NURS 601 Final Exam Questions with Verified
Answers Latest Update 2024 Test
Developmental changes Physiological - Correct Answer 1. Reduced physiological
reserve of most body systems, particularly cardiac, respiratory, and renal.
2. There are reduced homeostatic mechanisms that fail to adjust regulatory systems
such as temperature control and fluid and electrolyte balance.
3. There are changes in the sympathetic response, which contribute to orthostasis and
falls, as well as lack of hypoglycemic response.
4. There is impaired immunological function: infection risk is greater and autoimmune
diseases are more prevalent.
Laboratory: Reference ranges for older adults might be the intervals within which 9%%
of persons over 70 fall.
Causes: Physiologically: fasting or activity status.
Pharmacologically: medication, tobacco, or alcohol use.
Physiological aging - Correct Answer Age related Change
Functional Change
Implications
Integumentary System
Loss of dermal and epidermal thickness
Loss of subcutaneous tissue and thin epidermis.
Prone to skin breakdown and injury
Decreased vascularity
• Atrophy of sweat glands resulting in decreased sweat production
• Decreased body odor
• Decreased heat loss
• Dryness
• Alteration in thermoregulatory response
• Fluid requirements may change seasonally
• Loss of skin water
• Increased risk of heat stroke
Respiratory System
Decreased lung tissue elasticity
Decreased vital capacity
Reduced overall efficiency of ventilatory exchange
Cilia atrophy
Change in mucociliary transport
,Increased susceptibility to infection
Decreased respiratory muscle strength
• Reduced ability to handle secretions and reduced effectiveness against noxious
foreign particles
• Partial inflation of lungs at rest
Increased risk of atelectasis
Cardiovascular System
Heart valves thicken and become fibrotic
Reduced stroke volume, cardiac output; may be altered
Decreased responsiveness to stress
Fibroelastic thickening of the sinoatrial node; decreased number of pacemaker cells
Slower heart rate
Increased prevalence of arrhythmias
Decreased baroreceptor sensitivity (stretch receptors)
Decreased sensitivity to changes in blood pressure
Prone to loss of balance, which increases the risk for falls
GI
Liver becomes smaller
Decreased storage capacity
Decreased muscle tone
Altered motility
Increases risk of constipation, functional bowel syndrome, esophageal spasm,
diverticular disease
Decreased basal metabolic rate (rate at which fuel is converted into energy)
May need fewer calories
Lab results Dunphy table 77.2 - Correct Answer UA Normal Changes with age
Comments
Protein 0-5 rises slightly Due to kidney changes, UTI, renal
SG 1.005-1.020 Lower 1.016-1.022 Decline in nephrons impairs ability to
Concentrate urine
Hematology
ESR M: 0-20 W: 0-30 Sign increase Neither sensitive nor specific
Iron binding 50-160 230-410 Slight decrease
HGB M: 13-18 W:12-16 M: 10-17 W: none Anemia is common in elderly
HCT M: 45-52 W: 37-48 Slight decrease Decline in hematopoiesis
Leukocytes 4,300-10,800 Drop to 3,100-9,000 Decrease may be due to drugs or sepsis
Lymphocytes 500-2,400 Tcells Fall infection risk higher
50-200 Bcells Immunizations encouraged
Platelets 150,000-350,000 no change
Blood chemistry
Albumin 3.5-5.0 Decline R/T decreased liver size and enzymes.
,Protein-energy malnutrition common.
Globulin 2.3-3.5 Slight increase
Total serum
Protein 6.0-8.4 no change Decrease may indicate malnutrition
Infection, liver disease
BUN M: 10-25 Increases significantly Decline in GFR
W: 8-20 up to 69 Decreased cardiac output
Creatinine 0.6-1.5 increases to 1.9 RT lean body mass
Creatinine Decreases 10% Used for prescribing meds
Clearance 104-124 after 40 yrs old for drugs excreted by kidney
GT 62-110 (after fasting) Slight increase 10 Diabetes increase in prevalent
<120 (2h PP) after 30 yrs drugs may cause intolerance
Alk Phos 13-39 increase by 8-10 Elevation >20% usually due to disease
Elevations may be found with bone
Abnormalities, drugs (narcotics), and
Eating fatty meals.
Atypical disease presentation - Correct Answer 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
RLQ and become diffuse.
Depression: Anorexia, vague abdominal complaints, new onset of constipation,
insomnia, hyperactivity, lack of sadness
Hyperthyroidism: Hyperthyroidism presenting as "apathetic thyrotoxicosis," (fatigue and
weakness; weight loss may result instead of weight gain; patients report palpations,
tachycardia, new onset of atrial fibrillation, and heart failure may occur with
undiagnosed hyperthyroidism).
Hypothyroidism: Often presents with confusion and agitation; new onset of anorexia,
weight loss, and arthralgias may occur.
Malignancy: New or worsening back pain secondary to metastases from slow growing
breast masses. Silent masses of the bowel.
Myocardial infarction: Absence of chest pain. Vague symptoms of fatigue, nausea, and
a decrease in functional and cognitive status; classic presentations: dyspnea, epigastria
discomfort, weakness, vomiting; history of previous cardiac failure. Higher prevalence in
females versus males. Non-Q-wave MI.
Overall Infectious disease process: Absence of fever or low-grade fever. Malaise.
Sepsis without usual leukocytosis and fever. Falls, anorexia, new onset of confusion,
and/or alteration in change in mental status, decrease in usual functional status.
Peptic ulcer disease: Absence of abdominal pain, dyspepsia, early satiety. Painless,
bloodless. New onset of confusion, unexplained tachycardia, and/or hypotension.
Pneumonia: Absence of fever; mild coughing without copious sputum, especially in
dehydrated patients; tachycardia and tachypnea; anorexia and malaise are common;
alterations in cognition.
Pulmonary edema: : Lack of paroxysmal nocturnal dyspnea or coughing; insidious
, Geriatric syndrome - Correct Answer SPICES
Sleep Disturbances
Problems with eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
They are starting to experience bladder control problems, sleep problems, delirium,
dementia, falls, gait and balance, depression, visual acuity, and weight loss.
Early implementation of preventive therapies and safety measurement are important.
Prevention is best provided using an interdisciplinary team approach. Early detection
and correction of problems such as sensory deficits, confusion, and gait and balance
issues can increase independence and longevity among this group. The focus of all
healthcare should be on maintaining function, dignity, and individual control to promote
health and quality of life. Associated with substantial morbidity and poor outcomes.
They are multifactorial and although each is distinct, they share several risk factors. For
example, older age, cognitive impairment, functional impairment, and mobility
impairments are risk factors for falls, functional decline, delirium, and pressure ulcers.
Categories of aging-know age ranges for old, young old, old-old, ect. - Correct Answer
TABLE 1-2 Select Bimodal Presentations of Illness in Younger Adults versus Older
Adults
TYPE OF CONDITION
YOUNGER ADULTS
OLDER ADULTS
Dermatological Psoriasis
Late teens to 20sIrregular course which tends to generalize Hereditary factors
50s—males60s—femalesSporadic onset
GastrointestinalInflammatory bowel disease Ulcerative colitis (UC) Crohn's disease
(CD)
20-40 years oldRight lower UCInsidious onset
>60-75 years old a second peak occursMore often older womenProctitisLeft-sided
UCHigher rates of anemiaMay present as chronic diarrheaFistula
developmentIncreased cases of associated malnutritionExtraintestinal manifestations
including: arthritis spondylitis,uveitis, and erythema nodosumMore comorbid
conditionsMay be confused with other forms of colitis
MalignanciesHodgkin's lymphoma
20-30 years oldPossible infectious etiology
>50 years oldIncreased mortality
NeurodegenerativeMyasthenia gravis (MG)
Women 20-40 years oldMore thymus abnormalities
Men—50-70 years oldWomen—70 years oldDysphoniaMore frequent ocular form
MGIncreased rate of AChR seropositivity
Answers Latest Update 2024 Test
Developmental changes Physiological - Correct Answer 1. Reduced physiological
reserve of most body systems, particularly cardiac, respiratory, and renal.
2. There are reduced homeostatic mechanisms that fail to adjust regulatory systems
such as temperature control and fluid and electrolyte balance.
3. There are changes in the sympathetic response, which contribute to orthostasis and
falls, as well as lack of hypoglycemic response.
4. There is impaired immunological function: infection risk is greater and autoimmune
diseases are more prevalent.
Laboratory: Reference ranges for older adults might be the intervals within which 9%%
of persons over 70 fall.
Causes: Physiologically: fasting or activity status.
Pharmacologically: medication, tobacco, or alcohol use.
Physiological aging - Correct Answer Age related Change
Functional Change
Implications
Integumentary System
Loss of dermal and epidermal thickness
Loss of subcutaneous tissue and thin epidermis.
Prone to skin breakdown and injury
Decreased vascularity
• Atrophy of sweat glands resulting in decreased sweat production
• Decreased body odor
• Decreased heat loss
• Dryness
• Alteration in thermoregulatory response
• Fluid requirements may change seasonally
• Loss of skin water
• Increased risk of heat stroke
Respiratory System
Decreased lung tissue elasticity
Decreased vital capacity
Reduced overall efficiency of ventilatory exchange
Cilia atrophy
Change in mucociliary transport
,Increased susceptibility to infection
Decreased respiratory muscle strength
• Reduced ability to handle secretions and reduced effectiveness against noxious
foreign particles
• Partial inflation of lungs at rest
Increased risk of atelectasis
Cardiovascular System
Heart valves thicken and become fibrotic
Reduced stroke volume, cardiac output; may be altered
Decreased responsiveness to stress
Fibroelastic thickening of the sinoatrial node; decreased number of pacemaker cells
Slower heart rate
Increased prevalence of arrhythmias
Decreased baroreceptor sensitivity (stretch receptors)
Decreased sensitivity to changes in blood pressure
Prone to loss of balance, which increases the risk for falls
GI
Liver becomes smaller
Decreased storage capacity
Decreased muscle tone
Altered motility
Increases risk of constipation, functional bowel syndrome, esophageal spasm,
diverticular disease
Decreased basal metabolic rate (rate at which fuel is converted into energy)
May need fewer calories
Lab results Dunphy table 77.2 - Correct Answer UA Normal Changes with age
Comments
Protein 0-5 rises slightly Due to kidney changes, UTI, renal
SG 1.005-1.020 Lower 1.016-1.022 Decline in nephrons impairs ability to
Concentrate urine
Hematology
ESR M: 0-20 W: 0-30 Sign increase Neither sensitive nor specific
Iron binding 50-160 230-410 Slight decrease
HGB M: 13-18 W:12-16 M: 10-17 W: none Anemia is common in elderly
HCT M: 45-52 W: 37-48 Slight decrease Decline in hematopoiesis
Leukocytes 4,300-10,800 Drop to 3,100-9,000 Decrease may be due to drugs or sepsis
Lymphocytes 500-2,400 Tcells Fall infection risk higher
50-200 Bcells Immunizations encouraged
Platelets 150,000-350,000 no change
Blood chemistry
Albumin 3.5-5.0 Decline R/T decreased liver size and enzymes.
,Protein-energy malnutrition common.
Globulin 2.3-3.5 Slight increase
Total serum
Protein 6.0-8.4 no change Decrease may indicate malnutrition
Infection, liver disease
BUN M: 10-25 Increases significantly Decline in GFR
W: 8-20 up to 69 Decreased cardiac output
Creatinine 0.6-1.5 increases to 1.9 RT lean body mass
Creatinine Decreases 10% Used for prescribing meds
Clearance 104-124 after 40 yrs old for drugs excreted by kidney
GT 62-110 (after fasting) Slight increase 10 Diabetes increase in prevalent
<120 (2h PP) after 30 yrs drugs may cause intolerance
Alk Phos 13-39 increase by 8-10 Elevation >20% usually due to disease
Elevations may be found with bone
Abnormalities, drugs (narcotics), and
Eating fatty meals.
Atypical disease presentation - Correct Answer 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
RLQ and become diffuse.
Depression: Anorexia, vague abdominal complaints, new onset of constipation,
insomnia, hyperactivity, lack of sadness
Hyperthyroidism: Hyperthyroidism presenting as "apathetic thyrotoxicosis," (fatigue and
weakness; weight loss may result instead of weight gain; patients report palpations,
tachycardia, new onset of atrial fibrillation, and heart failure may occur with
undiagnosed hyperthyroidism).
Hypothyroidism: Often presents with confusion and agitation; new onset of anorexia,
weight loss, and arthralgias may occur.
Malignancy: New or worsening back pain secondary to metastases from slow growing
breast masses. Silent masses of the bowel.
Myocardial infarction: Absence of chest pain. Vague symptoms of fatigue, nausea, and
a decrease in functional and cognitive status; classic presentations: dyspnea, epigastria
discomfort, weakness, vomiting; history of previous cardiac failure. Higher prevalence in
females versus males. Non-Q-wave MI.
Overall Infectious disease process: Absence of fever or low-grade fever. Malaise.
Sepsis without usual leukocytosis and fever. Falls, anorexia, new onset of confusion,
and/or alteration in change in mental status, decrease in usual functional status.
Peptic ulcer disease: Absence of abdominal pain, dyspepsia, early satiety. Painless,
bloodless. New onset of confusion, unexplained tachycardia, and/or hypotension.
Pneumonia: Absence of fever; mild coughing without copious sputum, especially in
dehydrated patients; tachycardia and tachypnea; anorexia and malaise are common;
alterations in cognition.
Pulmonary edema: : Lack of paroxysmal nocturnal dyspnea or coughing; insidious
, Geriatric syndrome - Correct Answer SPICES
Sleep Disturbances
Problems with eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
They are starting to experience bladder control problems, sleep problems, delirium,
dementia, falls, gait and balance, depression, visual acuity, and weight loss.
Early implementation of preventive therapies and safety measurement are important.
Prevention is best provided using an interdisciplinary team approach. Early detection
and correction of problems such as sensory deficits, confusion, and gait and balance
issues can increase independence and longevity among this group. The focus of all
healthcare should be on maintaining function, dignity, and individual control to promote
health and quality of life. Associated with substantial morbidity and poor outcomes.
They are multifactorial and although each is distinct, they share several risk factors. For
example, older age, cognitive impairment, functional impairment, and mobility
impairments are risk factors for falls, functional decline, delirium, and pressure ulcers.
Categories of aging-know age ranges for old, young old, old-old, ect. - Correct Answer
TABLE 1-2 Select Bimodal Presentations of Illness in Younger Adults versus Older
Adults
TYPE OF CONDITION
YOUNGER ADULTS
OLDER ADULTS
Dermatological Psoriasis
Late teens to 20sIrregular course which tends to generalize Hereditary factors
50s—males60s—femalesSporadic onset
GastrointestinalInflammatory bowel disease Ulcerative colitis (UC) Crohn's disease
(CD)
20-40 years oldRight lower UCInsidious onset
>60-75 years old a second peak occursMore often older womenProctitisLeft-sided
UCHigher rates of anemiaMay present as chronic diarrheaFistula
developmentIncreased cases of associated malnutritionExtraintestinal manifestations
including: arthritis spondylitis,uveitis, and erythema nodosumMore comorbid
conditionsMay be confused with other forms of colitis
MalignanciesHodgkin's lymphoma
20-30 years oldPossible infectious etiology
>50 years oldIncreased mortality
NeurodegenerativeMyasthenia gravis (MG)
Women 20-40 years oldMore thymus abnormalities
Men—50-70 years oldWomen—70 years oldDysphoniaMore frequent ocular form
MGIncreased rate of AChR seropositivity
