APEA 3P EXAM PREP4-HEALTH PROMOTION WITH RATIONALE

APEA 3P EXAM PREP4-HEALTH PROMOTION WITH RATIONALE

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.

Examine him for hemorrhoids.

Refer him for a colonoscopy. 

A fecal occult blood test is performed multiple times on different days because tumors don’t consistently excrete blood. The reason multiple tests 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.

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. 

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.

 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. 

prostate-specific  antigen (PSA) now.

PSA  and digital rectal exam now.

digital  rectal exam only.

At age 50 years, males of average prostate cancer risk should have a PSA measurement with or without a 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 the 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.

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 

He should have received one at age 70 years

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.

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. 

Have a pharmacist review your list once a year

A list of current medications should be kept with each patient and carried with him, especially when healthcare visits are scheduled. Many older adults can take 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.

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 

Less than 130 degrees

Less than 140 degrees

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.

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. 

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.

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 at 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. 

She should receive this. The immunization is not alive.

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.

What choice below would be beneficial to a 76-year-old who takes daily oral steroids 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)