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1
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
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,
,A patient
D. has
recommendation
screening
meats a positive
you
B. Strict
Encourage family
would
physical
the history
want
activity
patient C. of
tothem tocolon
Encourage
reduce cancer.
adhere
intake to?
the
of A.Which of increase
Encourage
patient
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baseline is aintake of red
colonoscopy
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2
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
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?
,A patient
D. has
recommendation
screening
meats a positive
you
B. Strict
Encourage family
would
physical
the history
want
activity
patient C. of
tothem tocolon
Encourage
reduce cancer.
adhere
intake to?
the
of A.Which of increase
Encourage
patient
fiber to the following
baseline is aintake of red
colonoscopy
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3
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.
Explanation:
This patient is at risk for rubella because she does not have a sufficient titer. The MMR
immunization is an attenuated virus. Though an attenuated immunization is weakened,
it is still considered live and so is contraindicated in anyone who may be
immunocompromised. Since her CD4 cell count is unknown, she should not receive this
immunization yet. She may be able to receive this immunization if her CD4 count is
normal.
Question:
9- What choice below would be beneficial to a 76-year-old who takes daily oral steroids
, A patient
D. has
recommendation
screening
meats a positive
you
B. Strict
Encourage family
would
physical
the history
want
activity
patient C. of
tothem tocolon
Encourage
reduce cancer.
adhere
intake to?
the
of A.Which of increase
Encourage
patient
fiber to the following
baseline is aintake of red
colonoscopy
dietary
4
for COPD and now takes a daily aspirin for primary prevention of myocardial
infarction?
Screen for infection with H. pylori
Daily proton pump inhibitor (PPI) Correct
Antacids PRN heartburn
Daily use of low dose famotidine
Explanation:
Aspirin does increase the risk of gastrointestinal bleeding, especially if it is given in
combination with oral steroids. Most learned authorities and ACOVE (Assessing Care
of Vulnerable Elders) agree that when two or more risk factors for GI bleed are present,
aspirin should not be added without some form of protection for the GI tract
(misoprostol or a daily PPI). In considering all the risks for GI bleed, the most
significant ones are age > 75 years, history of GI bleeding, warfarin use, daily NSAID
use, and chronic steroid use.
Question:
10- A patient who is 62 years old asks if she can get the shingles vaccine. She has never
had shingles but states that she wants to make sure she doesn’t get it. What should the
nurse practitioner advise?
The immunization will protect you from acquiring shingles.
You are not old enough to receive the immunization.
The immunization is offered only to those who have had shingles.
You are eligible to receive it but you still may get shingles. Correct
Explanation:
Patients must be at least 50 years old to receive the shingles immunization. It is
generally well tolerated but provides protection from shingles in 50-64% of patients.
The incidence of postherpetic neuralgia is decreased up to 65% after immunization. The
patient still may develop shingles after receiving the immunization. The vaccine may be
offered regardless of whether the patient has history of shingles. However, since it is a
live vaccine, it may be contraindicated because of steroid use or immune status.
Question:
11- Which pharmacokinetic factor is influenced by a decrease in liver mass in an older
adult?
Absorption
Distribution
Metabolism Correct
Elimination
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