NR601 Primary Care of the Maturing and Aged Family
Week 1 Discussion
DQ1 Polypharmacy
Purpose
The purpose of student discussions is to provide the opportunity for deeper understanding of polypharmacy
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Summarize the different polypharmacy definitions found within the literature. (WO1.5) (CO1)
Discuss polypharmacy risk factors (WO1.5) (CO1)
Explain thee actions steps for polypharmacy prevention (WO1.5) (CO1, 7)
Requirements:
Your initial discussion post should include the following:
Identify and discuss 2-3 definitions of polypharmacy (there are multiple definitions). Your textbook can count as 1 reference. You must also include an additional reference from an evidence-based practice journal article or national guideline.
Identify three risk factors that can lead to polypharmacy. Explain the rationale for why each listed item is a risk factor. Risk factors are different than adverse drug reactions. ADRs can be a result of polypharmacy, and is important, but ADRs are not a risk factor.
Explore three action steps that a provider can take to prevent polypharmacy.
Provide an example of how your clinical preceptors have addressed polypharmacy.
DQ2 Comprehensive Geriatric Assessment
Purpose
The purpose of this assignment is to review the components of the comprehensive geriatric assessment
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Discuss components of a comprehensive geriatric assessment (WO 1.1, 1.2, 1.3, 1.4) (CO1, 5, 7)
Evaluate screening tools used as part of the comprehensive geriatric assessment (WO 1.4) (CO 1, 7)
Requirements:
Step 1:
Review the assigned topics which are listed by student number. For example, if your student number is 2 you will discuss the functional health domain and then respond to a classmate who has posted on the psychological health domain.
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Your student number:
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Your assessment domain
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Your peer response domain
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1, 5 and 9
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Physical health
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Socioenvironmental health & quality of life measures
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2, 6 and 10
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Functional health
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Psychological health
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3 and 7
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Psychological health
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Functional health
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4 and 8
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Socioenvironmental health & quality of life measures
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Physical health
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Step 2:
For your assigned assessment domain:
Provide a brief 3-5 sentence summary of the components of the domain assessment*
Choose a screening tool which is appropriate for your domain. Explain the screening tool purpose, components and scoring technique*
Provide 2 references in APA format beneath the table which support your work. You may use the textbook. The second reference must be a scholarly source.
*All responses must be your work, in your own words.
Your table should look like the following:
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Comprehensive Geriatric
Assessment
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Domain
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Dimensions of assessment
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Screening tool related to the domain(s)
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References:
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Step 3:
Paste table inside the discussion board post. Do not attach as a document.
Step 4:
Respond to a peer’s post. Your assigned response to a peer requirement is listed within the assignment table.
Compares peer domain to student’s assigned assessment domain, noting similarities and differences*
Peer review: discuss how your assigned peer’s screening tool can be applicable in your own future practice*
NR601 Primary Care of the Maturing and Aged Family
Week 2 Discussion
DQ1 COPD Case Study Part 1
Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) ?(CO,2,3,4,5)
Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses.?(WO 2.2) (CO 2,4)
Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)
Case Study - Part 1
A 62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint.
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History of Present Illness
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Onset
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6 months
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Location
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Chest
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Duration
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Cough is intermittent but frequent, worse in the AM
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Characteristics
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Productive; whitish-yellow phlegm
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Aggravating factors
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Activity
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Relieving factors
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Rest
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Treatments
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Tried Robitussin DM without relief of symptoms
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Severity
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Unable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without difficulty
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Review of Systems (ROS)
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Constitutional
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Denies fever, chills, or weight loss?
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Ears
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Denies otalgia and otorrhea
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Nose
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Denies rhinorrhea, nasal congestion, sneezing or post nasal drip.
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Throat
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Denies ST and redness
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Neck
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Denies lymph node tenderness or swelling
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Chest
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Describes a persistent productive cough upon wakening for the last 6 months. Color of phlegm is usually white-yellowish. Shortness of breath with activity.
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Cardiovascular
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Denies chest pain and lower extremity edema
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History
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Medications
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Metoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin daily
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PMH
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Primary hypertension
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PSH
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Cholecystectomy, appendectomy
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Allergies
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Penicillin (hives)
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Social
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Married, 3 children
Senior accountant at a risk management firm
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Habits
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Former smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use.
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FH
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Father died of MI & CHF at age 59 years (diabetes, hypertension, smoker)
Mother is alive (osteoporosis)
Healthy siblings
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Physical exam reveals the following:
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Physical Exam
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Constitutional
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Adult male in NAD, alert and oriented, able to speak in full sentences
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VS
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Temp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RA
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Head
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Normocephalic
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Ears
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Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender.
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Nose
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Nares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear.
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Throat
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Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted.
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Neck
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Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. No JVD
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Cardiopulmonary
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Heart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema.
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Abdomen
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Soft, non-tender. No organomegaly
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Requirements/Questions:
Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.
Provide a differential diagnosis (minimum of 3) which might explain the patient's chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.
Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
Rank the differential in order of most likely to least likely.
Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence.
DQ2 COPD Case Study Part 2
Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO 2,3,4,5)
Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses.?(WO 2.2) (CO 2,4)
Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)
Case Study - Part 2
You ordered a CXR and spirometry at the previous visit and he returns today to review the results. Physical exam and symptoms are unchanged since last visit. Vital signs at this visit are: Temp-98.3, P-68, RR-20, BP 152/90, Height 68.9in., Weight 258 pounds, O2sat 94% on RA
CXR Result:
No acute infiltrates or consolidations are seen. Cardiac and mediastinal silhouettes are normal. No hilar enlargement is evident. Osseous thorax is intact.
Spirometry Results:
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Pre-Bronchodilator
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Post-Bronchodilator
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Predicted
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Actual
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%Predicted
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Actual
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% Predicted
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% Change
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FVC (L)
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4.52
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3.01
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67
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3.08
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68
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2
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FEV1 (L)
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3.40
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1.58
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46
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1.60
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47
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1
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FEV1/FV
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.75
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.52
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---
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.52
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---
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0
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Requirements/Questions:
What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
Identify the corresponding ICD-10 code.
Provide a treatment plan for this patient's primary diagnosis which includes:
Medication*
Any additional testing necessary for this particular diagnosis*
Patient education
Referral
Follow up
Provide an active problem list for this patient based on the information given in the case.
Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBP argument for each treatment or testing decision.
*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based practice (EBP) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
Over-the-counter (OTC) and RXs must be written in full as if handing a prescription to the patient in the office.??
Example:??
Amoxicillin 500 mg capsule?
1 tab po BID q 10 days?
Disp #20 no refills??
NR601 Primary Care of the Maturing and Aged Family
Week 3 Discussion
Psychiatric Disorders and Screening
Purpose
The purpose of student discussions is to provide the opportunity for application of depression and anxiety screening tools to a selected case patient.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Explain the purpose of two selected screening tools (CO7)
Interpret the scoring criteria of two selected screening tools (CO7)
Discuss the mechanism of action, side effects and expected onset of action for a selected medication (CO4)
Requirements:
Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice.
Review this case study
HPI: KF, 56-year-old Caucasian female presents to office with complaints of “no energy and not wanting to go out.” These symptoms have been present for about 3?months and seem worse in the morning and improve slightly through the day. It is hard to get out of bed and get the day started because does not feel rested when she wakes up in the morning.? KF reports a "loss of joy". States" I really don't feel like going anywhere or doing anything".? She tries to do at least one social activity a week, but it can be really exhausting. Reports she also has difficulty completing projects for work, she cannot stay focused anymore. She reports not feeling hungry, so she is not eating regularly and has lost some weight.? KB has been a widow for 2 years. Her husband died unexpectedly, he had a MI. She recently got a puppy, which she thought would help with the loneliness, but the care of the puppy seems overwhelming at times. Rest and exercise, specifically yoga and meditation seem to help her feel better. At this time, she does not want to do either, it seems like too much effort to get up and go. She has not tried any medications, prescribed or otherwise. She reports drinking a lot of coffee, but that does not seem to help with her energy levels.?
Current medications: Excedrin PM about once a week when she can't sleep, seems to help a bit. NKDA.?
PMH: no major illnesses. Immunizations up to date.?
SH: widowed, employed full time as a consultant. Drinks 1 glass of wine almost every night. No tobacco use, no illicit drug use. Previously married 20 years ago while living in France, reports an abusive relationship. The French government gave custody of her son to the ex-husband. She returned to US without her son 10 years ago. She sees her son two times a year, they skype and text "all the time" but she misses him. Her son is now an adult and is considering moving to the US.??
FH: Parents are alive and well. Has one son, age 21, he is healthy but lives in France with his father.
ROS?
CONSTITUTIONAL: reports weight loss of 4-5 pounds, no fever, chills, or weakness reported. Daily fatigue.??
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.?
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.?
RESPIRATORY: No shortness of breath, cough or sputum.?
GASTROINTESTINAL: Reports decreased appetite for about 3 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.?
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.?
GENITOURINARY: no burning on urination. Last menstrual period 4 years ago.?
PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history of great anxiety due to verbal and concern for physical abuse, reports feeling very sad and anxious when divorcing and leaving her son in France. Did not seek treatment. She started to feel better after about 4 months.?
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia?
ALLERGIES: No history of asthma, hives, eczema or rhinitis.?
Discussion Questions:?
Research screening tools for depression and anxiety. Choose one screening tool for depression and one screening tool for anxiety that you feel are appropriate to screen KF.
Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.
Score KF using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool.? In your response include what questions could be scored, and your chosen score.? Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time.
Identify your next step for evaluation and treatment for KF. Remember to consider both physical and mental health differential diagnoses when answering this question.?? (2-3 sentences).
What medication or treatment is appropriate for KF based on her screening score today? Provide the rationale. Any medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for KF. Include initial prescribing information.??
If the medication works as expected, when should KF expect to start feeling better??
NR601 Primary Care of the Maturing and Aged Family
Week 6 Discussion
Post-Menopausal and Sexuality Issues in the Maturing and Older Adult
Purpose
The purpose of this student discussion is to discuss Post-Menopausal and Sexuality Issues in the Maturing and Older Adult
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
1) Discuss the symptoms related to genitourinary syndrome of menopause (GSM) (WO 6.2,6.3) (CO 1,3,5)
2) Reflect on personal comfort level when performing a sexual history on the maturing an older adult. (WO 6.2,6.3) (CO 1,3,5)
Requirements:
Ageism and gender bias can affect to whom and how we ask about sexual health, sexual activity, and concerning symptoms. Depending on your own level of comfort and cultural norms this can be a tough conversation for some providers but this is an important topic. As this week's required NAMS videos discussed, women are wanting us to ask about sexual concerns. This week we also reviewed sexually transmitted diseases and the effects of ageism on the time to diagnosis so it is necessary to ask these questions and provide good education for all patients. You will not know any needs unless you ask.
Discussion Questions:
Review the required NAMS videos. What was the most surprising statement or topic that you heard in the videos? Explain why this was surprising to you.
What is GSM? What body systems are involved? How does GSM affect a woman's quality of life?
Review one aspect of treatment that Dr Shapiro recommends for GSM and include an EBP journal article or guideline recommendation in addition to referencing the video in your response.
Sexuality and the older adult
What is your level of comfort in taking a complete sexual history? Is this comfort level different for male or female patients? If so, why?
How will this week's information impact the way you will interact with your mature and elderly clients in the future?
NR601 Primary Care of the Maturing and Aged Family
Week 7 Discussion
Reflection
Purpose
Students will complete a self-reflection assignment for the purpose of validating their personal progress and academic growth in NR 601. The goal for this activity is to engage the student in considering how their clinical abilities and professional growth are advancing .
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Reflect upon how the assigned program outcome, MSN Essential and NONFP competencies have been achieved in NR 601. (WO7.4) (CO1-7)
Link course assignments and clinical activities to the assigned program outcome, MSN Essential and NONPF competencies. (WO7.4) (CO1-7)
Requirements:
Reflect over the past seven weeks and describe how the achievement of the course outcomes in this course have prepared you to meet:
MSN program Outcome # 5
MSN Essential # VIII
NONPF Nurse Practitioner Core Competency # 8
Chamberlain College of Nursing Program Outcome #5
Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice. (Extraordinary nursing)
Masters Essential VIII: Clinical Prevention and Population Health for Improving Health
Integrate clinical prevention and population health concepts in the development of culturally relevant and linguistically appropriate health education, communication strategies, and interventions.
Design patient-centered and culturally responsive strategies in the delivery of clinical prevention and health promote on interventions and/or services to individuals, families, communities, and aggregates/clinical populations.
NONPF: #8 Ethics Competencies
Integrates ethical principles in decision making.
Evaluates the ethical consequences of decisions.
Applies ethically sound solutions to complex issues related to individuals, populations and systems of care.
Students will reflect on each of the listed outcomes or competencies listed above individually and provide two (2) examples for each. Examples can be from course assignments or clinical experiences.
NR601 Primary Care of the Maturing and Aged Family
Week 5 Assignment
Case Study Assignment
Purpose
The purpose of this case study assignment is to?:
Analyze provided subjective and objective information to diagnose and develop a management plan for the selected case study patient.?
Apply national diabetes guidelines to a case study patient.?
Apply national guidelines to develop a management plan for all identified secondary diagnosis(es).
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Select appropriate health promotion and disease prevention strategies for patients with or at risk for a glucose metabolism disorder (WO5.1) (CO1,2,3,4,5)
Demonstrate competence in the evaluation and management of patients with glucose metabolism disorders (WO5.2) (CO1,2,3,4,)
Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO5.3) (CO1,2,3,4,5)
Apply polypharmacy knowledge to medication reconciliation for selected case study patient.(WO5.4) (CO 6)
This assignment is submitted through Turn It In (TII).* Students are allowed two opportunities to submit. The first Turn It In submission allows the student to view the Turn It In Score and edit the assignment if necessary. The second submission is considered the final submission and will be graded. Any further Turn IT In submissions will not be considered for grading.
*due to the amount of common case study content it is not unusual that the TII may exceed 25%. It is the original work, such as rationale statements and treatment plans that are evaluated for similarity by the faculty.
Requirements:
The assignment is a paper, which is to be written in APA format using the provided assignment template. The paper shall not exceed 10 pages, excluding title page and references.
NR601 _week 5 case study paper template_Nov 19.docxPreview the document
Case Study Patient - March 2020Preview the document
Review the provided patient visit information. You are provided with the subjective and objective exam findings. As the provider, you are to diagnose the case study patient and develop the management plan for this case study patient.??Keep in mind this is a complex patient who has more than one diagnosis, which is common in primary care.
Use the provided case study template for your paper. Review the APA Manual to adhere to APA formatting.?
Introduction: briefly discuss the purpose of this paper.??(no more than 5 sentences)
Assessment: review the provided case study information.?
Identify the primary and secondary diagnosis for the patient. Each diagnosis will include the following information:?
ICD 10 code.?
A brief pathophysiology statement which is no longer that two sentences, paraphrased and includes common signs and symptoms of the diagnosis and proper citation.?
The patient’s pertinent positive and negative findings, including a brief 1-2 sentence statement, which links the subjective and objective findings (including lab data and interpretation).?
An evidence-based rationale statement, which summarizes why the diagnosis was chosen.???
Do not include quotes, paraphrase all scholarly information and provide an in-text citation to your scholarly reference. Use the Reference Guidelines document for information on scholarly references.??
Plan: (there are five (5) sections to the management plan)
Diagnostics. List all labs and diagnostic test you would like to order. Each test includes a rationale statement following the listed lab, which includes the diagnosis requiring the test, the purpose of the test and how the test results will contribute to your management plan. Each rationale statement is cited.? Include all future follow up labs for each listed diagnosis.??
Medications: Each medication is listed in prescription format. Each prescribed and OTC medication is linked to a specific diagnosis and includes a paraphrased EBP rationale for prescribing.??
Education: section includes personalized detailed education on all five (5) subcategories: diagnosis, each medication purpose and side effects, diet, personalized appropriate exercise recommendations and warning sign for diagnosis and medications if applicable. All education steps are linked to a diagnosis, paraphrased, and include a paraphrased EBP rationale. Review the NR601 Clinical SOAP note guideline for more detailed information.??
Referrals: any recommended referrals are appropriate to the patient diagnosis and current condition, is linked to a specific diagnosis and includes a paraphrased EBP rationale with in text citation. Review the ADA guidelines for specific follow up recommendations.?
Follow up: Follow up includes a specific time, not a time range, to return to PCP office for next scheduled appointment. Includes EBP rationale with in text citation.??
Assessment of Comorbidities: in this section students will review the ADA Standards of Medical Care in Diabetes (the guidelines)?Assessment of Comorbidities section on comorbidities subsection and choose one listed comorbidity.? Students will discuss the significance of and the relationship between the patient’s primary diagnosis and the chosen comorbidity, explaining how one diagnosis affects the other diagnosis.? Any recommended screening, diagnostic testing, and referrals are also included.??
Medication costs: in this section students will research the costs of all prescribed and OTC monthly medications that you have prescribed and that the patient is currently taking that you would like to continue.? Students may use Good Rx, Epocrates or another resource (students may use local pharmacy websites) which provides medication costs. Students will list each medication, the monthly cost of the medication and the reference source. Students will calculate the monthly cost of the case study patient’s prescribed and OTC medications and provide the total costs of the month’s medications. Reflect on the monthly cost of the medications prescribed. Discuss if prescriptions were adjusted due to cost. Discuss if will you use medication pricing resources in future practice.?
NR601 Primary Care of the Maturing and Aged Family
Week 1 Weekly Clinical Goal
Please respond to this required discussion by including the following:
Weekly schedule for clinical.
Using your clinical competency checklist to guide you, please share your clinical goals for the week.
Do you anticipate barriers or opportunities specific to your clinical site and/or preceptor?
NR601 Primary Care of the Maturing and Aged Family
Week 2 Weekly Clinical Goal
Please respond to this required discussion by including the following:
Weekly schedule for clinical.
Using your clinical competency checklist to guide you, please share your clinical goals for the week.
Do you anticipate barriers or opportunities specific to your clinical site and/or preceptor?
NR601 Primary Care of the Maturing and Aged Family
Week 3 Weekly Clinical Goal
Please respond to this required discussion by including the following:
Weekly schedule for clinical.
Using your clinical competency checklist to guide you, please share your clinical goals for the week.
Do you anticipate barriers or opportunities specific to your clinical site and/or preceptor?
NR601 Primary Care of the Maturing and Aged Family
Week 4 Weekly Clinical Goal
Please respond to this required discussion by including the following
Weekly schedule for clinical.
Using your clinical competency checklist to guide you, please share your clinical goals for the week.
Do you anticipate barriers or opportunities specific to your clinical site and/or preceptor?
NR601 Primary Care of the Maturing and Aged Family
Week 5 Weekly Clinical Goal
Please respond to this required discussion by including the following:
Weekly schedule for clinical.
Using your clinical competency checklist to guide you, please share your clinical goals for the week.
Do you anticipate barriers or opportunities specific to your clinical site and/or preceptor?
NR601 Primary Care of the Maturing and Aged Family
Week 6 Weekly Clinical Goal
Please respond to this required discussion by including the following:
Weekly schedule for clinical.
Using your clinical competency checklist to guide you, please share your clinical goals for the week.
Do you anticipate barriers or opportunities specific to your clinical site and/or preceptor?
NR601 Primary Care of the Maturing and Aged Family
Week 7 Weekly Clinical Goal
Please respond to this required discussion by including the following:
Weekly schedule for clinical.
Using your clinical competency checklist to guide you, please share your clinical goals for the week.
Do you anticipate barriers or opportunities specific to your clinical site and/or preceptor?
NR601 Primary Care of the Maturing and Aged Family
Week 8 Weekly Clinical Goal
Please respond to this required discussion by including the following:
Weekly schedule for clinical.
Using your clinical competency checklist to guide you, please share your clinical goals for the week.
Do you anticipate barriers or opportunities specific to your clinical site and/or preceptor?
NR601 Primary Care of the Maturing and Aged Family
Week 2 Test Your Knowledge
Question 1A >12% change from pre-bronchodilator to post-bronchodilator results indicate which of the following ?
the patient has emphysema
the patient has mild COPD
the obstruction is reversible
the obstruction is not reversible
Question 2Which of the following is most common pathogen responsible for community acquired pneumonia (CAP)?
methicillin resistant S. aureus
S. pneumonia
H. influenzae
M. catarrhalis
Question 3The nurse practitioner student is assessing a patient with chronic obstructive pulmonary disease (COPD). This patient would be most likely to demonstrate which of the following lung changes?
permanently deflated alveoli
decreased residual volume
increased surface volume for gas exchange
hyperinflation of the lungs
Question 4The amount of air exhaled in 1 second (FEV1), if normal, should be at least which of the following?
50%
75%
80%
70%
Question 5Which of the following is total volume of air a patient is able to exhale in the first second, during maximal effort?
FEV 1
FVC
TLC
FEV1/FVC ratio
NR601 Primary Care of the Maturing and Aged Family
Week 3 Test Your Knowledge
Question 1 Periods of increased activity, when the patient did not seem to need to sleep or reports of being very productive and not needing sleep, are symptoms of which of the following?
symptoms of hypomania or mania
symptoms of worsening depression
symptoms of unipolar depression
symptoms of schizophrenia
Question 2 What is the first-line treatment for chronic insomnia?
Cognitive behavioral therapy (CBT)
over the counter (OTC) sleep aids, such as ZzzQuil
zolpidem
ramelteon
Question 3 Which study has proven that onset of generalized anxiety disorder (GAD) is in childhood?
PHQ 9
DSM-5
ACES
GABA
Question 4 Symptoms of depression, which are distinct to the elderly, include which of the following?
lack of emotions
flat affect
appetite and weight disturbances
loss of pleasure in usual activities
Question 5 The criteria for diagnosing generalized anxiety disorder (GAD), in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM V), states that excessive worry or apprehension must be present more days than not for what length of time?
6 months
1 month
3 months
2 months
NR601 Primary Care of the Maturing and Aged Family
Week 5 Test Your Knowledge
Question 1 Which statement, made by a patient with Type 1 diabetes, indicates successful teaching regarding general guidelines for exercise?
"I will exercise when my urine ketones are positive, but blood sugar is 260."
“I will not exercise if my blood sugar is 215.”
“I will check my blood glucose every 20 minutes during exercise.”
“I should eat more carbohydrates if my blood glucose is less than 200.”
Question 2 Which “P” is a component of “the 3 P’s” of diabetes mellitus?
polygraphia
paresthesia
pain
polyphagia
Question 3 What are some of the signs and symptoms of hypoglycemia?
lack of coordination, decreased pulse and pale moist skin
slurred speech, lack of coordination, increased pulse and pale moist skin
lack of coordination, decreased pulse and ruddy, moist skin
slurred speech, lack of concentration, increased pulse and ruddy skin
Question 4 Which diagnosis below refers to hyperglycemic state that does not meet criteria for a Type 2 diabetes diagnosis?
impaired glucose tolerance
polyphagia
insulin resistance
HB A1C 6.0%
Question 5 Which of the following occurs commonly in Type 2 diabetes?
fluid overload
yeast infection
anorexia
elevated high density lipoprotein cholesterol (HDL)
NR601 Primary Care of the Maturing and Aged Family
Week 6 Test Your Knowledge
Question 1 The nurse practitioner considers which of the following when discussing causes of erectile dysfunction (ED) with a 70-year-old male?
most cases have an underlying cause
ED is a normal part of aging
depression is not a cause for ED
treatments for younger men are seldom successful in older men
Question 2 Menopause management is based on which of the following?
symptom management
hormone levels
agefamily history
Question 3 Which of the following is a non-hormonal option for vasomotor symptoms?
SSRI
estrace
Divigel (estradiol) gel
provera
Question 4 Which of the following symptoms is the most common subjective complaint of a woman presenting with an uncomplicated urinary tract infection?
urinary frequency
fever
gastrointestinal upset
suprapubic tenderness
Question 5 An 89-year-old patient was recently an inpatient for pneumonia and was bedridden for 1 week. He presents today, to the office, with dysuria and suprapubic tenderness, accompanied by fever and increased confusion. Based on his recent history, which of the following conditions may be developing?
cystitis
distended bladder
prostate enlargement
pulmonary embolus
NR601 Primary Care of the Maturing and Aged Family
Week 7 Test Your Knowledge
Question 1 Which type of dementia has the highest incidence?
vascular type
neurosyphilis type
Alzheimer's type
Parkinson's type
Question 2 An elderly patient arrives with her daughter for an appointment. The mother reports the daughter will not provide assistance with her activities of daily living. As a result the mother has poor hygiene, has lost weight, and is not taking medications as prescribed. The nurse practitioner diagnoses the patient with which of the following?
neglect
exploitation
emotional abuse
abandonment
Question 3 Which of the following can present as a single episode of recurrent feeling of pervasive sadness?
depression
dementia
delirium
Question 4 Which neurological change presents with an acute change in mental status?
dementia
depression
delirium
Question 5 According to the Alzheimer's disease reasoning algorithm, what is the next step for patients without impairment of multiple cognitive functions?
refer to respite care
refer to neurology
refer to dementia specialist
refer to palliative care
NR601 Primary Care of the Maturing and Aged Family
Week 4 Midterm Exam
1. The percentage of the FVC expired in one second is:
2. The aging process causes what normal physiological changes in the heart?
3. A 55yo Caucasian male follows up after referral to cardiologist. He thinks his med is causing a cough and sometimes he has difficulty breathing. Which med was most likely prescribed?
4. JM is a 68yo man who presents for a physical. He has T2DM x5yrs, smokes 1/2 PPD, BMI is 30. No other previous medical dx, no current complaints. According to the AHA/ACC guidelines, JM is stage A HF. Treatment goals for him include:
5. MJ presents with h/o structural damage with current s/s of HF. Treatment will be based on his stage of HF, which is:
6. 65yo Caucasian female presents with mitral valve stenosis, physical exam unremarkable. You know her stage of HF is:
7. DG, 65yo man, presents for eval of CP and L-sided shoulder pain, beginning after strenuous activity, including walking. Pain is dull, aching, 8/10 during activity, otherwise 0/10. Began few mo ago, intermittent, aggravated by exercise, relieved by rest. Occasional nausea. Pain is retrosternal, radiating to L shoulder, affects QOL by limiting activity. Pain is worse today, did not go away after stopped walking. BP 120/80, HR 72 and regular. Normal heart sounds, no murmur, S1, S2. Which differential dx would be most likely?
8. The best way to dx structural heart dz/dysfunction non-invasively is:
9. Chronic pain can have major impact on pt's ability to function and have profound impact on overall QOL. Ongoing pain may be linked to:
10. The Beers criteria are appropriate for use in evaluating use of certain meds in pts:
NR601 Primary Care of the Maturing and Aged Family
Week 8 Final Exam
1. Which of the following statements is NOT true about palliative care teams?
2. A 55-year-old women has type 2 DM she had three UTIs in the last 9 months and she is concerned about her kidneys. She has no report of dysuria, frequency or urgency at this time. Which of the following is the best action to follow?
3. According to the sexuality presentation, atrophic vaginitis (AV)
4. Ms. L 55-year-old women with BMI of 28, has 20-yearhx of primary HTN and has been on hydrochlorothiazide 25 mg daily for years with excellent response. During follow up visit Mrs L reports that for the last 6 months she has felt thirsty all of the time even though she drinks at least 10 glasses of water a day. Upon chart review the N notes that the last two fasting blood glucose levels have been 136 mg/dl and 165 mg/dl. The NP checks a random blood glucose, which is 210 mg/dl. What is the next appropriate test?
5. A patient has been prescribed Metformin (Glucophage). One week later he returns with lowered blood sugars but complaints of some loose stools during the week. How should the NP respond?
6. A 60-year-old obese male client has type 2 DM and a lipid panel of TC= 250, HDL = 32, LDL= 165. The NP teaches the patient about his modifiable cardiac risk factors which include:
7. Lifestyle approaches to postmenopausal symptom management include
8. When treating depression associated with dementia, which of the following would be a poor choice and should not be prescribed?
9. How does women’s anatomy make them more susceptible to UTIs?
