NR 601 Final Exam Study Guide
Elderly high risk for delirium- sensory decline, polypharmacy, comorbidities
Essential tremor- occurs with purposeful movements
Comorbid with dementia- depression
Terazosin (Alpha blocker) tx- BPH and HTN
End of life medications- opioids for dyspnea
Mini-cog- score 0-2 is positive for dementia
Common cause of seizures- stroke
Hospice and palliative underused- all (not well understood, denial, confusion)
82 y/o dribbling /difficulty starting stream /differentials- BPH, prostate CX, parkinson’s (all)
Alzheimer’s treatment- cholinesterase inhibitors
Type 2 DM screening- 2 hour OGTT, HA1C, fasting plasma glucose
Mrs. R BMI 26, fasting 102 and 108- order another fasting glucose
NOT true about anxiety- a normal part of aging
Annual check for diabetic patient- eye exam with ophthalmologist
Most likely cause of delirium- acute infection
DM leading cause of- kidney failure
48 y/o male screened for DM 120- educate about lifestyle changes to lower blood glucose
Brief onset of right sided weakness, slurring, confusion, CT normal- identify modifiable CV RFs
New medication metformin, loose stools- reassure patient anticipated side effect
Elderly with tremors identify Parkinson’s- resting tremor, slow unsteady gait, cogwheel rigidity
Patient w/o risk of adverse effect from metformin- patient with BMI > 30
68 y/o woman stress incontinence, leukocyte esterase +, nitrates +, 15 WBCs- no tx necessary
66 y/o woman, BMI 28, HTN, fasting 126 last year, repeat 115, 201 random- prescribe metformin
Adjuvant analgesics- neuropathic pain patients
Increased r/f for ED- obesity, CAD, DM (all)
60 y/o TC= 250, HDL= 32, LDL= 165- modifiable---diabetes, obesity, and ^ LDL
Woman w/complicated cystitis & s/s of upper tract disease needs culture- and sensitivity test
Noted in patients with parkinson’s- micrographia and bradykinesia
Medication that blunts s/s of hypoglycemia- beta blockers
depression + dementia poor choice for medication, DON’T prescribe- Amitriptyline
Role of APRN in palliative cancer care- detecting, identifying, managing, arranging (all)
Characteristic of delirium distinguished from dementia- acute onset
58 y/o caucasian man, DM II, metformin, HA1C 7%, BP 142/96- furosemide
Most patients in hospice care die- at home
Dementia- sundowning- becomes worse towards the evening
Medication to treat pain and dyspnea in a dying patient- morphine
Male patient BMI 33, s/s of DM, how do you screen- OGTT, fasting, HA1c (all)
Atrophic vaginitis- contributing factor for frequent UTIs
,Number 1 r/f for urinary incontinence is - aging
Hospice differs from palliative- supports family/patients in dying and in bereavement process
Woman’s anatomy susceptible to UTI- shorter urethra
Screening tool for delirium- confusion assessment method
Which is true regarding pain- pain is subjective
Jean 44 y/o 5 days S/S, 2nd occurrence since 3 months ago - UA, culture and sensitivity, ABX
Barrier to sexual eval in older adult- ageist attitudes
75 y/o with metastatic prostate c, how to manage outpatient- none are appropriate management
Which DX considered in patient with ED- depression, atherosclerosis, DM (all)
52 y/o microscopic hematuria differentials include- renal stenosis
Contraindicated maneuver in patient with acute prostatitis- massaging the infected prostate
50 y/o dx with acute prostatitis, afebrile, w/o pain, tx with ABX- 10 days
68 y/o woman, urine leak with sneezing- stress incontinence
DM leading cause of - kidney failure
Not true in palliative care teams- provide weekly home visits
56 y/o fasting glucose 96- repeat in THREE years
R sided weakness, slurred speech, confusion- evaluate for stroke and transport to hospital
Most elderly patients die in institutions
Age-related change in bladder, urethra, & ureters in older women- except- increased estrogen production
Male, BMI 33, fatigue, excess hunger & thirst, CMP, HA1C 5.7- prediabetes
Elder abuse signs is NOT- decreased anxiety and depression
52 y/o female fasting glucose 123- repeat fasting plasma in ONE year
Tasks of grieving include all EXCEPT- begin to disengage
Mrs G experiences UI despite lifestyle changes- second tx- antimuscarinic medication
BPH patient on finasteride (proscar) assess for side effects- urinary incontinence
Delirium characterized by EXCEPT- hyperactive level of psychomotor activity
Appropriate treatment of mild BPH- prescribe tamsulosin
1st step in treating delirium- identify the cause
Drug combo in opiate naive patient with moderate pain- acetaminophen/ hydrocodone
Urinary incontinence is- unintentional voiding, loss or leakage of urine
Dementia patients who have agnosia- agnosia is inability to- recognize objects
80 y/o patient with multiple comorbidities not appropriate for hospice- prognosis is > 6 months
Palliative care may be provided for patients- regardless of life expectancy
Male, 30 BMI, fasting 130- repeat fasting glucose test
Middle-aged with new parkinson’s diagnosis, NP starts meds why?- S/S inferring with functional ability
65 y/o hispanic, female, DM2, annual labs include- microalbumin
Acanthosis nigricans is associated with- tinea versicolor
55 y/o caucasian, male, HA1c 7%, takes metformin BID, 142/96 BP- chlorthalidone
Stage 2 HTN is defined as- >140/ >90
Obstructive lung disease that is reversible asthma
54 y/o woman, insomnia chronic, 2nd treatment- zolpidem 5 mg QHS #7 NRF
,“Heart flipping in her chest”- arrhythmia cornerstone- EKG, physical exam, Hx (all)
66y/o female, asian, smokes 2packs daily, 2 beers daily, DEXA -2.5- Osteroporosis
58 y/o increased SOB, CXR for CHF diagnosis- kerley BS, cephalization
65 y/o caucasian current beta blocker, what stage CHF- stabe B
78 y/o female, restless with poor appetite, 1st line for depression- sertraline (SSRI)
54 y/o AA woman, BMI 23, BP 116/76, 120/78- no treatment, normal
Correct management of benzos- should not be stopped abruptly if taking for > 1 month
50 y/o man low energy, lack of joy, decreased appetite- SIG-E-CAPS- E= energy
Inflammatory pain do not treat with- Opioids
Recommended BP goal for 55 y/o man with hx CKD- <130/80
GOLD criteria normal FEV1/FVC ratio- > 70%
Osteoarthritis patients have distinguished gait- antalgic
RA deformities- swan neck deformities
CXR in COPD- flattened diaphragm PA film, enlarged retrosternal space
57 y.o native american, female, 1st line treatment- clonazepam
65 y/o caucasian, female, smokes and drinks, modifiable r/f for osteoporosis- medications ? (tobacco
use)
Insomnia can be caused by medications except- guaifenesin
Patients with S/S with marked exertion- stage 2
COPD patient NOT at higher risk for- diabetes
Nervous system pain- neuropathic
Stage 1 or stage 2 CKD with albuminuria should be started on- ACE inhibitor … to low progression
, NR 601 Final Exam Study Guide And Practice Questions
How to conduct Mini-Cog-
The Mini-Cog has been demonstrated to have comparable psychometric properties to the MMSE
The primary advantage of the Mini-Cog is that it is shorter than the MMSE and measures executive function.
It is composed of a three-item recall and the Clock Drawing Test (CDT) and takes about 3 minutes to administer
The Mini-Cog is a short dementia assessment that combines three-word recall with clock-drawing capability.
Patients are given a total score reflecting accuracy in clock drawing and recollection of the given three words.
A score of 0 to 2 is a positive screen for dementia
Causes of delirium in elderly-
Causes of delirium are numerous and in elderly hospitalized patients there are often multiple etiologies, including
metabolic, infection, cardiac, neurological, pulmonary, sensory impairments, medications, and toxins.
Regardless of cause, a consistent finding is significant reduction in regional cerebral perfusion during periods of
delirium in comparison with blood flow patterns after recovery.
A possible neurological common pathway may involve acetylcholine and dopamine, and the disruption in the
sleep-wake cycle in delirium indicates melatonin as a possible factor. (Kennedy-Malone 59)
Agnosia
Loss of ability to identify objects
ADA criteria for diagnosing DM-
FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.*
2-h PG ≥200 mg/dL (11.1 mmol/L) during OGTT. The test should be performed as described by the WHO, using
a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water.*
A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified
and standardized to the DCCT assay.*
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200
mg/dL (11.1 mmol/L).
• Urinary incontinence-
Involuntary loss of urine from the bladder
▪ So common in women many consider it normal
▪ Common in older men w/ enlarged prostate
o Can affect quality of life
o Significance-One of the most common complains w/ older adults, Distress & embarrassment, Cost burden to pt&
society as a whole, Not life-threatening, may effect QOL, PCP essential to educating individuals
o Epidemiology- Increased prevalence w/ age in men & women, Nursing home population – 40-70%, Often a factor in
placement
▪ URGENCY UI is greater in men
▪ STRESS UI is greater in women
o Terminology
▪ UI- Unintentional voiding, loss or leakage of urine
▪ Continuous incontinence-Continuous loss or leak of urine
▪ Increased daytime frequency-More frequent during day than considered normal
▪ Nocturia-Interruption of sleep one or more times due to the need to urinate – increases in frequency after age 50
▪ Urgency-Sudden, compelling desire to pass urine that’s difficult to prevent
▪ Overactive bladder syndrome- Urgency, frequency, nocturia w/ or w/o incontinence
o Risk Factors-Aging,Obesity,Smoking, Caffeine,Uncontrolled DM, Constipation,Use of diuretics
o Risk Factors by gender-Women:Aging, obesity, smoking, caffeine intake, DM, pregnancy, multiparity, estrogen
deficiency, hx of pelvic surgery, diuretics
Men:Aging, obesity, smoking, caffeine, DM, prostate dx, hx of prostate surgery, hx of UTIs, diuretics
o Physical changes w/ aging that contribute to UI
▪ Lower urinary tract-Detrusor muscle over activity,Decrease in detrusor contractility, Increase in post void
residual,Decrease in urethral blood flow
1
Elderly high risk for delirium- sensory decline, polypharmacy, comorbidities
Essential tremor- occurs with purposeful movements
Comorbid with dementia- depression
Terazosin (Alpha blocker) tx- BPH and HTN
End of life medications- opioids for dyspnea
Mini-cog- score 0-2 is positive for dementia
Common cause of seizures- stroke
Hospice and palliative underused- all (not well understood, denial, confusion)
82 y/o dribbling /difficulty starting stream /differentials- BPH, prostate CX, parkinson’s (all)
Alzheimer’s treatment- cholinesterase inhibitors
Type 2 DM screening- 2 hour OGTT, HA1C, fasting plasma glucose
Mrs. R BMI 26, fasting 102 and 108- order another fasting glucose
NOT true about anxiety- a normal part of aging
Annual check for diabetic patient- eye exam with ophthalmologist
Most likely cause of delirium- acute infection
DM leading cause of- kidney failure
48 y/o male screened for DM 120- educate about lifestyle changes to lower blood glucose
Brief onset of right sided weakness, slurring, confusion, CT normal- identify modifiable CV RFs
New medication metformin, loose stools- reassure patient anticipated side effect
Elderly with tremors identify Parkinson’s- resting tremor, slow unsteady gait, cogwheel rigidity
Patient w/o risk of adverse effect from metformin- patient with BMI > 30
68 y/o woman stress incontinence, leukocyte esterase +, nitrates +, 15 WBCs- no tx necessary
66 y/o woman, BMI 28, HTN, fasting 126 last year, repeat 115, 201 random- prescribe metformin
Adjuvant analgesics- neuropathic pain patients
Increased r/f for ED- obesity, CAD, DM (all)
60 y/o TC= 250, HDL= 32, LDL= 165- modifiable---diabetes, obesity, and ^ LDL
Woman w/complicated cystitis & s/s of upper tract disease needs culture- and sensitivity test
Noted in patients with parkinson’s- micrographia and bradykinesia
Medication that blunts s/s of hypoglycemia- beta blockers
depression + dementia poor choice for medication, DON’T prescribe- Amitriptyline
Role of APRN in palliative cancer care- detecting, identifying, managing, arranging (all)
Characteristic of delirium distinguished from dementia- acute onset
58 y/o caucasian man, DM II, metformin, HA1C 7%, BP 142/96- furosemide
Most patients in hospice care die- at home
Dementia- sundowning- becomes worse towards the evening
Medication to treat pain and dyspnea in a dying patient- morphine
Male patient BMI 33, s/s of DM, how do you screen- OGTT, fasting, HA1c (all)
Atrophic vaginitis- contributing factor for frequent UTIs
,Number 1 r/f for urinary incontinence is - aging
Hospice differs from palliative- supports family/patients in dying and in bereavement process
Woman’s anatomy susceptible to UTI- shorter urethra
Screening tool for delirium- confusion assessment method
Which is true regarding pain- pain is subjective
Jean 44 y/o 5 days S/S, 2nd occurrence since 3 months ago - UA, culture and sensitivity, ABX
Barrier to sexual eval in older adult- ageist attitudes
75 y/o with metastatic prostate c, how to manage outpatient- none are appropriate management
Which DX considered in patient with ED- depression, atherosclerosis, DM (all)
52 y/o microscopic hematuria differentials include- renal stenosis
Contraindicated maneuver in patient with acute prostatitis- massaging the infected prostate
50 y/o dx with acute prostatitis, afebrile, w/o pain, tx with ABX- 10 days
68 y/o woman, urine leak with sneezing- stress incontinence
DM leading cause of - kidney failure
Not true in palliative care teams- provide weekly home visits
56 y/o fasting glucose 96- repeat in THREE years
R sided weakness, slurred speech, confusion- evaluate for stroke and transport to hospital
Most elderly patients die in institutions
Age-related change in bladder, urethra, & ureters in older women- except- increased estrogen production
Male, BMI 33, fatigue, excess hunger & thirst, CMP, HA1C 5.7- prediabetes
Elder abuse signs is NOT- decreased anxiety and depression
52 y/o female fasting glucose 123- repeat fasting plasma in ONE year
Tasks of grieving include all EXCEPT- begin to disengage
Mrs G experiences UI despite lifestyle changes- second tx- antimuscarinic medication
BPH patient on finasteride (proscar) assess for side effects- urinary incontinence
Delirium characterized by EXCEPT- hyperactive level of psychomotor activity
Appropriate treatment of mild BPH- prescribe tamsulosin
1st step in treating delirium- identify the cause
Drug combo in opiate naive patient with moderate pain- acetaminophen/ hydrocodone
Urinary incontinence is- unintentional voiding, loss or leakage of urine
Dementia patients who have agnosia- agnosia is inability to- recognize objects
80 y/o patient with multiple comorbidities not appropriate for hospice- prognosis is > 6 months
Palliative care may be provided for patients- regardless of life expectancy
Male, 30 BMI, fasting 130- repeat fasting glucose test
Middle-aged with new parkinson’s diagnosis, NP starts meds why?- S/S inferring with functional ability
65 y/o hispanic, female, DM2, annual labs include- microalbumin
Acanthosis nigricans is associated with- tinea versicolor
55 y/o caucasian, male, HA1c 7%, takes metformin BID, 142/96 BP- chlorthalidone
Stage 2 HTN is defined as- >140/ >90
Obstructive lung disease that is reversible asthma
54 y/o woman, insomnia chronic, 2nd treatment- zolpidem 5 mg QHS #7 NRF
,“Heart flipping in her chest”- arrhythmia cornerstone- EKG, physical exam, Hx (all)
66y/o female, asian, smokes 2packs daily, 2 beers daily, DEXA -2.5- Osteroporosis
58 y/o increased SOB, CXR for CHF diagnosis- kerley BS, cephalization
65 y/o caucasian current beta blocker, what stage CHF- stabe B
78 y/o female, restless with poor appetite, 1st line for depression- sertraline (SSRI)
54 y/o AA woman, BMI 23, BP 116/76, 120/78- no treatment, normal
Correct management of benzos- should not be stopped abruptly if taking for > 1 month
50 y/o man low energy, lack of joy, decreased appetite- SIG-E-CAPS- E= energy
Inflammatory pain do not treat with- Opioids
Recommended BP goal for 55 y/o man with hx CKD- <130/80
GOLD criteria normal FEV1/FVC ratio- > 70%
Osteoarthritis patients have distinguished gait- antalgic
RA deformities- swan neck deformities
CXR in COPD- flattened diaphragm PA film, enlarged retrosternal space
57 y.o native american, female, 1st line treatment- clonazepam
65 y/o caucasian, female, smokes and drinks, modifiable r/f for osteoporosis- medications ? (tobacco
use)
Insomnia can be caused by medications except- guaifenesin
Patients with S/S with marked exertion- stage 2
COPD patient NOT at higher risk for- diabetes
Nervous system pain- neuropathic
Stage 1 or stage 2 CKD with albuminuria should be started on- ACE inhibitor … to low progression
, NR 601 Final Exam Study Guide And Practice Questions
How to conduct Mini-Cog-
The Mini-Cog has been demonstrated to have comparable psychometric properties to the MMSE
The primary advantage of the Mini-Cog is that it is shorter than the MMSE and measures executive function.
It is composed of a three-item recall and the Clock Drawing Test (CDT) and takes about 3 minutes to administer
The Mini-Cog is a short dementia assessment that combines three-word recall with clock-drawing capability.
Patients are given a total score reflecting accuracy in clock drawing and recollection of the given three words.
A score of 0 to 2 is a positive screen for dementia
Causes of delirium in elderly-
Causes of delirium are numerous and in elderly hospitalized patients there are often multiple etiologies, including
metabolic, infection, cardiac, neurological, pulmonary, sensory impairments, medications, and toxins.
Regardless of cause, a consistent finding is significant reduction in regional cerebral perfusion during periods of
delirium in comparison with blood flow patterns after recovery.
A possible neurological common pathway may involve acetylcholine and dopamine, and the disruption in the
sleep-wake cycle in delirium indicates melatonin as a possible factor. (Kennedy-Malone 59)
Agnosia
Loss of ability to identify objects
ADA criteria for diagnosing DM-
FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.*
2-h PG ≥200 mg/dL (11.1 mmol/L) during OGTT. The test should be performed as described by the WHO, using
a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water.*
A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified
and standardized to the DCCT assay.*
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200
mg/dL (11.1 mmol/L).
• Urinary incontinence-
Involuntary loss of urine from the bladder
▪ So common in women many consider it normal
▪ Common in older men w/ enlarged prostate
o Can affect quality of life
o Significance-One of the most common complains w/ older adults, Distress & embarrassment, Cost burden to pt&
society as a whole, Not life-threatening, may effect QOL, PCP essential to educating individuals
o Epidemiology- Increased prevalence w/ age in men & women, Nursing home population – 40-70%, Often a factor in
placement
▪ URGENCY UI is greater in men
▪ STRESS UI is greater in women
o Terminology
▪ UI- Unintentional voiding, loss or leakage of urine
▪ Continuous incontinence-Continuous loss or leak of urine
▪ Increased daytime frequency-More frequent during day than considered normal
▪ Nocturia-Interruption of sleep one or more times due to the need to urinate – increases in frequency after age 50
▪ Urgency-Sudden, compelling desire to pass urine that’s difficult to prevent
▪ Overactive bladder syndrome- Urgency, frequency, nocturia w/ or w/o incontinence
o Risk Factors-Aging,Obesity,Smoking, Caffeine,Uncontrolled DM, Constipation,Use of diuretics
o Risk Factors by gender-Women:Aging, obesity, smoking, caffeine intake, DM, pregnancy, multiparity, estrogen
deficiency, hx of pelvic surgery, diuretics
Men:Aging, obesity, smoking, caffeine, DM, prostate dx, hx of prostate surgery, hx of UTIs, diuretics
o Physical changes w/ aging that contribute to UI
▪ Lower urinary tract-Detrusor muscle over activity,Decrease in detrusor contractility, Increase in post void
residual,Decrease in urethral blood flow
1
