NR 601 Primary Care of the Maturing and Aged Family Essay Paper

NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Week 5 Case Study

This case study involves Mrs. Wu, a 59-year-old Asian female who present to the clinic for a follow up visit for her recently diagnosed right knee arthritis. She presents with new concerns that will be need to be addressed. This paper will examine the pertinent subjective and objective data that wascollected in order to diagnose and cultivate a treatment plan for Mrs. Wu. This paper will discuss the assessment of a primary, secondary, and differential diagnosis, including the pathophysiology, pertinent positive findings, pertinent negative findings, and the rationale.A treatment plan for each diagnosis, which consists of diagnostics, medications, education, referrals, and follow up will also be discussed. A discussion on medication costswill be presented and conclude with a summarized SOAP note.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

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Assessment

According to the subjective and objective data collected from Mrs. Wu, there are concerns that need to be addressed. She came in to the office today with new concerns of increased fatigue for 12 weeks, weight gain of 4 lbs., increased hunger and thirst, and frequently urination during the day and at night. According to the Centers for Disease Control and Prevention (2018), her BMI is 30.7, which classifies her as obese. Her lab work resulted with a fasting glucose of 136, HbA1c 6.8%, UA with 1+ glucose, total cholesterol 215 mg/dl, LDL 144 mg/dl, VLDL 36 mg/dl, HDL 32mg/dl, and Triglycerides of 229. All other lab values were within normal limits, ruling out hypothyroidism and anemia.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Primary Diagnosis

Diabetes Mellitus type 2 (E11.9)

            Pathophysiology

Diabetes Mellitus Type 2 (DM2) accounts for 90-95% of all diabetes (American Diabetes Association, 2018).It is a “heterogeneous disease caused by a combination of genetic factors related to inadequate insulin secretion and insulin resistance as well as environmental factors such as obesity, stress, overeating, lack of exercise, and aging” (Dunphy, Winland-Brown, Porter, & Thomas, 2011).Common signs and symptoms are increased urination during the day (polyuria), increased urination during the night (nocturia), increased thirst (polydipsia), increased hunger (polyphagia), and weight gain (Goroll, 2014).NR 601 Primary Care of the Maturing and Aged Family Essay Paper

            Pertinent Positive Findings

Pertinent positives include: increased fatigue for about the last 12 weeks, tiredness, weight gain of 4 lbs. since menopause 4 years ago despiteexercising twice a week, polyphagia, polydipsia, polyuria and nocturia, obesity with a BMI of 30.7, her age of 59, and Asian race (ADA, 2018). Her lab work resulted with an elevated fasting glucose of 130,Hemoglobin A1C of 6.8%, and 1+ glucose in urine, which also support the diagnosis of DM2.

            Pertinent Negative Findings

Pertinent negatives include: acanthosis, oropharynx moist without erythema, and peripheralneuropathy (Dunphy, Winland-Brown, Porter, & Thomas, 2011).

            Rationale for the Diagnosis

A primary diagnosis of DM2 was chosen based on the patient’s symptoms and lab work. According to American Diabetes Association (2018), the risk of developing DM2 increases with age, obesity, racial/ethnic subgroups, such as Asian Americans, and those with hypertension or hyperlipidemia. Mrs. Wu displays a clear presentation of DM2 with increased fatigue, polydipsia, polyphagia, weight gain, nocturia, and polyuria.Obesity also enhances insulin resistance and predisposes patients to DM2 (Dunphy, Winland-Brown, Porter, &Thomas, 2011).NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Secondary Diagnosis

Hyperlipidemia (E78.5)

            Pathophysiology

            Hyperlipidemia is a heterogeneous metabolic disorder involvingelevated levels of cholesterol in the blood. The levels of lipids and lipoproteins in the blood increase the risk of atherosclerosis (Dunphy, Winland-Brown, Porter, & Thomas, 2011). Clinically, patients are asymptomatic and hyperlipidemia is undetected unless the patient’s lipid panel is checked via lab work. However, common diseases such as hypertension (HTN) or coronary artery disease (CAD) exist alongside with hyperlipidemia (Dunphy, Winland-Brown, Porter, & Thomas, 2011). According to Dunphy, Winland-Brown, Porter, & Thomas (2015), desirablelevels include: total cholesterol <200 mg/dL, low-density lipoprotein (LDL) <100 mg/dL, triglycerides  <150 mg/dL, and high level lipoprotein (HDL) <40 mg/dL.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

            Pertinent Positive Findings

Pertinent positives include: gender, ethnicity, weight gain, increased hunger, increased thirst, DM2, and obesity (Dunphy, Winland-Brown, Porter, & Thomas, 2011). Her lab work resulted with elevated TC 215 mg/dL, LDL 144 mg/dL, VLDL 36 mg/dL, triglycerides 229 mg/dL, and a low HDL 32 mg/dL.In her case, hyperlipidemia was detected by completing lab work during a physical exam.

            Pertinent Negative Findings

Pertinent negatives include: HTN and CAD, and yellowish skin deposits of cholesterol called xanthomas (Dunphy, Winland-Brown, Porter, & Thomas, 2011). Her BP is 112/76 and her HR is 80. HTN and CAD are both associated with hyperlipidemia and she has no history of either disease.

            Rationale for the Diagnosis

Mrs. Wu had lab work resulted with elevated TC of 215 mg/dL, LDL of 144 mg/dL, VLDL of 36 mg/dL, triglycerides of 229 mg/dL, and a low HDL of 32 mg/dL, which is indicative of a secondary diagnosis of hyperlipidemia. Hyperlipidemia is a significant part of metabolic syndrome. In Mrs. Wu’s case, her increased BMI, hyperglycemia, hypertriglyceridemia, and low levels of HDL establish a diagnosis of hyperlipidemia (Dunphy, Winland-Brown, Porter, & Thomas, 2011).NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Differential Diagnosis

Depression (F32.9)

            Pathophysiology

Depression is a mood disorder caused by “psychological, social, biologic factors that can contribute to the onset include genetic predisposition, central nervous system disorders, hormonal changes, stress, and ineffective coping strategies” (Boling & Smith, 2018). Norepinephrine and serotonin are the two neurotransmitters that are associated with the cause of mood disorders. Also, there is evidence that drugs that antagonize N-methyl-D-aspartate (NMDA) receptors have antidepressant effects (Dunphy, Winland-Brown, Porter, & Thomas, 2011). There is also a correlation between the hyper secretion of cortisol and depression.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

            Rationale for the Diagnosis

Depression is chosen as a differential diagnosis due to the pertinent positives upon examination, which include increased fatigue for about the last 12 weeks, tiredness, weight gain of 4 lbs., obesity, menopause 4 years ago, divorced, and alcohol use of 1-2 glasses of wine daily. Given that she has life changes, hormonal changes, and has been newly diagnosed with right knee arthritis and now diabetes and hyperlipidemia, she is at risk for depression, which needs to be closely considered and monitored (Goroll, & Mulley, 2014).NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Plan

Diagnostics

            Lab test

Additional lab tests will need to be completed for Mrs. Wu. In 3 months a repeat fasting CMP, blood glucose, HbA1c, lipid panel, and UA will need to be obtained as a follow up for DM2 and hyperlipidemia. Additional labs that I would include would be LFT, vitamin D, folate, and serum vitamin B12.It is important to assess her liver function because metformin is contraindicated with liver disease (ADA, 2018). Vitamin D and folate could be related to her fatigue and tiredness, and vitamin B12 could be decreased due to metformin. Also, decrease levels of B vitamins and folate can be associated with depression (Gorroll& Mulley, 2014).NR 601 Primary Care of the Maturing and Aged Family Essay Paper

I would screen Mrs. Wu for depression using the PHQ-9 tool. This is a fast instrument used to screen, diagnose, monitor, and measure the severity of depression in the following areas: pleasure, mood, sleep, fatigue, appetite, self-blame, concentration level, restlessness, and thoughts of suicide (Peres, Mercante, Tobo, Kamei, &Bigal, 2017). She is newly diagnosed with arthritis, DM2, and hyperlipidemia, divorced, drinks 1-2 glasses of wine a day, and has increased fatigue for 12 weeks.

Medications

I would have Mrs. Wu continue current medications of Tylenol 500mg 2 tabs in AM and a daily multivitamin. I would prescribe Metformin, as it is the first line medication for DM2. It can be used a monotherapy or combined with sulfonylureas and insulin. Metformin is beneficial for obese patients because he has a neutral effect on weight. It should only be used in patients with adequate renal function (Dunphy, Winland-Brown, Porter, & Thomas, 2011). In this patient’s case, her renal function is within normal limits, BUN 12 and creatinine 0.7.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Metformin 500 mg tablet

Sig: Take one tablet by mouth twice daily with meals

Disp: 60 tablets

Refill: 2 (Metformin Hydrochloride, 2018). Since Mrs. Wu is newly diagnosed with DM2, she would need a glucometer, lancets, and test strips in order to check and monitor her blood glucose levels (ADA, 2018).

Glucagon Emergency Kit 1mg

Sig: Inject 1mg IM as directed.

Disp: 1 kit.

RF: 2 (Glucagon, 2018).NR 601 Primary Care of the Maturing and Aged Family Essay Paper

First line drug of choice are statins for lowering LDL and also for cardio protection (American Diabetes Association, 2018). Atorvastatin treats hyperlipidemia and triglyceride levels. Atorvastatin also reduces the risk of angina, heart attack, and certain heart and blood vessel diseases. It reduces LDL levels by 40-60% and has a great effect on lowering TGs  (Dunphy, Winland-Brown, Porter, & Thomas, 2011).

Atorvastatin 10 mg tablet

Sig: Take one tablet by mouth daily

Disp: 30 tablets

Refill: 2

Aspirin has been proven to decrease cardiovascular events in diabetic patients (Dunphy, Winland-Brown, Porter, & Thomas, 2011).

Aspirin EC 81 mg tablet

Sig: Take one tablet by mouth daily

Disp: 30 tablets

Refill: NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Education

            Diagnoses

            DM2: The treatment for DM2 includes medication, diet, and exercise combined. Compliance is key. Mrs. Wu will need to understand the difference between hypoglycemia and hyperglycemia. Hypoglycemia is blood glucose level 70 mg/dL or lower, and can cause fatigue, pale skin, anxiety, sweating, hunger, and irritability and blurry vision. Treatment for low blood glucose includes drinking a cup of orange juice or a piece of candy to increase blood glucose levels. Hyperglycemia is blood glucose above 180 mg/dL. Symptoms include fatigue, polydipsia, polyphagia, headache, and polyuria (ADA, 2018). Symptoms should be monitored and reported immediately.

            Hyperlipidemia: Its important to make Mrs. Wu aware of the importance of lowering her cholesterol levels. Hyperlipidemia coexists with DM2, therefore, puts her at a higher risk for CAD. Medication, diet, and exercise should strongly be addressed. In her case, a repeat LDL level will be checked in 3 months, then every 6-12 months until normal, then yearly once controlled (ADA, 2018).NR 601 Primary Care of the Maturing and Aged Family Essay Paper

            Depression:Since Mrs. Wu now has to make lifestyle changes; she is at risk for depression and should be screened annually. It is important to educate on the signs and symptoms are depression, which include, increased fatigue, appetite changes, sleep disturbances, and mood changes. These symptoms should be reported immediately (Dunphy, Winland-Brown, Porter, & Thomas, 2011).

            Medication

            Metformin:Metformin is an antihyperglycemic agent that improves glucose tolerance. It is best to be taken with food or milk. Common signs and symptoms include diarrhea, flatulence, nausea, vomiting, metallic taste in mouth, weight loss, and can cause lactic acidosis as a severe adverse effect. It is important to seek medical attention if experiencing malaise, respiratory distress, or severe abdominal pain (Metformin, 2018).NR 601 Primary Care of the Maturing and Aged Family Essay Paper

            Atorvastatin:Atorvastatin is used to treat high cholesterol and high triglycerides. It reduces the risk of CAD (Atorvastatin, 2018). Common side effects include diarrhea, arthralgia, myalgia, extremity pain, and UTI’s. Patients should avoid grapefruit and be instructed to report signs and symptoms of muscle pain, weakness, and fever (Atorvastatin 2018).

            Aspirin: Aspirin reduces the formation of platelets in the blood, reducing the risk of blood clot formation (Aspirin, 2018). Patients should report any type of bleeding. Side effects include “dyspepsia, agitation, confusion, dizziness, lethargy, and seizures” (Aspirin, 2018). Patients should take aspirin with a full glass of water, at the same time every day, usually in the morning (Aspirin, 2018).

            Glucagon kit: Glucagon is used in the prevention of hypoglycemia, (Glucagon, 2018). Gluconeogenesis and glycogenolysis in the liver are stimulated resulting in an increase in blood sugar (Glucagon, 2018). It should be administered if a blood glucose reading drops below 54mg/dL or if the patient is unconscious (ADA, 2018). Common signs and symptoms include nausea and vomiting, hypotension, and tachycardia (Glucagon, 2018). Mrs. Wu’s should keep this medication with her at all times and her family should be instructed on how to give this medication in case of an emergency.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

            Diet

Obesity contributes to diabetes, and considering that Mrs. Wu is obese, it is important to educate her on her diet. Healthy low calorie eating patterns should be encouraged. It is important for patients with DM2 to reduce their calorie intake by at least 500 calories per day, decreasing carbohydrates, high salt foods, saturated fats, trans fats, and cholesterol (ADA, 2018). According to the ADA (2018), the Mediterranean diet involves eating more vegetables, fruits, whole grains, cereals, nuts, seeds, and beans, which has shown to protect against heart disease, improve blood glucose and loss weight. Avoiding fats and cholesterol will improve her blood glucose levels and cholesterol levels.

            Exercise 

            Exercise and weight loss can improve ones blood glucose level and cholesterol level. It is recommended to participate in 150 minutes per week of moderate intensity physical activity in order to improve insulin sensitivity.“Both aerobic exercise and strength training can improve glucose control, lipid levels, decrease the risk of falls and fractures, improve functional capacity and well-being” (ACCE, 2018). Although Mrs. Wu states she is experiencing less pain and increased mobility with her right knee and has been newly diagnosed with arthritis, I would initially recommend for her to participate in water aerobics or another low impact activity instead of walking on the treadmill.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

            Warning Signs for Diagnoses and Medications

Mrs. Wu will need to be educated on the warning signs of her diagnoses and medications. Signs and symptoms of hypoglycemia and hyperglycemia should be discussed as well as self-treatment. She should assess her feet daily for any scrapes, wounds, or change in color of skin, due to DM2 causing poor circulation and neuropathy. Retinopathy is another complication and she should be referred to see an eye doctor annually and report any visual changes. Nephropathy, including renal disease, and macrovascular diseases such as PVD should also be monitored closely (Dunphy, Winland-Brown, Porter, & Thomas, 2011).

Referral

At this time I would refer Mrs. Wu to a dietitian for recommendations onindividualized meal planning, diet control, and healthier food choices to maintain her blood glucose level and cholesterol with proper nutrition.I would also refer her to a diabetic educator,who empowers patients to manage their diabetes. They teach patients on how to self-monitor blood glucose levels using a glucometer at home (ADA, 2018). Overall, they teach patients how to make behavior-changing goals in order to improve their health.A thorough physical exam, including feet, will be completed at each visit to determine any further referrals. Complications of DM2 that would closely be examined for and monitored are:NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Retinopathy: I would have Mrs. Wu follow up with an ophthalmologist, if she does not have one already.It is recommended to have a comprehensive dilated eye and visual exam annually to assess for retinopathy (Dunphy, Winland-Brown, Porter, & Thomas, 2011).

Nephropathy: Screening for a routine serum creatinine, urinalysis, and microalbuminuria should be preformed at the time of diagnosis in order to prevent the progression of renal disease (Dunphy, Winland-Brown, Porter, & Thomas, 2011). Patients with urinary symptoms or impotence should be referred to an urologist.

Macrovascular disease: In diseases such as a stroke, CAD, and peripheral vascular disease (PVD), and experiencing loss of sensation or pain to their feet, patients may need a referral to a podiatrist, orthopedic surgeon, and/or vascular surgeon (Dunphy, Winland-Brown, Porter, & Thomas, 2011). NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Follow up      

The frequency of patient visits depends on compliance of the disease and controlling blood glucose levels, changes in management, and other medical complications. If Mrs. Wu is competent and compliant with self-managing blood glucose, telephone consultations may be deemed instead of an office visit (Dunphy, Winland-Brown, Porter, & Thomas, 2011).I would follow up with Mrs. Wu in 2 weeks via a telephone call to evaluate her symptoms and review her blood glucose log.I would have her follow up in the office in 3 months to re-evaluate her symptoms and repeat lab work including, CMP, fasting glucose, HbA1c, lipid panel and UA.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Medication Cost

I would assess if Mrs. Wu has insurance or not. If not, Mrs. Wu can get her medication, metformin, atorvastatin, aspirin, Tylenol, and multivitaminfrom Wal-Mart. For 60 tablets of metformin 500 mg, the cost would be $4.00 with no coupon necessary. Monthly she would be paying $4.00 for metformin. For 30 tablets of atorvastatin 10 mg, the cost would be $9.00 monthly, with no coupon necessary. For 30 tablets of aspirin 81mg it would cost $1.32 monthly (GoodRx, 2018). Tylenol and multivitamins can also be purchased at Wal-Mart or anywhere over the counter. For 250 tablets the cost would be less than $7.00 at Wal-Mart (GoodRx, 2018). If she buys 50 tablets of One A Day Women’s Menopause Formula Multivitamin it would cost $12.99, which would last her one month and twenty days. (Walmart, 2018). A monthly cost for all medication would come out to being a total of $34.31.

In the case of Mrs. Wu not having insurance, she can obtain a coupon for 75% off from www.helprx.com (2018) for a glucagon kit. Glucagon kits are expensive, ranging from $250-$300 without insurance. The ReliOnglucometer from Wal-Mart would cost $9.00, 200 lancets would cost $5.28, 100 test strips would cost $17.88, and 200 sterile alcohol prep pads would cost $2.07 (Walmart, 2018).  This is a good resource to use in my future practice as a nurse practitioner. Patients would be more compliant if given the resources for more affordable medication.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

This paper examined the analysis of the pertinent subjective and objective data that was collected from Mrs. Wu in order to diagnose and develop a treatment plan for her. This paper also discussed the assessment of the primary, the secondary, and the differential diagnoses, including the pathophysiology, pertinent positive findings, pertinent negative findings, and the rationale for each diagnosis. A treatment plan for each diagnosis, which consists of diagnostics, medications, education, referrals, and follow up was also discussed. A discussion on medication costs for all prescribed and over the counter (OTC) medications was presented.

Clinical Chart SOAP Note

Patient information: Mrs. Wu, 59, Female, Asian

S (Subjective):

Chief Complaint (CC): increased fatigue, weight gain, polydipsia, polyphagia, polyuria  NR 601 Primary Care of the Maturing and Aged Family Essay Paper

HPI: Mrs. Wu, a 59 year old female presents to the office for a follow up visit for her recently diagnosed right knee arthritis and reports new complaints of increased fatigue for the last 12 weeks, weight gain of 4 lbs. despite working out on the treadmill for 30 minutes and light weight lifting twice a week. She reports more frequent urination during the day and waking up during the night for about 3 months but is able to fall back asleep immediately.

Current medications: Tylenol 500 mg 2 tabs in AM for knee pain, daily vitamin, turmeric

Allergies: Bactrim, cats, pollen

PMHx: Right knee arthritis, German measles, ASCUS pap (1998), vaccinations up to date

PSHx:Health screening: Mammogram last year benign, colonoscopy WNL

SH: Divorced, works from home as an administrative assistant, drinks 1-2 glasses of wine daily, former smoker, quit 10 years ago, no illicit drug use

FH: Parent’s deceased, child alive and well, no siblings

ROS:

General: reports increased fatigue and tired for last 12 weeks, 4 lb. weight gain since menopause 4 years ago

Skin: no abnormalities reported

HEENT: no abnormalities reported

CV: no abnormalities reported

Respiratory: no abnormalities reported

Abdomen: no abnormalities reported

GU: reports frequent urination during the day, waking up at night to urinate for 3 months

Musculoskeletal: increased mobility and less pain in right knee (newly diagnosed with arthritis)NR 601 Primary Care of the Maturing and Aged Family Essay Paper

O (Objective):

PE:

BP 112/76, HR 80, regular, R 16, regular, Ht 5’1.5”, Wt 165 lbs, BMI 30.7

General: Female, alert, oriented, and cooperative, in no acute distress

Skin: Warm, dry, and intact. No lesions noted.

HEENT: Head normocephalic. Hair thick and distribution throughout scalp.Eyes without exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light reflex noted.Pinna and tragus nontender.Nares patent without exudate.Oropharynx moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior and posterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.

CV: S1 and S2 RRR without murmurs or rubs

Respiratory: Clear to auscultation bilaterally, respirations unlabored

Abdomen: soft, round, nontender with positive bowel sounds presents; no organomegaly, no abdominal bruits, no CVAT.NR 601 Primary Care of the Maturing and Aged Family Essay Paper

GU: bladder nontender upon palpation

Musculoskeletal: full ROM both knees, nontender to palpation bilaterally, gait normal

Lab Work: (fasting labs drawn this morning)

CBC: WBC 6,300/mm3

Hgb12.8 gm/dl

Hct 42%

RBC 4.6 million

MCV 93 fl

MCHC 34 g/dl

RDW 13.8%

CMP: Sodium 136

Potassium 4.4

Chloride 100

CO2 29

Glucose 130

BUN 12

Creatinine 0.7

GFR est non-AA  99 mL/min/1.73

GFR est AA 101 mL/min/1.73

Calcium 9.4

Total protein 7.6 NR 601 Primary Care of the Maturing and Aged Family Essay Paper

Bilirubin, total 0.5

Alkaline phosphatase 72

AST 25

ALT 29

Anion gap 8.10

Bun/Creat 17.7

Hemoglobin A1C: 6.8 %

TSH: 2.31, Free T 4 0.9 ng/dL

TC 215 mg/dl

LDL 144 mg/dl

VLDL 36 mg/dl

HDL 32mg/dl

Triglycerides 229

UA: pH 5, SpGr 1.010, Leukocyte esterase negative, nitrites negative, 1+ glucose; negative protein; negative ketones

1. A 60-year-old woman presents with a chief complaint of uncomfortable breathing on exertion. She has had a minimally productive cough for several years that does not bother her. On further questioning, she states that her breathing gets much worse when she lies down. The most likely cause of her dyspnea is:NR 601 Primary Care of the Maturing and Aged Family Essay Paper
2. A 68-year-old male presents with a chief complaint of episodes of lightheadedness or dizziness. He states that sweating, tachycardia, and some hand trembling are often … with these episodes. Which one of the following questions should you ask to help confirm the diagnosis?
3. A 68-year-old male presents with a chief complaint of episodic dizziness. Although not dizzy at present, he states that he has noted onset of dizzy episodes when he rolls over in bed and occasionally when he turns his head rapidly. Episodes last about 3 minutes. The most likely diagnosis is:
4. A 75-year old resident in the nursing home has end stage dementia and experiences a 10-pound weight loss over the course of 2 months. The resident has become increasingly difficult to feed and often spits out food, pockets food, and frequently drools. The family is concerned about the resident’s nutritional status. What is the initial action of the nurse practitioner?
5. A 77-year-old client … treated for glaucoma asks the nurse practitioner what causes glaucoma. The nurse bases the response on the knowledge that the increase in intraocular pressure is a result of:
6. . A 78-year-old man is being evaluated in the geriatric clinic. His daughter reports that he has been very forgetful lately, and she is concerned that he might be “senile.” The advanced practice nurse administers the clock drawing test and the patient draws a distorted circular shape and places the numbers all on one side of the shape. Based on his performance, the nurse concludes that the patient:
7. The abrupt onset of symptoms of stress or urge incontinence is most often due to a urinary tract infection
8. After first managing the pain … experienced by the client with gout, the treatment focuses on:
9. Based on current demographic data, which statement identifies a predictive trend regarding the health care needs of society?NR 601 Primary Care of the Maturing and Aged Family Essay Paper
10. The caregiver for an older adult with cognitive impairment is concerned about the individual’s seeming disinterest in eating. Which suggestion does the nurse practitioner offer based upon a known effect of dementia on a client’s nutrition?
11. A client is newly … with type 2 diabetes mellitus. Which diagnostic test will best evaluate the management plan prescribed for this client?
12. Compared with acute pain, persistent chronic pain requires the nurse practitioner to:
13. Ethnocentrism is defined as:
14. The FANCAPES assessment tool focuses on the older adult’s:
15. The following are true statements about bipolar disorders in older adults except
16. The greatest risk for injury for a client with progressed Parkinson’s disease is:
17. In the elderly population, the fastest growing group is the age range:
18. It has been projected that the cultural group presenting the greatest growth rate among the older adult population will … the:
19. The nurse is teaching a health promotion class at a senior center. Which of the following statements demonstrate that the participant does not understand the topic:
20. The nurse practitioner educates that client that Healthy People 2010:
21. The nurse practitioner is caring for a client with a newly diagnosed chronic illness. In answering the client’s questions, the nurse practitioner most accurately responds when basing the response on the fact that:
22. The nurse practitioner is developing a class on stroke prevention for a local senior citizens center. What would be an important focus when teaching stroke prevention directed at modifiable risk factors?
23. The nurse practitioner provides a client with education regarding the use of My Pyramid. What is the primary advantage of the United States Department of Agriculture’s (USDA) My Pyramid to the older adult client?
24. The nurse practitioner shows an understanding of appropriate influenza vaccination guidelines for a client over the age of 65 when stating:
25. The nurse shows understanding of the need to promote healthy skin in the older adult when encouraging the client to all of the following except :
26. Of the following clients, all of whom are 65 years of age or older, the nurse practitioner anticipates that the one who will rate himself or herself as has having excellent health will be:
27. An older adult client … voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging?
28. An older adult client shares with the nurse that, “I don’t know what it is but it seems that I need more light for reading or even watching television as I get older.” The nurse explains that aging may cause this change due to the:
29. An older adult is admitted to the hospital during the night after a serious fall. When you round on the patient, you note that the patient has been prescribed meperidine (Demerol) for muscle pain. The nurse practitioner:
30. An older adult is currently prescribed both aspirin (81 mg) and ibuprofen daily. What instructions are most important for the nurse practitioner to provide to assure the expected outcomes for this client?NR 601 Primary Care of the Maturing and Aged Family Essay Paper
31. An older adult recently diagnosed with depression asks, “How long will it take for the antidepressant medication to make me feel better?” The nurse practitioner correctly responds:
32. An older man has a history of medication therapy for hypertension. Which intervention does the nurse practitioner implement when the client reports that, “I’ve fallen twice in 5 weeks”?
33. Tinnitus is defined as:
34. Weight loss is frequently … by ingestion of one or more of the following drugs.
35. What information will … included in client education for an older adult who needs to manage their calcium levels?
36. When best promoting a sense of well-being, the role of the nurse practitioner caring for a terminally ill client is to:
37. When considering Erikson’s developmental stages, the task for later life is … to as:
38. When diagnosed with diverticulosis, a client asks how this problem occurred. Which assessment data identifies a risk factor for diverticulosis?
39. When educating the older adult population about the risks to physical health that chronic alcohol abuse presents, the nurse practitioner is especially careful to include the:
40. Which assessment data does not support the medical diagnosis of coronary heart disease?
41. Which assessment data would not be of particular concern when attempting to manage an older adult’s risk for dehydration?
42. Which diagnostic laboratory test would the nurse practitioner typically not order for the purpose of evaluating an individual’s acute, unexplained weight loss?
43. Which intervention is not therapeutic when facilitating communication with a cognitively impaired older client?
44. Which of the following causes of chest pain are often … by sublingual nitroglycerin?
45. Which of the following culturally diverse male clients will most benefit from educational material related to “Staying Healthy into your 80s”
46. Which of the following drugs does not typically cause constipation?
47. Which of the following drugs do not trigger or aggravate a cough?
48. Which of the following is not a common cause of constipation?
49. Which statement correctly describes normal changes of aging?
50. Which statement made by a client recently diagnosed with diverticular disease would indicate that she needs additional teaching regarding dietary considerations?NR 601 Primary Care of the Maturing and Aged Family Essay Pape