AGPCNP - NSG 0600 Clinical Proficiency - Updated Final Exam Guide 2024, Exams of Nursing

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NSG 0600

Clinical Proficiency

UPDATED FINAL EXAM GUIDE

1. 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.
2. 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.
3. 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

6. 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.
7. 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.
8. 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.

9. 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.
10. 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
11. 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.
12. Routine screening for osteoporosis is recommended for all women aged 65 years and older. Answer: True

16. 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.
17. 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.
18. 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.

19. 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.

20. 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.

25. 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
26. 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.
27. 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.

28. 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.
29. 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.
30. 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