NR 601 Midterm Exam Study Guide
file:///C:/Users/Stephanie/Downloads/Advanced%20Practice%20Nursing%20in%20the%20Care%20of
%20Older%20Adults%202nd%20edition%20pdf_compressed%20(1).pdf
Weeks 1-4
content Week
Topics
1 Developmental changes
o Review Kennedy and Dunphy readings for age related changes
o Physiological the major impact that occurs with physiological changes are –
all of the above
the strongest evidence regarding normal physiological ageing is availiable through longitudinal studies
5-5 Beginning at about age 55, most people can expect which of the following changes? A. A 1- to 2-in.
decline in height B. Stable body weight C. Sharper vision and hearing D. Increased strength
5-31 Which of these musculoskeletal changes accompany older adulthood? A. Change in stature B.
Increased stride length
5-35 Which one of the following is a normal physiological change of aging? A. A decrease in strength
and speed of muscle contraction in the extremities B. Degenerative arthritis C. Rheumatoid arthritis D.
Bulging intervertebral disks
5-37 Evaluating an older adult client according to the successful aging paradigm involves assessment of
A. cognition, problem-solving, physical skills, and memory. B. health, social engagement, mental activity,
and life satisfaction. C. vision, hearing, balance, and strength. D. coping, social support, fi nancial
resources, and living arrangement.
5-49 The benefi ts of exercise during middle adulthood include which of the following? A. Less need
for an increase in dietary calcium B. Slower decli ne in central nervous system processing
,5-50 When completing the health history and review of systems for a healthy 88-year-old woman,
you would expect which age-related change to be reported? A. Mildly blurry vision B. Chronically dry
and itchy eyes and eyelids C. Increasing presbyopia
5-61 Which cognitive change is expected in healthy older adults aged 65 and older? A. Decrease in IQ B.
Slower information processing C. Low capacity for learning D. Decreased attentional focus
5-57 Sleep in older adults is characterized by which pattern? A. Increased time spent in REM sleep B.
Increased overall sleep time C. Increased sleep latency D. Increased proportion of deep sleep
5-67 Risks for automobile accidents are increased in older adult drivers due to which normal changes
associated with aging? A. Decreased ability to understand driving-related dangers B. Lack of recognition
of their own physical challenges C. Magnifi ed physiological response to stressful situations D. Increased
reaction time
5-85 Older adults face greater risks for fl uid imbalance than young adults and middle adults due to
which age-related factor? A. Increased amounts of intracellular fl uid and total body water B.
Higher proportion of fat to muscle cells C. Faster speed of metabolism D. Increased intestinal
motility
5-86 Which strategy for care of older adults is inconsistent with an approach supportive of aging in
place? A. Make changes to the home environment that can accommodate an individual’s changing
needs. B. Refer for home care and adult day-care services. C. Hire assistants to help with activities
of daily living. D. Emphasize the individual’s limitations and likely need for long-term care
placement.
5-96 Which theory of aging focuses on older adults’ development of specifi c strategies to manage
losses of function over time? A. Disengagement theory B. Activity/developmental task theory C. Person-
environment fi t theory D. Selective optimization with compensation theory
5-107 Why is Alzheimer’s disease (AD) considered a specifi c disease, distinct from the normal . changes
of aging? A. There are types of AD that are inherited and present before age 60. B. There are changes in
biological processes that occur with normal aging. C. There is a notable decline in cognitive functioning
as people age. D. There are multiple changes in organ functioning, especially in the brain.
5-115 Physiological changes of aging can affect functional mobility. Screening for functional mobility of
older adults involves which screening tool? A. Katz Index B. Get Up and Go Test C. Functional
Independence Measure D. Mini Mental State Exam
5-112 Your 66-year-old patient is able to correctly interpret the meaning of the proverb “A penny saved
is a penny earned.” This helps to establish the patient’s expected ability to A. access long-term memory.
B. engage in abstract reasoning. C. execute concrete operations. D. follow complex instructions.
13-68 In the older adult, which physiological change affects pharmacokinetics? A. Decreased creatinine
clearance B. Increased lean muscle mass C. Decreased total body fat D. Increased serum albumin level
18-98 Physiological changes in the immune system of older adults include A. an increase in
immunoglobulin A and G antibodies. B. a high rate of T-lymphocyte proliferation. C. an increase in the
number of cytotoxic T cells. D. an increase in CD8, which affects regulation of the immune system.
, 61 The aging process results in a variety of physiological changes. One change is A. a decreased
absorption of fat-soluble vitamins. B. an increase in pupil size. C. an increase of enzymatic activity. D. an
increase in spleen size.
A- the heart valve
o Lab results- Dunphy Table 77.2
TABLE 77.2 Changes in Laboratory Values for Older Adults
Laboratory Test Normal Values Changes With Age Comments
URINALYSIS
Protein 0–5 mg/100 mL Rises slightly May be due to kidney changes wi
pathology
Specific gravity 1.005–1.020 Lower maximum in Decline in nephrons impairs abili
elderly 1.016–1.022
HEMATOLOGY
Erythrocyte Men: 0–20 Significant increase Neither sensitive nor specific in a
sedimentation rate Women: 0–30
Iron binding 50–160 mcg/dL Slight decrease
230–410 mcg/dL Decrease
Hemoglobin Men: 13–18 g/100 mL Men: 10–17 g/mL Anemia common in the elderly
Women: 12–16 g/100 Women: none noted
mL
Hematocrit Men: 45%–52% Slight decrease Decline in hematopoiesis
Women: 37%–48% speculated
Leukocytes 4,300–10,800/mm3 Drop to 3,100– Decrease may be due to drugs or
9,000/mm3 immediately to age
Lymphocytes 500–2,400 T T-cell and B-cell levels Infection risk higher; immunizati
cells/mm3 fall
50–200 B cells/mm3
Platelets 150,000–350,000/mm3 No change in number
BLOOD CHEMISTRY
Albumin 3.5–5.0/100 mL Decline Related to decrease in liver size a
malnutrition common
Globulin 2.3–3.5 g/100 mL Slight increase
, Total serum protein 6.0–8.4 g/100 mL No change Decreases may indicate malnutrit
Blood urea nitrogen Men: 10–25 mg/100 Increases significantly Decline in glomerular filtration ra
mL up to 69 mg/100 mL
Women: 8–20 mg/100
mL
Creatinine 0.6–1.5 mg/100 mL Increases to 1.9 Related to lean body mass decrea
mg/100 mL seen
Creatinine clearance 104–124 mL/min Decreases 10%/decade Used for prescribing medications
after age 40 years
Glucose tolerance 62–110 mg/dL after Slight increase of 10 Diabetes increasingly prevalent; d
fasting; >120 mg/dL mg/dL/decade after 30
after 2 hours years of age
postprandial
Alkaline phosphatase 13–39 IU/L Increase by 8–10 IU/L Elevations >20% usually due to d
bone abnormalities, drugs (e.g., n
all of the following are true about lab results except : abnormal findings are usually due to physiological
aging.
o Atypical disease presentations
1. Acute abdomen
Absence of symptoms or vague symptoms, acute confusion, mild discomfort and constipation,
some tachypnea and possibly vague respiratory symptoms, appendicitis pain may begin in right
lower quadrant and become diffuse
2. Depression
Anorexia, vague abdominal complaints, new onset of constipation, insomnia
hyperactivity, lack of sadness
3. Hyperthyroidism
Hyperthyroidism presenting as “apathetic thyrotoxicosis,” i.e., fatigue and weakness; weight
loss may result instead of weight gain; patients report palpitations, tachycardia, new onset of
atrial fibrillation, and heart failure may occur with undiagnosed hyperthyroidism
4. Hypothyroidism
Hypothyroidism often presents with confusion and agitation; new onset of anorexia, weight
loss, and arthralgias may occur
5. Malignancy
file:///C:/Users/Stephanie/Downloads/Advanced%20Practice%20Nursing%20in%20the%20Care%20of
%20Older%20Adults%202nd%20edition%20pdf_compressed%20(1).pdf
Weeks 1-4
content Week
Topics
1 Developmental changes
o Review Kennedy and Dunphy readings for age related changes
o Physiological the major impact that occurs with physiological changes are –
all of the above
the strongest evidence regarding normal physiological ageing is availiable through longitudinal studies
5-5 Beginning at about age 55, most people can expect which of the following changes? A. A 1- to 2-in.
decline in height B. Stable body weight C. Sharper vision and hearing D. Increased strength
5-31 Which of these musculoskeletal changes accompany older adulthood? A. Change in stature B.
Increased stride length
5-35 Which one of the following is a normal physiological change of aging? A. A decrease in strength
and speed of muscle contraction in the extremities B. Degenerative arthritis C. Rheumatoid arthritis D.
Bulging intervertebral disks
5-37 Evaluating an older adult client according to the successful aging paradigm involves assessment of
A. cognition, problem-solving, physical skills, and memory. B. health, social engagement, mental activity,
and life satisfaction. C. vision, hearing, balance, and strength. D. coping, social support, fi nancial
resources, and living arrangement.
5-49 The benefi ts of exercise during middle adulthood include which of the following? A. Less need
for an increase in dietary calcium B. Slower decli ne in central nervous system processing
,5-50 When completing the health history and review of systems for a healthy 88-year-old woman,
you would expect which age-related change to be reported? A. Mildly blurry vision B. Chronically dry
and itchy eyes and eyelids C. Increasing presbyopia
5-61 Which cognitive change is expected in healthy older adults aged 65 and older? A. Decrease in IQ B.
Slower information processing C. Low capacity for learning D. Decreased attentional focus
5-57 Sleep in older adults is characterized by which pattern? A. Increased time spent in REM sleep B.
Increased overall sleep time C. Increased sleep latency D. Increased proportion of deep sleep
5-67 Risks for automobile accidents are increased in older adult drivers due to which normal changes
associated with aging? A. Decreased ability to understand driving-related dangers B. Lack of recognition
of their own physical challenges C. Magnifi ed physiological response to stressful situations D. Increased
reaction time
5-85 Older adults face greater risks for fl uid imbalance than young adults and middle adults due to
which age-related factor? A. Increased amounts of intracellular fl uid and total body water B.
Higher proportion of fat to muscle cells C. Faster speed of metabolism D. Increased intestinal
motility
5-86 Which strategy for care of older adults is inconsistent with an approach supportive of aging in
place? A. Make changes to the home environment that can accommodate an individual’s changing
needs. B. Refer for home care and adult day-care services. C. Hire assistants to help with activities
of daily living. D. Emphasize the individual’s limitations and likely need for long-term care
placement.
5-96 Which theory of aging focuses on older adults’ development of specifi c strategies to manage
losses of function over time? A. Disengagement theory B. Activity/developmental task theory C. Person-
environment fi t theory D. Selective optimization with compensation theory
5-107 Why is Alzheimer’s disease (AD) considered a specifi c disease, distinct from the normal . changes
of aging? A. There are types of AD that are inherited and present before age 60. B. There are changes in
biological processes that occur with normal aging. C. There is a notable decline in cognitive functioning
as people age. D. There are multiple changes in organ functioning, especially in the brain.
5-115 Physiological changes of aging can affect functional mobility. Screening for functional mobility of
older adults involves which screening tool? A. Katz Index B. Get Up and Go Test C. Functional
Independence Measure D. Mini Mental State Exam
5-112 Your 66-year-old patient is able to correctly interpret the meaning of the proverb “A penny saved
is a penny earned.” This helps to establish the patient’s expected ability to A. access long-term memory.
B. engage in abstract reasoning. C. execute concrete operations. D. follow complex instructions.
13-68 In the older adult, which physiological change affects pharmacokinetics? A. Decreased creatinine
clearance B. Increased lean muscle mass C. Decreased total body fat D. Increased serum albumin level
18-98 Physiological changes in the immune system of older adults include A. an increase in
immunoglobulin A and G antibodies. B. a high rate of T-lymphocyte proliferation. C. an increase in the
number of cytotoxic T cells. D. an increase in CD8, which affects regulation of the immune system.
, 61 The aging process results in a variety of physiological changes. One change is A. a decreased
absorption of fat-soluble vitamins. B. an increase in pupil size. C. an increase of enzymatic activity. D. an
increase in spleen size.
A- the heart valve
o Lab results- Dunphy Table 77.2
TABLE 77.2 Changes in Laboratory Values for Older Adults
Laboratory Test Normal Values Changes With Age Comments
URINALYSIS
Protein 0–5 mg/100 mL Rises slightly May be due to kidney changes wi
pathology
Specific gravity 1.005–1.020 Lower maximum in Decline in nephrons impairs abili
elderly 1.016–1.022
HEMATOLOGY
Erythrocyte Men: 0–20 Significant increase Neither sensitive nor specific in a
sedimentation rate Women: 0–30
Iron binding 50–160 mcg/dL Slight decrease
230–410 mcg/dL Decrease
Hemoglobin Men: 13–18 g/100 mL Men: 10–17 g/mL Anemia common in the elderly
Women: 12–16 g/100 Women: none noted
mL
Hematocrit Men: 45%–52% Slight decrease Decline in hematopoiesis
Women: 37%–48% speculated
Leukocytes 4,300–10,800/mm3 Drop to 3,100– Decrease may be due to drugs or
9,000/mm3 immediately to age
Lymphocytes 500–2,400 T T-cell and B-cell levels Infection risk higher; immunizati
cells/mm3 fall
50–200 B cells/mm3
Platelets 150,000–350,000/mm3 No change in number
BLOOD CHEMISTRY
Albumin 3.5–5.0/100 mL Decline Related to decrease in liver size a
malnutrition common
Globulin 2.3–3.5 g/100 mL Slight increase
, Total serum protein 6.0–8.4 g/100 mL No change Decreases may indicate malnutrit
Blood urea nitrogen Men: 10–25 mg/100 Increases significantly Decline in glomerular filtration ra
mL up to 69 mg/100 mL
Women: 8–20 mg/100
mL
Creatinine 0.6–1.5 mg/100 mL Increases to 1.9 Related to lean body mass decrea
mg/100 mL seen
Creatinine clearance 104–124 mL/min Decreases 10%/decade Used for prescribing medications
after age 40 years
Glucose tolerance 62–110 mg/dL after Slight increase of 10 Diabetes increasingly prevalent; d
fasting; >120 mg/dL mg/dL/decade after 30
after 2 hours years of age
postprandial
Alkaline phosphatase 13–39 IU/L Increase by 8–10 IU/L Elevations >20% usually due to d
bone abnormalities, drugs (e.g., n
all of the following are true about lab results except : abnormal findings are usually due to physiological
aging.
o Atypical disease presentations
1. Acute abdomen
Absence of symptoms or vague symptoms, acute confusion, mild discomfort and constipation,
some tachypnea and possibly vague respiratory symptoms, appendicitis pain may begin in right
lower quadrant and become diffuse
2. Depression
Anorexia, vague abdominal complaints, new onset of constipation, insomnia
hyperactivity, lack of sadness
3. Hyperthyroidism
Hyperthyroidism presenting as “apathetic thyrotoxicosis,” i.e., fatigue and weakness; weight
loss may result instead of weight gain; patients report palpitations, tachycardia, new onset of
atrial fibrillation, and heart failure may occur with undiagnosed hyperthyroidism
4. Hypothyroidism
Hypothyroidism often presents with confusion and agitation; new onset of anorexia, weight
loss, and arthralgias may occur
5. Malignancy
