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NSG 0600
Clinical Proficiency
UPDATED FINAL EXAM GUIDE
- Which method is most optimal for assessing renal function in older adults with chronic kidney disease?
- A) Serum creatinine levels
- B) Glomerular Filtration Rate (GFR)
- C) Blood urea nitrogen (BUN)
- D) Urinalysis Answer: B) Glomerular Filtration Rate (GFR) Rationale: GFR provides a more accurate measure of renal function, particularly in patients with chronic kidney disease, compared to serum creatinine levels and BUN which can be influenced by other factors.
- The best pharmacological treatment for managing hypertension in a geriatric patient with diabetes is:
- A) Thiazide diuretics
- B) Angiotensin-converting enzyme (ACE) inhibitors
- C) Beta-blockers
- D) Calcium channel blockers Answer: B) Angiotensin-converting enzyme (ACE) inhibitors Rationale: ACE inhibitors are preferred for hypertensive geriatric patients with diabetes as they offer renal protection and reduce the risk of cardiovascular events.
- Which of the following is NOT a common symptom of delirium in older adults?
- D) Using continuous pain medication Answer: B) Engaging in low-impact aerobic exercises Rationale: Low-impact aerobic exercises help to strengthen muscles around joints, improve flexibility, and reduce symptoms of osteoarthritis. Fill-in-the-Blank Questions
- Older adults are often more susceptible to adverse drug reactions due to decreased _________ and _________ of medications. Answer: metabolism, excretion Rationale: Decreased metabolism and excretion in older adults can lead to higher drug levels in the body, increasing the risk of adverse reactions.
- The strongest predictor of falls in geriatric patients is a history of _________. Answer: previous falls Rationale: A history of previous falls is the strongest predictor of future falls, highlighting the need for targeted interventions.
- Polypharmacy is defined as the use of _______ or more medications taken concurrently. Answer: five Rationale: Polypharmacy is commonly defined as the use of five or more medications and can increase the risk of adverse effects and drug interactions.
- Depression in older adults is often underdiagnosed because its symptoms can be attributed to ___________ rather than a mental health condition. Answer: physical illnesses Rationale: Symptoms of depression, such as fatigue and changes in sleep patterns, can be misattributed to physical illnesses, leading to underdiagnosis in older adults.
- The primary marker for diagnosing rheumatoid arthritis is the presence of _________ in the blood. Answer: rheumatoid factor (RF) Rationale: Rheumatoid factor (RF) is an antibody found in the blood and helps in the diagnosis of rheumatoid arthritis. True/False Questions
- Sarcopenia, or the loss of muscle mass, is a natural part of aging and is not preventable. Answer: False Rationale: While sarcopenia is a natural part of aging, it can be mitigated through resistance training and adequate nutrition.
- Routine screening for osteoporosis is recommended for all women aged 65 years and older. Answer: True
- When treating depression in older adults, the first-line choice of medication is generally:
- A) Tricyclic antidepressants (TCAs)
- B) Selective serotonin reuptake inhibitors (SSRIs)
- C) Monoamine oxidase inhibitors (MAOIs)
- D) Benzodiazepines Answer: B) Selective serotonin reuptake inhibitors (SSRIs) Rationale: SSRIs are preferred due to their favorable side effect profile compared to TCAs and MAOIs.
- Which of the following factors does NOT contribute to elder abuse?
- A) Social isolation
- B) High socioeconomic status
- C) Cognitive impairment
- D) Caregiver stress Answer: B) High socioeconomic status Rationale: High socioeconomic status is not typically associated with increased risk of elder abuse, unlike other listed factors.
- The preferred method for screening diabetic nephropathy in older adults with type 2 diabetes is:
- A) Random blood glucose levels
- B) Microalbuminuria test
- C) Fasting blood glucose levels
- D) HbA1c levels Answer: B) Microalbuminuria test Rationale: Microalbuminuria is an early marker of diabetic nephropathy and helps in timely intervention.
- Which intervention is most effective in managing chronic heart failure in older adults?
- A) Sodium-restricted diet
- B) Increased fluid intake
- C) High-intensity interval training
- D) Use of loop diuretics only Answer: A) Sodium-restricted diet Rationale: A sodium-restricted diet is effective in managing fluid balance and symptoms in chronic heart failure.
- The gold standard for diagnosing Alzheimer’s disease in older adults is:
- A) MRI scan
- B) Neuropsychological testing
- C) CT scan
- D) Clinical history and physical examination Answer: D) Clinical history and physical examination
Answer: concurrent use of multiple medications Rationale: Polypharmacy involves the concurrent use of multiple medications which can raise the risk of adverse effects and interactions.
- One of the initial signs of urinary retention in older adults could be ____________. Answer: increased urinary frequency Rationale: Increased urinary frequency can be an early sign of urinary retention or other lower urinary tract dysfunctions. True/False Questions
- Hearing loss is an inevitable part of aging and does not require medical evaluation. Answer: False Rationale: While common, hearing loss should be evaluated medically to determine potential causes and treatments.
- The Mini-Mental State Examination (MMSE) is a reliable tool for diagnosing specific forms of dementia in older adults. Answer: False Rationale: The MMSE is a screening tool for cognitive impairment but does not specifically diagnose types of dementia.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can exacerbate heart failure symptoms in older adults. Answer: True Rationale: NSAIDs can lead to fluid retention and exacerbate heart failure symptoms in older adults.
- In older adults, poor oral health is often linked with systemic diseases such as cardiovascular disease. Answer: True Rationale: Poor oral health has been linked to systemic diseases, including cardiovascular conditions, due to chronic inflammation and infection.
- Adults over the age of 65 should receive the pneumococcal vaccine regardless of underlying health conditions. Answer: True Rationale: The pneumococcal vaccine is recommended for all adults over 65 to prevent pneumonia and related infections. Multiple Choice: Which of the following is a common symptom of acute myocardial infarction? A) Diarrhea B) Headache C) Chest pain
Rationale: Sepsis is often associated with fever or hyperthermia rather than hypothermia. Fill-in-the-Blank: Patients with chronic obstructive pulmonary disease (COPD) often present with barrel chest due to hyperinflation of the lungs. True/False: True or False: An arterial blood gas (ABG) result of pH 7.30 indicates respiratory alkalosis. Correct Answer: False Rationale: A pH of 7.30 indicates acidosis, not alkalosis. Multiple Choice: Which medication is commonly used in the treatment of atrial fibrillation to control heart rate? A) Warfarin B) Amiodarone C) Furosemide D) Lisinopril Correct Answer: B) Amiodarone Rationale: Amiodarone is a class III antiarrhythmic agent used to control heart rate in atrial fibrillation.
Fill-in-the-Blank: Dyspnea is a common symptom experienced by patients with heart failure due to fluid accumulation in the lungs. True/False: True or False: An ECG showing inverted T waves in multiple leads is suggestive of myocardial infarction. Correct Answer: True Rationale: Inverted T waves in multiple leads can indicate ischemia or infarction of the myocardium. Multiple Choice: Which of the following is a characteristic feature of chronic kidney disease (CKD)? A) Hyperkalemia B) Hypocalcemia C) Hypophosphatemia D) Hypoglycemia Correct Answer: A) Hyperkalemia Rationale: CKD often leads to impaired potassium excretion, resulting in hyperkalemia. Fill-in-the-Blank:
True/False: True or False: Metformin is a first-line medication for the management of type 1 diabetes mellitus. Correct Answer: False Rationale: Metformin is primarily used in the treatment of type 2 diabetes mellitus, not type 1 diabetes. Multiple Choice: Which of the following is a common symptom of rheumatoid arthritis? A) Oliguria B) Morning stiffness C) Dysphagia D) Hypotension Correct Answer: B) Morning stiffness Rationale: Morning stiffness, lasting more than 1 hour, is a hallmark symptom of rheumatoid arthritis. Fill-in-the-Blank: Rheumatoid factor is an autoantibody commonly found in the serum of patients with rheumatoid arthritis. True/False:
True or False: Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically contraindicated in the management of rheumatoid arthritis. Correct Answer: False Rationale: NSAIDs are commonly used to alleviate pain and inflammation in rheumatoid arthritis patients. Multiple Choice: Which of the following laboratory findings is indicative of systemic lupus erythematosus (SLE)? A) Elevated antinuclear antibodies (ANA) B) Decreased erythrocyte sedimentation rate (ESR) C) Low levels of C-reactive protein (CRP) D) Normal complement levels Correct Answer: A) Elevated antinuclear antibodies (ANA) Rationale: Elevated ANA is a characteristic finding in patients with SLE. Fill-in-the-Blank: Butterfly rash is a distinctive facial rash seen in patients with systemic lupus erythematosus. Multiple Choice: A 78-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) presents with increased shortness of breath. Which of the following interventions should the nurse prioritize? a) Administering a bronchodilator