NRNP6540 Advanced Practice Care of Older Adults
Week 1 Discussion
Evaluation Plan
As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as a nurse practitioner, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of older adult patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, you will consider which assessment tools would be appropriate for a patient in a case scenario.
Photo Credit: LIGHTFIELD STUDIOS - stock.adobe
To prepare:
Review this week’s Learning Resources, considering how assessment tools are used to evaluate patients.
Your Instructor will assign a case study to use for this Discussion. Review the case study and, based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
Consider immunization requirements that may be needed for this patient.
By Day 3
Post an explanation of your evaluation plan for the patient in the case study provided, and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, etc. Also explain the immunization requirements related to health promotion and disease prevention for the patient.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days in one or more of the following ways:
Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
Explain other health promotion considerations for patients in this population or with related issues.
NRNP6540 Advanced Practice Care of Older Adults
Week 2 Assignment
Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression
Photo Credit: Getty Images
With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as an advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care.
To prepare:
Review the case study provided by your Instructor. Reflect on the way the patient presented in the case, including whether the patient might be presenting with dementia, delirium, or depression.
Reflect on the patient’s symptoms and aspects of disorders that may be present. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results? How would you interpret and address the results of the Mini-Mental State Examination (MMSE)?
Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other healthcare providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6540 Advanced Practice Care of Older Adults
Week 4 Assignment
Assessing, Diagnosing, and Treating Head, Neck, and Face Disorders
Photo Credit: Getty Images/Blend Images
Head, neck, and face disorders are common, and thus you will likely care for elderly patients with these disorders. In your role as an advanced practice nurse, you must be able not only to ly assess and diagnose patients but also help patients manage the disorder by planning necessary treatments, assessments, and follow-up care.
To prepare:
Review the case study provided by your Instructor.
Reflect on the patient’s symptoms and aspects of disorders that may be present.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6540 Advanced Practice Care of Older Adults
Week 5 Assignment
Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders
Photo Credit: Getty Images/RooM RF
Cardiovascular conditions are among the leading causes of hospitalization and death among older adults, even though many of the risk factors that contribute to such conditions are preventable or manageable. In your role as an advanced practice nurse, you must be able to apply sound critical thinking and diagnostic reasoning skills to ly assess and diagnosis these conditions. You also play an important role in helping patients manage disorders by planning necessary treatments, assessments, and follow-up care.
To prepare:
Review the Week 5 Case Assignment document in the Learning Resources.
Reflect on the patient’s symptoms and aspects of disorders that may be present.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.
The Assignment:
After reviewing the case and the accompanying case analysis questions, included in the document, answer the 10 questions directly in the Case Assignment document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.
Click the Week 5 Assignment link.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6540 Advanced Practice Care of Older Adults
Week 7 Assignment
Assessing, Diagnosing, and Treating Abdominal, Urological, and Gynecological Disorders
Photo Credit: Teodor Lazarev - stock.adobe.com
Accurate history taking of abdominal, urological, and gynecological complaints is essential for completing an assessment of the older adult. For this Assignment, as you examine this week’s patient case study, consider how you might evaluate and treat older adult patients who present with health concerns related to the abdominal, urological, or gynecological systems.
To prepare:
Review the case study provided by your Instructor.
Reflect on the patient’s symptoms and aspects of disorders that may be present.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6540 Advanced Practice Care of Older Adults
Week 8 Assignment
Assessing, Diagnosing, and Treating Hematological and Immune System Disorders
Many factors affect patients’ hematological and immune status. Additionally, manifestations of these disorders may appear in different organ systems. As an advanced practice nurse, you must be able to diagnose and treat patients with hematological and immune status disorders by prescribing necessary treatments, assessments, and follow-up care.
Photo Credit: Getty Images/Westend61
To prepare:
Review the case study provided by your Instructor.
Reflect on the patient’s symptoms and aspects of disorders that may be present.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 8 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6540 Advanced Practice Care of Older Adults
Week 9 Assignment
Assessing, Diagnosing, and Treating Endocrine, Metabolic, and Nutritional Disorders
Like many disorders affecting other systems, those related to endocrine, metabolic, and nutritional concerns have specific considerations for geriatric populations. Accurate history taking of symptoms associated with these disorders is essential for completing an assessment of the older adult, since onset of symptoms (for example, with some endocrine disorders) may appear more subtly than those in younger patients. It can also be difficult to determine onset and severity of illness in older adults.
Keep in mind special considerations for older adults as you complete your case analysis and SOAP note on endocrine, metabolic, and nutritional disorders.
Photo Credit: [Mark Hatfield]/[iStock / Getty Images Plus]/Getty Images
To prepare:
Review the case study provided by your Instructor.
Reflect on the patient’s symptoms and aspects of disorders that may be present.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK9Assgn+last name+first initial.(extension)” as the name.
Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6540 Advanced Practice Care of Older Adults
Week 10 Assignment
Assessing, Diagnosing, and Treating Musculoskeletal and Neurologic Disorders
Consider the example of Sue from the case study in Chapter 13 of your textbook:
Sue is a 68-year-old healthy woman with no significant medical history. She is in the office today with complaint of intractable nausea and vomiting for the past 5 weeks with an 11-pound weight loss. On review of systems she also has noted a dull, persistent headache, difficulty with concentration, and some blurred vision.
(Kennedy-Malone et al., 2019, p. 359)
Photo Credit: [Blend Images/Ariel Skelley]/[Blend Images]/Getty Images
Sue also has a notable family history of diabetes and heart attack. How would you, as an advanced practice nurse, assess, diagnose, and treat Sue? What specific considerations related to the older adult population would you need to consider? Keep these thoughts in mind as you examine this week’s case study.
Reference:
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. G. (2019). Advanced practice nursing in the care of older adults (2nd ed., p. 359). F. A. Davis.
To prepare:
Review the case study provided by your Instructor.
Reflect on the patient’s symptoms and aspects of disorders that may be present.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK10Assgn+last name+first initial.(extension)” as the name.
Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6540 Advanced Practice Care of Older Adults
Week 3 Knowledge Check
Question 1 Your 69-year-old male patient with type 2 diabetes presents with a seven-inch swollen, erythematous area on his lower leg. He says it is tender, and the reddened area is warm to the touch and has been getting larger. The opposite leg appears normal. He admits that his dog may have scratched him when he jumped up on him several days ago. What condition would you suspect the patient has, why, and what course of treatment would you recommend?
Question 2 Your patient has herpes zoster ophthalmicus (HZO) as shown in the photo. What would your treatment plan for this patient be?
Question 3 Describe the etiology of lymphedema.
Question 4 What is the primary mechanism of herpes zoster ophthalmicus?
Question 5 Your 78-year-old patient comes to the clinical with the chief complaint of a lesion on his arm that has been there for two years. He states it alternately crusts and heals, and it began as a shiny papule, but now looks like this. You suspect basal cell carcinoma. What would be your primary reason for suspecting it is a basal cell carcinoma?
Question 6 Your 98-year-old patient complains of a corn behind his big toe that bothers him when he walks. Describe how corns usually form.
Question 7 Explain why diuretics are not helpful in the treatment of lymphedema.
Question 8 What is the preferred treatment of tinea infections of the skin?
Question 9 Your 81-year-old patient presents with the following skin eruptions on his arms and hand. His previous medical history (PMH) includes hypertension (HTN) for which he takes Ramipril (ACEI) 20 mg per day. He has osteoarthritis pain and takes Advil daily, 200 mg OTC about three to four times a day. He has lichen planus. What would your treatment plan for this patient be?
Question 10 Your 79-year-old Caucasian male patient comes to the clinic with a “sore” on the top of his ear that does not seem to be healing. He admits he does not often wear a hat or sunscreen when he golfs or mows the lawn. He states he has picked it off, but it keeps coming back, and now it bleeds. What risk factors does he have that lead you to the diagnosis of a basal cell carcinoma (BCC)?
NRNP6540 Advanced Practice Care of Older Adults
Week 4 Knowledge Check
QUESTION 1Another type of AMD includes wet, exudative, or neovascular macular degeneration (NVAMD). List some of the characteristics of this type of AMD.
QUESTION 2Mary is a 68-year-old patient who complains of a hard-rubbery lump in her upper eyelid that has been there for several months. The area does not look infected nor reddened. Describe your primary diagnosis and your rationale for this diagnosis.
QUESTION 3You are evaluating your 81-year-old patient for decreasing vision and worsening night vision and being bothered by the glare of headlights. You suspect cataract. Name at least three differential diagnoses that would be important to rule out before making the primary diagnosis of cataract.
QUESTION 4Martin is an 82-year-old with a history of smoking and alcohol use, which are known risk factors in developing oral cancers. List another risk factor for oral cancer for developing oral cancer.
QUESTION 5Martin is an 82-year-old male with a past history of heavy smoking (2 ppd x 20 years) and drinking several beers at night for the past 30 years. He recently quit smoking. He noticed a white lesion on the side of his tongue which then ulcerated and has not been healing for the past two months. What are your primary differential diagnoses? List at least three.
QUESTION 6Name two topical drugs for treatment of glaucoma, and list three side effects of each.
QUESTION 7Maggie is a 65-year-old who complains of clear nasal drainage every morning when she awakens. What differential diagnoses will you want to consider and rule in or rule out? Please list at least three with rationale.
QUESTION 8What other diagnostic testing would you perform to evaluate for cataracts?
QUESTION 9Describe the characteristics of dry, nonexudative, or atrophic macular degeneration.
QUESTION 10 What education would you give your older patients about the preventable causes of hearing loss?
NRNP6540 Advanced Practice Care of Older Adults
Week 5 Knowledge Check
QUESTION 1Name three of the changes in the respiratory system common in older adults.
QUESTION 2Alex is an 82-year-old patient who has presented for his annual check-up. He states he has been feeling more tired lately and has noticed that his ankles have been swelling at the end of the day. Upon auscultation of his heart, you hear a new S3. What are your two differential diagnoses?
QUESTION 3A 78-year-old patient, past one ppd smoker times 10 years (quit 10 years ago) presents with increasing shortness of breath, dyspnea on exertion, and no other symptoms. Name two diagnostic tests you could order to differentiate between asthma and COPD.
QUESTION 4According to the GOLD Pocket Guide to COPD Diagnosis, Management, and Prevention, A Guide for Health Care Professionals, 2017, what would the predicted FEV be for GOLD 4 very severe COPD?
QUESTION 5You are performing a Medicare home assessment on an 84-year-old male. Part of this exam is checking for carotid bruits. Describe two reasons this exam is important in an older adult:
QUESTION 6There are known risk factors for coronary artery disease (CAD). Name the two most important risk factors that can be remedied (modified).
QUESTION 7There are known risk factors for coronary artery disease (CAD). Name the two most important risk factors that cannot be remedied (modified).
QUESTION 8Edna is a typically healthy 80-year-old patient who is now complaining of new shortness of breath when she climbs stairs at home, and she states she has been more tired than usual. List three ROS questions you would want to ask her, using the OLDCARTS method.
QUESTION 9Clara is an 89-year-old African American female who comes to see you in the clinic today. She describes a new complaint of “heartburn” after doing housework. You are concerned about these new symptoms. What information would you seek in your review of symptoms (list at least three)?
QUESTION 10
Your 69-year-old African American female patient has a PMH of asthma. You know that In the United States, asthma is more prevalent in African Americans. List at least three (3) factors that contribute to the development of asthma.
NRNP6540 Advanced Practice Care of Older Adults
Week 7 Knowledge Check
QUESTION 1You prescribe Flomax for your patient for the treatment of BPH. Explain why you would recommend that your patient take this medication at bedtime rather than in the morning?
QUESTION 2Maggie is a 70-year-old female who presents for a routine checkup. She admits she has not been to a health care provider for 10 years. Describe at least four (4) important ROS questions you will ask this older female about her genitourinary and reproductive system.
QUESTION 3List at least three types of treatment for breast cancer.
QUESTION 4A patient wants to know what the risk of her daughter getting breast cancer is if the daughter tests positive for the BRCA1 gene. What would you say to her?
QUESTION 5Sarah is a 68-year-old patient who had a mammogram and biopsy positive for breast cancer. Her breast cancer is staged at T1N0M0. Sarah asks you what this means. Please describe what TNM indicates.
QUESTION 6You suspect cholecystitis in your 72-year-old patient complaining of right-sided abdominal pain, nausea, and vomiting that began after eating 3 days ago. Beside ultrasound, what other diagnostic tests could you order? Describe at least two tests.
QUESTION 7You are prescribing Proscar for Alex, a 67-year-old male with BPH and significant urinary frequency and nocturia. What are some of the side effects that you would discuss with him? List at least two.
QUESTION 8June is a 69-year-old being seen for her GYN exam. She still has her uterus and ovaries. What do you expect to find on bimanual examination?
QUESTION 9Would you perform a pap smear on June, your 69-year-old patient? (She has had normal pap smears in the past.)
QUESTION 10Ben is your 85-year-old patient with mild BPH. Name at least two classes of medications that Ben should avoid that could make voiding with BPH more difficult.
NRNP6540 Advanced Practice Care of Older Adults
Week 8 Knowledge Check
QUESTION 1Margery is a 78-year-old female who comes to you with non-specific complaints of fatigue and red blood in the toilet after having stools she attributes to her hemorrhoids bleeding for the past 4 months. What type of anemia would you suspect?
QUESTION 2Your 89-year-old patient complains of the following symptoms: bleeding gums, bone pain, fever, frequent nosebleeds, fatigue, and shortness of breath. Your physical exam shows lymphadenopathy, paleness, and generalized weakness. What are your differential diagnoses? List at least three.
QUESTION 3Describe two possible causes of immune thrombocytopenic purpura (ITP).
QUESTION 4What is the classification of iron deficiency anemia?
QUESTION 5Albert, your 89-year-old male patient, was diagnosed with CLL, chronic lymphocytic leukemia. Describe the incidence, most common age affected, and gender most affected.
QUESTION 6Knowing that elderly persons frequently encounter multiple chronic comorbidities, which type of anemia is very common in this population?
QUESTION 7When testing blood for anemia of chronic disease (ACD), how would the differentials be classified? List three.
QUESTION 8Briefly describe the mechanism of immune thrombocytopenic purpura (ITP).
QUESTION 9What is the World Health Organization’s definition of anemia by Hgb for men and women?
QUESTION 10You have a patient with acute myeloid leukemia (AML). Although rare, it is more common in the older adult and has a poor prognosis. List four contributing factors to developing AML:
NRNP6540 Advanced Practice Care of Older Adults
Week 9 Knowledge Check
Question 1 The NP recognizes that all of the following patients have an increased risk of developing adverse effects from metformin (Glucophage) except:
a. Patients who are overweight
b. Patients who drink lots of alcohol
c. Patients who are dehydrated
d. Patients with renal disease
Question 2 Ms. Davis, a 72 y/o female with a known history of diabetes, presents to your office for her routine follow up visit. Which of the following would you recommend on an annual basis for an elderly patient with Type II Diabetes?
Answers:
a. An eye examination with an ophthalmologist
b. An eye exam with an optometrist
c. Colonoscopy
d. Bone density scan
Question 3 Miss Johnson presents today with concerns of functional decline, progressive appetite loss, and no willingness to eat or drink. The student NP recognizes that these are symptoms of
a. Adult failure to thrive
b. Hashimotos thyroiditis
c. Acute pancreatitis
d. None of the above as this is a normal part of aging
Question 4 Identify the lab findings consistent with primary hypothyroidism.
a. Elevated thyroid stimulating hormone and elevated free T4 level
b. Decreased thyroid stimulating hormone and elevated free thyroxine level
c. Elevated thyroid stimulating hormone and decreased T4 level
d. Decreased thyroid stimulating hormone and low free T4
Question 5The most appropriate time to begin screening for renal nephropathy in a patient with Type I Diabetes is:
a. Two to three years after diagnosis
b. Five years after diagnosis
c. Once annually after diagnosis
d. At diagnosis
Question 6 A 68-year-old female comes to the clinic for a health evaluation. During the course of a systems review, the patient reports that she has developed episodes of blurred vision. She denies any pain or photophobia. During funduscopic examination, the nurse practitioner appreciates retinal drusen. This presentation is consistent with
a. Cataracts
b. Glaucoma
c. Herpes opthalmicus
d. Macular degeneration
Question 7 Which of the following groups have been recommended to be screened for thyroid disease?
a. Men under 60
b. Adolescent females
c. Women over 50 years of age
d. School-age children
Question 8 The NP recognizes all of the following being a contributing factor to pancreatitis except
a. Excessive alcohol use
b. Excessive caffeine intake
c. Hypercalcemia
d. Hypertriglyceridemia
Question 9 A 65-year old female patient who has hypothyroidism takes level thyroxine daily. Based on the following lab results, how should the nurse practitioner proceed?
|
TSH
|
28.2 mIU/L
|
Normal Values:
0.4-3.8 mIU/L
|
|
Free T4
|
0.05 ng/dL
|
Normal Values:
0.8-2.8 ng/dL
|
|
Total Cholesterol
|
272 mg/dL
|
Normal Values:
<200 mg/dl
|
|
LDL Cholesterol
|
189 mg/dL
|
Normal Values:
<100
|
|
HDL Cholesterol
|
34 mg/dL
|
Normal Values:
40-60
|
|
Triglycerides
|
142 mg/dL
|
Normal Values:
<150
|
a. Begin statin therapy
b. Adjust levothyroxine dose
c. Encourage diet modifications
d. Encourage lifestyle modifications
Question 10 Which of the following BMI choices would be considered obesity?
a. BMI 30 or greater
b. BMI 24 or greater
c. BMI 21 or greater
d. BMI 29 or greater
NRNP6540 Advanced Practice Care of Older Adults
Week 10 Knowledge Check
Question 1 List the medication and dosage for the treatment of chronic gout.
Question 2 Describe the types of strokes that are most likely to cause a seizure.
Question 3 Your 72-year-old patient has complaints of morning stiffness greater than 1 hour; joint swelling and pain, especially at the small joints of the hands, wrists, and feet; symmetrical inflammatory polyarthritis. List at least three differential diagnoses you will explore for this patient.
Question 4 Name symptoms and PE findings a patient would have for a suspected fracture after falling off of a stepladder in her home, now with 6/10 pain in her back and hip. List at least four.
Question 5 Your 68-year-old male complains of a hot, swollen, reddened MTP joint of the great toe. What is your primary diagnosis?
Question 6 Your 79-year-old patient comes in with his wife, who states she is concerned because her husband seems to be losing his sense of smell. Describe at least four concerns for this complaint.
Question 7 Your 74-year-old patient has gout and has a BMI of 34. He admits to having a taste for non-diet soda, “meat and potatoes,” and gets little exercise. What exercise and dietary recommendations will you make for him to reduce his insulin resistance? Describe at least three strategies.
Question 8 Mrs. G arrives for her annual exam, and you note that her height is 5 foot 6 inches, down 1 inch from 2 years ago. Describe at least three of the changes in the muscular system that are a part of the normal aging process.
Question 9 Describe a cognitive screening test that measures the status of a patient’s attention, concentration, executive function, memory, and orientation.
Question 10 Martha is an 80-year-old female with long-standing osteoarthritis pain. She takes Tylenol for the pain. What education do you want to provide to her about taking Tylenol on a daily basis? Explain at least two educational cautions about taking Tylenol.
