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.
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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link, and then select Create Thread to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
NRNP6540 Advanced Practice Care of Older Adults
Week 2 Assignment
Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression
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.
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 correctly 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 correctly 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 / Adobe Stock
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 1 Knowledge Check
Question 1 What are the most current recommendations for vaccination of patients near the end of life, including hospice patients?
Question 2E. D. is a 78-year-old woman who does not remember if she has ever had the immunization for herpes zoster. She does remember having chicken pox as a child. What would you recommend for her?
Question 3Your 78-year-old patient has never had a flu vaccine, and states “I have heard that the flu shot gives you the flu. I don’t want one.” What education would you provide for this patient?
Question 4Which immunization would you not give your 65-year-old patient with HIV infection and a CD4 count less than 200/mm? What is your rationale for withholding the immunization?
Question 5Many older adults travel worldwide when they retire. For patients who are planning to travel overseas, what would you recommend?
Question 6What is the maximum number of doses of PPSV23 that can be given to high-risk older adults 65 or older?
Question 7When would the influenza vaccine be absolutely contraindicated?
Question 8Please list which immunizations you would give to your 65-year-old patient with HIV infection and a CD4 count of 200/mm or greater.
Question 9You are caring for older adults in a nursing home. As a general rule, patients over 65 years of age and in general good health can receive which immunizations?
Question 10In older patients about to receive a solid organ transplant, which immunization would you withhold and for what reason?
NRNP6540 Advanced Practice Care of Older Adults
Week 3 Knowledge Check
Question 1Your 98-year-old patient complains of a corn behind his big toe that bothers him when he walks. Describe how corns usually form.
Question 2Your 82-year-old patient comes in for a routine checkup and mentions that she is worried about a skin lesion on her back. She is concerned that it might be “cancer” because it looks ugly, warty, and is getting bigger over 5 years. You examine it and determine it to be a seborrheic keratosis. What would your differential diagnoses include?
Question 3Describe the most common reason women are affected by lymphedema more than men.
Question 4Explain why diuretics are not helpful in the treatment of lymphedema.
Question 5What are some of the differential diagnoses of suspected lymphedema? List three.
Question 6A 75-year-old male patient returns to the clinic with complaints of worsening psoriasis. Describe two treatments you might prescribe for this patient.
Question 7Would you give the HZ vaccine to an older adult patient who has recovered from a herpes zoster ophthalmicus outbreak?
Question 8Your 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 9Your 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 10What is the preferred treatment of tinea infections of the skin?
NRNP6540 Advanced Practice Care of Older Adults
Week 4 Knowledge Check
Question 1What would your next step be for a patient you suspect has a diagnosis of acute angle glaucoma?
Question 2Describe the characteristics of dry, nonexudative, or atrophic macular degeneration.
Question 3You are performing a commercial driver’s exam on a 69-year-old male. He jokes that his wife says he “never listens to her.” You perform an ear exam. You find that he has cerumen impaction bilaterally. How would you treat this?
Question 4Epistaxis (nose bleeds) can be more common in an older person. Name three reasons epistaxis can occur in an older person.
Question 5You suspect your patient may have a hordeolum or chalazion Please list at least four differential diagnoses that need to be considered and ruled out:
Question 6What education would you give your older patients about the preventable causes of hearing loss?
Question 7Your 81-year-old patient comes to the clinical complaining of decreasing vision in her left eye, with worsening night vision. She states the glare from other headlights bother her so much she has given up night driving. What do you suspect is her diagnosis?
Question 8What type of glaucoma causes the most blindness in African Americans in the U.S.?
Question 9Although epistaxis can be more common in an older person, name two reasons a nosebleed would warrant an ENT referral?
Question 10To evaluate for cataracts, what would your examination include?
NRNP6540 Advanced Practice Care of Older Adults
Week 5 Knowledge Check
Question 1You 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 2A 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 3Edna 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 4Your 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 development of asthma.
Question 5Your 69-year-old patient who has daily asthma symptoms with nighttime awakenings weekly but not nightly, and an FEV >60 but <80 would have the diagnosis of what type of asthma?
Question 6According 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 7 You diagnose your older patient with intermittent asthma. List at least three (3) criteria for the diagnosis of intermittent asthma.
Question 8Edna is 81 years old with a diagnosis of chronic obstructive pulmonary disease (COPD). You know that a characteristic of COPD is chronic airflow limitation resulting from a parenchymal destruction (emphysema) and small airways disease (e.g., obstructive bronchiolitis). Describe at least three (3) risk factors for developing COPD.
Question 9Mrs. L is a 71-year-old Hispanic female with a PMH of seasonal allergies and her only medication is aspirin 81 mg; she presents to the clinic with the following symptoms: Recurrent wheezing, cough (especially occurring at night), recurrent chest tightness, and dyspnea on exertion. She also complains of a chronic rhinorrhea with postnasal drip. Please list four (4) differential diagnoses for these symptoms.
Question 10Clara 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 these new symptoms might be cardiovascular in etiology and would continue your review of symptoms with her by asking which questions (list at least three ROS questions)?
NRNP6540 Advanced Practice Care of Older Adults
Week 7 Knowledge Check
Question 1A 79-year-old patient presents with cramping abdominal pain, nausea, and vomiting for 4 days. List at least three (3) differential diagnoses.
Question 2Sarah 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 3List at least three types of treatment for breast cancer.
Question 4You 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 5 Sam is a pleasant 72-year-old male who comes in with his wife. His wife states that he is getting up “at least seven to eight times a night to pee.” What ROS questions would you ask Sam? Please list at least four.
Question 6Your 82-year-old patient comes to the clinic with complaints of cramping abdominal pain, nausea, vomiting, and obstipation for the past 4 days. His PMH includes hernia repair, HTN, and atrial fibrillation. Your examination leads you to suspect a small bowel obstruction. What is your diagnostic test of choice to determine the diagnosis?
Question 7You 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 8Would you perform a pap smear on June, your 69-year-old patient? (She has had normal pap smears in the past.)
Question 9Clark is a 72-year-old patient who complains of worsening symptoms of BPH, his nocturia has increased significantly over the past year. He would like to try a medication to ease these symptoms. List two medications you would consider for him and describe the mechanism of action for the two medications you chose.
Question 10Mary is a 67-year-old post-menopausal female who complains of vaginal dryness, vulvar and vaginal itching, urinary frequency, blood-tinged vaginal discharge, and dyspareunia. What would be your primary diagnosis?
NRNP6540 Advanced Practice Care of Older Adults
Week 8 Knowledge Check
Question 1What is the World Health Organization’s definition of anemia by Hgb for men and women?
Question 2The signs and symptoms of anemia (such as, fatigue, weakness, or dyspnea) in the older person are often attributed to “aging.” What is a reliable physical sign of anemia in the older person that should trigger a workup for anemia?
Question 3Your 69-year-old female patient who is complaining of easy bruising also admits to some recent shortness of breath and dizziness when standing up quickly. What questions about her past medical and surgical history do you want to explore? Name at least three PMH items.
Question 4Margery 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 5You 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:
Question 6Describe two types of GI surgeries that can lead to iron deficiency anemia.
Question 7Your older patient has been diagnosed with anemia of chronic disease, and a trial of iron has not been effective. List two medications you would consider prescribing for this patient.
Question 8Albert, 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 9Upon review of the diagnostic lab work for your older patient with anemia, your review of the ferritin levels leads to your diagnosis of ACD rather than iron deficiency anemia (IDA). Explain this.
Question 10What educational information would you give to your older patient taking iron supplements by mouth? List at least three educational statements.
NRNP6540 Advanced Practice Care of Older Adults
Week 9 Knowledge Check
Question 1 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 2The 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 3A 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 4Ms. 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?
a. An eye examination with an ophthalmologist
b. An eye exam with an optometrist
c. Colonoscopy
d. Bone density scan
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 6A 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 7Miss 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 8Identify 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 9The 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 10Which 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 1Describe the difference between bursitis and tendinitis.
Question 2Your 68-year-old male complains of a hot, swollen, reddened MTP joint of the great toe. What is your primary diagnosis?
Question 3Name 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 4Which drug/s are FDA approved for treatment of peripheral neuropathy?
Question 5Describe two preferred treatments for restless leg syndrome (RLS).
Question 6Identify at least three validated screening tests for cognitive impairment.
Question 7 Briefly describe three treatments for symptom control of rheumatoid arthritis.
Question 8Beth is an 82-year-old female who complains of morning joint stiffness that improves after 30 minutes; and joint stiffness that improves with mild activity. On clinical exam you find Heberden’ s nodes of her DIP joints, and joint crepitus. What type of arthritis would you diagnose her with, and which joints are most affected?
Question 9 How soon should a patient be treated for an acute gout attack?
Question 10Your 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.
