Test Bank of Advanced Practice Nursing in the Care of Older Adults By Laurie Kennedy

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Test Bank of Advanced Practice Nursing in the Care of Older Adults By Laurie Kennedy

 

Chapter 3: Exercise in Older Adults

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Exercise recommended for older adults should include activities that:

A. Conserve energy
B. Restrict flexibility
C. Strengthen muscles
D. Are anaerobic in nature

 

 

____    2.   Preferred amount of exercise for older adults is:

A. 10 minutes of physical activity each morning
B. 30 minutes per day of aerobic activity five times a week
C. Any increase in physical activity over a sedentary lifestyle
D. 60 minutes per day that includes 30 minutes of aerobic activity and 30 minutes of weight training five times a week

 

 

____    3.   Which of the following medical conditions is not considered restrictive for engaging in physical activity?

A. Unstable angina
B. Dehydration
C. Depression
D. Uncontrolled tachycardia

 

 

____    4.   The best recommendation for a patient who states they have no equipment to exercise would be:

A. Sign a contract for a year’s membership to a local gym
B. Borrow free weights from grandchildren
C. Have a personal trainer come to the home three times a week
D. Improvise with recommended objects at home that can be used

 

 

____    5.   When the nurse practitioner recommends exercise for a sedentary older adult, which of the following pieces of advice should be considered for all types of exercise?

A. Only use equipment recommended by physical trainers
B. Start low and go slow
C. Only group exercise is beneficial to someone who has not been active in a long time
D. Focus only on one type of exercise for the first few months

Chapter 6: Skin and Lymphatic Disorders

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Which of the following dermatological conditions results from reactivation of the dormant varicella virus?

A. Tinea versicolor
B. Seborrheic keratosis
C. Verruca
D. Herpes zoster

 

 

____    2.   An older adult male presents with pain in his right chest wall for the past 48 hours. Upon examination, the nurse practitioner notices a vesicular eruption along the dermatome and identifies this as herpes zoster. The NP informs the gentleman that:

A. All symptoms should disappear within three days
B. Oral medications can dramatically reduce the duration and intensity of his symptoms
C. He has chickenpox and can be contagious to his grandchildren
D. He has a sexually transmitted disease

 

 

____    3.   A 70-year-old white male comes to the clinic with a slightly raised, scaly, pink, and irregular lesion on his scalp. He is a farmer and works outside all day. You suspect actinic keratosis, but cannot rule out other lesions. What recommendation would you give him?

A. Ignore the lesion, as it is associated with aging.
B. Instruct him to use a nonprescription hydrocortisone cream to dry up the lesion.
C. Perform a biopsy or refer to a dermatologist.
D. Advise him to use a dandruff shampoo and return in one month if the lesion has not gone away.

 

 

____    4.   The immunofluorescent antibody (IFA) is a laboratory test used to diagnose which of the following disorders?

A. Tinea versicolor
B. Herpes zoster
C. Squamous cell carcinoma
D. Human papilloma virus

 

 

____    5.   A wound with drainage and foul odor should be cleansed with:

A. Normal saline
B. Hydrogen peroxide
C. 20% acetic acid
D. Betadine

 

 

____    6.   A full thickness pressure ulcer is partially covered with eschar and the surrounding tissue is reddened. Which of the following is the most appropriate treatment for this condition?

A. Apply an occlusive dressing
B. Debride mechanically or chemically
C. Saline moistened gauze dressings
D. Vacuum-assisted wound closure

 

 

____    7.   In examining the skin of your nursing home patient, you note a “stained glass” brownish mark on the face. Which of the following lesions best describes a stained glass brownish mark?

A. Actinic keratosis
B. Seborrhea keratosis
C. Lentigo maligna
D. Superficial spreading malignant melanoma

 

 

____    8.   Patients who have an underlying tinea infection to the cellulitis should also be treated with which one of the following?

A. An anti-fungal medication
B. Topical steroids
C. Oral steroids
D. Zinc oxide

 

 

____    9.   Identify the type of malignant melanoma that is associated with the Hutchinson’s sign of the cuticle of the finger.

A. Lentigo maligna
B. Acral lentiginous
C. Nodular
D. Superficial spreading malignant melanoma

 

 

____  10.   A smooth round nodule with a pearly gray border and central induration best describes which skin lesion?

A. Seborrheic keratosis
B. Malignant melanoma
C. Herpes zoster
D. Basal cell carcinoma

 

 

____  11.   Cellulitis is a deep skin infection involving the dermis and subcutaneous tissues. The nurse practitioner suspects cellulitis in a 70-year-old Asian diabetic male presenting with reddened edematous skin around his nares. Which statement below will the nurse practitioner use in her decision-making process for the differential diagnosis pertaining to reddened edematous skin?

A. Cellulitis is two times more common in women
B. Facial cellulitis is more common in people >55
C. There is low incidence of cellulitis in patients with diabetes
D. Cellulitis is only a disease of the lower extremities of patients with known arterial insufficiency

 

 

____  12.   An 82-year-old female has a “pimple” on his nose that occasionally bleeds and may have increased in size in the past year. The lesion is a 0.7-cm, dome-shaped, umbilicated papule with pearly translucence. There is also a hemorrhagic crust covering the central portion. Which of the following is the most likely diagnosis?

A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Keratocanthoma
D. Sebaceous hyperplasia

 

 

____  13.   Which of the following is generally not a first-line treatment for post herpetic neuralgia?

A. Intrathecal methylprednisolone
B. Gabapentin
C. 5% lidocaine patch
D. Topical capsaicin

 

 

____  14.   A nursing home resident with a Stage 4 pressure ulcer that extends to the muscle layer and has significant undermining with heavy exudate should be treated with:

A. Dry gauze dressings
B. Duoderm
C. Chemical debridement
D. Calcium alginate dressings

 

 

____  15.   Which of the following descriptions accurately documents cellulitis?

A. Cool, erythematous, shiny hairless extremity with decreased pulse
B. Scattered, erythematous ring-like lesions with clear centers
C. Clearly demarcated, raised erythematous area of face
D. Diffusely inflamed skin that is warm and tender to palpation

 

 

____  16.   Asymmetrical bi-color lesion with irregular border measuring 8 mm is found on the right lower arm of an adult patient. This assessment finding is consistent with:

A. Melanoma
B. Basal cell carcinoma
C. Leukoplakia
D. Senile lentigines

 

 

____  17.   Which of the following descriptions best illustrates assessment findings consistent with tinea capitis?

A. Circular erythematous patches with papular, scaly annular borders and clear centers
B. Inflamed scaly dry patches with broken hairs
C. Web lesions with erythema and scaling borders
D. Scaly pruritic erythematous lesions on inguinal creases

 

 

____  18.   A hyperkeratatotic nodule formed as the result of exposure of the foot to moisture from perspiration is called:

A. Hard corn
B. Tinea pedis
C. Soft corn
D. Plantar warts (verrucae)

 

 

____  19.   A 64-year-old male presents with an exacerbation of psoriasis. His social history includes 50-year two packs a day of cigarettes and a six-pack a week of beer. He states he had a recent sore throat, which he attributes to minding his young grandson. He reports that until recently the pruritis was only minimal. His BMI is 37. Which of the following factors most likely contributed to the acute presentation of psoriasis?

A. Alcohol abuse
B. Smoking
C. Streptococcal infection
D. Obesity

 

 

____  20.   Treatment of complicated cellulitis of the lower extremity resulting from an anaerobe requires all of the following except:

A. Extended antibiotic medication lasting at least 7-10 days
B. Topical antifungal medication
C. Inquiry when last tetanus toxoid booster was given
D. Elevation of limb and consideration of compression bandaging

Chapter 11: Urological and Gynecological Disorders

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Which ethnic group has the highest incidence of prostate cancer?

A. Asians
B. Hispanics
C. African Americans
D. American Indians

 

 

____    2.   Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what intervals?

A. Every 6 months
B. Yearly
C. Every 2 years
D. Every 2 to 4 years

 

 

____    3.   All of the following may be reasons associated with an elevated PSA besides prostate cancer except:

A. Prostatitis
B. Urinary tract infection
C. Perineal trauma
D. Digital rectal exam

 

 

____    4.   In the diagnosis of acute bacterial prostatitis, a midstream urine culture is of benefit. To be diagnostic, the specimen should reveal how many white blood cells per high-power field?

A. Five
B. Ten
C. Fifteen
D. Twenty

 

 

____    5.   In chronic bacterial prostatitis, what is the organism most commonly associated with the disease?

A. Klebsiella
B. Proteus
C. Pseudomonas
D. Escherichia coli

 

 

____    6.   In acute prostatitis, an exam of the prostate may find the gland to be:

A. Nodular
B. Cool and pliable
C. Swollen and tender
D. Asymmetrical

 

 

____    7.   All of the following antimicrobials may be indicated in chronic bacterial prostatitis except:

A. Ciprofloxacin
B. Levofloxacin
C. Trimethoprim
D. Azithromycin

 

 

____    8.   Age-related changes in the bladder, urethra, and ureters include all of the following in older women except:

A. Increased estrogen production’s influence on the bladder and ureter
B. Decline in bladder outlet function
C. Decline in ureteral resistance pressure
D. Laxity of the pelvic muscle

 

 

____    9.   Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the past week. He has never had a surgical procedure in his life and seeks clarification on the availability of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a radical prostatectomy. Which of the following is NOT a potential side effect of this procedure?

A. Urinary incontinence
B. Impotence
C. Dribbling urine
D. Selected low back pain

 

 

____  10.   The nurse practitioner is evaluating a patient’s pelvic muscle strength by digital examination. This is performed when:

A. A male patient complains of nocturia and dribbling
B. The nurse practitioner needs to confirm a cystocele or stress incontinence
C. The patient reports sudden loss of large amounts of urine or urge incontinence
D. The nurse practitioner suspects overflow incontinence

 

 

____  11.   A pelvic mass in a postmenopausal woman:

A. is most commonly due to uterine fibroids.
B. is always symptomatic.
C. is highly suspicious for ovarian cancer.
D. should be monitored over a period of time.

 

 

____  12.   A 79-year-old man is being evaluated for frequent urinary dribbling without burning. Physical examination reveals a smooth but slightly enlarged prostate gland. His PSA level is 3.3 ng/mL. The patient undergoes formal urodynamic studies, and findings are as follows: a decreased bladder capacity of 370 mL; a few involuntary detrusor contractions at a low bladder volume of 246 mL; an increased postvoid residual urine volume of 225 mL; and a slightly decreased urinary flow rate. Which of the following is not consistent with a normal age-associated change?

A. PSA level of 3.3 ng/mL
B. Decreased bladder capacity
C. Involuntary detrusor contradictions
D. Increased postvoid residual urine volume

 

 

____  13.   Mrs. Smith, a 65-year-old woman presents to clinic for the first time and complains of urinary incontinence and dyspareunia. She went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 82 years of age. The patient’s most recent mammogram was 5 years ago and no known family history of breast cancer. She is not taking any medications. Her physical examination is unremarkable except for findings consistent with atrophic vaginitis. You decide to begin topical hormone replacement therapy. Which of the following evaluations would be necessary prior to initiating hormone replacement therapy?

A. Mammogram
B. Endometrial biopsy
C. Bone mineral density measurement
D. Papanicolaou smear

 

 

____  14.   Mrs. L. Billings is a 77-year-old Caucasian female who has a history of breast cancer. She has been in remission for 6 years. As her primary care provider, you are seeing her for follow-up of her recent complaint of intermittent abdominal pain of a 3-month duration and some general malaise. Given the brief history above, what will you direct your assessment at during physical examination?

A. Examination of her thyroid to rule out thyroid nodules that may contribute to her feeling fatigued.
B. Auscultation of her abdomen for abnormal bowel sounds to rule out peritonitis.
C. Thorough abdominal and gynecological exam to rule out masses and identify any tenderness.
D. A rectal examination to rule out colon cancer as a secondary site for breast cancer.

 

 

____  15.   A 78-year-old female comes to the office because she has pain when she urinates. She has been seen three times for this problem in the last 3 months. Each time she was told she had a UTI and was given antibiotics. She carefully followed the instructions but has had no relief of symptoms. Last sUA:

WBCs: 2-3/high-power field

RBCs: 0-2/high-power field

Epithelial cells: Few

Nitrite: Negative

Leuckocyte esterase: Negative

Which of the following should be done next?

A. Obtain a clean catch urine for UA and urine for C&S
B. Perform a pelvic examination
C. Reassure the patient that she has asymptomatic bacteriuria and does not need antibiotics
D. Order a pelvic ultrasound

Chapter 15: Hematological and Immune System Disorders

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data?

A. Hemoglobin and hematocrit
B. Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)
C. Serum ferritin and serum iron
D. Total iron binding capacity and transferrin saturation

 

 

____    2.   Initial therapy for patients with IDA is:

A. Blood transfusion
B. Increasing dietary intake of green leafy vegetables
C. Ferrous sulfate 325 mg orally bid-tid
D. Parenteral administration of Venofer

 

 

____    3.   Mrs. G, a 70-year-old patient, presents to you with a hemoglobin of 9.4 and a decreased MCV/MCV. You diagnose her with IDA and start her on ferrous sulfate 325 mg PO tid. The next step in your work-up would be:

A. Send Mrs. G for a GI consult
B. Obtain hemoglobin one week after oral therapy
C. Schedule Mrs. G for an upper GI series
D. Obtain stool for occult blood

 

 

____    4.   Despite adherence to oral iron therapy of 2 weeks, your elderly patient with IDA demonstrates a drop in his hemoglobin from 8.4 to 7.4. He is complaining of fatigue, dyspnea, and heart racing. You would change his therapy by which of the following:

A. Schedule patient for outpatient parenteral iron infusion
B. Switch to a different form of oral therapy
C. Schedule patient for outpatient blood transfusion
D. Make no changes until evaluated by GI specialist

 

 

____    5.   You are prescribing oral iron therapy for a patient with IDA. In teaching your patient about iron therapy, all of the following instructions should be reviewed except:

A. Iron is best taken on an empty stomach one hour before meals
B. Meat, fish, poultry, beans, and green leafy vegetables are good dietary sources of iron
C. Adding vitamin D daily enhances absorption of iron
D. Common GI side effects of iron therapy include constipation, nausea, and black stools

 

 

____    6.   When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD):

A. Hemoglobin <12 g/dl, Mean Corpuscular Volume (MCV) decreased, Mean Corpuscular Hemoglobin (MCH) decreased
B. Hemoglobin >12 g/dl, Mean Corpuscular Volume (MCV) increased, Mean Corpuscular Hemoglobin (MCH) increased
C. Hemoglobin <12 g/dl, Mean Corpuscular Volume (MCV) normal, Mean Corpuscular Hemoglobin (MCH) normal
D. Hemoglobin >12 g/dl, Mean Corpuscular Volume (MCV) decreased, Mean Corpuscular Hemoglobin (MCH) increased

 

 

____    7.   The pathophysiological hallmark of ACD is:

A. Depleted iron stores
B. Impaired ability to use iron stores
C. Chronic uncorrectable bleeding
D. Reduced intestinal absorption of iron

 

 

____    8.   The main focus of treatment of patients with ACD is:

A. Replenishing iron stores
B. Providing for adequate nutrition high in iron
C. Management of the underlying disorder
D. Administration of monthly vitamin B12 injections

 

 

____    9.   In addition to the CBC with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA?

A. Serum iron
B. Total iron binding capacity
C. Transferrin saturation
D. Serum ferritin

 

 

____  10.   Education of patient and family regarding ACD includes discussion of all of the following except:

A. Early prevention of chronic conditions through healthy lifestyle measures
B. Importance of adherence to the treatment plan for management of chronic conditions
C. Explaining the ACD is mainly attributed to the aging process
D. Importance of regular follow-up to monitor responses to treatments

 

 

____  11.   Symptoms in the initial HIV infection include all of the following except:

A. Sore throat
B. Fever
C. Weight loss
D. Headache

 

 

____  12.   The primary mode of HIV transmission in the U.S. is:

A. Blood transfusion
B. Men having sex with men
C. Heterosexual contact
D. Needle sharing

 

 

____  13.   In the older adult, which group comprises the highest rate of HIV/AIDS?

A. African American women
B. African American men
C. Hispanic women
D. Hispanic men

 

 

____  14.   Contributing factors in HIV development in the older adult include all of the following except:

A. Older adults are less likely to be tested
B. Healthcare providers do not routinely ask older adults about HIV risks
C. Older adults are less likely to use condoms
D. Older adults are at low risk to contract HIV

 

 

____  15.   Immune system changes that render older adults more susceptible to contracting HIV include all of the following except:

A. Hyper-responsive T cells
B. Age-related thymic involution
C. Depletion of naïve CD4 cells
D. Decline in B cell function

 

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