HEALTH PROMOTION (31)
1- A 58-year-old patient has an annual exam. A fecal occult blood test was used to
screen for colon cancer. Three were ordered on separate days. The first test was
positive; the last two were negative. How should the nurse practitioner proceed?
Rescreen in one year.
Perform a fourth exam.
Refer him for a colonoscopy. Correct
Examine him for hemorrhoids.
Explanation:
A fecal occult blood test is performed multiple times on different days because tumors
don’t consistently excrete blood. The reason multiple are performed is to increase the
likelihood of identifying blood. The patient needs to have a colonoscopy performed for
examination of the colon. The standard of practice is to refer all positive colon cancer
screens for colonoscopy.
2 -A criterion for medication choice in an older adult is:
long half-life to prevent frequent dosing.
dosing of 3-4 times daily.
pill color and shape for easy identification.
half-life less than 24 hours. Correct
Explanation:
Many factors go into prescribing for older adults. Some important safety criteria include
established efficacy, low adverse event profile, and half-life less than 24 hours with no
active metabolites. Active metabolites would produce a longer effect of the drug in the
patient. Dosing of a medication three to four times daily invites dosing and medication
errors. Once- or twice-daily dosing is ideal. Pill color and shape is never a criterion for
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prescribing. Patients who are cognitively able will recognize the color, shape, and size
of pills they take on a regular basis.
3- What should the nurse practitioner recommend to any elder taking medications?
Have someone check your medications prior to taking them
Never take your medicine on an empty stomach
Keep a list of all of your medications with you Correct
Have a pharmacist review your list once a year
Explanation:
A list of current medications should be kept with each patient and carried with him,
especially when healthcare visits are scheduled. Many older adults are capable of taking
medications without supervision. Many medications should be taken without food
(thyroid supplementation for example). A pharmacist can evaluate the list of
medications for drug-drug interactions, but the pharmacist will not know the diagnoses
and other reasons for choosing the medications.
Question:
4- What temperature should be set on a water heater in the home of an older adult to
prevent burn injury?
Less than 110 degrees
Less than 120 degrees correct
Less than 130 degrees
Less than 140 degrees
Explanation:
Hot water heaters are common sources of burns in homes of older adults and very
young patients. Many safety organizations in the United States believe that burns can be
prevented if hot water heaters are set to less than 120° F.
Question:
5- What is the recommendation from American Cancer Society for assessment of the
prostate gland in a man who is 45 years old and of average risk for development of
prostate cancer? He should have:
screening starting at 50 years of age. Correct
prostate specific antigen (PSA) now.
PSA and digital rectal exam now.
digital rectal exam only.
Explanation:
At age 50 years, males of average prostate cancer risk should have PSA measurement
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with or without digital rectal exam (DRE). If they are deemed to be of high risk because
of a family history (first-degree relative with prostate cancer before age 65 years) or
race (African American), screening discussions should take place at age 40-45 years. If
initial PSA is > 2.5 ng/mL, annual testing should take place. If the initial PSA is < 2.5
ng/mL, test every 2 years.
Question:
6 - A 75-year-old adult asks for the pneumonia vaccine. His immunization record
indicates that he had one at age 65 and another a year later. What is the recommendation
of the CDC about how the NP should handle his request?
Revaccination is recommended now
Revaccination is recommended every 5 years after age 65 years
Do not revaccinate this patient at this time Correct
He should have received one at age 70 years
Explanation:
The recommendation of CDC is NOT to revaccinate this patient. After initial
vaccination with PCV13 at age 65 years and subsequent vaccination with PPSV23 1
year later, no revaccination is recommended in this patient.
Question
7- A patient who has been treated for hypothyroidism presents for her annual exam. Her
TSH is 4.1 (normal = 0.4- 3.8). She feels well. How should she be managed?
Continue her current dosage of thyroid replacement.
Increase her replacement.
Decrease her replacement.
Repeat the TSH in 2-3 weeks. Correct
Explanation:
When an abnormal TSH is received, especially when a patient is not symptomatic, it
should be repeated. Sometimes there are periods of transient hypothyroidism, lab error,
and missed doses that can cause changes in TSH levels.
Question:
8 - A 20-year-old student has an MMR titer that demonstrates an unprotective titer for
rubella. She is HIV positive. Her CD4 cell count is unknown. Which statement is true?
She should not receive the MMR immunization because she is low risk for the disease.
MMR is safe to give but she does not need this.
She is at risk for MMR but should not be immunized. Correct
She should receive this. The immunization is not alive.
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