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An exam with rationales and case studies related to advanced primary care for older adults. The exam covers topics such as the primary goal of advanced primary care, characteristic features, care coordination, advanced care planning, common conditions, and falls risk assessment. The case studies cover topics such as orthostatic hypotension, electrolyte imbalances, delirium screening, low-dose opioids, diabetes medication regimen, and cognitive stimulation activities. insights into the best practices for providing comprehensive and tailored care for older adults.
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ensure appropriate dosing. Periodic medication adjustments based on patient response and changing needs are crucial for optimizing outcomes.
effective communication with older adults by avoiding the use of complex medical terminology. Using simpler language and providing clear explanations help promote patient understanding and engagement in their care.
Rationale: Regular cognitive screenings, such as the Mini- Mental State Examination (MMSE), are recommended every 2-3 years in advanced primary care for older adults. Early identification of cognitive decline enables timely interventions, such as support services, therapy, and safety measures.
Rationale: Falls risk assessment in advanced primary care aims to identify older adults at risk for falls and develop personalized interventions to minimize the risk. Recommendations may include exercises, environmental modifications, assistive devices, and education to prevent falls.
Case Study 1 Mrs. Johnson, an 82-year-old woman, presents with a history of falls. She takes multiple medications, including a diuretic for hypertension. She also experiences occasional dizziness. What should the nurse practitioner prioritize in the assessment? a) Review of medication list b) Orthostatic blood pressure measurements c) Cognitive assessment d) Gait and balance evaluation Answer: b) Orthostatic blood pressure measurements Rationale: Mrs. Johnson's history of falls, dizziness, and hypertension medication usage indicates the need for orthostatic blood pressure measurements to assess for orthostatic hypotension, a common cause of falls in older adults. Case Study 2 Mr. Tan, a 78-year-old man, has a history of heart failure and is prescribed a loop diuretic. He presents with worsening shortness of breath. Which intervention should the nurse prioritize? a) Administering oxygen therapy b) Assessing for pedal edema c) Monitoring serum electrolytes
d) Reviewing recent medication adherence Answer: c) Monitoring serum electrolytes Rationale: Loop diuretics can lead to electrolyte imbalances, especially in older adults with heart failure. Monitoring serum electrolytes is crucial in managing his worsening symptoms. Case Study 3 Mrs. Lee, an 85-year-old woman, is admitted with a urinary tract infection. She has a history of mild cognitive impairment and functional decline. What assessment should be included in the plan of care? a) Swallowing evaluation b) Mobility assessment c) Pain assessment d) Delirium screening Answer: d) Delirium screening Rationale: Older adults with cognitive impairment are at higher risk of delirium when hospitalized. Screening for delirium is essential for early intervention. Case Study 4 Mr. Patel, an 88-year-old man, presents with chronic pain due to osteoarthritis. He is currently taking acetaminophen but reports inadequate pain relief. What is the next appropriate pharmacological intervention? a) Prescribing an NSAID b) Initiating a low-dose opioid c) Recommending physical therapy d) Referring for surgical consultation
pneumococcal vaccination an essential intervention. Case Study 7 Mrs. Kim, an 84-year-old woman, presents with symptoms of depression. She has no prior history of mental health concerns. What should be the initial approach in her management? a) Referring to a psychiatrist b) Initiating pharmacotherapy c) Performing a comprehensive mood assessment d) Recommending psychotherapy Answer: c) Performing a comprehensive mood assessment Rationale: A comprehensive mood assessment is essential to differentiate depression from other medical conditions common in older adults and to guide appropriate interventions. Case Study 8 Mr. Singh, an 89-year-old man, is living independently but experiences social isolation. What intervention is most appropriate to address his situation? a) Facilitating participation in group activities b) Arranging home health aide services c) Referring to a geriatric psychiatrist d) Assessing for cognitive impairment Answer: a) Facilitating participation in group activities Rationale: Social isolation in older adults can contribute to adverse health outcomes. Facilitating participation in group activities can help mitigate the effects of social
isolation. Case Study 9 Mrs. Chen, an 86-year-old woman, is at risk of polypharmacy due to multiple chronic conditions. What intervention is essential in preventing adverse drug events? a) Simplifying the medication regimen b) Conducting comprehensive geriatric assessment c) Performing medication reconciliation d) Initiating deprescribing discussions Answer: c) Performing medication reconciliation Rationale: Medication reconciliation helps identify and resolve discrepancies, reducing the risk of adverse drug events in older adults with complex medication regimens. Case Study 10 Mr. Brown, an 83-year-old man, presents with a recent history of unexplained falls. Which assessment is crucial in identifying fall risk factors? a) Vision testing b) Assessing for postural hypotension c) Reviewing footwear quality d) Evaluating environmental hazards Answer: b) Assessing for postural hypotension Rationale: Postural hypotension is a common and modifiable risk factor for falls in older adults, making its assessment crucial in fall prevention. Case Study 11 Mrs. Jackson, an 81-year-old woman, is recovering from
a) Formalizing a do-not-resuscitate (DNR) order b) Initiating discussions on end-of-life care preferences c) Referring to hospice services d) Administering comfort-focused medications Answer: b) Initiating discussions on end-of-life care preferences Rationale: Initiating discussions on end-of-life care preferences aligns the care plan with Mrs. Garcia's wishes and ensures her preferences are respected. Case Study 14 Mr. Kim, an 84-year-old man, is at risk of elder abuse. What intervention is essential in addressing this concern? a) Initiating a referral to adult protective services b) Assessing for cognitive impairment c) Interviewing family members for insights d) Reviewing financial records for irregularities Answer: a) Initiating a referral to adult protective services Rationale: Suspected elder abuse warrants immediate action to ensure the safety and well-being of the older adult, making a referral to adult protective services essential. Case Study 15 Mrs. Patel, an 86-year-old woman, has advanced heart failure and is considering hospice care. What should the primary care team prioritize in her management? a) Initiating discussions on comfort care goals b) Referring to a palliative care specialist
c) Administering advanced heart failure medications d) Arranging for caregiver respite services Answer: a) Initiating discussions on comfort care goals Rationale: Initiating discussions on comfort care goals ensures that Mrs. Patel's preferences are honored and guides the care plan in alignment with her end-of-life wishes. C:
and ask the nurse practitioner for advice. What are some interventions that the nurse practitioner can implement to support the patient's independence and quality of life? A) Prescribe antidepressants and antipsychotics and arrange for home health care services. B) Suggest cognitive stimulation therapy and music therapy and enroll the patient in an adult day care program. C) Recommend occupational therapy and physical therapy and provide assistive devices and home modifications. D) All of the above. Answer: D Rationale: All of the above interventions can help the patient with Alzheimer's disease and depression maintain their functional abilities, cognitive skills, mood, and social engagement. Antidepressants and antipsychotics can help manage depressive symptoms and behavioral disturbances. Home health care services can provide personal care, medication management, and monitoring. Cognitive stimulation therapy and music therapy can enhance memory, language, attention, and emotional expression. Adult day care programs can offer socialization, recreation, and supervision. Occupational therapy and physical therapy can improve self-care, mobility, balance, and fall prevention. Assistive devices and home modifications can increase safety, accessibility, and comfort.
symptoms as signs of dysphagia and performs a bedside screening test. What does this test involve? A) Asking the patient to drink water from a cup without spilling or coughing. B) Asking the patient to stick out their tongue and move it from side to side. C) Asking the patient to say "ah" and observe their palate movement. D) All of the above. Answer: D Rationale: All of the above tasks are part of a bedside screening test for dysphagia, which is a difficulty or inability to swallow food or liquids. Dysphagia can lead to malnutrition, dehydration, aspiration pneumonia, and reduced quality of life. The bedside screening test assesses the patient's oral motor function, coordination, sensation, strength, and reflexes.