply and demand.
Frequently manifested as angina.
Leading COD in elderly.
134. Preceding a stress test, the following lab work might include:
a. CBC w/diff to differentiate ischemic heart dz from anemia.
Thyroid studies to rule out hyperthyroidism.
135. On exam, what type of murmur can be auscultated w/aortic regurg?
a. Austin flint
136. Which of the following statements is true regarding anti-arrhythmic drugs?
a. Most anti-arrhythmics have low toxic/therapeutic ratio and some are exceedingly toxic.
137. In mitral stenosis, p waves may suggest:
a. L atrial enlargement
138. Aortic regurg requires medical tx for early signs of CHF with:
a. ACEi
139. The best evidence rating drugs in a post-MI pt include:
a. ASA, ACEi/ARB, BB, aldosterone blockade
140. 55yo post-menopausal woman with h/o HTN c/o jaw pain on heavy exertion. No c/o CP. EKG is NSR w/out ST segment abnormalities. Your plan may include:
a. Exercise stress test
141. What is the most common valvular heart dz in elderly?
a. Aortic stenosis
142. Elderly may present with atypical clinical signs of pna. You need to be aware that clustering of all of the following s/s may indicate pna in the elderly except for:
a. Bradycardia
143. A common auscultatory finding in CHF is:
a. S3
144. The most common organism responsible for CAP in the elderly is:
a. Strep pneumoniae
145. 72yo woman and her husband are driving cross-country. After a long day of driving, they stop to eat. Midway through the meal, the woman becomes very SOB w/CP and a sense of panic. Which problem is most likely?
a. Pulmonary embolism
146. Exercise recommended for elderly should include activities that:
a. Strengthen muscles
147. Preferred amount of exercise for elderly is:
a. 30min of aerobic activity a day 5 days a week
148. Which of the following medical conditions is not considered restrictive for engaging in physical activity?
a. Depression
149. The best recommendation for a pt who says they have no equipment to exercise is:
a. Improvise w/recommended objects at home that can be used
150. When you recommend exercise for elderly, which of the following pieces of advice should be considered for all types of exercise?
a. Start low and go slow
151. All of the following statements are true about lab values in the elderly except:
a. Abnormal findings are often due to physiological aging
152. Biochemical individuality is best described as:
a. Each individual's variation is often much smaller than that of a larger group
153. All the following statements about drug absorption are false except:
a. Underlying chronic dz has little impact on drug absorption
154. The cytochrome p system involves enzymes that are generally:
a. Inhibited or induced by drugs
155. A statement not shown to be true about pharmacodynamic changes with aging is:
a. Decreased sensitivity to oral anticoagulants
156. The major impact of the physiological changes that occur w/aging is:
a. Reduced physiological reserve
Reduced homeostatic mechanisms
Impaired immunolgoical response
157. The strongest evidence regarding normal physiological aging is available through:
a. Longitudinal studies
158. Pharmacokinetic changes w/aging is reflective of:
a. What the body does to the drug
159. All of the following statements are true about drug distribution in the elderly except:
a. Drugs distributed in water have lower concentration
160. Men have faster and more efficient biotransformation of drugs and this is thought to be due to:
a. Testosterone
161. Atypical presentation of dz in elderly is reflected by all the following except:
a. MI w/CP and diaphoresis
162. Polypharmacy is best described as taking:
a. Even a single med if there is not a clear indication for its use [Show Less]