Gerontology Class…. Week 1:MIDTERM EXAM GUIDE
Kennedy Malone APN in the Care of older adults TB
Question :
The major impact of the physiological
... [Show More] changes that occur with
aging is:
Student
Answer:
Reduced physiological reserve
Reduced homeostatic mechanisms
Impaired immunological response
All of the above
Instructor
Explanation:
The major impact of all of these physiological changes can be highlighted
with three primary points. First, there is a reduced physiological reserve of
most body systems, particularly cardiac, respiratory, and renal. Second,
there are reduced homeostatic mechanisms that fail to adjust regulatory
systems such as temperature control and fluid and electrolyte balance.
Third, there is impaired immunological function: infection risk is greater,
and autoimmune diseases are more prevalent. (Kennedy-Malone 3)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced
Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-
01-14. VitalBook file.
Points Received: 2 of 2
Comments:
Question 2
.
Question :
Men have faster and more efficient biotransformation of drugs
and this is thought to be due to:
Student
Answer:
Less obesity rates than women
Prostate enlargement
Testosterone
-582355588 MultipleChoice 1 True
0 -582355588 MultipleChoice 1
Less estrogen than women
Instructor
Explanation:
Men have faster and more efficient biotransformation, presumably because
of serum testosterone. Conditions of increased or decreased liver perfusion
alter the overall level of the drug that is absorbed and how it is
metabolized. (Kennedy-Malone 5)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced
Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-
01-14. VitalBook file.
Points Received: 2 of 2
Comments:
Question 3
.
Question :
The cytochrome p system involves enzymes that are generally:
Student
Answer:
Inhibited by drugs
Induced by drugs
Inhibited or induced by drugs
Associated with decreased liver perfusion
Instructor
Explanation:
Biotransformation occurs in all body tissues but primarily in the liver,
where enzymatic activity (cytochrome P [CYP] system) alters and
detoxifies the drug and prepares it for excretion. (Kennedy-Malone 5)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank.
Advanced Practice Nursing in the Care of Older Adults. F.A. Davis
Company, 2014-01-14. VitalBook file.
Points Received: 2 of 2
Comments:
-582355587 MultipleChoice 2 True
0 -582355587 MultipleChoice 2
-582355586 MultipleChoice 3 True
Question 4
.
Question :
Functional abilities are best assessed by:
Student
Answer:
Self-report of function
Observed assessment of function
A comprehensive head-to-toe examination
Family report of function
Instructor
Explanation:
Two well-established tools used to evaluate function in older adults are the
Katz Activities of Daily Living Scale (Katz et al., 1963) and the Lawton
and Brody scale for Instrumental Activities of Daily Living (Lawton &
Brody, 1969). It is important to be cautious about self-report of function
(rather than direct observation of function) and to ask, “Do you …?”
instead of “Can you …?” in order to determine if patients actually perform
the activity. (Kennedy-Malone 40)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced
Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-
01-14. VitalBook file.
Points Received: 2 of 2
Comments:
Question 5
.
Question :
Iron Deficiency Anemia (IDA) is classified as a microcytic,
hypochromic anemia. This classification refers to which of the
following laboratory data?
Student Answer: Hemoglobin and Hematocrit
Mean Corpuscular Volume (MCV) and Mean Corpuscular
Hemoglobin (MCH)
0 -582355586 MultipleChoice 3
-582355585 MultipleChoice 4 True
0 -582355585 MultipleChoice 4
Serum ferritin and serum iron
Total iron binding capacity and transferrin saturation
Instructor
Explanation:
RBC indices reveal an MCV (mean corpuscular volume/RBC size) that
will be decreased to <80 fL in adults; MCH (mean corpuscular
hemoglobin/RBC color) will show hypochromia or pale cells; RBC
distribution width (RDW)/volume variation will be increased.
(Kennedy-Malone page 519)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank.
Advanced Practice Nursing in the Care of Older Adults. F.A. Davis
Company, 2014-01-14. VitalBook file.
Points Received: 0 of 2
Comments:
Question 6
.
Question :
When interpreting laboratory data, you would expect to see the
following in a patient with Anemia of Chronic Disease (ACD):
Student
Answer:
Hemoglobin <12 g/dl, MCV decreased, MCH decreased
Hemoglobin >12 g/dl, MCV increased, MCH increased
Hemoglobin <12 g/dl, MCV normal, MCH normal
Hemoglobin >12 g/dl, MCV decreased, MCH increased
Instructor
Explanation:
Hemoglobin (Hgb): <12 g/dL (120 g/L) women <13 g/dL (130 g/L) men
Rarely <10 g/dL (100 g/L) Mean corpuscular volume: 80–96 mcm3
(normocytic) Mean corpuscular hemoglobin Normochromic (normal
color) RBC distribution width: normal (Kennedy-Malone page 517)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank.
Advanced Practice Nursing in the Care of Older Adults. F.A. Davis
Company, 2014-01-14. VitalBook file.
-582355584 MultipleChoice 5 False
0 -582355584 MultipleChoice 5
Points Received: 0 of 2
Comments:
Question 7
.
Question :
The pathophysiological hallmark of ACD is:
Student
Answer:
Depleted iron stores
Impaired ability to use iron stores
Chronic uncorrectable bleeding
Reduced intestinal absorption of iron
Instructor
Explanation:
The pathophysiological hallmark of ACD is a disregulation of iron
homeostasis, characterized by an increased uptake and retention of iron
within the cells of the reticuloendothelial system (liver/spleen), resulting in
decreased RBC production. Essentially, iron is present but inaccessible for
use in the production of Hgb with the erythrocytes (Bross et al., 2010). A
shortened RBC survival is also a contributing factor to ACD. (KennedyMalone page 516-517)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced
Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-
01-14. VitalBook file.
Points Received: 0 of 2
Comments:
Question 8
.
Question :
The main focus of treatment of patients with ACD is:
Student
Answer:
Replenishing iron stores
-582355583 MultipleChoice 6 False
0 -582355583 MultipleChoice 6
-582355582 MultipleChoice 7 False
0 -582355582 MultipleChoice 7
Providing for adequate nutrition high in iron
Management of the underlying disorder
Administration of monthly vitamin B12 injections
Instructor
Explanation:
Treatment: Treatment of ACD focuses on management of the underlying
disorder. Iron supplementation is of no benefit in ACD, except in cases of
coexisting IDA. A therapeutic trial of iron supplementation of no longer
than 1 month may be useful in delineating between ACD and IDA. In
ACD, there would be no hematological response to iron therapy (Chen &
Gandhi, 2004). (Kennedy-Malone page 518)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced
Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-
01-14. VitalBook file.
Points Received: 2 of 2
Comments:
Question 9
.
Question :
In addition to the complete blood count (CBC) with differential,
which of the following laboratory tests is considered to be most
useful in diagnosing ACD and IDA?
Student
Answer:
Serum iron
Total iron binding capacity
Transferrin saturation
Serum ferritin
Instructor
Explanation:
Treatment: Treatment of ACD focuses on management of the underlying
disorder. Iron supplementation is of no benefit in ACD, except in cases of
coexisting IDA. A therapeutic trial of iron supplementation of no longer than
1 month may be useful in delineating between ACD and IDA. In ACD, there
would be no hematological response to iron therapy (Chen & Gandhi, 2004).
-582355581 MultipleChoice 8 True
0 -582355581 MultipleChoice 8
(Kennedy-Malone page 518)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced
Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-
01-14. VitalBook file.
Points Received: 2 of 2
Comments:
Question 10
.
Question :
Symptoms in the initial human immunodeficiency virus (HIV)
infection include all of the following except:
Student
Answer:
Sore throat
Fever
Weight loss
Headache
Instructor
Explanation:
Signal symptoms: The initial HIV infection is characterized by
mononucleosis-like illness with fever, sore throat, lymphadenopathy,
headache, and fatigue. A roseola-like rash may also develop. These initial
symptoms are followed by an asymptomatic phase, which may last 10 years or
more. Later, if untreated, lymphadenopathy, weight loss, myalgias, and
diarrhea may develop (Cohen, Kuritzkes, & Sax, 2011). In advanced disease,
malignancies and opportunistic infections occur. Co-infection with hepatitis B
or C is common (25% to 30%) in IV drug users, so hepatitis symptoms may
also appear (Centers for Disease Control and Prevention [CDC], 2010a).
(Kennedy-Malone page 521)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced
Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-
14. VitalBook file.
Points Received: 0 of 2
-582355580 MultipleChoice 9 True
0 -582355580 MultipleChoice 9
Comments:
Question 11
.
Question :
Essential parts of a health history include all of the following
except:
Student Answer: Chief complaint
History of the present illness
Current vital signs
All of the above are essential history components
Instructor
Explanation:
Vital signs are part of the physical examination portion of patient
assessment, not part of the health history.
Points Received: 2 of 2
Comments:
Question 12
.
Question :
Which of the following clinical reasoning tools is defined as
evidence-based resource based on mathematical modeling to
express the likelihood of a condition in select situations, settings,
and/or patients?
Student
Answer:
Clinical practice guideline
Clinical decision rule
Clinical algorithm
Clinical recommendation
Instructor Clinical decision (or prediction) rules provide another support for clinical
-582355579 MultipleChoice 10 False
0 -582355579 MultipleChoice 10
-582355578 MultipleChoice 11 True
0 -582355578 MultipleChoice 11
Explanation: reasoning. Clinical decision rules are evidence-based resources that provide
probabilistic statements regarding the likelihood that a condition exists if
certain variables are met with regard to the prognosis of patients with
specific findings. Decision rules use mathematical models and are specific
to certain situations, settings, and/or patient characteristics. Goolsby page 7
Points Received: 2 of 2
Comments:
Question 13
.
Question :
The first step in the genomic assessment of a patient is obtaining
information regarding:
Student
Answer:
Family history
Environmental exposures
Lifestyle and behaviors
Current medications
Instructor
Explanation:
A critical first step in genomic assessment, including assessment of risk, is
the use of family history. Family history is considered the first genetic
screen (Berry & Shooner 2004) and is a critical component of care because
it reflects shared genetic susceptibilities, shared environment, and common
behaviors (Yoon, Scheuner, & Khoury 2003). Goolsby page 18
Points Received: 2 of 2
Comments:
Question 14
.
Question :
In autosomal recessive (AR) disorders, individuals need:
Student
Answer:
Only one mutated gene on the sex chromosomes to acquire the
disease
-582355577 MultipleChoice 12 True
0 -582355577 MultipleChoice 12
-582355576 MultipleChoice 13 True
0 -582355576 MultipleChoice 13
Only one mutated gene to acquire the disease
Two mutated genes to acquire the disease
Two mutated genes to become carriers
Instructor
Explanation:
In autosomal recessive (AR) disorders, the offspring inherits the condition
by receiving one copy of the gene mutation from each of the parents.
Autosomal recessive disorders must be inherited through both parents
(Nussbaum et al. 2007). Individuals who have an AR disorder have two
mutated genes, one on each locus of the chromosome. Parents of an
affected person are called carriers because each carries one copy of the
mutation on one chromosome and a normal gene on the other
chromosome. Carriers typically are not affected by the disease. Goolsby
page 28
Points Received: 0 of 2
Comments:
Question 15
.
Question :
In AR disorders, carriers have:
Student
Answer:
Two mutated genes; two from one parent that cause disease
A mutation on a sex chromosome that causes a disease
A single gene mutation that causes the disease
One copy of a gene mutation but not the disease
Instructor
Explanation:
Individuals who have an AR disorder have two mutated genes, one on
each allele of the chromosome. Parents of an affected person are called
carriers because each parent carries one copy of the mutation on one
chromosome and a normal gene on the other chromosome. Carriers
typically are not affected by the disease. In pedigrees with an AR
inheritance patterns, males and females will be equally affected because
the gene mutation is on an autosome. Goolsby page 28 [Show Less]