NRNP 6540 Advanced Practice Care Of Older Adults new 1

NRNP 6540 MIDTERM EXAM LATEST 2023 PRIME EXAM

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A previous severe allergic reaction to influenza vaccine, regardless of the component suspected of bei

2.You see a 69-year-old patient who recently moved to town and does not remember his last tetanus shot. What would

Correct
Answer: You could do one of two strategies: perform serologic testing for tetanus and diphtheria antitoxin to see if
Tetanus/Tdap:
In older adults, if the recommended childhood series was not done at all, the recommendation is one dose of Tdap, f

3. E. D. is a 78-year-old woman who does not remember if she has ever had the immunization for herpes zoster. She does

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Discuss the risks of herpes zoster and SE of vaccination with the patient and decide on whether to imm
Herpes Zoster
Recombinant zoster vaccine (RZV) was approved by the U.S. Food and Drug Administration in 2017 and reco
Zoster vaccine live (ZVL) became available in 2006 and was recommended by the ACIP in 2008 for use in
RZV is recommended by the ACIP to be given to adults aged 50 years or older. It is a two-dose vaccine serie
Neither the Centers for Disease Control and Prevention (CDC) nor the World
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Health Organization (WHO) have updated their recommendations since RZV was
introduced, regarding zoster vaccination for older adults who are not sure of
their zoster vaccination status.

4. Name the most common allergic response to the flu vaccine,

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All influenza vaccines have the potential to cause an egg-related allergic reaction. Persons with a history o

5. Many older adults travel worldwide when they retire. For patients who are planning to travel
overseas, what would you recommend?

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Before travel, older adults should be up to date on routine vaccines. Older adults should also receive othe

6. Give three reasons why older adults are especially vulnerable to complications of influenza

infections.

Correct
Answer: Older individuals are more likely to experience a severe infection, develop pneumonia, require hospitalizati
and older. Following an acute care hospitalization, many older adults fail to return to their previous level of function
Nearly 40% of relatively healthy community-dwelling older adults who reported the presence of influenza or influen

7. You have an 89-year-old patient on hospice care in a long-term care facility. The protocol is for flu

vaccine to be given to all patients each fall. Would you vaccinate? Why, or why not?

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Answer: According to Coll and colleagues, one study of the efficacy of the influenza
vaccine in end-of-life cancer patients found that influenza vaccine maintains
efficacy despite the decreased immune response in these patients and
concluded that the vaccine should be offered to patients in the last few
months of life.
Reference:
Coll, P. P., Costello, V. W., Kuchel, G. A., Bartley, J., & McElhaney, J. E. (2019).
The prevention of infections in older adults: Vaccination. Journal of the American
Geriatrics Society, 68(1), 207–214. https://doi.org/10.1111/jgs.16205

8. Which 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?

Selected Answer:
If the patient is 65-year-old with HIV infection and a CD4 count less than 200/mm,

then few immunizations are withheld due to severely immunocompromised health conditions. List of immun
-Influenza vaccine, live, attenuated (LAIV)

-Measles, mumps, and rubella vaccine (MMR)

-Varicella vaccine (VAR)

-Zoster vaccine live (ZVL)

9. Which influenza vaccine is recommended for the older adult?

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The High-dose IIV3 (Fluzone) vaccine is recommended for the older adult.

10. What is the maximum number of doses of PPSV23 that can be given to high-risk older adults 65 or older?

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The ACIP has clarified that a maximum of three doses of PPSV23 are recommended for high-risk perso

11. Identify three common causes of lymphedema.

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Lymphedema is most commonly caused by surgery, radiation, or infection that damages the lymphatic
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12. Your patient has herpes zoster ophthalmicus (HZO) as shown in the photo. What would your
treatment plan for this patient be?

Correct
Answer: Your treatment plan for this patient with HZO would be oral antivirals (e.g., acyclovir, famciclovir, valacyclov
treatment with acyclovir 800 mg po five times/day or famciclovir 500 mg or valacyclovir 1 g po tid for 7 days reduces o
Intraocular pressure must be monitored and treated if it rises significantly above normal values.
Patients with uveitis or keratitis require topical corticosteroids (e.g., prednisolone acetate 1% instilled q 1 h for uveitis o

13. Your 78-year-old patient comes in yearly for a skin check. She was a self-
proclaimed “sun worshipper” in her younger days. She has multiple freckles over
her face, arms, and back. She is concerned about a freckle on her back that seems
to be getter larger. This is what you see, what is your impression?

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Because of its irregular border, various colors, and its growth, you suspect a melanoma.

14. Define wheal, pustule, and vesicle.

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A wheal is a plague or papule with a red border and pale center, a pustule is a raised lesion with pus fill

15. Tinea pedis is also known as “athlete’s foot.” What is the most common presentation of athlete’s foot?

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Tinea pedis, or athlete’s foot, often presents as interdigital erythematous pruritic scaly skin, hyperke

16. Cellulitis is most commonly caused by which pathogens?

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Cellulitis is most often caused by group A strep (pyrogenes) and
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staph aureus.

17. List the four steps of decongestive physiotherapy (CDP) for lymphedema.

Correct
Answer: Complete decongestive physiotherapy (CDP) is the gold standard for lymphedema management. CDP is a spe
manual lymph drainage (MLD), compression bandaging, exercises, and skin care.

18. 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?

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Basal cell carcinoma typically alternately crusts and heals. Most commonly, the carcinoma begins as a

19. A 75-year-old male patient returns to the clinic with complaints of worsening psoriasis. Describe two tre

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Possible treatments include: corticosteroids, vitamin D analogues, calcipotriene topical, retinoids, tazaro

20. Based on your primary diagnosis of melanoma, what is your treatment plan for this patient’s
lesion?

Correct
Answer: Surgical excision and biopsy. Malignant melanoma arises from melanocytes in a pigmented area (e.g., s
to cure.

21. You 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:
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The carotid arteries should be assessed routinely for the presence of bruit. Asymptomatic carotid bruit is

22 When performing an assessment on patients over 65 years of age, what are at least
. three (3) key symptoms that may indicate cardiovascular disease?
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Key symptoms for cardiovascular assessment include dizziness, syncope, orthopnea, angina, edema, a

23. Your 72-year-old patient comes in for a checkup. His BMI is 32, BP is 152/79, and BG 139. He is
currently not taking his HTN medications. You check his HgA1C and it is 9. He admits he does not get
much exercise and smokes half a pack of cigarettes a day. Describe the three most important
strategies you will plan for this patient to decrease his risk for a cardiovascular event.

Correct
A 78-year-old
Answer:
24. Additional patient, past onerisk
proven or postulated ppd smoker
factors times 10 years
for cardiovascular (quit
disease in 10 years
older
adults include obesity, lack of exercise, and impaired
ago) presents with increasing shortness of breath, dyspnea on exertion, and glucose tolerance. Older
adult individuals
no other symptoms. Name are two
most diagnostic
likely to have a combination
tests you could of order
risk factors,
to which
has a cumulative effect of increasing the risk of CAD. Control of hypertension is
differentiate between
clearly the mostasthma andremediable
potentially COPD. risk factor. Evidence is compelling for
discontinuation of cigarette smoking at any age. More information is needed
Correct regarding the effectiveness and feasibility of lowering cholesterol levels, weight
reduction, improved exercise plans, and strict control of blood glucose levels,
Answer:
25. Two
Accordingwith tests
to the youto
GOLD
respect could
the order
Pocket Guide would of be
to COPD
incidence spirometry
Diagnosis,
CHD, or pulmonary
Management,
particularly offunction
in those and testing.
Prevention,
most A Guide
advanced age.
Forced expiratory volume in 1 second (FEV1), FEV6, forced vital capacity
for Health Care Professionals, 2017, what would the predicted FEV be for GOLD 4 very severe COPD?
(FVC), and FEV1/FVC ratio before and after bronchodilator challenge, showing an
improvement of 12% and 200 mL, indicates reversible airway obstruction
(Brigham & West, 2015). This is helpful in differentiating asthma from COPD,
particularly in an older adult with a prior smoking history.
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GOLD 4: Very Severe would have an FEV1 <30% predicted

26. 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 development of asthma.

Correct
Answer: Exposure to allergens, respiratory infections, family history/genetic predisposition, atopy, occupational irrita
Wilson, 2015).

27. Clara is an 89-year-old African American female who comes to see you in the clinic today. She describes a new comp
her by asking which questions (list at least three ROS questions)?

Correct
Answer: The older patient may have atypical symptoms of a cardiovascular event.
Establish the patient’s usual baseline activities of daily living (ADLs) and activity
level and ask how symptoms are affecting this. Some older adults experience palpitations as a nervous feeling, so incl

28.There are known risk factors for coronary artery disease (CAD). Name the two most important risk factors tha

Correc t
The two most important risk factors for atherosclerosis that cannot be remedied
Answe areadvanced age and male gender.
r:

29. You examine a new 69-year-old patient who presents with a whitish gray ring around his iris.
What is the name of this phenomena and how is it related to cardiovascular disease?

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Answer: This phenomenon is an arcus senilis. The eye examination reveals the thick corneal arcus, or white ring

30. Alex is an 82-year-old patient who has presented for his annual checkup. 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?

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An S3 in an individual more than 50 years old is usually pathological and reflects an increased filling ra