Chapter 14: Renal and Urological Disorders
1. Mrs. Borden is 67 years old and her primary care physician wants her to be seen by a nurse
practitioner who specializes in geriatric issues. On completing the interview and examination, the
nurse practitioner tells Mrs. Borden that she will order a blood laboratory specimen for thyroid
function and pancreatic function. Mrs. Borden asks what the reason is. Which of the following is the
nurse practitioner's best response?
1. Diabetes is more common in older patients.
2. Thyroid issues are less common in older patients.
3. These are common tests to be done on any new patient.
4. These tests are necessary to obtain baseline information. - 1. Answer: 1
Page: 361
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1.
The nurse practitioner recognizes that normal aging changes of the endocrine system primarily are
related to a decrease in pancreatic function (inability to sufficiently secrete insulin), resulting in
diabetes mellitus.
, 2.
The nurse practitioner needs to screen older adults periodically for diabetes mellitus and thyroid
disease because the incidence of these conditions increases with age.
3.
The nurse practitioner managing the care of older adults needs to differentiate among four clinical
states. One of those is an endocrine function that is altered relative to that of younger patients, but is an
expected consequence of normal aging.
4.
Overall, the nurse practitioner managing the care of older adults needs to differentiate among four
clinical states:
1. An endocrine function that is altered relative to that of younger patients, but is an
expected consequence of normal aging.
2. Altered endocrine function secondary to coincident nonendocrine disease, but is not of known
pathological significance.
3. Iatrogenic changes in endocrine function that largely reflect the polypharmacy seen in the
older adult population.
4. Authentic endocrinopathy.
2. Mr. Jones is 70 years old and sees the nurse practitioner for a yearly checkup. He states that he needs
to urinate a lot and seems to always be thirsty. He also finds himself gaining some weight. In the
process of the examination, the nurse practitioner detects that he is vague in his answers. Which of the
following may be the reason?
1. Mr. Jones is cold and bundled in a sweater.
2. There is no family history of diabetes.
3. The symptoms seem to have appeared slowly.
4. He does not want to admit to eating too much. - 2. Answer:
3 Page: 361
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1.
Explore with the patient any difficulty with temperature regulation, changes in skin texture, or
distribution of body hair.
2.
Reevaluate the patient's family history for endocrine and metabolic disease.
3.
Because changes in the endocrine system may appear subtle to the older person or atypical as
compared to younger patients, it may be difficult to pinpoint the onset of the presentation.
4.
Review with the patient any episodes of unexplained weight loss or gain, new or increased fatigue,
weakness, malaise, and recent infections.
, 3. Ms. Allen, 72 years old, is being evaluated by the nurse practitioner for type 2 diabetes. Because
symptoms of endocrine disorders in older adults are vague, which of the following questions is best to
ask?
1. Do you have any trouble carrying out your daily activities?
2. Can you tell me what you ate yesterday?
3. Have you seen a dentist in the last year?
4. Have you noticed that you have less hair? - 3. Answer:
1 Page: 361
Feedback
1.
Given the vagueness or atypical presentation of endocrine, metabolic, and nutritional disorders in older
adults, specific questions directed at these conditions are imperative during the review of systems. Any
alteration in the ability to carry out activities of daily living (ADLs) or instrumental ADLs due to
fatigue or subjective weakness.
2.
Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient or
significant other(s) if there have been any acute changes in memory or mood.
3.
Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient
about any mouth ulcerations.
4.
Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient
about any noticeable dryness to hair or loss of hair.
4. Mrs. Smith, 80 years old, has been vomiting and having bouts of loose stools for several days. She
is taking several medications that are prescribed. The nurse practitioner conducts a medication review
because:
1. An accounting of all prescribed and over-the-counter (OTC) medications may uncover reasons for
her symptoms.
2. There could be drug-drug interactions leading to her symptoms.
3. Side effects of the gastrointestinal tract are not seen in many medications.
4. The administration of some of her medications may be appropriate. - 4. Answer: 2
Page: 362
Feedback
1.
A thorough review of all medications, including OTC and home remedies, is important to discern for
alterations in the absorption of medications.
1. Mrs. Borden is 67 years old and her primary care physician wants her to be seen by a nurse
practitioner who specializes in geriatric issues. On completing the interview and examination, the
nurse practitioner tells Mrs. Borden that she will order a blood laboratory specimen for thyroid
function and pancreatic function. Mrs. Borden asks what the reason is. Which of the following is the
nurse practitioner's best response?
1. Diabetes is more common in older patients.
2. Thyroid issues are less common in older patients.
3. These are common tests to be done on any new patient.
4. These tests are necessary to obtain baseline information. - 1. Answer: 1
Page: 361
Feedback
1.
The nurse practitioner recognizes that normal aging changes of the endocrine system primarily are
related to a decrease in pancreatic function (inability to sufficiently secrete insulin), resulting in
diabetes mellitus.
, 2.
The nurse practitioner needs to screen older adults periodically for diabetes mellitus and thyroid
disease because the incidence of these conditions increases with age.
3.
The nurse practitioner managing the care of older adults needs to differentiate among four clinical
states. One of those is an endocrine function that is altered relative to that of younger patients, but is an
expected consequence of normal aging.
4.
Overall, the nurse practitioner managing the care of older adults needs to differentiate among four
clinical states:
1. An endocrine function that is altered relative to that of younger patients, but is an
expected consequence of normal aging.
2. Altered endocrine function secondary to coincident nonendocrine disease, but is not of known
pathological significance.
3. Iatrogenic changes in endocrine function that largely reflect the polypharmacy seen in the
older adult population.
4. Authentic endocrinopathy.
2. Mr. Jones is 70 years old and sees the nurse practitioner for a yearly checkup. He states that he needs
to urinate a lot and seems to always be thirsty. He also finds himself gaining some weight. In the
process of the examination, the nurse practitioner detects that he is vague in his answers. Which of the
following may be the reason?
1. Mr. Jones is cold and bundled in a sweater.
2. There is no family history of diabetes.
3. The symptoms seem to have appeared slowly.
4. He does not want to admit to eating too much. - 2. Answer:
3 Page: 361
Feedback
1.
Explore with the patient any difficulty with temperature regulation, changes in skin texture, or
distribution of body hair.
2.
Reevaluate the patient's family history for endocrine and metabolic disease.
3.
Because changes in the endocrine system may appear subtle to the older person or atypical as
compared to younger patients, it may be difficult to pinpoint the onset of the presentation.
4.
Review with the patient any episodes of unexplained weight loss or gain, new or increased fatigue,
weakness, malaise, and recent infections.
, 3. Ms. Allen, 72 years old, is being evaluated by the nurse practitioner for type 2 diabetes. Because
symptoms of endocrine disorders in older adults are vague, which of the following questions is best to
ask?
1. Do you have any trouble carrying out your daily activities?
2. Can you tell me what you ate yesterday?
3. Have you seen a dentist in the last year?
4. Have you noticed that you have less hair? - 3. Answer:
1 Page: 361
Feedback
1.
Given the vagueness or atypical presentation of endocrine, metabolic, and nutritional disorders in older
adults, specific questions directed at these conditions are imperative during the review of systems. Any
alteration in the ability to carry out activities of daily living (ADLs) or instrumental ADLs due to
fatigue or subjective weakness.
2.
Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient or
significant other(s) if there have been any acute changes in memory or mood.
3.
Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient
about any mouth ulcerations.
4.
Given the vagueness or atypical presentation of endocrine symptoms in older adults, ask the patient
about any noticeable dryness to hair or loss of hair.
4. Mrs. Smith, 80 years old, has been vomiting and having bouts of loose stools for several days. She
is taking several medications that are prescribed. The nurse practitioner conducts a medication review
because:
1. An accounting of all prescribed and over-the-counter (OTC) medications may uncover reasons for
her symptoms.
2. There could be drug-drug interactions leading to her symptoms.
3. Side effects of the gastrointestinal tract are not seen in many medications.
4. The administration of some of her medications may be appropriate. - 4. Answer: 2
Page: 362
Feedback
1.
A thorough review of all medications, including OTC and home remedies, is important to discern for
alterations in the absorption of medications.
