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AANC Clinical Nurse Specialist Adult
Gerontology AGCNS 2024 Exam Review
Questions and Answers 100% Pass
Barthel index of ADLs - Answer>> tool to assess functional ability of older adults. Assess person's disabililities and need for assistance. 10 categories scored from 0 to 10-15 or 0 to 1-3.i 10 Categories of Barthel Index of ADLs - Answer>> Feeding, mobility, personal grooming, toileting, urinary control, fecal control, ascending and descending stairs, ambulatory status on level ground, transferring and sitting up in bed, bathing. Cardiovascular changes with aging - Answer>> reduction in ability of the cardiovascular system to pump blood. decrease in oxygen delivery. Reduced cardiac output causes circulation time to increase. left ventricle may enlarge baroreceptor response may decrease Diastolic dysfunction may be evident Reduction in the resting and maximal heart rates Atria may enlarge A-fib, Aflutter, CHF Neurological changes with aging - Answer>> Number of nerve cells in the brain and spinal cord decreases. slight reduction in brain mass. loss of neurons occurs particularly in the frontal lobes. decrease in cerebral blood flow. short term memory loss may occur. Cognitive processes are not usually affected unless underlying brain disease. skeletal muscles may atrophy. Ability of peripheral nerves to repair themselves is reduced.
Slower reflexes. Reduced perspiration Pulmonary changes with aging - Answer>> Decrease in elasticity of the lungs. between 40 and 70 maximum breathing capacity decreases by about 40%. Alveoli flatten and the alveolar ducts enlarge. Air tends to stay in alveolar ducts rather than in alveoli. Decrease in efficiency of oxygen exchange. Increase in residual volume of the lungs. Reduction in forced expiratory volume (FEV) and forced vital capacity (FVC). Decrease in overall strength, less able to breathe deeply. cough reflex is reduced. ciliary action decreases. Protective laryngeal reflexes may be lost. total lung capacity does not change. Eyes with aging - Answer>> eyes: cloouding of lens as cells die and accumulate. cataract incidence is >50% by age 80. Difficulty focusing Decreased night vision Increased photophobia Tend to become farsighted Kidney and Bladder with aging - Answer>> Kidneys are less efficient at removing wastes from blood Bladder capacity declines,often resulting in frequency and urgency. Fat with aging - Answer>> body fat increases until middle age, stablizes, and decreases in older age.
May have trouble paying attention for any length of time. Longer to react to situations Longer to complete cognitive tasks Working memory is affected by age Implicit memory is unaffected by age Explicit memory may decline with age. fluid intelligence - Answer>> ability to process information crystallized intelligence - Answer>> ability to solve practical problems implicit memory - Answer>> Skills explicit memory - Answer>> Information Sensory changes with aging - Answer>> Deteriorating vision (presbyopia and cataract) Less sensitive to color differences Night vision decreases Hearing impairment occurs taste and smell not significantly affected sense of touch including the ability to sense vibration, temperature, and pain, is reduced. Sensory decrease in temperature may put older adults at risk for burns, hyperthermia, and hypothermia. Developmental concerns in late adolescence/young adulthood - Answer>> failure to take on adult roles, no life goals or future plans low self-esteem lack of intimate relationships, sexual identification concerns gang association
continued identification with peer group or dependence on parents high-risk sexual behavior, multiple partners and unprotected sex poor academic progress or ability psychosomatic complaints, depression lack of impulse control poor nutrition poor dental health chronic disease obesity lack of exercise Erickson's therory of child/adult development - Answer>> trust vs mistrust-birth to 1 year autonomy vs shame/doubt-1-3 years initiative vs guilt- 3-6 years industry vs inferiority-6-12 years identify vs role confsuion-12-18 years intimacy vs isolation-young adulthood generativity vs stagnation-middle age ego integrity vs despair-older adulthood Peck's theory of adult development - Answer>> Middle age valuing wisdom vs physical powers socializing vs sexualizing cathectic (libidinal energy) flexibility vs cathectic impoverishment Mental flexibility vs mental rigidity older adult ego differentiation vs work role preoccupation body transcendence vs body preoccupation ego transcendence vs ego preoccupation Scott Pecks theory of development - Answer>> 4 stages. 1-chaotic/antisocial 2-formal/institutional
Remediating-Juran's quality improvement process - Answer>> includes considering various alternative solutions and then designing and implementing specific solutions and controls while addressing institutional resistance to change. As causes of problems are identified and remediation instituted to remove the problems, the process should improve. Holding- Juran's quality improvement process - Answer>> invovles evaluating performance and monitoring the control system in order to maintain gains. Practice improvement based on system-level assessment - Answer>> Part of strategic planning and requires an organization to look at needs of the organization, the community, and the customers and establish goals for not only the near future (2 to 4 years) but also into the extended future (10 to 15 years) when designing practice improvement projects. Based on assessments, both internal and external, to determine present courses of action, needed changes, priorities, and methodologies to effect change. Includes collecting data and doing an external analysis of customer needs relation to regulations and demographics. Analyzing internal services and functions identifying and understand key issues, including the strengths and weaknesses of the organization, as well as potential opportunities and negative impacts. Assessing and developing a revised mission and vision statement that identifies core values establishing specific goals and objectives based on assessments. Assessment of customer needs with surveys - Answer>> Surveys are valuable tools in assessing both progress and customer needs. However, care must be taken in the design of
the survey if it is to have validity. Number of decisions must be made: Target group-who will receive the survey Type of survey-paper, telephone, or internet Type of questions- yes/no, open ended, scales Format-font size, color, general layout, and American disability act compliance. Follow up-reminders or incentives for people to complete surveys. Identification of clinical problems amenable to research - Answer>> Evolving skill. Inexperienced nurses especially those just starting out in nursing practice, are often looking to build information and skills. They research information about a disease or treatment. Experienced nurses often look for information to improve patient outcomes researching new procedures, treatments, or equipment for broader application. Questioning and evaluating practice through research and experience. Seeking a variety of data on a topic, evaluating the data, pooling results, and making determinations as to validity or applicability to the clinical practice. Gardner's Theory of Multiple Intelligences - Answer>> There are seven categories of intelligence's that people utilize to comprehend the world around them and to learn. Teaching that engages more intelligence is more effective. Linguistic Logical/mathematical visuospatial body/kinesthetic musical/rhytmic interpersonal intrapersonal Gardner's Intelligence- Linguistic - Answer>> ability to use and understand language, written or spoken
staff retention improves staff engaged in learning process programs developed for nursing education are implemented and evaluated for effectiveness care is cost effective through the efficient use of resources bowel retraining - Answer>> behavioral modification. keep bowel diary for a week. diet and fluid intake are modified. increasing fiber at scheduled times avoiding foods that increase bowel dysfunction schedule for defecation established same time daily 20-30 minutes after meal kegel exercises stimulus used to promote defecation decrease use approaches to teaching - Answer>> educational workshops lectures discussions one on one instruction computer and internet modules kegel exercises - Answer>> pelvic floor muscle exercises used to stregthen the periurethral and pelvic muscles in order to increase control of urination and fecal elimination. 3 seconds 10 times build to 10 seconds. Three methods to check that the pelvic floor muscles are flexing: stop flow of urine in midst pull in anus trying to stop from passing gas in supine position, finger in vagina, squeeze, feel tightness. diabetic foot ulcers screening - Answer>> occurs toes to heels. appear as laceration, blisters, or punctures with wound usually circular well defined edges.
common sites toes, metatarsal heads, bunion, midfoot, heels 7th report joint national committee on prevention, detection, evaluation, and treatment of high blood pressure - Answer>> specific recommendations regarding evaluation: follow-up- recheck in 2 years for normal, 1 year for prehypertension, 2 months for stage 1, and 1 month for stage 2 with immediate treatment for bp> 180/110 mmHg. Ambulatory BP-done for white-coat hypertension (reactive) if no target damage to organs, drug resistance, hypotension related to antihyertensives, episodic hypertension and autonomic dysfunction. Diagnostic tests-12 lead EKG, urinalysis, blood glucose, HCT, K, Cr,calcium, lipoprotein profile. Internal consulting - Answer>> occurs within an institution or facility by a coonsultant who is a direct employee. Advantages to internal consultants include cost-effectiveness, especially if consultation is needed on an ongoing basis; familiarity with goals, mission, and needs of institution; ability to respond quickly; and maintenance of institutional privacy. may have biases and may not represent best practices. External consulting - Answer>> occurs consultant is contracted for a particular purpose, based on expertise. Advantages include the ability to find an expert in a specific area and cost- effectiveness if consultation is needed for only a prescribed period of time. The hourly wage may be higher, but benefit costs are lower. Additionally the contract can more easily be terminated if results are unsatisfactory. Disadvantages include less control over institutional privacy, increased ed for the consultant to become familiar with the institution, and less commitment to the institution's goals.
Flexible-estimates are made regarding anticipated changes in revenue and expenses and both fixed and variable costs are identified. Zero-based-all cost centers are re-evaluated each budget period to determine if they should be funded or eliminated, partially or completely. Responsibility center- budgeting is a cost center (department) or centers with one person holding overall responsibility. Program-organizational programs are identified and revenues and costs for each program are budgeted. Appropriations- government funds are requested and dispersed through this process. Continuous/rolling-periodic updates to the budget, including revenues, costs, volume, are done prior to the next budget cycle. Joint Commission Core Measures - Answer>> to determine if healthcare institutions are in compliance with current standards, based on CMS quality indicators. Involve series of questions that are answered yes or no to indicate if an action was completed. There are 14 core measure sets acute myocardial infaraction children's asthma care emergency department heart failure hospital based inpatient psychiatric services hospital outpatient department measures immunization perinatal care pneumonia stroke substance use surgical care improvement project SCIP
venous thromboembolism tobacco treatment Team Building - Answer>> leading, facilitating, and participating in performance improvement initial interactions-members begin to define their roles and develop relationships, determining if they are comfortable in the group power issues-members observe the leader and determine who controls the meeting and how control is exercised and begin to form alliances organizing-methods to achieve work are clarified and team members begin to work together, gaining respect for each other's contributions and work toward common goal team identification-interactions often become less formal as members develop rapport, and members are more willing to help and support each other to acheive goals. Excellence-develops through a combination of good leadership, committed team members, clear goals, high standards, external recognition, spirit of collaboration, and a shared commitment to the process Therapeutic communication - Answer>> begins with respect for the patient/family and the assumption that all communication, verbal and non-verbal, has meaning. Empathetic listening. Techniques to facilitate: Introduction Encouragement empathy To lead intra- and inter-disciplinary teams - Answer>> Communicate openly encourage all team members to participate
practical and goal oriented-provides overviews or summaries and examples. self-directed-provide active involvement, asking for input. Give responsibilities. knowledgeable-show respect for their life experiences/education. Relevancy-oriented- explain how information will be applied. Clearly identify objectives. Motivated-provide certificates of achievement or recognition. symptoms of hypertension - Answer>> headache, disorientation, confusion, and epistaxis incidence increases with age 60-80 % patients age 60 and older defined systolic pressure > 140mmHg and Diastolic pressure > 90mmHg Males risk higher hypertensive crisis management - Answer>> should have blood pressure decreased over a period of hours to days elderly patients require even slower reductions to decrease risk of cerebral and myocardial ischemia If never had previous treatment for hypertension: May consist of calcium channel blocker, beta blocker, angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB) or a combination of these agents. Nonpharmacologic treatment options are rest, quiet environment. Education for Hyperlipidemia - Answer>> Elevated levels of HDL cholesterol lower the risk of cardiovascular disease A level greater than or equal to 60 mg/dL is desireable HDL levels less than 40 mg/dL may increase the risk of cardiovascular disease. Reducing foods that contain a high level of cholesterol such as eggs and organ meats are recommended
HMG-CoA reductase inhibitors also known as Statins, may cause myopathies that manifest as muscle pain and weakness grapefruit and grapefruit jucie should be limited when taking Statins-they increase risk of side effects of medication. cardiac tamponade - Answer>> When blood or fluid fills the pericardium, putting excess pressure on the myocardium and preventing the ventricles from fully expanding. Decrease perfusion. Risk factors: myocardial infarction, malignancy, dissecting aortic aneurysm, cardiac surgery or invasive cardiac procedures, pericarditis, renal failure, or cardiac truama. Symptoms: hypotension, tachycardia, tachypena, elevated jugular venous pressure, weak or absent pulses, cool clammy skin, drowsiness, and dyspnea. acute coronary syndrome (ACS) - Answer>> Includes unstable angina as well as ST elevation and non ST elevation myocardial infarctions. AMA guidelines for elderly, odds for an in hospital death for an ACS patient increases by 70% every 10 years of age. acute heart failure - Answer>> occurs when body cannot compensate for heart's inability to provide adequate perfusion. occurs suddenly. can be precipitated by dysrhythmias, illness, noncompliance with medications, acute ischemia, fluid overload, or hypertensive crisis. treatment options include administration of diuretics and vasoldilators, airway assessment with continuous pulse oximetry, supplemental oxygen and potential ventilatory support, sodium restriction, urine output monitoring, and continuous cardiac monitoring. Opiate therapy is not recommended.
Coarctation of the aorta - Answer>> narrowing of the aorta that restricts blood flow through the aorta, resulting in hypertension Symptoms of Ascending colon cancer - Answer>> fatigue, generalized weakness, pallor, dull abdominal pain, loss of appetite, weight loss, occult blood or melena, hypochromic microcytic anemia, chronic iron deficiency anemia, palpitations, congestive heart failure, palpable abdominal mass, chronic diarrhea, bowel obstruction. pathology Ascending Colon Cancer - Answer>> Stool enters the cecum and ascending colon in liquid form; may get large size before obstruction and obvious symptoms. 22% of colorectal tumors originate in the ascending colon. alzheimer's disease - Answer>> 7 stages developed by gary reisberg, md. MMSE - Answer>> mini mental status exam name 3 common objects, recall later counting backward from 100 by 7's spelling "world" backward repeat common phrases copying picture of interlocking shapes follow simple 3 part instructions Mini-cog - Answer>> 3 item recall and clock drawing test Trail Making Test - Answer>> asses brain function and indicates increasing dementia. tool for detecting early Alzheimer's disease. Part A has 25 sequentially numbered scattered circles across the page, take pencil go 1 to 25.
Part B circles with numbers and circles with letters scattered across page, draw continuous line alternating between numbers and letters in ascending order. CAGE TOOL - Answer>> C- cutting down A-Annoyed at criticism G-Gulity feeling E- Eye opener Geriatric Depression Scale - Answer>> self assessment tool to identify older adults with depression. 15 questions yes or no.
5 = depression Confusion Assessment Method (CAM) - Answer>> Points to delirium in the older adult FEATURE 1: evidence of acute change in mental status FEATURE 2: Inattention, difficulty focussing attention, keeping on track (feature 1 and 2 always present) PLUS EITHER FEATURE 3: disorganized thinking OR FEATURE 4: altered level of consciousness Step two - Answer>> according to WHO three step ladder approach to pain management if patients abdominal pain aries 4 to 8 on scale, pain control should be initiated at....
