SG 6420: FNP I Adult/Gero Final Review Study Guide
1. General Concepts in Geriatrics
Impact of physiological changes with aging: Kennedy Chapter 1.
The major impact of all of these physiological changes can be highlighted with three primary
points. First, there is a reduced physiological reserv...
NSG 6420: FNP I Adult/Gero Final Review Study Guide
1. General Concepts in Geriatrics
Impact of physiological changes with aging: Kennedy Chapter 1.
The major impact of all of these physiological changes can be highlighted with three primary
points. First, there is a reduced physiological reserve of most body systems, particularly cardiac,
respiratory, and renal. Second, there are reduced homeostatic mechanisms that fail to adjust
regulatory systems such as temperature control and fluid and electrolyte balance. Third, there is
impaired immunological function: infection risk is greater, and autoimmune diseases are more
prevalent. Reduced renal function, particularly the glomerular filtration rate (GFR), affects the
clearance of many drugs, and creatinine clearance provides an index of renal function for use in
choosing doses of renally eliminated or nephrotoxic drugs (such as digoxin, H2 blockers,
lithium, and water-soluble antibiotics).
Normal age related changes:
Changes in kidney function begin in the fourth decade of life and continue to decline with each
subsequent decade. by age 70, an individual might reasonably have a 40% to 50% decrease in
renal function, even in the absence of disease.
With advancing age, the ability of the liver to metabolize drugs does not decline. Although liver
size and blood flow do decline with age, routine liver function test results are typically normal
when no disease exists. Decreased liver size and blood flow can result in decreased first-pass
metabolism.
Older adults often experience more sedation from central nervous system drugs than younger
persons at the same concentration.
Signs and symptoms of depression:
Altered presentation is another common feature in older adults. The patient with depression
may not present with a dysphoric mood but rather agitation and psychotic features.
Questions
The major impact of the physiological changes that occur with aging is:
Reduced physiological reserve
Reduced homeostatic mechanisms
Impaired immunological response
All of the above
All of the following statements are true about laboratory values in older
adults except
Reference ranges are preferable
Abnormal findings are often due to physiological aging
Normal ranges may not be applicable for older adults
Reference values are not necessarily acceptable values
, Mini Mental Status: Buttaro Chapter 13
Geriatric specialists have multiple assessment tools, such as the Folstein Mini-Mental State
Examination, the Mini-Cog screen for dementia, the Short Portable Mental Status
Questionnaire, the AD8 Dementia Screening Interview, and the Montreal Cognitive Assessment
(MoCa), to differentiate short-term memory loss from dementia and to observe the progression
of cognitive impairment.
Questions
When prescribing medications to an 80-year-old patient, the provider will
a. begin with higher doses and decrease according to the patient’s response.
b. consult the Beers list to help identify potentially problematic drugs.
c. ensure that the patient does not take more than five concurrent medications.
d. review all patient medications at the annual health maintenance visit.
The Beers list provides a list of potentially inappropriate medications in all patients age 65 and
older and helps minimize drug-related problems in this age group. Older patients should be
started on lower doses with gradual increase of doses depending on response and side effects.
Patients who take five or more drugs are at increased risk for problems of polypharmacy, but
many will need to take more than five drugs; providers must monitor their response more closely.
Medications should be reviewed at all visits, not just annually. REF:
Polypharmacy/Consequences of Polypharmacy/Management
An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds. She
appears somewhat confused, according to her daughter, who is concerned that she is developing
dementia. The provider learns that the woman still drives, volunteers at the local hospital, and
attends a book club with several friends once a month. What is the initial step in evaluating this
patient?
a. Obtain a CBC, serum electrolytes, BUN, and glucose
b. Ordering a CBC, serum ferritin, and TIBC
c. Referring the patient to a dietician for nutritional evaluation
d. Referring the patient to a neurologist for evaluation for AD
Patients with weight loss, confusion, and lethargy are often dehydrated and this should be
evaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient is currently leading an
active life, so the likelihood that recent symptoms are related to AD, although this may be
evaluated if dehydration is ruled out. Anemia would be a consideration when dehydration is
ruled out. Referrals are not necessary unless initial evaluations suggest that malnutrition or AD is
present. REF: Dehydration/Pathophysiology/Clinical Presentation/Physical Examination
,The practitioner is establishing a plan for routine health maintenance for a new female client who
is 80 years old. The client has never smoked and has been in good health. What will the
practitioner include in routine care for this patient?
Select all that apply.
a. Annual hypertension screening
b. Baseline abdominal aorta ultrasound
c. Colonoscopy every 10 years
d. One-time hepatitis B vaccine
e. Pneumovax vaccine if not previously given
f. Yearly influenza vaccine
For older clients a one-time pneumovax is given after age 65. Influenza vaccine should be given
every year. Hypertension screening should be performed at each office visit, not just annually. An
abdominal aorta US is performed once for every smoking male. Colonoscopy is performed every
10 years after age 50, but not after age 74. REF: Table 13-1: Recommended Screening and
Immunizations
2. HEENT
Pharyngitis Buttaro Chapter 101
In noninfectious pharyngitis the patient reports a sore throat and dryness; if environmental
allergens are the cause, symptoms often include rhinorrhea, watery eyes, and postnasal drip.
Viral causes are more common (rhinorivus) In viral pharyngitis, findings include fever, cough,
nasal symptoms, and mild erythema with little or no pharyngeal exudate. Treatment of viral
pharyngitis includes rest, fluids, humidification, voice rest, and warm saline gargles to ease
discomfort. 7 Acetaminophen or ibuprofen should be used for fever and general discomfort.
Bacterial pharyngitis is more common in children younger than 15. Streptococcus pyogenes is
the etiologic agent for acute pharyngitis. Group A β-hemolytic Streptococcus (GAS) is the most
important to identify because it is responsible for acute rheumatic fever (ARF) and
poststreptococcal glomerulonephritis. Patients may report a sudden onset of sore throat, painful
swallowing, fever (temperature higher than 38.5° C [101.3° F]), chills, headache, nausea,
vomiting, and abdominal pain. With bacterial pharyngitis, rhinitis, cough, conjunctivitis, and
myalgias are not typically present. Diagnostic studies used to detect GAS infection include a
throat culture, a rapid antigen detection test (RADT).
Penicillin V, 500 mg 2-3 times daily for 10 days) is indicated in GAS pharyngitis primarily to
prevent complications, such as suppurative tonsillitis, glomerulonephritis, and rheumatic fever.
Clarithromycin, 250 mg twice daily for 10 days, is indicated for patients with penicillin allergy.
questions
A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical
lymphadenopathy. What will the provider do next to manage this patient’s symptoms?
, a. Order an antistreptolysin O titer
b. Perform a rapid antigen detection test
c. Prescribe empiric penicillin
d. Refer to an otolaryngologist
The RADT is performed initially to determine whether GAS is present. The ASO titer is not used
during initial diagnostic screening. Penicillin should not be given empirically. A referral to a
specialist is not required for GAS infection.
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes
mild erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is
the most likely cause of these symptoms?
a. Allergic pharyngitis
b. Group A streptococcus
c. Infectious mononucleosis
d. Viral pharyngitis
Viral pharyngitis will cause sore throat, fever, and malaise and is often accompanied by URI
symptoms of cough and runny nose. Allergic pharyngitis usually also causes dryness. GAS
causes high fever, cervical adenopathy, and marked erythema with exudate. Infectious
mononucleosis will cause an exudate along with cervical adenopathy
A school-age child has had 5 episodes of tonsillitis in the past year and 2 episodes the previous
year. The child’s parent asks the provider if the child needs a tonsillectomy. What will the
provider tell this parent?
a. Current recommendations do not support tonsillectomy for this child.
b. If there is one more episode in the next 6 months, a tonsillectomy is necessary.
c. The child should have radiographic studies to evaluate the need for tonsillectomy.
d. Tonsillectomy is recommended based on this child’s history.
Recommendations suggest 6 to 7 documented episodes of GAS within 1 year, 5/year for 2
consecutive years, or 3/year for 3 years. Radiographic studies are not indicated
Mononucleosis (Buttaro Chapter 233)
EBV-IM (Epstein-Bar Virus infectious mononucleosis) occurs most often in adolescents and
young adults, with the highest incident at ages 15 to 19. Transmission of EBV-IM occurs through
exposure to oropharyngeal secretions. The classic triad of symptoms of acute IM includes fever,
pharyngitis, and lymphadenopathy. The typical adolescent with EBV-IM is seen with sore throat,
fever, and lymph node and tonsillar enlargement. Additional common presenting symptoms
include pharyngeal inflammation and transient palatal petechiae. Reports indicate that splenic
enlargement occurs in 40% to 100% of cases and can be confirmed with ultrasound. An
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