NU 662 ADULT GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER II REVIEW EXAM Q & A 2024 HERZING, Exams of Nursing

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NU 662

Adult Gerontology

Primary Care Nurse

Practitioner II Review

Exam

Q & A

1. A 68-year-old male patient presents with a history of hypertension and type 2 diabetes. Which of the following interventions should be prioritized in his management plan? A) Initiation of insulin therapy B) Lifestyle modifications including diet and exercise C) Routine screening for prostate cancer D) Referral to a cardiologist Answer: B. Lifestyle modifications are crucial in the management of hypertension and type 2 diabetes and can significantly impact the patient's health outcomes.
2. In assessing a 72-year-old female with suspected heart failure, which diagnostic tool would provide the most valuable information? A) Chest X-ray B) Echocardiogram C) Electrocardiogram (ECG) D) Complete blood count (CBC) Answer: B. An echocardiogram is essential for evaluating cardiac function and structure, aiding in the diagnosis of heart failure.
3. When considering medication management for an older adult with multiple chronic conditions, what is an important consideration to prevent polypharmacy? A) Prescribing the newest medications available B) Ensuring all medications are taken with food C) Regular review and rationalization of all prescribed medications D) Using only over-the-counter medications when possible Answer: C. Regular medication reviews help to minimize the risk of polypharmacy and its associated adverse effects.
4. A 70-year-old patient with a history of atrial fibrillation is on anticoagulation therapy. What is a key aspect of their care? A) Frequent neurological assessments B) Monitoring for signs of bleeding C) Annual influenza vaccination D) Monthly liver function tests Answer: B. Monitoring for signs of bleeding is crucial due to the

Answer: a) Their social support system Rationale: The social support system plays a crucial role in the overall health and well-being of older adults, as it can impact their access to care and ability to adhere to treatment plans.

2. When managing chronic conditions in older adults, which factor should be taken into consideration? a) Age b) Gender c) Family history d) Cultural background Answer: d) Cultural background Rationale: Cultural background can influence an individual's beliefs about health and healthcare, as well as their treatment preferences and practices.
3. What is a common health concern in older adults that can impact their overall well-being? a) Acne b) Osteoporosis c) Chickenpox d) Eczema Answer: b) Osteoporosis Rationale: Osteoporosis is a common condition in older adults that can lead to an increased risk of fractures and impact their mobility and independence.
4. When assessing an older adult for potential cognitive impairment, which tool is commonly used in primary care settings? a) MMSE (Mini-Mental State Examination) b) BMI (Body Mass Index) c) ECG (Electrocardiogram) d) CBC (Complete Blood Count) Answer: a) MMSE (Mini-Mental State Examination) Rationale: The MMSE is a widely used screening tool for cognitive

impairment in older adults, as it assesses various cognitive functions such as memory, attention, and language.

5. Which of the following is an evidence-based guideline for the management of hypertension in older adults? a) Lowering blood pressure to 120/80 mmHg b) Avoiding medication therapy c) Implementing lifestyle modifications only d) Individualized treatment to achieve optimal blood pressure control Answer: d) Individualized treatment to achieve optimal blood pressure control Rationale: Treatment for hypertension in older adults should be individualized based on factors such as comorbidities, tolerability, and overall health status.
6. In the assessment of an older adult with diabetes, which parameter is important to monitor to prevent potential complications? a) Hemoglobin A1C b) Blood pressure c) Cholesterol levels d) Body weight Answer: a) Hemoglobin A1C Rationale: Hemoglobin A1C levels provide information about long-term glucose control, which is important in managing diabetes and preventing complications.
7. Which of the following is a preventive health measure recommended for older adults in primary care settings? a) Drinking alcohol in moderation b) Engaging in regular physical activity c) Avoiding annual flu vaccinations d) Smoking cessation Answer: b) Engaging in regular physical activity Rationale: Regular physical activity is beneficial for older adults in maintaining overall health and preventing chronic conditions such as

11. Which of the following is a potential consequence of polypharmacy in older adults? a) Improved medication adherence b) Reduced risk of drug interactions c) Increased risk of adverse drug reactions d) Decreased healthcare costs Answer: c) Increased risk of adverse drug reactions Rationale: Polypharmacy, or the use of multiple medications, can increase the risk of adverse drug reactions and medication errors in older adults.
12. What is an important consideration when assessing an older adult for malnutrition? a) Body mass index (BMI) b) Blood pressure c) Shoe size d) Eye color Answer: a) Body mass index (BMI) Rationale: Body mass index (BMI) can provide information about an individual's nutritional status and risk of malnutrition, especially in older adults.
13. Which of the following is a recommended preventive health measure for older adults to reduce the risk of cardiovascular disease? a) Eating a high-fat diet b) Smoking c) Regular exercise d) Excessive alcohol consumption Answer: c) Regular exercise Rationale: Regular exercise can help reduce the risk of cardiovascular disease in older adults by improving cardiovascular fitness, lowering blood pressure, and reducing cholesterol levels.
14. When assessing an older adult for potential hearing loss, which screening test is commonly used in primary care settings? a) Snellen eye chart

b) Urine dipstick c) Audiometry d) Height and weight measurement Answer: c) Audiometry Rationale: Audiometry is a common screening test used to assess hearing loss in older adults, as it measures the individual's ability to hear sounds of varying frequencies.

15. What is an important component of a comprehensive assessment for depression in older adults? a) Avoiding discussions about emotions b) Ignoring physical symptoms c) Assessing for suicidal ideation d) Focusing solely on medication therapy Answer: c) Assessing for suicidal ideation Rationale: Suicidal ideation is a serious concern in older adults with depression, so it is important to assess for thoughts of self-harm and implement appropriate interventions.
16. Which of the following is a recommended screening test for cognitive impairment in older adults? a) ECG (Electrocardiogram) b) CBC (Complete Blood Count) c) MMSE (Mini-Mental State Examination) d) Pap smear Answer: c) MMSE (Mini-Mental State Examination) Rationale: The MMSE is a common screening test used to assess cognitive impairment in older adults by evaluating various cognitive functions.
17. What is an important consideration when assessing an older adult for potential falls risk? a) Dim lighting in the home b) Comfortable and supportive footwear c) Cluttered and hazardous home environment

Rationale: The Snellen eye chart is a common screening test used to assess visual acuity and detect potential vision loss in older adults.

21. What is an important component of a comprehensive assessment for urinary incontinence in older adults? a) Ignoring the impact on quality of life b) Avoiding discussions about emotional well-being c) Assessing for potential contributing factors d) Focusing solely on medication therapy Answer: c) Assessing for potential contributing factors Rationale: Urinary incontinence in older adults can have various contributing factors, such as medications, bladder dysfunction, and cognitive impairment, so it is important to assess for these factors.
22. Which of the following is a common health concern in older adults that can impact their oral health? a) Diabetes b) Osteoporosis c) Arthritis d) Hearing loss Answer: b) Osteoporosis Rationale: Osteoporosis can impact oral health in older adults by affecting tooth and bone density, leading to an increased risk of tooth loss and dental problems.
23. What is an important consideration when assessing an older adult for potential medication adherence issues? a) Inadequate health literacy b) Prescribing additional medications c) Avoiding discussions about side effects d) Disregarding medication side effects Answer: a) Inadequate health literacy Rationale: Inadequate health literacy can contribute to medication adherence issues in older adults, so it is important to assess for understanding of treatment plans and provide education as needed.

24. When managing hypertension in older adults, which approach is recommended in primary care settings? a) Avoiding blood pressure monitoring b) Ignoring lifestyle modifications c) Promoting medication adherence d) Refusing to discuss treatment options Answer: c) Promoting medication adherence Rationale: Promoting medication adherence is important in managing hypertension in older adults to achieve optimal blood pressure control and reduce the risk of cardiovascular complications.
25. Which of the following is a recommended preventive health measure for older adults to reduce the risk of pneumonia? a) Annual flu vaccination b) Smoking c) Excessive alcohol consumption d) Sedentary lifestyle Answer: a) Annual flu vaccination Rationale: Annual flu vaccination is recommended for older adults to reduce the risk of pneumonia and other respiratory infections, especially during flu season. Question: What is the most common chronic condition affecting older adults in primary care settings? a) Hypertension b) Diabetes mellitus c) Osteoarthritis d) Chronic obstructive pulmonary disease (COPD) Answer: a) Hypertension Rationale: Hypertension is the most common chronic condition affecting older adults, often requiring ongoing monitoring and management in primary care settings.

screening in older women with an average risk of breast cancer? a) Every 2 years b) Every 3 years c) Annually d) Only if symptoms are present Answer: a) Every 2 years Rationale: Biennial mammography screening is recommended for older women with an average risk of breast cancer, aligning with evidence- based guidelines for preventive care in primary care settings. Question: Which of the following cognitive assessment tools is specifically designed for detecting dementia in older adults? a) Mini-Cog b) Clock Drawing Test c) Confusion Assessment Method (CAM) d) Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) Answer: a) Mini-Cog Rationale: The Mini-Cog is a brief and effective tool for detecting cognitive impairment, including dementia, in older adults, making it valuable in primary care assessments. Question: When assessing an older adult for malnutrition risk, which anthropometric measurement is particularly useful? a) Body mass index (BMI) b) Waist circumference c) Mid-arm circumference d) Hip circumference Answer: c) Mid-arm circumference Rationale: Mid-arm circumference is a valuable anthropometric measurement for assessing malnutrition risk in older adults, as it reflects changes in muscle mass and fat stores. Question: Which of the following interventions is recommended for preventing delirium in hospitalized older adults? a) Encouraging sleep disruption to align with hospital routines b) Minimizing use of eyeglasses and hearing aids c) Providing orientation cues in the patient's environment d) Limiting mobility to reduce the risk of falls

Answer: c) Providing orientation cues in the patient's environment Rationale: Providing orientation cues in the patient's environment is a key intervention for preventing delirium in hospitalized older adults, supporting their cognitive function and reducing disorientation. Question: Which of the following screening tools is commonly used to assess depression in older adults? a) Beck Depression Inventory (BDI) b) Hamilton Rating Scale for Depression (HAM-D) c) Patient Health Questionnaire-9 (PHQ-9) d) Zung Self-Rating Depression Scale Answer: c) Patient Health Questionnaire-9 (PHQ-9) Rationale: The PHQ-9 is a widely used screening tool for assessing depression in older adults, providing valuable insights into their mental health status in primary care settings. Question: In older adults, which vaccination is recommended to prevent herpes zoster? a) MMR (Measles, Mumps, Rubella) b) Pneumococcal conjugate vaccine (PCV13) c) Influenza vaccine d) Herpes zoster vaccine Answer: d) Herpes zoster vaccine Rationale: The herpes zoster vaccine is recommended for older adults to prevent shingles, a common and potentially debilitating condition in this age group. Question: What is the most common cause of preventable hospitalizations in older adults? a) Urinary tract infections (UTIs) b) Heart failure exacerbations c) Adverse drug events d) Pneumonia Answer: c) Adverse drug events Rationale: Adverse drug events are a leading cause of preventable hospitalizations in older adults, highlighting the importance of medication management in primary care.

Answer: a) Mini Nutritional Assessment (MNA) Rationale: The MNA is a widely utilized screening tool for assessing the risk of malnutrition in older adults, enabling early intervention to support their nutritional status. Question: Which of the following factors is associated with an increased risk of pressure ulcers in older adults? a) Adequate mobility and repositioning b) Maintaining moisture on the skin c) Poor nutrition and hydration d) Frequent use of pressure-relieving devices Answer: c) Poor nutrition and hydration Rationale: Poor nutrition and hydration are associated with an increased risk of pressure ulcers in older adults, emphasizing the importance of adequate dietary and fluid intake. Question: What is the recommended approach to screening for cognitive impairment in older adults? a) Routine use of magnetic resonance imaging (MRI) b) Universal screening with the Mini-Mental State Examination (MMSE) c) Assessing only if family members report concerns d) Utilizing a combination of cognitive screening tools Answer: d) Utilizing a combination of cognitive screening tools Rationale: Utilizing a combination of cognitive screening tools is recommended for comprehensive assessment of cognitive impairment in older adults, allowing for a more thorough evaluation. Question: Which of the following is a common manifestation of atypical presentation of illness in older adults? a) Classic symptoms that align with textbook descriptions b) Rapid response to standard treatments c) Unexplained changes in cognitive function d) Consistent adherence to prescribed medication regimens Answer: c) Unexplained changes in cognitive function Rationale: Unexplained changes in cognitive function are often observed in atypical presentations of illness in older adults, necessitating careful assessment and consideration of underlying causes.

Question: In older adults with multiple chronic conditions, which care delivery model is designed to improve coordination and continuity of care? a) Fee-for-service reimbursement b) Fragmented care across multiple specialists c) Patient-centered medical home (PCMH) d) Reactive management of acute exacerbations Answer: c) Patient-centered medical home (PCMH) Rationale: The patient-centered medical home (PCMH) model is designed to improve coordination and continuity of care for older adults with multiple chronic conditions, aligning with best practices in primary care settings. Question: Which of the following is a common challenge in medication adherence for older adults? a) Limited number of prescribed medications b) Low prevalence of drug interactions c) High out-of-pocket medication costs d) Minimal impact of forgetfulness Answer: c) High out-of-pocket medication costs Rationale: High out-of-pocket medication costs present a common challenge in medication adherence for older adults, influencing their ability to maintain prescribed regimens. Question: What is the recommended approach to advance care planning in older adults? a) Deferring discussions until acute illness occurs b) Considering only the individual's medical preferences c) Initiating discussions early and revisiting periodically d) Limiting involvement of family members in decision-making Answer: c) Initiating discussions early and revisiting periodically Rationale: Initiating advance care planning discussions early and revisiting them periodically supports older adults in expressing their values and preferences for future medical care. Question: Which of the following is a key principle in managing urinary incontinence in older adults?

Rationale: Medication-related issues, such as adverse drug events and non-adherence, are the most common reasons for hospital readmissions in older adults within 30 days of discharge, emphasizing the critical role of medication management in transitional care.