Test is coming up very soon! So scared!

[RM, MSN]

Well, my second AANP exam is coming up quickly and I am scared to death. I am still not doing well on my questions and I have no idea why. I must be honest though, they are dumb questions that an average person wouldn't know, such as a nurse practitioner is assessing a 47-year-old client who has come to the office for his annual physical. One of the first physical signs of aging is? (THIS QUESTION WAS NOT FROM THE ACTUAL TEST. IT WAS FROM MY PRACTICE BOOK). A) having more frequent aches and pains, B) failing eyesight, especially close vision, C) increasing loss of muscle tone, or D) diminished hearing or taste. These are the kinds of questions I am failing on. Any 47 year old could go through any of those symptoms. I don't understand how they are picking these questions. I am so frustrated!!!!!!

[PixieRN1]

It's B cause think of when u start vision screens etc at age 40 right?

Alright bright soon-to-be-nurses!! Get ready for a long post where I aim to demonstrate the critical thinking skills that I would use to answer this particular example of a question on the NCLEX...and others like it.

The NCLEX loves to give you answer options where each of them, in the right situation, could be right. But the truth is, there is always only one most right” answer. I want to show you how to find that right answer, with the info that is already floating around in your brain. I swear, you just have to find it there!

I'm doing this because we need smart new nurses like you to join the ranks (I will retire one day!) and I want to help. If this doesn't interest you, happy scrolling on!

With a question like this, I recommend to first start with ruling OUT the answers that are most obviously wrong.

In this case, that's easily option D. Why?

40-somethings do not experience developmentally expected hearing loss or loss of taste. It would be pathological at this age. Even if you didn't know that specifically, you should know deep down that those problems are very much geriatric-specific issues. And Geriatrics are defined as 65+. Our 47 year old guy doesn't fit that criteria.

Let's say you know nothing about the appropriate age for hearing or taste loss. It's time to critically think. You can still get this. Imagine in your head you are in a room of a thousand 40-something year olds...intuitively, would many of them would have hearing aids or hearing loss? Just off your life experience. Think of your parents, your teachers...are even half of them going deaf? No, of course not. So there you go, one bad answer down...

Next... you can safely rule out C as well. Why?

Let's think of losing muscle tone or muscle wasting. Just to have fun and use a pop culture example, do Oprah or George Clooney look like they are suffering from decreased muscle tone due to the muscle wasting that occurs due to age? No, of course not. And most healthy 47 year olds aren't going to experience decreased muscle tone or wasting either. Just think of how many strong, strapping fire fighters are out there killing it in their 40's and early 50's.

So, C is obviously not correct. Again, that is a geriatric issue that you should be aware of and geriatrics...greater than 65. But if you don't know that...imagine your grandma...or the late Hugh Hefner...or all the seniors you saw in med surg. Think of loose skin hanging off of what used to be lots of muscle. Muscle wasting? Darn skippy! Do George and Oprah look like grandma? Nope! So that won't fit our guy either.

Down to the last two: Deteriorating close up vision? Or increasing aches and pain? Tricky, tricky. Could be either. These two may seem like a close call, particularly if you are young and not in your 40's! But they really aren't if you break it all the way down.

The way that I would tease out these two is, again, developmental! Can you see a trend?

A middle age person with aches and pains is usually going to have a disease or injury that causes aches and pains; think arthritis, a back injury, turning patients, years of running causing knee problems. They aren't going to ache just for no reason. At least, not yet.

If you were to imagine a sample of healthy, uninjured 40-somethings that you could interview, most likely they really aren't going to to have a collective experience of aches and pains across the board. But if you pooled a group of 65+? Not only will they have aches from 65+ years of basic wear and tear, but they will also have some osteoporosis and osteoarthritis that the younger pool of peeps didn't have yet. So while we can't rule this out as an answer, we need to analyze the other one first.

They are being trixy with this question!! Because, on its face, option C seems entirely plausible. But is it the MOST plausible? If you know your basic human development, you can realize that C is more likely outside of the NORM of middle age...why?

The older you get, the less padding your joints provide, worn down from basic wear and tear (not necessarily injuries). You lose muscle mass, and muscle serves to support joints...supported, padded joints hurt less. So while not impossible for a 47 year old to complain of non-specific aches and pains, and could just be somewhat normative; it's still not the BEST ANSWER. Or at least we have to check out our next option to see if it's better. Here we go...

Option B: That is the most correct answer. And I'm going to tell you why.

What IS a truth of normal development, regardless of status of health or injury, is that near vision begins deteriorating in middle age, some later than others for sure. But this is considered NORMAL development...or deterioration. It's is expected and you can be healthy as a horse your whole life and still have your eyes go south in middle age.

I'll say it again for those in the back: deteriorating close up vision is normal for middle age. But what if you don't know that?

B being correct has nothing to do with a set age to start vision screens that you can memorize. It doesn't exist! Vision screens are generally recommended to be annual for healthy adults, regardless of age. So that's no help.

It's not like a mammogram where 40 is the magical age that boobs allegedly start misbehaving and mammograms need to start. There is no hard line for ocular screens. So that rationale for B being correct...is incorrect.

How can you deduce this if you don't know? Again, imagine yourself in that room with 40-50 year olds...you know them. They are your former patients, bosses, teachers, instructors, doctors, coworkers...have you ever seen a decent number of them with a pair of glasses on their head or in their pocket? Do middle aged cashiers sometimes whip out reading glasses to double check your receipt? Of course.

From a purely knowledge-based perspective, Option B is the best answer because it is the most developmentally correct and doesn't rely on the presence of another illness or injury to make it true. From my real life” analysis, you could probably correctly select B as well, if you realized how many people you know with readers versus how many 40-somethings you know complaining of pain that isn't pathological in nature.

I know this was LONG. But I want to help you very much by showing you the thought process that has to happen in order to answer these questions. This question to me is very much a critical thinking skills question.

You know you have those skills, now it's time to sharpen them. The answer will likely be hidden among other answers that seem reasonable. It's was the same way 16 years ago when I sat for Boards as it is now. All of them can be right in some circumstances...but which one is the most right in that circumstance?

In this case, would you get there faster and easier if you could rattle off what is developmentally appropriate aging for that group? Of course. But you still have experiences that can help you out, even without a solid knowledge base.

Dear Lord, I hope I am making sense because I really want to help you all! And I'm rambling, which is just getting embarrassing here.

So my advice, rule out the obvious, and then dive into what needs to be true for the other answers to be true.

Good luck!

[lwsoccjs]

Gerontology which is taught in Adult NP and Family would teach you D) Presbycusis= starts over 50 ; B) Presbyopia= over 40, A excessive body aches means nothing relative to age more to do with lifestyle, and C) muscle wasting is false, its actual adipose tissue you lose. NP school should instill this knowledge into you.

[chilurae1]

Please email me si i xan give you my number [email protected]. please it is urgent.

[chilurae1]

How can i reach you. My emaik is [email protected].

[RM, MSN]

[email protected]

[chilurae1]

I have emailed you, i hope u received it.