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NR 601 MIDTERM EXAM – QUESTION WITH ANSWERS
(LATEST, GRADED A)( CHAMBERLAIN COLLEGE OF
NURSING)
1. The percentage of the FVC expired in one second is: a. FEV1/FVC ratio 2. The aging process causes what normal physiological changes in the heart? a. The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis. 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? a. Lisinopril 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: a. Heart healthy lifestyle 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: a. Stage C 6. 65yo Caucasian female presents with mitral valve stenosis, physical exam unremarkable. You know her stage of HF is: a. B 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? a. Coronary artery dz w/angina pectoris
8. The best way to dx structural heart dz/dysfunction non-invasively is: a. Echocardiogram 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: a. Depression, sleep disturbance, decreased socialization 10. The Beers criteria are appropriate for use in evaluating use of certain meds in pts: a. >65yo 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: a. < 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 a. B 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: a. <140/ 14. The pathophysiology of HF is due to: a. Inadequate cardiac output to meet the metabolic and O2 demands of the body 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? a. Chronic bronchitis
25. 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 26. 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 27. 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 28. Which pt is most likely to have osteoporosis? a. 80yo underweight male who smokes and has been on steroids for psoriasis 29. When evaluating the expected outcome for hypothyroid elderly pt on levothyroxine, you will: a. Assess TSH in 4 - 6wks 30. 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 31. 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 32. 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
33. 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 34. 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 35. Which of the following s/s of hyperthyroidism commonly manifest in younger populations, but is notably lacking in elderly? a. Exopthalmos 36. 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 37. 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 38. What is a s/s of insulin resistance that can present in African Americans? a. Acanthosis Nigricans 39. 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 40. 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
51. 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 52. 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 53. Which of the following DD for pt's presenting w/PMR can be ruled out w/a muscle biopsy? a. Polymyositis 54. 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) > 55. Which of the following is the most appropriate lab test for monitoring gout therapy over the long-term? a. Serum urate level 56. 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 57. The best method of verifying gout dx in a joint is which of the following: a. Joint aspiration and polarized-light microscopy 58. 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 59. 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
60. 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 61. Which of the following statements about OA is true? a. It affects primarily wt-bearing joints 62. 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 63. When examining the spine of an older adult you notice a curvature w/a sharp angle. This is referred to as a: a. Gibbus 64. The prevalence of depression in nursing home residents is greater than adults living in the community. a. 3 - 4 times 65. The majority of depressed older adults remain untreated because of: a. Misdiagnosis, social stigma, environmental barriers 66. Symptoms of depression distinct to the elderly include: a. Lack of emotions 67. 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 68. One major difference that is useful in the DD of dementia versus delirium is that: a. Dementia develops slowly and delirium develops quickly 69. Which of the following is the most appropriate screening tool for delirium? a. Confusion Assessment Method
80. What insect precautions are not necessary to prevent insect-borne dz's in the tropics? a. Using 100% DEET on skin to prevent bites 81. An example of secondary prevention you could recommend/order for older adults would be to: a. Check for fecal occult blood 82. 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 83. 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 84. 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. 85. Performing ROM exercises on a pt who has had a CVA is an example of which level of prevention? a. Tertiary 86. You demonstrate an understanding of primary prevention of falling among the elderly through which management plan? a. Provide info about meds, SE, interactions 87. An example of an active strategy of health promotion for an individual to accomplish would be: a. Beginning stress management program 88. The 4 main domains of clinical preventive services that you will provide are: a. Counseling interventions, screening tests, immunizations, chemoprophylaxis
89. 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 90. Meds known to contribute to constipation include all of the following except: a. Broad-spectrum abx 91. All of the following are considered contributors to dysphagia except: a. Smooth muscle relaxants 92. The term "geriatric syndrome" is best described as: a. Condition that has multiple underlying factors and involves multiple systems 93. The anal wink reflex is used to test: a. Sensation and pudental nerve function 94. Atypical presentation of acute coronary syndrome is: a. More common in females 95. What dz can mimic and often co-exists w/MI in elderly w/CAD? a. Esophageal dz 96. Thoracic aortic dissection presents typically as: a. Severe retrosternal CP that radiates to the back and both arms 97. Bordetella pertussis is best characterized by: a. Sub-acute cough lasting >2wks 98. Routine testing of TB should occur in all of the following vulnerable populations except: a. Hospitalized elderly 99. 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.
111. Lipedema is best described as: a. Bilat distribution of fat in lower extremities 112. Drug-induced pruritis is distinguished because it: a. May occur right after drug is taken or months later 113. A form of syncope that is more common in elderly than in younger adults is: a. Orthostatic hypotension 114. All of the following statements about tremor are true except: a. The most common tremor is the Parkinson tremor 115. Overflow incontinence is usually associated with: a. Bladder outlet obstruction 116. Wandering is best described as: a. Purposeful excessive ambulatory behavior 117. 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. 118. Which test is clinical standard for assessment of aortic stenosis? a. Echocardiogram 119. Ischemic heart dz is: a. Defined as an imbalance between O2 supply and demand. Frequently manifested as angina. Leading COD in elderly. 120. 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.
121. On exam, what type of murmur can be auscultated w/aortic regurg? a. Austin flint 122. 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. 123. In mitral stenosis, p waves may suggest: a. L atrial enlargement 124. Aortic regurg requires medical tx for early signs of CHF with: a. ACEi 125. The best evidence rating drugs in a post-MI pt include: a. ASA, ACEi/ARB, BB, aldosterone blockade 126. 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 127. What is the most common valvular heart dz in elderly? a. Aortic stenosis 128. 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 129. A common auscultatory finding in CHF is: a. S 130. The most common organism responsible for CAP in the elderly is: a. Strep pneumoniae
142. The major impact of the physiological changes that occur w/aging is: a. Reduced physiological reserve Reduced homeostatic mechanisms Impaired immunolgoical response 143. The strongest evidence regarding normal physiological aging is available through: a. Longitudinal studies 144. Pharmacokinetic changes w/aging is reflective of: a. What the body does to the drug 145. All of the following statements are true about drug distribution in the elderly except: a. Drugs distributed in water have lower concentration 146. Men have faster and more efficient biotransformation of drugs and this is thought to be due to: a. Testosterone 147. Atypical presentation of dz in elderly is reflected by all the following except: a. MI w/CP and diaphoresis 148. Polypharmacy is best described as taking: a. Even a single med if there is not a clear indication for its use
What is the major difference between varicose veins and atherosclerosis? Vessels that are affected Pt has had poorly controlled HTN >10yrs. Indicate the most likely position of his PMI. c. 5th ICS left of MCL 43yo hispanic male has audible diastolic murmur best heard at the mitral point. No audible click. He has been monitored for 2yrs. What is the most likely murmur? d. Mitral stenosis What are PFTs? Group of tests that provide quantifiable measurement of lung function, used to dx resp abnormalities or assess progression/resolution of lung dz. What is FEV1? Forced Expiratory Volume in 1 second (80-120%) What is FVC? Forced Vital Capacity (80-120%) What is normal FEV1/FVC ratio? <0.7 (70%) What is GOLD 1 criteria? Mild FEV1 >/= 80% predicted What is GOLD 2 criteria? Moderate FEV1 50 - 79% predicted What is GOLD 3 criteria? Severe FEV1 30 - 49% predicted What is GOLD 4 criteria? Very severe FEV1 <30% predicted What are the signal symptoms of COPD?
Why are long-acting beta agonists prescribed for COPD? They are for moderate airflow limitation. They relieve symptoms, increase exercise tolerance, reduce number of exacerbations, improve QOL. What are some non pulmonary diagnoses that result in COPD-type symptoms? CHF What are some Hyperventilation syndrome Panic attacks Vocal cord dysfunction Obstructive sleep apnea Aspergillosis Chronic fatigue syndrome What are signal symptoms of asthma? Wheezing Shortness of breath Cough (esp at night) Chest tightness What is chronic bronchitis? Daily chronic cough w/increased sputum for at least 3 consecutive months in at least 2 consecutive years. Usually worse on wakening. May or may not be associated with COPD. What is emphysema? Characterized by obstruction to airflow caused by abnormal airspace enlargement distal to terminal bronchioles. Chronic inflammation/remodeling, trapping air, hindering effective O2/CO2 exchange (all due to inflammatory mediators infiltrating airways). What are signal symptoms of ischemic heart dz? Chest pain Chest tightness Chest discomfort What is ischemic heart dz? Imbalance between supply and demand for blood flow to myocardium What are signal symptoms of lung CA?
Cough Dyspnea Wt loss Anorexia Hemoptysis What is lung CA? Malignant neoplasm originating in parenchyma of lung/airways What are signal symptoms of MI? Prolonged CP (>20min duration) SOB Confusion Weakness Worsening HF What is an MI? Necrosis of heart tissue caused by lack of blood and O2 supply to the heart What are signal symptoms of pneumonia? Fever Chills Hypothermia New cough w/or w/out sputum Chest discomfort or dyspnea Fatigue HA Some older adults will be asymptomatic but may experience falls/confusion What is community acquired pneumonia? Acute lower resp tract infection of lung parenchyma. Can be bacterial or viral. Bacterial is most common in older adults. What are signal symptoms of a PE? Dyspnea CP on inspiration Anxiety Presentation is variable Symptoms nonspecific Some asymptomatic What is PE description? Occlusion of one or more pulmonary vessels by traveling thrombus originating from distant site.
