Test Bank For Advanced Practice Nursing in the Care of
Older Adults, 3rd Edition Malone Kennedy |
Mr. Smith, 76, arrives to the clinic with his wife who states that he has had difficulty
focusing on tasks over the past 48 hours. Additionally, he has had difficulty sleeping,
is easily agitated, and has moments of confusion that wax and wane. What is Mr.
Smith likely experiencing?
A. Dementia
B. Delirium
C. Encephalitis
D. Alzheimer's disease - ANSWER Answer: B—Delirium
Dunphy, Winland-Brown, Porter, and Thomas (2015) discuss confusion and possible
differential diagnoses, including delirium and dementia. The main differences
between the two is clearly stated. Delirium typically as an abrupt onset over the
course of days to weeks, confusion that fluctuates throughout the day, with a
hallmark sign of inattention (p. 77-79). Furthermore, sleep-wake cycle disturbances
and agitation can also be found in patients with delirium (p. 79). Dementia slowly
becomes evident over months to years and patients often have a subtle decline (p.
77-79). Aphasia, apraxia, agnosia, and occupational and social functioning can all be
impaired with moderata dementia. Incontinence, difficulty with ADLs, inability to
speak more than 6 intelligible words in a day, and progressive weight loss of 10% of
body weight in the past 6 months are all signs of severe dementia.
Patients diagnosed with encephalitis will often present complaining of a headache
with an abrupt onset, along with nausea, vomiting, confusion, drowsiness, sensitivity
to bright light, and a poor appetite (Dunphy, et al., 2015, p. 138). A physical exam
may reveal fever, nuchal rigidity, paralysis, hyperresponsive deep tendon reflexes,
and possibly a viral rash (p. 138). Patient's with Alzheimer's disease will likely have
issues with remembering recent conversations, events, new information,
appointments, and frequently misplaces objects (p. 108). Furthermore, Alzheimer's
patients have trouble following a complex train of though or performing tasks that
require many steps, and appears more passive and less responsive (p. 108).
In the United States, adult bacterial meningitis is usually caused by:
A. S. pneumoniae (gram positive cocci)
B. N. meningitides (gram negative diplococci)
C. H. influenza
D. Both A and B. - ANSWER Answer: D—Both A and B.
Rationale: Dunphy, et al., (2015) note that adults bacterial meningitis in the United
States is usually caused by both S. pneumoniae and N. meningitides (p. 134). Both
types of bacteria can colonize the nasopharynx and can gain entry into the
underlying blood vessels as encapsulated bacteria from the infected nasopharyngeal
epithelium (p. 134).
Encephalitis often produces meningeal irritation. How can the APRN distinguish
between encephalitis and meningitis?
, A. It is too difficult to distinguish with out diagnostic
testing as both encephalitis and meningitis can
cause altered level of consciousness.
B. Encephalitis will reveal altered level of conscious
from the beginning where as an altered level of
consciousness may appear late in meningitis.
C. Patients with encephalitis will not show signs of
parenchymal damage (memory difficulties,
confusion, hallucination, dysphasia, seizures, and
focal motor/sensory deficits) and patients with
meningitis will show signs of parenchymal damage.
D. Patients with meningitis will present with a high fever
(>103 F) and patients with encephalitis will not
present with a low grade fever. - ANSWER Answer: B—Encephalitis will reveal
altered level of consciousness from the beginning where as an altered level of
consciousness may appear late in the course of meningitis.
Rationale: Dunphy, et al., (2015) specifically address the importance of being able to
distinguish the difference between encephalitis and meningitis by stating, the
differentiating factor to consider encephalitis over meningitis is usually alteration in
level of consciousness. Meningitis has an abrupt onset by signs of parenchymal
damage appear late in the course, where alteration in level of consciousness is
evident from the beginning with encephalitis (p. 139). While it is difficult to distinguish
between the two, a thorough history and physical will assist the APRN in a correct
differential diagnosis. Finally, patients with meningitis often present with a high fever
(>103 F) and patients with encephalitis will typically present with a fever as well (p.
135, 138).
Which of the following headaches is considered a medical emergency:
A. Tension headache
B. Migraine headache
C. Cluster headache
D. Traction or inflammatory headache - ANSWER Answer: D—Traction or
inflammatory headache.
Rationale: Dunphy, et al., (2015) discusses the four general classes of headaches,
and while all of them have the potential to impact level of functions and work
performance, a traction or inflammatory headache is an acute new-onset headache
that has an increasing intensity and is considered a medical emergency because it
may be symptomatic of a more serious condition (i.e., subarachnoid hemorrhage or
infection) (p. 121-122). A tension headache presents as a mild to moderate bilateral,
nonpulsating, tightening pain that is not aggravated by routine physical activity (p.
121). A migraine headache may last for 4 to 72 hours and may or may not be
precipitated by an aura and is usually moderate to severe intensity with pulsating
quality, aggravated by routine physical activity, and accompanied by nausea,
vomiting, and photophobia (p. 121). A cluster headache usually occurs at night and
may last 15 to 180 minutes with severe unilateral orbital, supraorbital, and/or pain
that is accompanied on the same side of the face with sweating, lacrimation, nasal
congestion, ptosis, rhinorrhea, eyelid edema, and/or conjunctival injection (p. 121).
Mr. Johnson, 65, presents to the clinic with complaints of weakness of his left arm
and hand and blurred vision in left eye. He states that he has had several episodes
,and the symptoms usually lasts for a few hours and resolve on its own. He states
that he recently quit smoking and has hypertension and hyperlipidemia. What is the
likely diagnosis for Mr. Johnson?
A. CVA
B. TIA
C. Delirium
D. Tension headache - ANSWER Answer: B—TIA
Rationale: Dunphy, et al., (2015) notes that patients will a TIA will experience sudden
neurological deficit that resolve in less than 24 hours (p. 113). Important modifiable
risk factors for CVA include hypertension, cardiac disease, diabetes,
hypercholesterolemia, smoking, illicit drug use, and lifestyle factors (obesity, lack of
physical exercise, etc.) (p. 113). A CVA should be suspected when a patient
presents with complaints of weakness, numbness or paralysis of one of both
extremities on one side of the body that does not resolve within 24 hours (p. 115).
Delirium typically as an abrupt onset over the course of days to weeks, confusion
that fluctuates throughout the day, with a hallmark sign of inattention (p. 77-79).
Furthermore, sleep-wake cycle disturbances and agitation can also be found in
patients with delirium (p. 79). A tension headache presents as a mild to moderate
bilateral, nonpulsating, tightening pain that is not aggravated by routine physical
activity (p. 121).
Mr. Jesse Price, and 76 year old white male presents to the outpatient clinic with
complaint of dizziness. After completing history and physical exam, the nurse
practitioner suspects peripheral vestibular disease because of the following findings:
A. Failure to hear whisper with right ear at 2 feet in,
cerumen impaction in right ear, and rotational
nystagmus with severe vertigo when performing
Hallpike maneuver, without feeling like he is about to
faint.
B. Difficulty with balance, tinnitus, vertigo, nausea and
vomiting, diplopia, diaphoresis, and denies feeling
like he about to faint.
C. Dizziness that is aggravated with postural changes,
bounding pulse, diaphoresis, and states he feels like
he is about to faint.
D. Facial numbness, diplopia, headache, and
dysarthria, and reported episodes of nausea and
vomiting.
E. Answers A and B are correct - ANSWER The answer is B. - difficulty with
balance, tinnitus, vertigo, nausea and vomiting, diaphoresis, and denies feeling like
he is going to faint.
Rationale: 44% of all cases of dizziness and vertigo are due to vestibular disease.
Many patients who experience dizziness may have a diseased vestibular nerve but
most often the problem is located in the middle ear, in the labyrinth. Signs and
symptoms include dizziness, nausea and vomiting, diaphoresis, difficulty with
balance, tinnitus, vertigo, fluctuating hearing loss, feelings of pressure in the ear, and
diplopia (Dunphy, 2015, p 80).
You are conducting a history and physical exam on a 42 year old female. She states
that she experienced weakness in her right hand and blurred vision in her right eye
, off and on for a few days. She stated that the symptoms seemed to be worse each
time and now included slurred speech and slight headache. Her daughter brought
her to the clinic. Based on the patient's history, you suspect:
A. Hemorrhagic CVA
B. Vertebrobasilar system TIA
C. Carotid artery pathology TIA
D. CVA caused by embolus
E. None of the above - ANSWER The answer is C. - Carotid artery pathology TIA.
Rationale: Likely findings for ischemic CVA caused by thrombus would show
symptoms beginning in the day, occurring gradually, and having periods of
improvement between episodes of worsening. Prodromal symptoms are associated
with TIA. Table 6.2 lists symptoms of TIA due to carotid artery pathology:
paresthesia, weakness of hand, arm, and face, aphasia, dysarthria, unilateral
neglect, transient blindness or blurred vision, in one eye, cognitive or behavioral
changes (Dunphy, 2015, p 115).
When evaluating musculoskeletal trauma, the nurse practitioner:
A. aims to differentiate between strains, sprains, and
bony fractures
B. obtains history to learn of any preceding
musculoskeletal trauma
C. may find lab tests such as a CBC helpful if a septic
joint is suspected
D. Only answers a. and b. are correct.
E. Answers A, B, and C are correct - ANSWER The correct answer is E.
Rationale: According to textbook, Dunphey, (2015), the goal of a differential
diagnosis when evaluating and treating a patient with musculoskeletal trauma is to
distinguish more serious bony fractures from strains and sprains because the
treatment for each is different (Dunphy, 2015, pp 1183-1184). It also states that it is
critical to consider a variety of rheumatological and infectious disorders such as a
septic joint and order lab tests such as CBC if suspected. It also states to obtain
appropriate history that to try to identify preceding musculoskeletal trauma to
differentiate between the conditions (Dunphy, 2015, p 1183-1184).
When ordering a chest x-ray, the APRN understands that
A. A chest radiograph obtained by portable x-ray
machine produces high spatial resolution comparable
to that of a standing PA chest radiograph therefore
patient comfort is the most important factor the
APRN considers when ordering a chest x-ray.
B. When reading a chest radiograph it is important to
know the radiographic projection used in order to
correctly interpret the images.
C. A posterior to anterior (PA) projection makes the
heart appear more true to size than an anterior to
posterior (AP) view because structures near the
detector appear closer to true size than structures
further from the detector.
D. Answers A and B are correct.
E. Answers B and C are correct. - ANSWER The answer is E.
Older Adults, 3rd Edition Malone Kennedy |
Mr. Smith, 76, arrives to the clinic with his wife who states that he has had difficulty
focusing on tasks over the past 48 hours. Additionally, he has had difficulty sleeping,
is easily agitated, and has moments of confusion that wax and wane. What is Mr.
Smith likely experiencing?
A. Dementia
B. Delirium
C. Encephalitis
D. Alzheimer's disease - ANSWER Answer: B—Delirium
Dunphy, Winland-Brown, Porter, and Thomas (2015) discuss confusion and possible
differential diagnoses, including delirium and dementia. The main differences
between the two is clearly stated. Delirium typically as an abrupt onset over the
course of days to weeks, confusion that fluctuates throughout the day, with a
hallmark sign of inattention (p. 77-79). Furthermore, sleep-wake cycle disturbances
and agitation can also be found in patients with delirium (p. 79). Dementia slowly
becomes evident over months to years and patients often have a subtle decline (p.
77-79). Aphasia, apraxia, agnosia, and occupational and social functioning can all be
impaired with moderata dementia. Incontinence, difficulty with ADLs, inability to
speak more than 6 intelligible words in a day, and progressive weight loss of 10% of
body weight in the past 6 months are all signs of severe dementia.
Patients diagnosed with encephalitis will often present complaining of a headache
with an abrupt onset, along with nausea, vomiting, confusion, drowsiness, sensitivity
to bright light, and a poor appetite (Dunphy, et al., 2015, p. 138). A physical exam
may reveal fever, nuchal rigidity, paralysis, hyperresponsive deep tendon reflexes,
and possibly a viral rash (p. 138). Patient's with Alzheimer's disease will likely have
issues with remembering recent conversations, events, new information,
appointments, and frequently misplaces objects (p. 108). Furthermore, Alzheimer's
patients have trouble following a complex train of though or performing tasks that
require many steps, and appears more passive and less responsive (p. 108).
In the United States, adult bacterial meningitis is usually caused by:
A. S. pneumoniae (gram positive cocci)
B. N. meningitides (gram negative diplococci)
C. H. influenza
D. Both A and B. - ANSWER Answer: D—Both A and B.
Rationale: Dunphy, et al., (2015) note that adults bacterial meningitis in the United
States is usually caused by both S. pneumoniae and N. meningitides (p. 134). Both
types of bacteria can colonize the nasopharynx and can gain entry into the
underlying blood vessels as encapsulated bacteria from the infected nasopharyngeal
epithelium (p. 134).
Encephalitis often produces meningeal irritation. How can the APRN distinguish
between encephalitis and meningitis?
, A. It is too difficult to distinguish with out diagnostic
testing as both encephalitis and meningitis can
cause altered level of consciousness.
B. Encephalitis will reveal altered level of conscious
from the beginning where as an altered level of
consciousness may appear late in meningitis.
C. Patients with encephalitis will not show signs of
parenchymal damage (memory difficulties,
confusion, hallucination, dysphasia, seizures, and
focal motor/sensory deficits) and patients with
meningitis will show signs of parenchymal damage.
D. Patients with meningitis will present with a high fever
(>103 F) and patients with encephalitis will not
present with a low grade fever. - ANSWER Answer: B—Encephalitis will reveal
altered level of consciousness from the beginning where as an altered level of
consciousness may appear late in the course of meningitis.
Rationale: Dunphy, et al., (2015) specifically address the importance of being able to
distinguish the difference between encephalitis and meningitis by stating, the
differentiating factor to consider encephalitis over meningitis is usually alteration in
level of consciousness. Meningitis has an abrupt onset by signs of parenchymal
damage appear late in the course, where alteration in level of consciousness is
evident from the beginning with encephalitis (p. 139). While it is difficult to distinguish
between the two, a thorough history and physical will assist the APRN in a correct
differential diagnosis. Finally, patients with meningitis often present with a high fever
(>103 F) and patients with encephalitis will typically present with a fever as well (p.
135, 138).
Which of the following headaches is considered a medical emergency:
A. Tension headache
B. Migraine headache
C. Cluster headache
D. Traction or inflammatory headache - ANSWER Answer: D—Traction or
inflammatory headache.
Rationale: Dunphy, et al., (2015) discusses the four general classes of headaches,
and while all of them have the potential to impact level of functions and work
performance, a traction or inflammatory headache is an acute new-onset headache
that has an increasing intensity and is considered a medical emergency because it
may be symptomatic of a more serious condition (i.e., subarachnoid hemorrhage or
infection) (p. 121-122). A tension headache presents as a mild to moderate bilateral,
nonpulsating, tightening pain that is not aggravated by routine physical activity (p.
121). A migraine headache may last for 4 to 72 hours and may or may not be
precipitated by an aura and is usually moderate to severe intensity with pulsating
quality, aggravated by routine physical activity, and accompanied by nausea,
vomiting, and photophobia (p. 121). A cluster headache usually occurs at night and
may last 15 to 180 minutes with severe unilateral orbital, supraorbital, and/or pain
that is accompanied on the same side of the face with sweating, lacrimation, nasal
congestion, ptosis, rhinorrhea, eyelid edema, and/or conjunctival injection (p. 121).
Mr. Johnson, 65, presents to the clinic with complaints of weakness of his left arm
and hand and blurred vision in left eye. He states that he has had several episodes
,and the symptoms usually lasts for a few hours and resolve on its own. He states
that he recently quit smoking and has hypertension and hyperlipidemia. What is the
likely diagnosis for Mr. Johnson?
A. CVA
B. TIA
C. Delirium
D. Tension headache - ANSWER Answer: B—TIA
Rationale: Dunphy, et al., (2015) notes that patients will a TIA will experience sudden
neurological deficit that resolve in less than 24 hours (p. 113). Important modifiable
risk factors for CVA include hypertension, cardiac disease, diabetes,
hypercholesterolemia, smoking, illicit drug use, and lifestyle factors (obesity, lack of
physical exercise, etc.) (p. 113). A CVA should be suspected when a patient
presents with complaints of weakness, numbness or paralysis of one of both
extremities on one side of the body that does not resolve within 24 hours (p. 115).
Delirium typically as an abrupt onset over the course of days to weeks, confusion
that fluctuates throughout the day, with a hallmark sign of inattention (p. 77-79).
Furthermore, sleep-wake cycle disturbances and agitation can also be found in
patients with delirium (p. 79). A tension headache presents as a mild to moderate
bilateral, nonpulsating, tightening pain that is not aggravated by routine physical
activity (p. 121).
Mr. Jesse Price, and 76 year old white male presents to the outpatient clinic with
complaint of dizziness. After completing history and physical exam, the nurse
practitioner suspects peripheral vestibular disease because of the following findings:
A. Failure to hear whisper with right ear at 2 feet in,
cerumen impaction in right ear, and rotational
nystagmus with severe vertigo when performing
Hallpike maneuver, without feeling like he is about to
faint.
B. Difficulty with balance, tinnitus, vertigo, nausea and
vomiting, diplopia, diaphoresis, and denies feeling
like he about to faint.
C. Dizziness that is aggravated with postural changes,
bounding pulse, diaphoresis, and states he feels like
he is about to faint.
D. Facial numbness, diplopia, headache, and
dysarthria, and reported episodes of nausea and
vomiting.
E. Answers A and B are correct - ANSWER The answer is B. - difficulty with
balance, tinnitus, vertigo, nausea and vomiting, diaphoresis, and denies feeling like
he is going to faint.
Rationale: 44% of all cases of dizziness and vertigo are due to vestibular disease.
Many patients who experience dizziness may have a diseased vestibular nerve but
most often the problem is located in the middle ear, in the labyrinth. Signs and
symptoms include dizziness, nausea and vomiting, diaphoresis, difficulty with
balance, tinnitus, vertigo, fluctuating hearing loss, feelings of pressure in the ear, and
diplopia (Dunphy, 2015, p 80).
You are conducting a history and physical exam on a 42 year old female. She states
that she experienced weakness in her right hand and blurred vision in her right eye
, off and on for a few days. She stated that the symptoms seemed to be worse each
time and now included slurred speech and slight headache. Her daughter brought
her to the clinic. Based on the patient's history, you suspect:
A. Hemorrhagic CVA
B. Vertebrobasilar system TIA
C. Carotid artery pathology TIA
D. CVA caused by embolus
E. None of the above - ANSWER The answer is C. - Carotid artery pathology TIA.
Rationale: Likely findings for ischemic CVA caused by thrombus would show
symptoms beginning in the day, occurring gradually, and having periods of
improvement between episodes of worsening. Prodromal symptoms are associated
with TIA. Table 6.2 lists symptoms of TIA due to carotid artery pathology:
paresthesia, weakness of hand, arm, and face, aphasia, dysarthria, unilateral
neglect, transient blindness or blurred vision, in one eye, cognitive or behavioral
changes (Dunphy, 2015, p 115).
When evaluating musculoskeletal trauma, the nurse practitioner:
A. aims to differentiate between strains, sprains, and
bony fractures
B. obtains history to learn of any preceding
musculoskeletal trauma
C. may find lab tests such as a CBC helpful if a septic
joint is suspected
D. Only answers a. and b. are correct.
E. Answers A, B, and C are correct - ANSWER The correct answer is E.
Rationale: According to textbook, Dunphey, (2015), the goal of a differential
diagnosis when evaluating and treating a patient with musculoskeletal trauma is to
distinguish more serious bony fractures from strains and sprains because the
treatment for each is different (Dunphy, 2015, pp 1183-1184). It also states that it is
critical to consider a variety of rheumatological and infectious disorders such as a
septic joint and order lab tests such as CBC if suspected. It also states to obtain
appropriate history that to try to identify preceding musculoskeletal trauma to
differentiate between the conditions (Dunphy, 2015, p 1183-1184).
When ordering a chest x-ray, the APRN understands that
A. A chest radiograph obtained by portable x-ray
machine produces high spatial resolution comparable
to that of a standing PA chest radiograph therefore
patient comfort is the most important factor the
APRN considers when ordering a chest x-ray.
B. When reading a chest radiograph it is important to
know the radiographic projection used in order to
correctly interpret the images.
C. A posterior to anterior (PA) projection makes the
heart appear more true to size than an anterior to
posterior (AP) view because structures near the
detector appear closer to true size than structures
further from the detector.
D. Answers A and B are correct.
E. Answers B and C are correct. - ANSWER The answer is E.
