NRNP 6540 Final Exam – Advanced Practice Care of Older Adults | 2026/2027 | 250 Questions and Correct Answers | Complete Exam PDF

NRNP 6540 Final Exam – Advanced Practice Care of Older Adults | 2026/2027 | 250 Questions and Correct Answers | Complete Exam PDF 2026 – 2027 EDITION | ACTUAL QUESTIONS + CORRECT ANSWERS | COMPLETE EXAM MATERIAL High-Yield • Fully Updated • 100% Verified • Board-Style Scenarios Includes: Geriatric Syndromes • Chronic Disease Management • Pharmacology • Cognitive Disorders • Functional Assessment • Acute & Long-Term Care Exam Overview Exam Structure • 260 Total Questions • Multiple-Choice Format • Advanced, Case-Based Clinical Scenarios • Timed Assessment (Board-Style) • Designed to Identify Knowledge Gaps Key Domains Covered • Chronic Illness Management in Older Adults • Geriatric Pharmacology & Polypharmacy Risks • Cognitive Impairment & Dementia Care • Functional, Mobility, & Fall-Risk Assessment • End-of-Life & Palliative Considerations • Acute Geriatric Emergencies • Health Promotion & Disease Prevention 1/ 23 2/ 23 Introduction The NRNP 6540 Final Exam provides a comprehensive review of advanced practice concepts specific to the older adult population. This exam mirrors the complexity and structure of graduate-level and certification-style assessments, ensuring that learners build the diagnostic reasoning, clinical judgment, and evidence-based decision-making required for excellence in geriatric care. Achieving strong performance on this exam is closely associated with success in graduate NP coursework, clinical rotations, and certification readiness. Answer Format • Questions are presented in bold, ensuring clarity and easy readability. • Correct answers are displayed in GREEN, providing instant recognition. • Reinforcing: Advanced geriatric assessment Pharmacologic reasoning Diagnostic accuracy Safe and effective patient care This structure strengthens mastery of core NRNP 6540 topics and prepares students for real-world advanced practice care. What are the cervical cancer screening recommendations Age 21-65 age 65 is not required What are the requirements for counseling patients 65 Exercise, nutrition, tobacco, alcohol What are the requirements of exercise for patients 65 Aerobic exercise for 30 minutes three times a week Strength exercise two times a week What are the alcohol recommendations for an adult one per day for women Per day for men What are the pneumonia immunization recommendations for patients 65 Pcv13 first PPS 23 one year later What are the zoster immunization recommendations All patients over the age of 60-regardless if they have had shingles or chicken pox in the past Contraindications-allergy to neomycin or gelatin Bone marrow cancer - such as lymphoma Current chemotherapy or steroids AIDS patients 3/ 23 the major impact of the physiological changes that occur Reduced physiological Reserve-Particularly the cardiac, respiratory, and renal with aging is systems Reduced homeostatic mechanisms-That fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance Changes in the sympathetic response-which contribute to orthostasis and Falls as well as a lack of hypoglycemic response Impaired immunologic response the strongest evidence regarding normal physiological aging is available through Longitudinal studies the following statements are true about laboratory values in older adults Reference ranges are preferable Normal ranges may not be applicable for older adults Reference ranges are not necessarily acceptable values biochemical individuality is best described as Each individual's variation is often much smaller than that of a larger group polypharmacy is best described as Even a single med if there is not a clear indication for its use pharmacokinetic changes with aging is reflective of What the body does to the drug All of the following statements are false about drug absorption except Underlying chronic disease has little impact on drug absorption all of the following statements are true about drug drugs distributed in fat have less intense, more prolonged effect distribution in the elderly drugs highly protein bound have greater potential to cause an adverse drug reaction the fastest way to deliver a drug to the action site is by inhalation men have faster and more efficient biotransformation of drugs and this is thought to be due to testosterone the cytochrome P system involves enzymes that are generally Inhibited or induced by drugs a statement not shown to be true about pharmacodynamics changes with aging and hand sensitivity to central nervous system drugs drug responsiveness can be influenced by patients activity level decreased sensitivity to beta blockers they do not have a decrease sensitivity to oral anticoagulants a typical presentation of disease in the elderly is reflected by all of the following infection without fever depression without dysphoric mood cardiac manifestations of thyroid disease 4/ 23 functional abilities are best assessed by Observed assessment of function What is a reference range in laboratory values How age or sexcan attribute to The leading cause of death in elderly Travelers worldwide Accidents What should be avoided in countries where food and water precautions are to be observed Salad buffet What insect precautions are not necessary to prevent insect-born diseases in the tropics Using 100% DEET on skin to prevent bites What is an example of a secondary prevention you could recommend order for older adults Check for a fecal occult blood Ali is a 72-year-old man who recently came to the US from Nigeria. He reports having BCG vaccination as a child. Which of the following is correct regarding a TB skin test Vaccination history is irrelevant, read as usual A 72-year-old woman and her husband are on a cross country driving Vacation. After a long day of driving, they stopped for dinner. Midway through the meal the woman becomes very short of breath, with chest pain and a feeling of panic which of the problems is most likely Pulmonary embolism Ivan is a 65-year-old man who is new to your practice. He is a history of COPD, CID, hypertension, and type 2 diabetes. He has no immunization since his discharge from the military at age 25. Childhood diseases include chicken pox, measles, mom's, and German Measles. He prevents for a disease management visit. Which of the following immunizations would you recommend for Ivan Tdap, pneumococcal, influenza, zostovax Personal health history includes smoking one pack per day, consuming a case of beer every weekend and working as an assembler for the past 10 years. Family history is first grew relatives include hypertension, high cholesterol, heart attack, and type 2 diabetes. Leo's BMI is 32, BP today is 1:30 over 86 you order a fasting glucose, lipid profile of Secondary prevention 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 recognized element of high risk within this group Performing range of motion exercises on a client who has had a stroke is an example of which level of prevention Tertiary prevention The nurse practitioner demonstrates an understanding of primary prevention of Falls among the elderly through which management plan Provide information about medications, side effects, and interactions 5/ 23 An example of an active strategy of health promotion for an individual to accomplish would be Beginning a Stress Management program You are working with an older male adult with a long history of alcohol abuse and a 30-year history of smoking. In recommending an intervention for this client you're responsibility is to Chest x-ray at the same time of PPD test What is primary prevention measures to decrease the incidence of disease What is secondary prevention? treating or controlling a disease or condition after it occurs What is tertiary prevention? Rehabilitative therapies and monitoring of health to prevent complications or further illness, injury, or disability What are some recommendations not to use with dementia patients Do not use antipsychotics as first line drug Do not recommend percutaneous feeding tubes Only use metformin in patients with Hemoglobin A1c of less than 7.5 What trip details are considered high risk in the elderly patient Longer than 3 weeks Mission, medical tourism, volunteerism, visiting friends or relatives Traveling alone Adventure-backpacking scuba diving Hostile, Budget Hotel, camp What is malaria chemoprophylaxis Subtropical areas in Africa South America, and South Asia What is travelers diarrhea -bacterial or parasitic -usually lasts 2-3 days -self limiting usually -only treat if severely ill, high fever, or lasts 7 days Treat with fluoroquinolones What are the exercise recommendations for older adults Strengthen muscles The best recommendation for a patient who states they have no equipment to exercise would be Improvise with recommended objects at home that can be used 6/ 23 When the nurse practitioner recommends exercise for sedentary older adult, which of the following pieces of advice should be considered for all types of exercise Start low and go slow The evidence reflects that comprehensive geriatric assessment should be conducted Targeting the vulnerable and frail elderly Evidence-based geriatric assessment instruments available to the clinician Include screening, evaluation, and measurement instruments in multiple domains When interviewing the older adult with the suspected dementia, it is most important that The Examiner should use short simple questionand recognize nonverbal signs of discomfort What are dimensions of symptomology Onset, location, absence of associated symptoms What is the best approach to taking a health history Start with open-ended questions A review of The Evidence relative to screening of the elderly reveals the highest evidence rating for Hearing screening Assessment of vital signs in the elderly reflect Older adults can be septic with the temperature within normal limits What is true about nutrition intake in the elderly The serum albumin is a good reflection of protein stores What is reflective of functional decline in older adults A functional decline is synonymous with Advanced staged The leading cause of traumatic death in the elderly Falls Timing of the get and go test enhances its sensitivity the process should take less than 16 seconds A validated tool for assessing cognitive function specific to dementia Confusion assessment method The medical outcome study short form 36 Remains the gold standard of quality of life instruments it measures Physical, mental, and social domains What is the half-life of albumin 21 days 7/ 23 What is the average lifespan of pre-albumin 1 to 2 days Short-term malnutrition level Pre-albumen of less than 10 A complex syndrome characterized by loss of weight, mostly due to loss of muscle mass resulting from metabolic abnormalities due to disease cachexia What are the domains of comprehensive geriatric assessment Physical health Functional Health Psychological health Socioeconomic support Quality of life measures what is the 4Ms Framework in geriatric assessment what matters, medication, mentation, mobility The term geriatric syndrome is best described as Condition that has multiple underlying factors and involves multiple systems The anal wink reflex is used to test Sensation and Prudential nerve function Atypical presentation of acute coronary syndrome is More common in females What disease can mimic an often coexist with myocardial infarctions in elderly with coronary artery disease Esophageal disease Thoracic aortic dissection presents typically as Severe retrosternal CP that radiates to the back and both arms Medications known to contribute to constipation include Stimulant laxatives Anticholinergic drugs Iron Bordetella pertussis is best described as Subacute cough lasting greater than 2 weeks The routine testing of tuberculosis should occur in all of the following vulnerable populations Nursing home residents Prison inmates Immunocompromised patients What is true about fluid balance in the elderly Thirst response decreases as a person ages Total body water decreases with age African Americans have higher rates of dehydration than white Americans 8/ 23 Distinguishing delirium from dementia can be problematic since they may coexist the primary consideration in the differential is Rapid change and fluctuating course of cognitive function Presbystasis age-related decline in equilibrium or dynamic balance If dizziness has a predictable pattern associated with it common the clinician should first consider Hypoglycemia What are contributing factors to dysphagia Anticholinergics Drugs that increase reflux Inadequate intake of fluids with medication and meals Evidence shows that the most important predictor of a fall is A prior history of Falls The most cost-effective intervention used to prevent Falls Home modifications and Vitamin D supplements Chronic fatigue syndrome is best described as Fatigue lasting longer than 6 months and not relieved by rest Which form of headache is bilateral Tension Microscopic hematuria is defined as 3 or more RBCs on 3 or more samples of urine What are the associated risk factors of finding malignancy in a patient with hemoptysis Male sex Smoking history Over the age of 40 Recent weight loss is defined as A loss of greater than 10 lb over the past 3 to 6 months The most common cause of disability in the elderly is due to Arthritis Lipedema is best described as Bilateral distribution of fat in the lower extremities Drug-induced pruritus is distinguished because it is May occur right after the drug is taken or months later 9/ 23 A form of syncope that is more common in the elderly than young adults is Orthostatic hypertension What is true about tremors Most individuals with Tremor do not seek medical attention Psychogenic Tremor is uncommon Tremor is more prevalent in whites than blacks Overflow incontinence is usually associated with bladder outlet obstruction Wandering is best described as Purposeful excessive ambulatory Behavior What are common disease causes of fecal incontinence Diabetes, shy dragger syndrome, toxic neuropathy, traumatic neuropathy, fecal infection What is a common musculoskeletal symptom of chest pain Costochondritis What is isotonic dehydration The most common type of fluid loss. Fluid is lost only from the extracellular fluid space, including both the plasma and the interstitial spaces. Circulation blood volume is decreased (hypovolemia) leading to poor tissue perfusion. What is hypertonic dehydration? When water loss exceeds electrolyte loss. Causes cellular dehydration and shrinkage. What is hypotonic dehydration? When electrolyte loss exceeds water loss. Causes a DECREASE in plasma volume. Severe unilateral periorbital pain 2 hours, ipsilateral Horner's syndrome, nasal congestion Cluster headache When should cystoscope be performed on a patient after hematuria Renal ultrasoundin addition with patients micro hematuria categorized as intermediate risk for malignancy What is life-threatening hemoptysis Greater than 100 ml in less than 24 hours Sudden onset of hemoptysis Probable PE What are common medications that can cause weight loss Antidepressants, digoxin, ACE inhibitors, beta blockers,laxatives,Flagyl,calcium carbonate, iron, potassium, NSAIDs,theophiland, Synthroid, anticolinergics What should be performed on a geriatric assessment for joint pain Swelling, deformity, decreased range of motion, crepitus,and whether there are multiple joints involved If applicable additional maneuver such as the McMurray test for a meniscus tear 10 / Should you check uric acid during a gout flare-up No because it is not useful since the urate will be sequestered in the affected joint Which electrolyte balances are related to muscle cramps Hypocalcemia Hypokalemia Hyponatremia Hypomagnesemia What lab value should you pay attention to with restless leg syndrome Iron if the ferritin is low iron replacement is required What is the Wells clinical rule Useful with DVT What is the primary diagnostic tool for Lymphedema Leg lymphoscintigraphy What is the most important diagnostic test with syncope EKG What should be placed for the long-term evaluation of syncope Loop recorder What are effective treatments for essential tremor Propanolol, primidone, and Topamax What medications can be used to treat stress incontinence Alpha adrenergics Serotonin norepinephrine reuptake inhibitors What is a measure of overall muscle strength Hand grips What is primary prevention Health promotion and illness prevention What is the best factor for predicting increased risk of malnutrition? Unexplained weight loss The NP is monitoring the immune response following hepatits B vaccination in an elderly hemodialysis patient. What test should be ordered and when to assess the immune response? HBsAb completed 2 months after the last dose As a general rule, patients over 65 years of age and in PCV 15, Tdap, and Quadrivalent high dose inactivated influenza vaccine,Two doses general good health can receive which immunizations? of RZV administered 2 to 6 weeks apart The NP sees a 69-year-old patient who recently moved to town and does not remember his last tetanus shot. The patient did not receive any immunizations as a child. What would you do? One does of Tdap now, one dose of Td in 4 weeks, and another dose of Td in 6-12 months. 11 / What are the three types of influenza vaccines available? Inactivated influenza vaccine (IIV) Recombinant influenza vaccine (RIV) Live attenuated influenza vaccine (LAIV What is the maximum number of doses of PPSV23 that can be given to high-risk older adults 65 or older? 1 The prevalence of depression in nursing home residents is greater than adults living in the community by how much 3 to 4 times The majority of depressed older adults remains untreated because of Misdiagnosis, social stigma, environmental barriers Symptoms of depression distinct in the elderly include Lack of emotions What is the most useful clinical evaluation tool to assist in the diagnosis of dementia St Louis University mental status exam (slums) The Cornerstone of pharmacotherapy and treating Alzheimer's disease is Cholinesterase inhibitors Examples of Cholinesterase Inhibitors Donepezil Rivastigmine Galantamine The comorbid psychiatric problem with the highest frequency and dementia is Anxiety When treating depression associated with dementia, which of the following would be a poor choiceAnd should not be prescribed Amitriptyline Miss James is a 78 year old and comes to the clinic for an annual checkup. The advanced practice registered nurse addresses the psychosocial needs of an older adult and specifically the needs for which of the following Dignity credibility and respect Mr sloveninsky 80 year old is unable to leave his home due to Mobility problems. Which patient factors might make the APR in consider conducting a social support assessment Making frequent appointments for consultation with the APRN 89-year-old is reporting bouts of agitation. The apron is counseling her family that these periods of agitations can be triggered by which of the following Approaches from other people The APRN is considering ordering medications to help Psychotropic medications-including antipsychotics, anxiolytics and antidepressants control an older patient's agitationWhich medication should they order An APRN is admitting a patientWho has diminished ability to ambulate and as difficulty with ADLs. When asked if he drinks alcohol he says yes the practitioner follows up with a psychosocial evaluation because His condition could be related to a long-term usage of alcohol or a new occurrence 12 / The daughter of a 7-year-old woman asked the APR and why her mother has had a change in functional ability recently.The mother has regularly been drinking for 40 years however her behavior is changingThe reply from the APRN should be Physical changes due to aging affect the body's metabolism of alcohol differently Older adults often have trouble sleeping due to age-related issues. What can the APRN suggest to help with insomnia Maximize daytime exposure to Bright Light during the day to help promote sleep What are some signs of bipolar with Mania or hypomania in a 67 year old Flight of ideas, rapid speech, grandiosity The APRN is assessing a 69-year-old man for possible bipolar. Which for the following are appropriate tests for to screen a patient for cognitive disorders related to bipolar disorder Diagnostic studies - CBC, CMP, toxicology, urinalysis, thyroid function test,Rapid plasma rhinogen, HIV, EKG Mini mental state examination St Louis University mental statu (slums) In 82-year-old is in rehab for a knee replacement. The APRN is visiting and find some confused, disoriented, and having difficulty speakingThe staff nurse says that his condition chain quickly over the last few hoursSome suggested orders would be Pulse oximetry,Evaluation for infection,Brain scan,Assessment for change in medications A 69-year-old is beginning to experience some cognitive decline. His son brings him to the practitioner for evaluation. The APRN assesses for which of the following signs or symptoms Cognitive decline is complex attention, executive function, learning, and memory Gradual onset and slow course of illness and progression Impaired ability to care for oneself Total or partial loss of ability to recognize familiar people A 75 year old is suffering from depression. He tells the API and that he is tired of feeling so low. He asked if depression is a normal part of aging.The APRN tells him the depression is which of the following Not a normal part of aging Can be related to nutritional deficiencies, especially vitamin B12 and D Triggered by one life event Compounded by learned helplessness, loss, and bereavement A 70-year-old being treated for geriatric depression. What would the APRN do for the treatment of the patient's depression Evaluate the present medication regimen Treat any comorbidity Order and SSRI Order Abilify A 90-year-old has a daytime caregiver. her daughter stays with her during the evening. The daughter suspect her mother is being abused. What should the APN inquire about Unusual bruising in areas that are not usually thought to be accident Weight loss are always being hungry in the evening Withdrawing from loved ones Physical signs include slap marks and unexplained Burns or blisters especially circular as from a cigarette An 84 year old has lost his wife 2 months ago. He goes to the APRN and complains of the same symptoms that his wifeHad before she died. Possible treatment options available to the APRN include which of the following Educate him on normal signs of grieving Time to remember his wife and discuss memories Provide emotional support Monitor current chronic medical conditions 13 / A 76-year-old comes in with a wound checked on her right leg she fell a month ago and the wound has not yet healed. She is concerned that something is wrong the APRN examines the wound and sees that it has been clean properly and has no signs of infection. The edges are approximated but the skin around the wound is red and tender to touch. The best response regarding Miss Williams wound concern is Wound healing for older people may take up to four times longer than it does for younger people The APRN is conducting patient rounds in a long-term care facility as the APRN talks with Miss Jones she notices that her arms and elbows are excoriated and the skin is shearingshe explains to the staff that Miss Jones needs frequent assessment of her skin and protection provided to prevent skin breakdown for which reason Fat has redistributed and left bony surfaces, which can result in injury And 91-year-old whose daughter notices that he has bruises and lacerations on his arms and reports to the APRNthe APRN instructs the daughter that older people bruise easily due to their fragile blood vessels. The skin lacerations happen because he has thin skin. Even so the APRN ensures the daughter that she will investigate further to ensure that he is getting proper care. Which of the following statement explains the aprns reasoning Bruises and lacerations can indicate inadequate care The APRN is assessing a patient's skin and fines an infectious lesion on the left lower leg. The lesion is considered a secondary lesion. The APRN explains that a secondary lesion is one that Secondary lesions or infections arise from changes to a primary lesion An 88 year old comes to the APRN with a complaint about a growth on her hand. She wants to have a biopsy done. Which question should they appear in ask the patient for a biopsies ordered Growths that weren't biopsy are those that have changed, blood, or are painful A 60-year-old male enters the burn center for triage and treatment due to a burn he has received at a campfire. His left arm has an area that is erythematis and painful, and another area has a blister. What is the degree of these Burns First and second degree What is a first degree burn? -Superficial burn involving the epidermis -Caused by sunburn and minor flash injuries -No edema, no blisters What is the second degree burn? epidermis and partial thickness of the dermis are involved. area is painful and blisters are present What is a third degree burn? epidermis full thickness of the dermis, and potentially deeper tissues are involved area is painless, white, and charred The APRN is concerned with primary prevention strategies. What primary prevention strategy with the APRN Implement for an 80 year old male patient who smokes Primary prevention includes educational programs designed to educate the public. The individual smoking in bedblah blah blah The aparn is conducting a safety class with Community- living older adults. Which risk of burn should they appear include for this population Thinner skin Less vascularity Diminished nerve function A weakened immune system 14 / In a puren is seeing a patient with herpes zoster rash on the right sideand face near their eyes. The areas are painful and weeping. Which of the following is true treatment of herpes zoster Acyclovir 800 mg is given five times a day for 7 days Glucocorticoids can be given as an adjunct IV antivirals are to be given to immunocompromised patients Ms Thomas is an 82-year-old and burned her hand while cooking. The APRN assess is second and third degree burns over approximately half of the back of her handthe APRN chooseswhich of the following initial treatments Rinse with cool tap water Remove any loose tissue but allow the blisters to remain A 75-year-old comes to the Urgent Care Center with complaints of fever, fast heartbeat, a swollen gland under her right arm, and redness in his upper left arm that is hurt for 2 to 3 days. The patient says that he has redness in his arm for months without any difficulty. The APRN suspects which primary and secondary conditions Cellulitis of the upper left arm Lymphangitis The treatment for cellulitis resulting from an open wound includes which of the following Oral antibiotics for mild cellulitis Dicloxacillin 500 mg four times a day as the antibiotic of choice Drug of choices typically given for 7 days Patient being treating for chemotherapy comes in and describes a couple of days of itching, burning, tingling on the left sidethe APRN advises the nursing staff to observe her vesicles for a few days. The patient ask why she is so sick. Which of the following responses from the APRN would be best We are not certain at this point. However these symptoms often occur before a break out of herpes zoster Because you had chickenpox as a child, and you now have a depressed immune system, the chance of developing herpes zoster is high Herpes zoster is more common in people 55 years and older Miss Peters and 82-year-old comes to the well Clinic to see an appear in for a bump on her ear. This growth has been there for almost a year but is recently grown. The area around the growth appears inflamed the APR and suggests a biopsy for which of these reasons The growth is elevated increasing in size The ear has high exposure to the Sun There is inflammation around the growth The patient is 82 years old The APRN is making patient rounds in a long-term care facility and is visiting a 95-year-old who has large amounts of fungus growing on his toenails. The staff nurse ask what can be done to help alleviate this nail fungus. Which of the following interventions does the APRN advise Wash and completely dry the feet and Toes daily Keep the patient's feet cool and dry Use aluminum acetate solution (Burrows solution) What is a stage 1 pressure injury? intact skin with localized area of non-blanchable erythema What is a stage 2 pressure injury partial thickness skin loss involving epidermis, dermis, or both What is a stage 3 pressure injury? Full-thickness skin loss Subcutaneous tissue and underlying fascia may be damaged or necrotic Bone, tendon, muscle NOT exposed May have undermining and tunneling What is a stage 4 pressure injury? a full-thickness skin and tissue loss, only it involves deep tissue necrosis of muscle, fascia, tendon, joint capsule, and sometimes bone What is an unstageable pressure injury involve full-thickness tissue loss but are impossible to accurately stage due to the wound bed being obscured by eschar or excessive slough 15 / What is a deep tissue injury? Localized area of discolored (purple or maroon) intact skin or blood-filled blister caused by underlying soft tissue damage resulting from pressure or shear. May be difficult to detect among individuals with dark skin tone. May include a blister over a dark wound bed; wound may become covered with eschar. What is the main contributing factor to pressure injury Pressure, Shear, adverse microclimate, and malnutrition Additionally moisture is cited as a related condition because it Alters the resiliency of the epidermis to external forces What are the main treatments for pressure injury I-infection-eliminate, reduced bioburden D-debride necrotic tissue -consider surgical, conservative, sharp, mechanical, enzymatic, biologic, autolytic I -insulate the wound P - protect the periwound tissue A - absorb excess exudate M-maintain a constant moisture level O - obliterate Dead Space P - prevent further injury Pharmacological treatment of pressure injury Most moisture retentive dressings are available without a prescription. Some antimicrobials such as silver sulfonamide and Bactroban, some antifungals fluconazole and some enzymatic debriding agents collagenase Common treatments for herpes zoster Acyclovir 800 mg 5 times a day for 7 days Patience with disseminated disease and those who are immunocompromised may need IV antivirals Glucocorticoids Capsaicin cream or Lidocaine patches Gabapentin or Lyrica Patients with involvement of the ocular should be consulted to see an ophthalmologist What are the common causes of cellulitis Beta - hemolytic streptococci,staphylococcus aureus,MSSA and MRSA, and occasional gram-negative organism What are the typical diagnostic test for cellulitis CBC,CRP,erythrocyte sediment rate, Patients with diabetes mellitus should have a radiograph of the area and an ESR to rule out the presence of osteomyelitis or necrotizing infection. Ultrasound can detect an abscess fascicular inflammation Common treatment for cellulitis clindamycin 300 to 600 mg four times daily po doxycycline 200 mg once followed by 100 mg every 12 hours bactrim 160 mg/800 mg one to two tablets twice daily linezolid 600 mg every 12 hours If wound culture is positive total duration of therapy is 7 to 14 days What is the most common mimicker of cellulitis Stasis dermatitis What is stasis dermatitis? Stasis dermatitis occurs with venous insufficiency and valvular incompetency. The proximal skin appears thin and brown, and may occur with distal macules, papules, red irritation, skin thickening and edema. Cellulitis is almost never bilateral Always unilateral 16 / Which cranial nerve should be assessed in the examination for disorders of the face Cranial nerve vii Which of the following medical specialists provides a comprehensive eye exam that can diagnose visual impairments and conditions Ophthalmologist 70 year old male visits urgent care and present symptoms of unilateral eye pain, visual blurring with halos around the eyes, red eye and photophobia. He also reports nausea and vomiting. Visual acuity shows the loss and the affected eye. He is immediately referred for a complete ophthalmic examination.Which of the following conditions may mr jones be experiencing Glaucoma Which of the following is the correct term for an eye condition that presents as a sterile mass on the eyelid that is painless and has no reddening Chalazion Oral cancer is a malignant tumor presented by a non healing sore in the mouth or lip that causes difficulty chewing or swallowing. Which of the following statements applies to an oral cancer diagnosis Unexplained lymph node swelling occurs in the neck A patient presents with complaints of not seeing well at night due to extreme glare. The patient is worried there's something very wrong. The aprn refers the patient to an ophthalmologist who states the patient has intraocular inflammation. Which of the following is a contributing factor for the symptoms and for intraocular pressure Cardiovascular disease Which eye disease has signs and symptoms of bilateral loss of central vision, seeing wavy lines, white yellow drusen spots, and difficulty driving Acute dry macular degeneration Anterior and posterior blepharitis can occur together and are chronic. Which statement best describes the cause of anterior blepharitis? Seborrheic dermatitis Evaluation for head and neck disorders should be performed with a systemic and thorough examination including inspection of the face, head, and scalp. This includes which of the following Palpating bones of the head for any anatomical irregularities Inspecting the scalp and hair for any balding problems Inspecting the patient's features for any abnormalities When looking for disorders, which of the following parts of the body should be inspected or palpated when examining the head, face, and neck? Select all that apply Sinuses Neck Temporomandibular joint Eye health education should be provided to maintain or minimize visual problems. Which of the following should be included in patients education The importance of protecting the eyes from sunlight Information on age-related visual changes Nosebleeds are generally minor and non reoccurring, but when a patient is seen for this, a consultation with an ent specialist has indicated when which of the following conditions occurs Bleeding that is not controlled after 15 minutes of compression A second episode were occurs within a week Massive bleeding 17 / Being losses a decreased ability or inability to hear. The loss may involve the external, middle, or inner ear and can be unilateral or bilateral. Which of the following ideologies may result in hearing loss Sensorineural abnormalities Conductiveissues There is no specific diagnostic test for hordeolum or chalazion Unless it becomes recurrent. Which of the following may be a differential diagnosis for these conditions orbital cellulitis Contact dermatitis Acute dacryocystitis Which of the following systemic ideologies can cause retinopathy Hypertension Macular degeneration Diabetes1/2 A patient comes into the emergency department complaining of itching, burning, scaling, and redness in their eye. Symptoms have been going on for some time and are affecting vision. The aprn diagnosis blepharitis. Which of the following should the patient be educated on regarding treatment Cleanse the eyelid once per day with diluted baby shampoo Apply a warm compress to the eye once a day Oral tetracycline should be taken as ordered What causes eyelid swelling when you pull down the lid there is redness treat conservatively or if unresolved with injectable steroids into the eye Chalazion-disorder of the eyelid Disorder of the eyelid that causes small pustule or stye at the edge of the eyelid, treat with warm compresses or antibiotics if unresolved Hordeolum Greasy scales or dandruff like on the eyelid, treat with gentle shampoo and cotton balls Blepharitis Ectropian eversion or turning outward of the eyelid entropion inward turning of the rim of the eyelid What is orbital cellulitis? Inflammation of eye tissues behind the orbital septum. It most commonly refers to an acute spread of infection into the eye socket, usually from untreated sinusitis. MC in ages 7-12 It is a medical emergency What is the treatment for orbital cellulitis HOSPITALIZE WITH IV ANTIBX, and possible surgery if recalcitrant ((nafcillin + metrondizaole OR clindamycin OR ceftriaxone) Vanco if MRSA suspected Ct scan Most likely staff or strep What is dacryoadenitis? inflammation of the lacrimal gland Bacterial conjunctivitis 18 / pterygium winglike growth of conjunctival tissue extending to the cornea What is the treatment for a corneal abrasion 1. Irrigation/foreign body removal 2. Topical Abx QID x 3-5 days (erythro, cipro, ofloxacin, sulfacetamide) 3. Lubricants hourly 4. Pain control- NO TOPICAL ANESTHESIA OR STEROIDS Can you use pressure patching but contraindicated with a foreign body What is herpes simplex keratitis a major cause of blindness from cornal scarring, usually HSV 1 subtype and usually from latent reactivation the proliferating viris is within epithelial cells and then lyses the cells What is hyphema and its S/S? Accumulation of blood, mainly RBC's that disperse and layer within the anterior chamber. A severe hymphema obscures entire anterior chamber + will diminish visual acuity severely or completely. Injuries are graded on amount of blood in chamber (Grades I-IV). S/S: - Blood in anterior chamber - Deep, aching pain - Mild to severe diminished visual acuity - Increased intraocular pressure A patient comes to the health care provider's office for a check up. Aprn notes that the patient is 67 years old and is presenting with symptoms of dizziness, orthopnea, edema.The aprn begins a focused assessment of the Cardiovascular system The appearance knows that one risk factor for cad is atherosclerosis. The APRN should provide counseling on which factors that can be remediated to help prevent cad Cholesterol levels and smoking An older adult patient presents with a systolic bp of 150 and a diastolic bp of 80. Which statement is correct regarding the blood pressure reading isolated systolic hypertension is defined as sbp greater than 160 and a dbp of less than 90 A 79 year old man who lives with his daughter. His Structural and physiological changes in the aging cardiovascular system can cause daughter provides excellent care for her father and wants decreased capacity to endure stresses and a decline in ability pertaining to physical to know which changes in his heart and circulatory system activity performance are due to aging in which to lifestyle choices The aprn sees a patient in the emergency department with reports of chest pain and nausea. To analyze the patient's condition what further information is needed A description of the pain Asking about precipitating factors, quality, radiation, severity, and timing (pqrst) The APRN in a student are examining the apical pulse of an 82 year old man. The student perceives that there is an s4 sound. This is likely An s4 sound in the absence of other findings is considered normal in older adults The np identifies a late systolic cardiac murmur in an older adult. A student nurse asks what condition this suggests. Which statement should the aprn state and their response? Papillary muscle dysfunction Mitral annular calcification Weakening valves What causes diastolic murmurs in older adults Heart blockages 19 / What is of the most common causes of mitral regurgitation Papillary muscle dysfunction Mitral annular calcification 89-year-old female presents to the emergency department ASA 162 milligrams is recommended to prevent an mi with epigastric pain that has been ongoing for about two hours and fatigue. The patient states she is not becoming Anti ischemic medications are recommended such as CCBs or sublingual nitro dyspneic the pain is radiating to her arms and neck. The np suspects ischemic heart disease and angina. Which of Blood pressure management is recommended to prevent mi after an anginal event. the following would be recommended treatments for this Blood pressure should be maintained under 140 / 90 patient to prevent a myocardial infarction What are modifiable risk factors for heart failure Inactivity is a modifiable risk factor Systolic bp of greater than 140 is a modifiable risk factor Which of the following should be considered as presenting symptoms for the older adult suffering in mi Vague ache in the sternum Stroke Dyspnea Weakness A 64 year old man has been feeling weak, lightheadedness, and slightly nauseous. He goes to the urgent care with an np initiates an assessment. Which of the following suggest an arrhythmia In age-related factor associated with tachyarrhythmias is increased left atrial size (chest x-ray showing an increased size of the left atria) Drugs that can cause an arrhythmia include digitalis and other antiarrhythmics, aminophylline, and alcohol Which of the following should be considered for management of valvular heart disease and an older adult Life expectancy Frailty risk All decisions should be made with the patient and clinician An 80-year-old man is experiencing weight gain, tachycardia, neck vein distension, and cognitive impairment. The np assesses for which of the following to support a diagnosis of heart failure Rails and bilateral lower lobes not due to atelectasis or sites Functional impairment Lateral displacement of point of maximum impulse of apical pulse What is systolic heart failure? Heart failure with reduced left ventricular ejection fraction 40% Is diastolic heart failure more common in men or women? Heart failure with preserved left ventricular ejection factor, EF 50% What are the classes of heart failure 1. NO limitation of activity 2. Slight limitation of activity 3. Marked limitation of activity but comfortable at rest 4. Symptomatic at rest What is the acc heart failure rating A-risk factors are present for heart failure without structural change, history of signs or symptoms or functional limitations B-risk factors and structural changes in the heart are present without signs or symptoms of heart failure C-risk factors, structural changes in the heart, and past or current signs or symptoms of heart failure are present. At this stage the patient is diagnosed with hf that does not regress back to former stages D-hf is refractory despite maximum medical management. Patients are symptomatic at rest or with minimal exertion 20 / Which bnp levels are suggestive of heart failure Greater than 500but is not a standalone test Mineral corticoid receptor antagonists Spirolactone-part of the gold standard of heart failure care What is recommended for heart failure patients as a combination therapy in patients who experience hypotension, hyperkalemia, angioedema, or renal insufficiency with ACE/ARB therapy Can be indicated in african American patients As is orbited and hydralazine What can cause potential harm in heart failure patients receiving ace/arb Aldosterone antagonist Which should be considered in the primary workup for hypertension Cmp, cbc, lipid panel, tsh, urinalysis, 12 lead ekg, echocardiogram and uric acid level What is postprandial hypertension A frequent cause of syncope and older adults. Defined as a drop in sbp by 20 mms within two hours of a meal, increase the risk of falls in older adults Is orthostatic hypotension Reduced barrow flex sensitivity with age and loss of arterial comp compliance, hypovolemia or polypharmacy A decrease in systolic bp of 20 mms or decrease in diastolic pressure of 10mm 's within 3 minutes of standing What is the hallmark of acute coronary syndrome A sudden imbalance between myocardial oxygen consumption and demand, which is usually the result of ca obstruction Angina in the absence of cad could be an early sign of Aortic stenosis The physical findings of mitral regurgitation S3 gallop holosystolic blowing murmur, radiates to the carotids Eccentric LVH Hypotension 67 year old female came in for an office visit presenting with symptoms of nasal congestion, itching, and sneezing and was diagnosed with rhinitis. Which of the following is true about the types of rhinitis Allergic rhinitis has an increased occurrence in those older than age 60 An 85 year old female who comes in to urgent care setting with reports of pleuritis, nasal congestion, fever, and general malaise. Influenza is diagnosed. Which comorbid issues would increase risk of severe illness and hospitalization Heart failure A patient presents to the clinic with flu like symptoms. The np knows that older adults a typically present with symptoms of influenza. Which influenza symptom is absent in patients who have received the flu vaccine Fever 21 / An older adult male comes to the clinic with worsening symptoms of dyspnea, cough, and sputum production. Spirometry is performed in fev slash fvc is less than .07 and fev1 is less than 80% predicted. According to the gold criteria in which stage of copd is this patient diagnosed Moderate copd is diagnosed with an fev fvc less than .07andand fev one less than 80 What is mild copd FEV1 80% What is severe copd FEV1 30-49% What is very severe COPD? FEV1 30% 80 year old male was diagnosed with copd about 10 years ago and the symptoms are getting progressively worse. The patient is on a combination bronchodilation therapy with a saba and LABA he needs better symptom management. What would be the best addition to the medication regimen to control his symptoms Inhaled glucocorticoid Interact one step one of asthma treatment which type of medication is preferred as a controller and a reliever to reduce the risk of exacerbations As needed ICS/SABA Which of the following disorders has symptoms of acute onset of chest discomfort, dyspnea, dizziness, palpitations, and anxiety Pulmonary embolism Which of the following medications can cause drug induced pulmonary parenchyma disease Hydralazine Amiodarone, nitrofurantoin and closing, gold chemotherapeutic agents, and procainamide can cause pulmonary parenchymal disease 72 year old woman comes to the clinic with concerned about her breathing. She states she is having trouble with mucus collection and difficulty coughing it out. The np response with which of the following explanations As you get older the tissue in your lungs is not as flexible to aid in exhalation The body contains less water as you age and the mucus begins to dry out The np is seeing patients in the respiratory clinic. In 85 year old woman comes in with concerns about difficulty breathing. When considering asthma, that np asks which of the following questions Do you feel out of breath during the day Do you have a cough, especially at night Do you feel a tightness in your chest May I listen for wheezing in your breathing You would not ask about dyspnea because older adults are less likely to sense dyspnea related to airway obstruction The aprn is preparing discharge instructions for 79 year old man with newly diagnosed asthma. Which instructions are important to include Experiencing strong emotions like anger can trigger an asthma episode Infections can lead to an occurrence of asthma Symptoms of asthma may include a runny nose or post nasal drip 22 / The np is providing education and implementation of a plan of care for an older patient with asthma. Following current recommendations, what should be included in the plan of care Patient, family, and professional education so as to create a partnership in asthma management Control of comorbidities Monitoring of appropriate use of medications A 69 year old female seeks medical advice because she is having trouble breathing. She is experiencing dyspnea, chronic cough with sputum production, decreased activity intolerance, and wheezing. She states that she has not been near anyone within a uri and wonders why this is happening Have you ever worked in a factory or foundry How long have you experienced these symptoms Do you have any past history of respiratory difficulties Have your symptoms increased as you've gotten older the most common diagnostic test for ar in the skin testing, Skin prick testing is a next step but intradermal testing may be needed if results are which involves scratching the surface of the skin with a negative single stylus for each allergen. Which of the following are possible if further testing is needed Imaging, such as ct scan, can be performed to help with diagnosis An older adult comes to the emergency department with hemoptysis, night sweats, fatigue and dyspnea. He states that he has never received treatment or been diagnosed with tb. What factors put this older adult at risk for development of active pulmonary tb Substance abuse Prolonged corticosteroids silicosis Heart failure And the assessment for pvd the clinician should begin with which of the following after the general history and physical examination Auscultation of the carotid arteries bilaterally Which of the following conditions is signaled by symptoms of swelling of the affected body part, usually the limb, because of impaired flow of lymph fluid Chronic lymphadenopathy Which of the following is the best screening test for diagnosis of a aaa Ultrasound of the abdominal aorta Was diagnosed with a symptomatic aaa. The initial treatment is aggressive blood pressure control at which of the following readings should mean arterial pressure be maintained Between 60 and 70 Which medical specialist is the best referral for patients with symptomatic aaa Vascular surgeon Pvd is a disease that alters blood flow to and from the extremities and vital organs other than the heart. According to studies which of the following remains the most important risk factor for pvp Smoking Which of the following differential diagnosis should be considered with the diagnosis of pad Raynaud's phenomenon Patient education is very important for individuals with pid what educating about conservative management, which of the following are true regarding pad Controlling blood pressure Managing diabetes Smoking cessation is the most important thing to do Exercise and is an essential element of management 23 / Aaa is mostly atherosclerotic in nature but can also be caused by trauma, infection, and inflammation. Which of the following is a true statement regarding the tendency to develop aaa White people have a higher risk of developing There is a familial history associated Aaa is the 13th leading cause of death in the united states In treating aaa, arterial monitoring is recommended. Which of the following iv antihypertensive agents should be used to rapidly and consistently maintain blood pressure in the mean arterial pressure ranges Nitroglycerin Esmolol Nicardipine Lymphedema is characterized by swelling of the extremity. Which of the following symptoms is also presented with lymphedema Aching in the affected area Restricted range of motion Cellulitis How would you diagnose acute arterial ischemia Pain, pulselessness, paresthesia, pallor, paralysis Patient visits the npp because of a dull ache in her legs, Elevation as much as possible during the day edema that is worse at night, painful varicose veins, and skin changes.The np diagnosis her with venous disease Compression stockings which of the following would be appropriate management Trental 400 milligrams three times per day Topical steroid cream A 70 year old patient with venous ulcers to her right lower Obesity extremity due to venous disease. She has a history of multiple pregnancies and surgeries that have had her in a Reduce mobility sedentary lifestyle. Which of the following would be possible contributing factors to her diagnosis