NR 601 FINAL EXAM LATEST CONTAINS
400 QUESTIONS & ANSWERS| 4
NEWEST VERSIONS
Anm86-year-
oldmfemalemcomesmtomyourmofficemformamwellnessmvisit.mHermbloodmpressuremism125/70mmmHg,mpu
lsem69mbeatsmpermmin,mandmrespiratorymratem18mbreathsmpermmin.mShemismwellmappearingmandmrep
ortsmshemismupmtomdatemonmhermroutinemvaccinations.mShemintroducesmhermpartnermofm35myearsmw
hommshemwouldmlikemtommakemmedicalmdecisionsmformherminmcasemshembecomesmunablemtommakem
decisionsmformherself.mShemreportsmthatmshemandmhermpartnermaremnotmmarried.mShemasksmifmshemn
eedsmanymfurthermdocumentationmtomensuremhermgoalsmofmcaremaremfollowed.mWhichmonemofmthem
followingmwouldmbemthemmostmappropriatemrecommendationmformthismpatientmandmhermpartner?m
-mCORRECTmANSWERAdvisemthemmtomfilemanmadvancedmdirective.
.mAnm81-year-
oldmtransgendermfemalemwithmhistorymofmdepressionmandmhyperlipidemiampresentsmtomyourmclinic
mformroutinemcare.mShemendorsesmamhistorymofmsmoking,mcurrentlymsmokingm1mpackmpermday,mandm
occasionallymdrinksmamglassmofmwine,malthoughmshemdeniesmillicitmdrugmuse.mShemreportsmshemtakes
matorvastatinm20mmgmandmsubcutaneousmestrogenmtherapy.m-
mCORRECTmANSWERCounselingmonmsmokingmcessation
Anm84-year-
oldmmalemwithmhistorymofmstrokemwithoutmresidualmdeficit,msystolicmheartmfailure,mandmtypem2mdiab
etesmpresentsmtomclinicmformfollow-
up.mHemismindependentlymlivingminmamretirementmcommunitymandmstillmworksmpartmtimemonmamgolfm
course.mHemcurrentlymtakesmaspirinm81mmg,mmetoprololmtartratem25mmgmBIDm(twicemamday),mfurose
midem20mmgmBID,mandmlisinoprilm10mmgmdaily.mHemreportsmhismlastmcolonoscopymwasm8myearsmago,m
withmnomabnormality.mHemreportsmhemismsexuallymactivemwithmmenmandmwomen,mengagingminmrece
ptivemoral,mreceptivemanal,mandmpenetrativemsex.mHemstatesmhemhasmhadmovermthreemsexualmpartn
ersminmthemlastmyearmwithmintermittentmcondommuse.mWhatmsexuallymtransmittedminfectionmtestin
gmshouldmbemoffered?m-
mCORRECTmANSWERUrinemtesting,mbloodmtesting,manalmswab,mandmoropharyngealmswab
,Whichmofmthemfollowingmismtruemaboutmtolterodine?m-
mCORRECTmANSWERItmhasmgreatermriskmofmadversemeffectsmwithmitsmtwice-dailymformulation.
Anm82-year-
oldmman,mMr.mA,mcomplainsmofmworseningmnocturia,moccurringmfourmtimesmpermnight.mHismotherml
owermurinarymtractmsymptomsmaremslowmstream,moccasionalmurgency,mandmurgency-
relatedmleakagemoncemweekly.mMedicalmproblemsmincludempoorlymcontrolledmhypertension,mdiast
olicmheartmfailure,mhyperlipidemia,mosteoarthritis,mandmprediabetes.mHismmedicationsmincludemlisi
noprilm20mmgmdaily,mmetoprololmsuccinatem75mmgmdaily,matorvastatinm10mmgmdaily,mmetforminm50
0mmgmtwicemdaily,mhydrocodone-
acetaminophenmasmneeded,mandmaspirinm81mmgmdaily.mAmlodipinem5mmgmdailymwasmrecentlymadd
edmbymhismcardiologist.mOnmreviewmofmsystems,mMr.mAmcomplainsmthatmnocturiamismcausingmdaytim
emfatigue,mandmhemismmoremconstipated.mPhysicalmexaminationmismnotablemformbloodmpressurem16
2/83mmmHg,mheartmratem60mbeatsmpermminute,mclearmlungs,msoftmabdomen,menlargedmprostate,ma
ndm21mpretibialmedema.mYourmnextmstepminmmanagementmshouldmbe:m-
mCORRECTmANSWERStopmamlodipinemandmincreasemlisinopril.
Themdaughtermofmam79-year-
oldmwomanmnotesmthatmhermmother,mwhomhasmdementiamandmlivesmwithmher,mismwettingmherselfmw
henmshemattendsmhermnewmdaymprogram.mProgrammstaffmhavemrequestedmthatm"somethingmbemdo
ne"masmshemismrequiringmamclothesmchangemnearlymeverymtimemshemismthere.mShemcannotmdescribem
themcircumstancesmofmleakage,msayingm"itmjustmcomes."mLeakagemismuncommonmatmhome.mHermme
dicationsmincludemdonepezilmandmacetaminophen.mPhysicalmexaminationmismnormal.mInitialmtreat
mentmapproachmwillmrequireminterventionmbymwhichmofmthemfollowing?m-
mCORRECTmANSWERDaymprogrammstaff
.mMs.mJ,mwhomism82myearsmold,mcomplainsmofmurinemleakagemwhilemplayingmgolf.mThismhasmgottenmw
orsemovermthempastmyear,mandmshemrarelymmakesmitmthroughmninemholesmwithoutmfeelingmlikemshem
needsmtom"runmintomthembushesmandmgo."mLeakagemismusuallymsmallmvolume,mbutmcausesmhermextr
ememembarrassmentmbecausemshemismafraidmshemwillmsmellmofmurine.mShemhasmtriedmlimitingmcaffe
ineminmthemmorningmbeforemshemgolfsmandmavoidingmdrinkingmwatermwhilemplaying,mtomnomeffect.mS
hemalsomtriedm"thosemKegler"mexercisesminmthempastmwithoutmsuccess.mWhichmofmthemfollowingmismt
hemmostmappropriatemrecommendationmformMs.mJ?m-mCORRECTmANSWERBladdermtraining
, Whatmismthemmostmcommonmcausemofmerectilemdysfunctionminmoldermmen?m-
mCORRECTmANSWERAtherosclerosis
Whichmismthemmostmreasonablemfirstmstepminmthemtreatmentmofmoldermmenmwithmerectilemdysfuncti
on?m-mCORRECTmANSWERSildenafil
Am72-year-
oldmwomanmreportsmvaginalmdrynessmthatminterferesmwithmcoitus.mHermmedicalmhistorymincludesmt
ypem2mdiabetes,mhypertension,mandmosteoarthritis.mMedicationsmaremglyburide,mchlorthalidone,ma
ndmacetaminophen.mWhatmwouldmbemyourmfirstmstepminmtherapy?m-
mCORRECTmANSWERStopmchlorthalidone
Am70-year-
oldmwomanmreportsmsexualmpainmwithmdeepmpenetrationmonly.mWhatmismthemmostmlikelymcausemofm
hermproblem?m-mCORRECTmANSWERHigh-tonempelvicmfloormdysfunction
Am79-year-oldmwomanmwithmam1.5-
cmmbreastmcancermunderwentmlumpectomy.mPathologymrevealedmductalmcarcinomamthatmismhorm
onemreceptormnegativem(estrogenmreceptorm0%,mprogesteronemreceptorm1%)mandmHER2/neumnega
tive.mSurgicalmmarginsmweremadequatemandmuninvolvedmwithmcancer.mSentinelmlymphmnodemsampl
ingmwasmnegativemformlymphmnodeminvolvement.mShemhasmgoodmperformancemstatusmandmnomacti
vitiesmofmdailymlivingm(ADL)morminstrumentalm(IADL)mdependencies.mWhatmtreatmentmwouldmyoumr
ecommend?m-mCORRECTmANSWERHormonalmtherapymonly
Anm86-year-
oldmmanmwithmnomADLmdeficitsmwhomhasmstoppedmdrivingmbecausemofmmacularmdegenerationmisme
valuatedmformamurinarymtractminfectionmassociatedmwithmurinarymretention.mThemconsultingmurolog
istmplacesmamFoleymcathetermandmsendsmamprostate-
specificmantigenm(PSA)mlevelmthatmcomesmbackm12mng/mL.mThreemmonthsmlatermaftermthemFoleymha
smbeenmremovedmandmhemhasmhadmamgoodmresponsemtomtamsulosin,mhismPSAmismstillm10mng/mL.mW
hatmismthemappropriatemnextmstepminmmanagingmthismman'smprostatemproblem?m-
mCORRECTmANSWERRepeatmPSAminm6mmonths
400 QUESTIONS & ANSWERS| 4
NEWEST VERSIONS
Anm86-year-
oldmfemalemcomesmtomyourmofficemformamwellnessmvisit.mHermbloodmpressuremism125/70mmmHg,mpu
lsem69mbeatsmpermmin,mandmrespiratorymratem18mbreathsmpermmin.mShemismwellmappearingmandmrep
ortsmshemismupmtomdatemonmhermroutinemvaccinations.mShemintroducesmhermpartnermofm35myearsmw
hommshemwouldmlikemtommakemmedicalmdecisionsmformherminmcasemshembecomesmunablemtommakem
decisionsmformherself.mShemreportsmthatmshemandmhermpartnermaremnotmmarried.mShemasksmifmshemn
eedsmanymfurthermdocumentationmtomensuremhermgoalsmofmcaremaremfollowed.mWhichmonemofmthem
followingmwouldmbemthemmostmappropriatemrecommendationmformthismpatientmandmhermpartner?m
-mCORRECTmANSWERAdvisemthemmtomfilemanmadvancedmdirective.
.mAnm81-year-
oldmtransgendermfemalemwithmhistorymofmdepressionmandmhyperlipidemiampresentsmtomyourmclinic
mformroutinemcare.mShemendorsesmamhistorymofmsmoking,mcurrentlymsmokingm1mpackmpermday,mandm
occasionallymdrinksmamglassmofmwine,malthoughmshemdeniesmillicitmdrugmuse.mShemreportsmshemtakes
matorvastatinm20mmgmandmsubcutaneousmestrogenmtherapy.m-
mCORRECTmANSWERCounselingmonmsmokingmcessation
Anm84-year-
oldmmalemwithmhistorymofmstrokemwithoutmresidualmdeficit,msystolicmheartmfailure,mandmtypem2mdiab
etesmpresentsmtomclinicmformfollow-
up.mHemismindependentlymlivingminmamretirementmcommunitymandmstillmworksmpartmtimemonmamgolfm
course.mHemcurrentlymtakesmaspirinm81mmg,mmetoprololmtartratem25mmgmBIDm(twicemamday),mfurose
midem20mmgmBID,mandmlisinoprilm10mmgmdaily.mHemreportsmhismlastmcolonoscopymwasm8myearsmago,m
withmnomabnormality.mHemreportsmhemismsexuallymactivemwithmmenmandmwomen,mengagingminmrece
ptivemoral,mreceptivemanal,mandmpenetrativemsex.mHemstatesmhemhasmhadmovermthreemsexualmpartn
ersminmthemlastmyearmwithmintermittentmcondommuse.mWhatmsexuallymtransmittedminfectionmtestin
gmshouldmbemoffered?m-
mCORRECTmANSWERUrinemtesting,mbloodmtesting,manalmswab,mandmoropharyngealmswab
,Whichmofmthemfollowingmismtruemaboutmtolterodine?m-
mCORRECTmANSWERItmhasmgreatermriskmofmadversemeffectsmwithmitsmtwice-dailymformulation.
Anm82-year-
oldmman,mMr.mA,mcomplainsmofmworseningmnocturia,moccurringmfourmtimesmpermnight.mHismotherml
owermurinarymtractmsymptomsmaremslowmstream,moccasionalmurgency,mandmurgency-
relatedmleakagemoncemweekly.mMedicalmproblemsmincludempoorlymcontrolledmhypertension,mdiast
olicmheartmfailure,mhyperlipidemia,mosteoarthritis,mandmprediabetes.mHismmedicationsmincludemlisi
noprilm20mmgmdaily,mmetoprololmsuccinatem75mmgmdaily,matorvastatinm10mmgmdaily,mmetforminm50
0mmgmtwicemdaily,mhydrocodone-
acetaminophenmasmneeded,mandmaspirinm81mmgmdaily.mAmlodipinem5mmgmdailymwasmrecentlymadd
edmbymhismcardiologist.mOnmreviewmofmsystems,mMr.mAmcomplainsmthatmnocturiamismcausingmdaytim
emfatigue,mandmhemismmoremconstipated.mPhysicalmexaminationmismnotablemformbloodmpressurem16
2/83mmmHg,mheartmratem60mbeatsmpermminute,mclearmlungs,msoftmabdomen,menlargedmprostate,ma
ndm21mpretibialmedema.mYourmnextmstepminmmanagementmshouldmbe:m-
mCORRECTmANSWERStopmamlodipinemandmincreasemlisinopril.
Themdaughtermofmam79-year-
oldmwomanmnotesmthatmhermmother,mwhomhasmdementiamandmlivesmwithmher,mismwettingmherselfmw
henmshemattendsmhermnewmdaymprogram.mProgrammstaffmhavemrequestedmthatm"somethingmbemdo
ne"masmshemismrequiringmamclothesmchangemnearlymeverymtimemshemismthere.mShemcannotmdescribem
themcircumstancesmofmleakage,msayingm"itmjustmcomes."mLeakagemismuncommonmatmhome.mHermme
dicationsmincludemdonepezilmandmacetaminophen.mPhysicalmexaminationmismnormal.mInitialmtreat
mentmapproachmwillmrequireminterventionmbymwhichmofmthemfollowing?m-
mCORRECTmANSWERDaymprogrammstaff
.mMs.mJ,mwhomism82myearsmold,mcomplainsmofmurinemleakagemwhilemplayingmgolf.mThismhasmgottenmw
orsemovermthempastmyear,mandmshemrarelymmakesmitmthroughmninemholesmwithoutmfeelingmlikemshem
needsmtom"runmintomthembushesmandmgo."mLeakagemismusuallymsmallmvolume,mbutmcausesmhermextr
ememembarrassmentmbecausemshemismafraidmshemwillmsmellmofmurine.mShemhasmtriedmlimitingmcaffe
ineminmthemmorningmbeforemshemgolfsmandmavoidingmdrinkingmwatermwhilemplaying,mtomnomeffect.mS
hemalsomtriedm"thosemKegler"mexercisesminmthempastmwithoutmsuccess.mWhichmofmthemfollowingmismt
hemmostmappropriatemrecommendationmformMs.mJ?m-mCORRECTmANSWERBladdermtraining
, Whatmismthemmostmcommonmcausemofmerectilemdysfunctionminmoldermmen?m-
mCORRECTmANSWERAtherosclerosis
Whichmismthemmostmreasonablemfirstmstepminmthemtreatmentmofmoldermmenmwithmerectilemdysfuncti
on?m-mCORRECTmANSWERSildenafil
Am72-year-
oldmwomanmreportsmvaginalmdrynessmthatminterferesmwithmcoitus.mHermmedicalmhistorymincludesmt
ypem2mdiabetes,mhypertension,mandmosteoarthritis.mMedicationsmaremglyburide,mchlorthalidone,ma
ndmacetaminophen.mWhatmwouldmbemyourmfirstmstepminmtherapy?m-
mCORRECTmANSWERStopmchlorthalidone
Am70-year-
oldmwomanmreportsmsexualmpainmwithmdeepmpenetrationmonly.mWhatmismthemmostmlikelymcausemofm
hermproblem?m-mCORRECTmANSWERHigh-tonempelvicmfloormdysfunction
Am79-year-oldmwomanmwithmam1.5-
cmmbreastmcancermunderwentmlumpectomy.mPathologymrevealedmductalmcarcinomamthatmismhorm
onemreceptormnegativem(estrogenmreceptorm0%,mprogesteronemreceptorm1%)mandmHER2/neumnega
tive.mSurgicalmmarginsmweremadequatemandmuninvolvedmwithmcancer.mSentinelmlymphmnodemsampl
ingmwasmnegativemformlymphmnodeminvolvement.mShemhasmgoodmperformancemstatusmandmnomacti
vitiesmofmdailymlivingm(ADL)morminstrumentalm(IADL)mdependencies.mWhatmtreatmentmwouldmyoumr
ecommend?m-mCORRECTmANSWERHormonalmtherapymonly
Anm86-year-
oldmmanmwithmnomADLmdeficitsmwhomhasmstoppedmdrivingmbecausemofmmacularmdegenerationmisme
valuatedmformamurinarymtractminfectionmassociatedmwithmurinarymretention.mThemconsultingmurolog
istmplacesmamFoleymcathetermandmsendsmamprostate-
specificmantigenm(PSA)mlevelmthatmcomesmbackm12mng/mL.mThreemmonthsmlatermaftermthemFoleymha
smbeenmremovedmandmhemhasmhadmamgoodmresponsemtomtamsulosin,mhismPSAmismstillm10mng/mL.mW
hatmismthemappropriatemnextmstepminmmanagingmthismman'smprostatemproblem?m-
mCORRECTmANSWERRepeatmPSAminm6mmonths
