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PRIMARY CARE OF THE MATURING AND AGED FAMILY PRACTICUM (NR 6011 QUESTIONS STUDY FINAL EXAM 2025 A+ GRADE) Obesity: What disease processes does your risk increase if you are obese? STI: First line treatment Menopause: symptoms of perimenopause; changes in your body for peri and regular menopause; defn of menopause and treatment elder abuse: Who is most at risk ethical issues: This is more generic and end of life planning? advance directives & advance care planning; When do you need this? What is the purpose? POLST: What is this? When do you use it? According to the Sexually presentation, atrophic vaginitis a. the symptomsm are the same for each woman b. creates a more acidic vaginal environment c. is a contributing factor for frequent urinary tract infections d. is not treated with vaginal lubricants Which of the following is the most appropriate screening tool for delirium? a. St Louis University Mental Status Exam (SLUMS) b. Montreal Cognitive Assessment c. Lawton Scale of instrumental Activities of Daily Living d. Confusion Assessment Model( question) A drug that can be used to treat two very common symptoms in a dying patient (pain and dyspnea_ is: a. lorazepam b. Gabapentin c. Methadone d. Morphine Which of the following would you recommend annually for the elderly type 2 diabetic? a. periodic visits to a gastroenterologist b. colonoscopy c. follow up with a urologist d. eye exam with an opthlamologist Which characteristic of delerium helps to distinguish it from dementia? a, short term memory impairment b. personality changes c. acute onset d. impaired attention he majority of patients enrolled in hospice care die: a. in the hospital b. in an inpatient hospice facility c. in a nursing home d. at home Which of the following is a role of the advanced practice nurse in palliative cancer care? a. detecting cancer in asymptomatic paitents or those with specific symptoms b. arranging for follow up including patiennts c. identifying and managing complications of care d. all of the above The elderly are at high risk for delerium because of: a. multiple medical problems When treating depression associated with dementia, which of the following would be a poor choice and not be prescribed a. desimpramine b. amitryptyline c. fluoxitine d. mirtazapine Male patient presents with a BMI of 30 presents to the office for an annual exam. You are reviewing the lab results. You ordered a CMP as part of routine labs. The fasting glucose was 130. Your next action is: a. repeat the fasting glucose b. start metformin 500mg BID c. repeat fasting glucose in 1 year d. call the patient and report lab results as normal The task of grieving include all of the following except a. begin to disengage b. acknowledge the reality of death c. work through the pain of grief d. restructure relationships All of the following are true statements regarding elder abuse except: a. anew STI in an elderly patient can be a sign of abuse b. persons over 80 years of age are at highest risk for abuse c. missing scheduled appointments and delays in medical care are common d. common signs of abuse include decreased anxiety and depression Hospice care differs from palliative care in that: a. it cannot be provided in the nursing home b. the majority of those admitted to hospice die within 7 days c. itis not covered by insurance d. it is designed for the last six months of life How dies womans anatomy make them more susceptible to UTI's a. the female urethra is shorter b. aymptomatic UTI's do not resolve themselves without treatment c. women tend to get UTI's when they are pregnant d. there is a longer distance between the urethra and anus Mrs. Smith, a 64 year old woman presents to the clinic for the first time and complains of uruinary incontinece and dyspareunia. She went through menipause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 87 years of age. The patiennt's most recent mammogram was 7 years ago and no known family history of breast cancer. She is not taking any medications. Her physical exam is unremarkable except for findings consistant with atrophic vaginitis. You prescribed topical hormone replacement therapy today. Which of the following evaluations should also be ordered today? Mammogram All of the following patients should be screened for diabetes except: a. a 44 year old caucasian male with hypertension b. a 42 year old femal on disability from back injury from back injury who is unable to exercise c. an overweight middle aged african american woman with a family history of type 2 diabetes mellitus d. an obese hispanic man A 60 year old obese male client has type 2 diabetes mellitus and a lipid panel of TC=250 HDL=32 LDL=165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include: a. diabetes, obesity and hyperlipidemia b. advancing age, diabetes, hyperlipidemia, and male gender c. hyperlipidemia, smoking and family history of heart disease d. male with age >45, diabetes mellitys and hyperlipidemia A 65 year old Hispanic woman who presents to the office for routine follow up of her type 2 diabetes mellitus. Her routine UA results are as follows: few epithelial cells, negative leukocytes, negative nitrates, negative protein, no ketones. Which of the following tests should also be ordered annually for diabetic patients: a. result is normal, no further testing is necessary b. urine for culture and sensitivity c. recommend a screening intravenous pyelogram (IVP) d. microalbumin The cornerstone of pharmacotherapy in treating Alzheimer's disease is: a. NMDA receptor antagonist b. Psychotropic medications c. Cholinesterase inhibitors d. Anxiolytics The Mini-Cog is a short screening tool used to assess cognition. Which of the following statements pertaining to the test is a true statement? a. a score of 0-2 is a positive screen for cognitive impairment An 80 year old female widow asks her nurse practitioner about her end of life options. Her diagnosis include congestive heart failure, hypertension and type 2 diabetes mellitus. She has noticed that in the last month she has lower extremity edema and she if finding it difficult to walk to the grocery store and chrch. She does not use oxygen. She is able to maintain her home but requires more frequent rests after vacuuming. She does not wish to be admitted to the hospital again in the future but if admitted wants to maintain full code status. How should the NP address this patients concerns today? a. start her on a medication for depression b provide her with information for senior day care services c. offer the patient a palliative care referral Hospice services and palliative care services are underutilized due to a. denial of impending death b. confusion remains over when it is appropriate to consult palliative care c. services are not understood d. all options are appropriate Delirium is typically characterized by all of the following except: a. altered level of consciousness b. insidious onset c. inattention Mrs. G has returned to your office for a follow up visit for urinary incontinence (UI). Mrs G has followed your 1st line recommendations. She has quit smoking, drinks plenty of fluids, and has eliminated caffeine and spicy foods. Despite all these changes, she still experiences UI. You decide to initiate second line treatement. You recommend: a. bladder control training b. keagels c. antimuscarinic medications d. alpha 1 adrenergic receptor antagonists Which of the following diagnoses should be considered in a patient presenting with erectile dysfunction? a. diabetes mellitus b. artherosclerosis c. depression d. all options are appropriate A patient has been prescribed metformin (Glucophage). One week later he returns with complaints of some loose stools during the week. How should the nurse practitioner respond? a. double the dosage of medication and have patient return in one week b. order a chem. 7 to check for lactic acidosis c. discontinue the medication immediately d. reassure the patient that this is an anticipated side effect A 48 year old male patient screened for diabetes has a fasting plasma glucose level of 120mg/dl (6.7mmol/L). The nurse practitioner plan includes: a. prescribe metformin 500mg po BID b. educate the patient on lifestyle changes to lower blood glucose c. initiate self monitoring of blood glucose d. review the effects of oral hypoglycemic medications Which of the listed conditions is most likely to cause delirium? a. acute infection b. multiple brain infarcts c. malnutrition d. fluid overload Age-related changes in the bladder, urethra and ureters include all of the following in older women except: a. decline in ureteral resistance pressure b. increased estrogen production’s influence on the bladder and ureter c. laxity of the pelvic muscle d. decline in bladder outlet function. a. hycosamine for respiratory secretions b. stimulant laxatives for treating constipation c. opioids for pain control d. opioids for dyspnea The comorbid psychiatric problem with the highest frequency in dementia is: a. depression b,, agitation and aggression c. psychosis d. anxiety According to the 2017 Guideline for High Blood pressure in adults, patients with stage 1 or 2 CKD with albuminuria should be started on the following medication to slow progression of kidney disease a. ACE inhibitors b. CCP c. ARNI d. thiazide diruetic Although the patient is currently asymptomatic, her history of three urinary tract infections (UTIs) in 8 months warrants testing while she is in the office. A UTI is defined as the presence of 100,000 organisms per milliliter of urine in asymptomatic patients or greater than 100 organisms per milliliter of urine with pyuria (>7 WBCs/mL) in a symptomatic patient. Diabetic patients are at higher risk for UTIs and over time may develop bladder damage (cystopathy) and nephropathy. A nephrology consult is prudent. Type 2 diabetes mellitus screening tests include fasting plasma glucose level (>126 mg/dL), random plasma glucose level (>200 mg/dL), and oral glucose tolerance testing (2-hour blood glucose level >200 mg/dL) with a 75-g glucose load. Normal A1C levels are less than 5.6%. Do not confuse the criteria for diabetes with those for prediabetes. For prediabetes, look for an A1C between 5.7% to 6.4%, fasting plasma glucose (FPG) of 100 to 125 mg/dL, and/or 75-g oral glucose tolerance test (OGTT) 2-hour postprandial glucose of 140 to 199 mg/dL. To diagnose diabetes, look for random blood glucose 4%c¥200 mg/dL with polyuria, polydipsia, and polyphagia, or A1C a%o¥6.5%, FPG of A%o¥126 mg/dL, or 2-hour OGTT A%0¥200 mg/dL (American Diabetes Association, 2016). Exercise is recommended because exercise helps to use the glucose stores and reduce blood sugar. When exercising, the patient should monitor blood sugar closely, especially if using insulin, to avoid hypoglycemia. Strenuous exercise is contraindicated for most patients with type 2 diabetes because of a higher risk of hypoglycemic episodes Chronic anovulation results in high levels of estrogen and androgens in the body. The risk of heart attack is four to seven times higher in women with polycystic ovary syndrome (PCOS) than women of the same age without PCOS. Women with PCOS are at greater risk of having high blood pressure and have high levels of low-density lipoprotein (LDL) and low levels of high- density lipoprotein (HDL) cholesterol. Lack of ovulation is usually the reason for fertility problems in women with PCOS. More than 50% of women with PCOS have diabetes or prediabetes (impaired glucose tolerance) before the age of 40. Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not progesterone. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia and cancer. 
