South University

NSG6420

1

Gerontology Class….

Week 1:

1. Question :

The major impact of the physiological changes that occur with aging is:

 Reduced physiological reserve

 Reduced homeostatic mechanisms

 Impaired immunological response

CORRECT All of the above

Instructor Explanation: The major impact of all of these physiological changes can be

highlighted with three primary points. First, there is a reduced physiological reserve of most body

systems, particularly cardiac, respiratory, and renal. Second, there are reduced homeostatic mechanisms

that fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance.

Third, there is impaired immunological function: infection risk is greater, and autoimmune diseases are

more prevalent. (Kennedy-Malone 3)

Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.

Question 2. Question :

Men have faster and more efficient biotransformation of drugs and this is thought to be due to:

 Less obesity rates than women

 Prostate enlargement

CORRECT Less estrogen than women

Instructor Explanation: Men have faster and more efficient biotransformation, presumably

because of serum testosterone. Conditions of increased or decreased liver perfusion alter the overall

level of the drug that is absorbed and how it is metabolized. (Kennedy-Malone 5)

Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.

Question 3. Question :

The cytochrome p system involves enzymes that are generally:

 Inhibited by drugs

NSG 6420 MIDTERM EXAM QUESTIONS AND ANSWERS

WITH RATIONALES

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South University

NSG6420

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 Induced by drugs

CORRECT Inhibited or induced by drugs

 Associated with decreased liver perfusion

Instructor Explanation: Biotransformation occurs in all body tissues but primarily in the liver,

where enzymatic activity (cytochrome P [CYP] system) alters and detoxifies the drug and prepares it for

excretion. (Kennedy-Malone 5)

Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.

Question 4. Question :

Functional abilities are best assessed by:

 Self-report of function

CORRECT Observed assessment of function

 A comprehensive head-to-toe examination

 Family report of function

Instructor Explanation: Two well-established tools used to evaluate function in older adults are

the Katz Activities of Daily Living Scale (Katz et al., 1963) and the Lawton and Brody scale for

Instrumental Activities of Daily Living (Lawton & Brody, 1969). It is important to be cautious about selfreport of function (rather than direct observation of function) and to ask, “Do you …?” instead of “Can

you …?” in order to determine if patients actually perform the activity. (Kennedy-Malone 40)

Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.

Question 5. Question :

Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers

to which of the following laboratory data?

 Hemoglobin and Hematocrit

CORRECT Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)

 Serum ferritin and serum iron

 Total iron binding capacity and transferrin saturation

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South University

NSG6420

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Instructor Explanation: RBC indices reveal an MCV (mean corpuscular volume/RBC size) that will

be decreased to <80 fL in adults; MCH (mean corpuscular hemoglobin/RBC color) will show hypochromia

or pale cells; RBC distribution width (RDW)/volume variation will be increased.

(Kennedy-Malone page 519)

Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.

Question 6. Question :

When interpreting laboratory data, you would expect to see the following in a patient with Anemia of

Chronic Disease (ACD):

 Hemoglobin <12 g/dl, MCV decreased, MCH decreased

 Hemoglobin >12 g/dl, MCV increased, MCH increased

CORRECT Hemoglobin <12 g/dl, MCV normal, MCH normal

 Hemoglobin >12 g/dl, MCV decreased, MCH increased

Instructor Explanation: Hemoglobin (Hgb): <12 g/dL (120 g/L) women <13 g/dL (130 g/L) men

Rarely <10 g/dL (100 g/L) Mean corpuscular volume: 80–96 mcm3 (normocytic) Mean corpuscular

hemoglobin Normochromic (normal color) RBC distribution width: normal (Kennedy-Malone page 517)

Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.

Question 7. Question :

The pathophysiological hallmark of ACD is:

 Depleted iron stores

CORRECT Impaired ability to use iron stores

 Chronic uncorrectable bleeding

 Reduced intestinal absorption of iron

Instructor Explanation: The pathophysiological hallmark of ACD is a disregulation of iron

homeostasis, characterized by an increased uptake and retention of iron within the cells of the

reticuloendothelial system (liver/spleen), resulting in decreased RBC production. Essentially, iron is

present but inaccessible for use in the production of Hgb with the erythrocytes (Bross et al., 2010). A

shortened RBC survival is also a contributing factor to ACD. (Kennedy-Malone page 516-517)

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South University

NSG6420

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Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.

Question 8. Question :

The main focus of treatment of patients with ACD is:

 Replenishing iron stores

 Providing for adequate nutrition high in iron

CORRECT Management of the underlying disorder

 Administration of monthly vitamin B12 injections

Instructor Explanation: Treatment: Treatment of ACD focuses on management of the underlying

disorder. Iron supplementation is of no benefit in ACD, except in cases of coexisting IDA. A therapeutic

trial of iron supplementation of no longer than 1 month may be useful in delineating between ACD and

IDA. In ACD, there would be no hematological response to iron therapy (Chen & Gandhi, 2004).

(Kennedy-Malone page 518)

Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.

Question 9. Question :

In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is

considered to be most useful in diagnosing ACD and IDA?

Student Answer: Serum iron

 Total iron binding capacity

 Transferrin saturation

CORRECT Serum ferritin

Instructor Explanation: Treatment: Treatment of ACD focuses on management of the underlying

disorder. Iron supplementation is of no benefit in ACD, except in cases of coexisting IDA. A therapeutic

trial of iron supplementation of no longer than 1 month may be useful in delineating between ACD and

IDA. In ACD, there would be no hematological response to iron therapy (Chen & Gandhi, 2004).

(Kennedy-Malone page 518)

Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of

Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file

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