South University 1
NSG6420
NSG 6420 Midterm Exam Study Guide
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 :
, South University 2
NSG6420
The cytochrome p system involves enzymes that are generally:
Inhibited by drugs
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 self-
report 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
, South University 3
NSG6420
Total iron binding capacity and transferrin saturation
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)
, South University 4
NSG6420
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
NSG6420
NSG 6420 Midterm Exam Study Guide
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 :
, South University 2
NSG6420
The cytochrome p system involves enzymes that are generally:
Inhibited by drugs
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 self-
report 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
, South University 3
NSG6420
Total iron binding capacity and transferrin saturation
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)
, South University 4
NSG6420
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
