NR 601 MIDETRM EXAM STUDY GUIDE

Chapter 1: Changes with Aging

Multiple Choice

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

____ 1. The major impact of the physiological changes that occur with aging is:

A. Reduced physiological reserve

B. Reduced homeostatic mechanisms

C. Impaired immunological response

D. All of the above

____ 2. The strongest evidence regarding normal physiological aging is available through:

A. Randomized controlled clinical trials

B. Cross-sectional studies

C. Longitudinal studies

D. Case control studies

____ 3. All of the following statements are true about laboratory values in older adults except:

A. Reference ranges are preferable

B. Abnormal findings are often due to physiological aging

C. Normal ranges may not be applicable for older adults

D. Reference values are not necessarily acceptable values

____ 4. Biochemical individuality is best described as:

A. Each individual’s variation is often much greater than that of a larger group

B. The unique biochemical profile of a selected population

C. The truly “normal” individual—falling within average range

D. Each individual’s variation is often much smaller than that of a larger group

____ 5. Polypharmacy is best described as taking:

A. More than nine medications per day

B. More than five medications per day

C. Even a single medication if there is not a clear indication for its use

D. When a drug is given to treat the side effect of another drug

____ 6. Pharmacokinetic changes with aging is reflective of:

A. What the drug does to the body

B. What the body does to the drug

C. The effect at the site of action and the time and intensity of the drug

D. The side effects commonly associated with the drug

____ 7. All the following statements are false about drug absorption except:

A. Antacids increase the bioavailability of digitalis

B. Gastric acidity decreases with age

C. Anticholinergics increase colonic motility

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D. Underlying chronic disease has little impact on drug absorption

____ 8. All of the following statements are true about drug distribution in the elderly except:

A. Drugs distributed in water have lower concentration

B. Drugs distributed in fat have less intense, more prolonged effect

C. Drugs highly protein bound have greater potential to cause an adverse drug

reaction

D. The fastest way to deliver a drug to the action site is by inhalation

____ 9. Men have faster and more efficient biotransformation of drugs and this is thought to be due to:

A. Less obesity rates than women

B. Prostate enlargement

C. Testosterone

D. Less estrogen than women

____ 10. The cytochrome p system involves enzymes that are generally:

A. Inhibited by drugs

B. Induced by drugs

C. Inhibited or induced by drugs

D. Associated with decreased liver perfusion

____ 11. A statement not shown to be true about pharmacodynamics changes with aging is:

A. Decreased sensitivity to oral anticoagulants

B. Enhanced sensitivity to central nervous system drugs

C. Drug responsiveness can be influenced by patient activity level

D. There is a decreased sensitivity to beta blockers

____ 12. Atypical presentation of disease in the elderly is reflected by all the following except:

A. Infection without fever

B. Depression without dysphoric mood

C. Myocardial infarction with chest pain and diaphoresis

D. Cardiac manifestations of thyroid disease

____ 13. Functional abilities are best assessed by:

A. Self-report of function

B. Observed assessment of function

C. A comprehensive head-to-toe examination

D. Family report of function

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Chapter 1: Changes with Aging

Answer Section

MULTIPLE CHOICE

1. ANS: D PTS: 1

2. ANS: C PTS: 1

3. ANS: B PTS: 1

4. ANS: D PTS: 1

5. ANS: C PTS: 1

6. ANS: B PTS: 1

7. ANS: D PTS: 1

8. ANS: A PTS: 1

9. ANS: C PTS: 1

10. ANS: C PTS: 1

11. ANS: A PTS: 1

12. ANS: C PTS: 1

13. ANS: B PTS: 1

Chapter 2: Health Promotion

Multiple Choice

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

____ 1. The leading cause of death in elderly travelers worldwide is:

A. Cardiovascular disease

B. Infections

C. Accidents

D. Malaria

____ 2. Which of the following should be avoided in countries where food and water precautions are to be

observed?

A. Hot coffee

B. Bottled water

C. Salad buffet

D. Unpeeled bananas

____ 3. What insect precautions are not necessary to prevent insect-borne diseases in the tropics?

A. Using 100% DEET on skin to prevent bites

B. Treating clothes with permetherin

C. Covering up exposed skin to lessen biting surface

D. Taking malaria pills as directed for areas at risk for malaria

____ 4. An example of secondary prevention you could recommend/order for older adults would be to:

A. Check for fecal occult blood

B. Wear seat belts in the car

C. Provide foot care for a diabetic patient

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D. Administer a tetanus shot

____ 5. Ali is a 72-year-old man who recently came to the U.S. from Nigeria. He reports having BCG

(bacille Calmette-Guerin) vaccination as a child. Which of the following is correct regarding a

tuberculin skin test?

A. It should not be done at all.

B. It should be read as smaller than it really is.

C. Vaccination history is irrelevant; read as usual.

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D.

It should be read as larger than it really is.

____ 6. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of

driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath,

with chest pain and a feeling of panic. Which of the following problems is most likely?

A. Pulmonary edema

B. Heart failure

C. Pulmonary embolism

D. Pneumonia

____ 7. Ivan W. is a 65-year-old man who is new to your practice. He has a history of COPD, CAD,

hypertension, and type 2 diabetes mellitus. He has had no immunizations since his discharge from

the military at age 25. Childhood diseases included chickenpox, measles, mumps, and “German

measles.” He presents for a disease management visit. Which of the following immunizations would

you recommend for Ivan?

A. MMR, influenza, pneumococcal, Zostavax

B. Influenza, pneumococcal, PPD, Hepatitis B

C. Tdap, pneumococcal, influenza, Zostavax

D. Hepatitis B, influenza, pneumococcal, Hepatitis A

____ 8. Leo L. is a 62-year-old African American male who comes for an initial visit to your practice.

Personal health history includes smoking 1 pack/day since age 11, consuming a case of beer (24

bottles) every weekend, and working as an assembler (sedentary job) for the past 10 years. Family

history in first-degree relatives includes hypertension, high cholesterol, heart attack, and type 2

diabetes mellitus. Leo’s BMI is 32; BP today is 130/86. You order a fasting glucose, lipid profile,

and return visit for BP check. This is an example of:

A. Primary prevention

B. Secondary prevention

C. Tertiary prevention

D. Health profiling

____ 9. A local chapter of a nurse practitioner organization has begun planning a community-based

screening for hypertension at a local congregate living facility. This population was selected on the

basis of:

A. A predicted decreased incidence of high blood pressure in this population

B. A recognized element of high risk within this group

C. Readily available treatment measures

D. Achieving an administrative goal for the congregate living facility

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