Nrnp 6540 midterm exam questions and answers
Nrnp 6540 midterm exam questions
Nrnp 6540 midterm exam answers
nrnp 6540 final exam walden university
week 6 midterm exam
What are the physiological changes of aging
- Reduced physiological reserve of most body systems
2.Reduced homeostatic mechanisms that fail to adjust - Changes in the sympathetic response
- Impaired immunological function- infection risk is greater and autoimmune diseases are more prevalent.
What factors influence lab value interpretation in the older adult
- physiological changes with aging
- the prevalence of chronic disease
- changes in nutritional and fluid intake
- Lifestyle
What lab values is important
Creatinine clearance, GFR and renal function
What are examples of drugs are eliminated renally
Digoxin, H2 blockers, lithium and water-soluable antibiotics
What are the two formulas to evaluate the kidney function
The Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD)
What neurological conditions commonly have an initial onset in older age?
Parkinson’s, dementia, stroke, and complex partial seizures
What are geriatric syndromes
Diseases that involve multiple systems and have more than one underlying cause
What are the geriatric syndrome giants currently
Frailty, anorexia of aging, sarcopenia and cognitive impariment
What are bimodal presentations of disease
Diseases that can present in a younger age and an older age.
What are examples of bimodal diseases?
Psoriasis, Inflammatory bowel disease, Ulcerative Colitis, Crohn’s disease, Hodgkin’s lymphoma, and myasthenia gravis
What is primary prevention?
Activities to prevent the occurrence of a disease or adverse, including mental health
What is secondary prevention
Tasks directed towards detection of a disease or adverse health condition in an asymptomatic individual who has risk factors
What is tertiary prevention
The management of existing conditions to prevent disability and minimize complications to prevent disability for optimal function
What is the key to increasing geriatric physical activity
motivation
What is the nutrition screening tool for community dwelling older adults
Mini-Nutritional Assessment (MNA)
What factors affect maintaining a healthy balanced diet in geriatrics?
- Chronic illness and disability-related to ADLs like shopping and meal preparation,
- Financial hardships-limit food choices
- Prescribed medications-affects absorption of nutrients, sense of taste or appetite
- Depression or social isolation
- Obesity
What is a big influence of geriatric functionality and quality of life?
Injury prevention
What are important 6 areas of geriatric safety prevention
- Safe storage and removal of firearms
- Fall prevention
- Wearing seatbelts
- no drinking and driving
- Having a working smoke detector
- Keeping hot water set below 120 degrees
Periodic screening of gums and mouth can screen for what?
- Oral cancer
- ill-fitting or poorly functioning dentures
- Periodontal disease
- Erosion of dentin
- dependence on others for dental resources
What screening tools are covered by Medicare?
1.HIV
- Alcohol misuse
- Smoking cessation
- Depression
- High blood pressure
- Blood glucose r/t cardiovascular risk assessment
- Lipids screening
- Mammography until aged 75
- Osteoporosis
- Colorectal cancer
What are the immunizations recommended for geriatrics?
- influenza- annually for all over 50
- Tetanus-diphtheria (Tdap)-once in a lifetime booster, then every 10 years
- Pneumococcal -1 time dose of PCV13 at 65 years old then PPSV23 1 year (12 months) later
- Hep B for high risk persons 1st dose then 6 months later 2nd dose, the 4-6 mos later the 3rd dose
- Shingrix for zoster
What are contraindications for exercise therapy
- unstable angina
- uncompensated heart failure
- Severe anemia
- Uncontrolled blood glucose
- Unstable aortic aneurysm
- Uncontrolled hypertension or tachycardia
- Severe dehydration or heat stroke
- Low oxygen saturation
What are the benefits of exercise?
Strengthen muscles
Maintain flexibility
Promote balance
Build and maintain bone mass
Prevent injury
Improve daily functioning, especially in elderly
Prevent chronic disease
What assessment screening tool evaluates functional decline?
How long is the time frame?
The Timed Get up and go Test
16 seconds.
What screening tool is used for domestic violence?
HITS
What screening tool is used for cognitive and affective disorders like dementia, delirium,depression and spiritual health
- Mini-Mental SE,
- The mini-Cog and
- the Montreal Cognitive (MoCA),
- Geriatric Depression scale
- HOPE, and SPIRIT
agitation
Change in behavior,-repeating questions, arguing,
Labs- CBC, CMP, B12, TSH
Tx-Psychotropic meds ( Abilify, Risperdal)
- antiseizure meds (Tegretol, Lamictal)
anxiolytics- alprazolam, diazepam
Alcoholism
alcohol misuse-tachycardia, peripheral neuropathy, tremors
Labs- SBIRT
Tx- sobriety or total abstinence
what is anxiety? what labs? what meds?
excessive worry difficult to control-poor health, financial insecurity, etc.
Labs- CBC, CMP, TSH Geriatric Anxiety Inventory screening
TX- start low and go slow-SSRIs-Escitalopram, sertraline, citalopram
What are the 5 domains of a comprehensive geriatric assessment
- Physical health,
- functional health
- psychological health
- socioenvironmental supports
- quality of life
What 3 things do a comprehensive geriatric assessment do?
- Identifies care needs
- Plans care
- Improves outcomes
What is the most frequently used criteria for evaluating drug use?
The BEERS criteria, the STOPP criteria and the START criteria
What are 9 biomarkers of nutritional deficiency?
- Prealbumin,
- transferrin,
- albumin,
- chemistries,
- cbc,
- vitamin B12,
- folate,
- vitamin D and
- thyroid panel
What bipolar disorder? What labs? What meds?
S and Sx: Euphoria or irritability, depression, hypomania, rapid speech and irritability, can begin after 50, assess with DIGFAST or SIGECAPS
Labs- cbc, cmp, tox screen, u/a, thyroid function, rpr
Meds: Mood stabilizers-lithium valproic acid, and the antipsychotics- quetiapine and olanzapine
Depression symptoms? Labs? Tx?
SIGECAPS measures the disturbance in:
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicidal Ideation
Labs assist in causative factors
Tx-Beahvior stabilizer-Haldol, mood stabilizer- olanzapine, risperidone, quetiapine
Dementia, Iabs and, Tx
A slowly progressive global cognitive decline- confusion, disorientation
Labs: cbc, electrolytes, glucose, BUN, Cr. LFTs, TSH, folate, syphilis serology and UA, Mini mental or MoCA
Tx- Cholinesterase inhibitors – donepezil, rivastigmine, galantamine or
Namenda
Depression, labs, tx?
A pervasive feeling of sadness, discouragement, can start at age 60.
Labs- electrolytes, hormone levels, nutritional deficiency, B13 and vitamin D deficiency
Tx- SNRI’s- duloxetine, Effexor, SNRIs-citalopram, escitalipram, sertraline
elder abuse
Any knowing, intentional, or negligent act by a caregiver or any other person to an older adult; the act causes harm or serious risk of harm
Labs-?
Tx-call the elder abuse hot line