Advanced Primary Care for the Older Adult Exam and Case Studies, Exams of Nursing

Download Advanced Primary Care for the Older Adult Exam and Case Studies and more Exams Nursing in PDF only on Docsity!

NGR 6640

Advanced Primary Care

for the Older Adult

LATEST EXAM w/ RATIONALES

1. What is the primary goal of advanced primary care for older adults? a. Managing acute illnesses b. Promoting healthy aging and preventing disease c. Providing emergency care as needed d. Assisting with end-of-life planning Answer: b. Promoting healthy aging and preventing disease Rationale: Advanced primary care for older adults focuses on proactive care strategies such as preventive services, health promotion, and disease prevention to optimize the health and well-being of older adults.
2. Which of the following is a characteristic feature of advanced primary care for older adults? a. Reactive management of chronic conditions b. Fragmented care coordination c. Multidisciplinary care teams d. Limited access to geriatric specialists Answer: c. Multidisciplinary care teams Rationale: Advanced primary care for older adults typically involves a team-based approach that includes a variety of healthcare professionals, such as geriatricians, geriatric nurses, social workers, pharmacists, and physical therapists, among others. This interdisciplinary collaboration ensures comprehensive and tailored care for older adults.

ensure appropriate dosing. Periodic medication adjustments based on patient response and changing needs are crucial for optimizing outcomes.

5. What is the preferred approach to pain management in advanced primary care for older adults? a. Aggressive opioid therapy b. Avoiding pain medication due to potential side effects c. Utilizing a multimodal and interdisciplinary approach d. Referring patients to specialty pain clinics Answer: c. Utilizing a multimodal and interdisciplinary approach Rationale: Advanced primary care for older adults recognizes the need for a multimodal and interdisciplinary approach to pain management. This approach involves combining medications, physical therapy, alternative therapies, counseling, and lifestyle modifications to effectively manage pain while minimizing the risk of medication-related adverse effects.
6. Which of the following is a common barrier to communication in advanced primary care for older adults? a. Use of medical jargon b. Overemphasis on patient autonomy c. Limited access to electronic health records d. Inadequate provider-patient ratio Answer: a. Use of medical jargon Rationale: Advanced primary care providers must ensure

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.

7. What is the role of care coordination in advanced primary care for older adults? a. Ensuring continuity of care across different healthcare settings b. Discharging patients to long-term care facilities c. Providing primary and specialty care simultaneously d. Coordinating regular follow-up appointments only Answer: a. Ensuring continuity of care across different healthcare settings Rationale: Care coordination is a critical component of advanced primary care for older adults. It involves planning, organizing, and facilitating seamless transitions between different healthcare services and settings, ensuring that the older adult receives holistic and continuous care.
8. Which of the following is a key aspect of the advanced care planning process? a. Respecting the patient's autonomy in decision-making b. Exclusively involving the primary care provider c. Prioritizing treatment interventions over quality of life d. Limiting discussions to end-of-life care only Answer: a. Respecting the patient's autonomy in decision- making

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.

11. Which of the following is an essential aspect of advanced primary care for older adults during hospital transitions? a. Minimizing communication with family members b. Discontinuation of chronic medications c. Timely medication reconciliation d. Avoiding geriatric assessment in the hospital Answer: c. Timely medication reconciliation Rationale: Advanced primary care for older adults prioritizes timely medication reconciliation during hospital transitions to prevent medication errors, avoid medication omissions, and ensure continuity of therapy. This process assists in optimizing patient safety and adherence.
12. What is the primary purpose of falls risk assessment in advanced primary care for older adults? a. Enforcing bed rest and immobilization b. Identifying environmental hazards only c. Recommending physical activity restrictions d. Implementing fall prevention strategies Answer: d. Implementing fall prevention strategies

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.

13. Which of the following is an important strategy for promoting social engagement in advanced primary care for older adults? a. Encouraging social isolation b. Discontinuing community activities c. Promoting group-based interventions d. Discouraging involvement in hobbies Answer: c. Promoting group-based interventions Rationale: Promoting social engagement is crucial in advanced primary care for older adults to prevent social isolation and enhance overall well-being. Group-based activities, such as structured exercise programs, support groups, and community events, provide opportunities for social interaction and participation.
14. What is the role of advanced primary care in managing geriatric syndromes such as urinary incontinence and immobility? a. Referring all cases to specialty clinics b. Providing palliative care only c. Offering comprehensive assessment and treatment d. Excluding geriatric syndromes from care plans

B:

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:

1. A 75 - year-old patient with hypertension, diabetes, and chronic kidney disease presents to the primary care clinic with fatigue, dyspnea, and edema. The nurse practitioner suspects heart failure and orders a B-type natriuretic peptide (BNP) test. What is the rationale for ordering this test? A) BNP is a hormone that is released by the heart when it is under stress and indicates the severity of heart failure. B) BNP is a marker of inflammation that is elevated in patients with heart failure and other cardiac conditions. C) BNP is a protein that is produced by the kidneys and reflects the renal function of patients with heart failure. D) BNP is a peptide that is secreted by the liver and regulates the fluid balance of patients with heart failure. Answer: A Rationale: BNP is a hormone that is released by the ventricles of the heart when they are stretched or

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.

4. A 78-year-old patient with Parkinson's disease visits the primary care clinic for a follow-up appointment. The patient reports difficulty swallowing, drooling, choking, and weight loss. The nurse practitioner recognizes these

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.

5. A 66-year-old patient with chronic obstructive pulmonary disease (COPD) visits the primary care clinic for a routine check-up. The nurse practitioner reviews the patient's spirometry results and determines that they have moderate COPD. What are some pharmacological treatments that the nurse practitioner can prescribe for this patient? A) A short-acting bronchodilator as needed for symptom relief. B) A long-acting bronchodilator daily for maintenance therapy.