1
NSG 6320 MIDTERM EXAM STUDY GUIDE
1.
An 82-year-old woman is brought to the primary care clinic by her daughter, who
reports that the patient has become increasingly withdrawn, has missed several
medication doses, and has unexplained bruises on her upper arms. The patient
becomes quiet when her daughter answers questions for her. Which assessment
approach should the nurse practitioner use first?
A. Ask the daughter to provide a complete history without the patient present
B. Document the bruising as an expected finding of aging
C. Tell the patient that family members must participate in all health decisions
D. Interview the patient privately and assess for possible abuse, neglect, or
coercion
Answer: D
2.
A 76-year-old patient reports increasing difficulty managing finances, preparing
meals, shopping, and organizing medications but remains independent with
bathing and dressing. Which assessment domain is most directly affected?
A. Instrumental activities of daily living
B. Basic activities of daily living
C. Cranial nerve function
D. Mental status orientation only
Answer: A
3.
An 84-year-old patient reports that she has fallen three times during the past six
months. She takes antihypertensive medication, a sedating sleep medication, and
an antihistamine. Which intervention should receive the highest priority during
the primary-care evaluation?
,2
A. Recommend complete bed rest
B. Perform a multifactorial fall-risk assessment, including medications, gait,
balance, vision, and environment
C. Tell the patient to discontinue all medications immediately
D. Reassure the patient that falls are a normal part of aging
Answer: B
4.
A 79-year-old patient presents with progressive fatigue, weakness, reduced
appetite, and difficulty recovering from a minor respiratory infection. The clinician
notices unintentional weight loss and decreased grip strength. Which geriatric
syndrome should be considered?
A. Delirium
B. Polyuria
C. Frailty
D. Hyperthyroidism
Answer: C
5.
An 88-year-old patient with multiple chronic conditions takes 12 prescription
medications, three over-the-counter products, and several herbal supplements.
The patient reports dizziness and occasional confusion. Which action is most
appropriate?
A. Perform comprehensive medication reconciliation and evaluate for potentially
inappropriate medications and interactions
B. Tell the patient to continue all medications until the next annual visit
C. Stop every medication simultaneously
D. Assume the symptoms are caused by normal aging
Answer: A
6.
,3
A 74-year-old patient presents for a routine visit and states, “I feel fine,” but the
clinician observes slowed gait and difficulty rising from a chair. Which assessment
would provide the most useful information about functional status?
A. Ask only about the patient's vaccination history
B. Measure abdominal circumference
C. Assess gait, balance, strength, and ability to perform daily activities
D. Perform only a cardiovascular examination
Answer: C
7.
A 71-year-old patient reports feeling dizzy when standing after sitting for a
prolonged period. Blood pressure decreases substantially after standing, and the
patient develops lightheadedness. Which diagnosis is most consistent?
A. Orthostatic hypotension
B. Essential hypertension
C. Hyperthyroidism
D. Increased intracranial pressure
Answer: A
8.
An older adult reports a recent decline in appetite, difficulty preparing meals, and
a 10-pound unintentional weight loss. Which additional assessment is most
important?
A. Preferred television programs
B. Dietary intake, dentition, swallowing ability, food access, mood, and medication
effects
C. Childhood vaccination history
D. Previous orthopedic injuries only
Answer: B
9.
, 4
A 68-year-old patient with obesity, hypertension, dyslipidemia, and a fasting
glucose of 116 mg/dL asks about cardiovascular risk. Which counseling approach
is most appropriate?
A. Explain that cardiovascular risk is determined only by cholesterol
B. Tell the patient that risk cannot be changed after age 65
C. Explain the importance of weight management, physical activity, blood-
pressure control, glucose management, and lipid management
D. Recommend avoiding all carbohydrates permanently
Answer: C
10.
A 66-year-old patient with a 40-pack-year smoking history presents for an annual
primary-care visit and states that he has no respiratory symptoms. Which
preventive approach is most appropriate?
A. Avoid discussing smoking because the patient is asymptomatic
B. Recommend routine antibiotics to prevent pneumonia
C. Recommend complete inactivity to prevent dyspnea
D. Assess smoking status and readiness to quit and provide evidence-based
cessation support
Answer: D
11.
A 72-year-old patient reports difficulty sleeping and requests a prescription for a
sedative-hypnotic. The patient already takes several medications that cause
sedation and has fallen twice in the previous year. Which response is most
appropriate?
A. Evaluate reversible causes of insomnia and medication-related risks before
prescribing a sedative
B. Prescribe the strongest available sedative
C. Recommend taking two sedative medications together
D. Tell the patient that insomnia is unavoidable in older adults
NSG 6320 MIDTERM EXAM STUDY GUIDE
1.
An 82-year-old woman is brought to the primary care clinic by her daughter, who
reports that the patient has become increasingly withdrawn, has missed several
medication doses, and has unexplained bruises on her upper arms. The patient
becomes quiet when her daughter answers questions for her. Which assessment
approach should the nurse practitioner use first?
A. Ask the daughter to provide a complete history without the patient present
B. Document the bruising as an expected finding of aging
C. Tell the patient that family members must participate in all health decisions
D. Interview the patient privately and assess for possible abuse, neglect, or
coercion
Answer: D
2.
A 76-year-old patient reports increasing difficulty managing finances, preparing
meals, shopping, and organizing medications but remains independent with
bathing and dressing. Which assessment domain is most directly affected?
A. Instrumental activities of daily living
B. Basic activities of daily living
C. Cranial nerve function
D. Mental status orientation only
Answer: A
3.
An 84-year-old patient reports that she has fallen three times during the past six
months. She takes antihypertensive medication, a sedating sleep medication, and
an antihistamine. Which intervention should receive the highest priority during
the primary-care evaluation?
,2
A. Recommend complete bed rest
B. Perform a multifactorial fall-risk assessment, including medications, gait,
balance, vision, and environment
C. Tell the patient to discontinue all medications immediately
D. Reassure the patient that falls are a normal part of aging
Answer: B
4.
A 79-year-old patient presents with progressive fatigue, weakness, reduced
appetite, and difficulty recovering from a minor respiratory infection. The clinician
notices unintentional weight loss and decreased grip strength. Which geriatric
syndrome should be considered?
A. Delirium
B. Polyuria
C. Frailty
D. Hyperthyroidism
Answer: C
5.
An 88-year-old patient with multiple chronic conditions takes 12 prescription
medications, three over-the-counter products, and several herbal supplements.
The patient reports dizziness and occasional confusion. Which action is most
appropriate?
A. Perform comprehensive medication reconciliation and evaluate for potentially
inappropriate medications and interactions
B. Tell the patient to continue all medications until the next annual visit
C. Stop every medication simultaneously
D. Assume the symptoms are caused by normal aging
Answer: A
6.
,3
A 74-year-old patient presents for a routine visit and states, “I feel fine,” but the
clinician observes slowed gait and difficulty rising from a chair. Which assessment
would provide the most useful information about functional status?
A. Ask only about the patient's vaccination history
B. Measure abdominal circumference
C. Assess gait, balance, strength, and ability to perform daily activities
D. Perform only a cardiovascular examination
Answer: C
7.
A 71-year-old patient reports feeling dizzy when standing after sitting for a
prolonged period. Blood pressure decreases substantially after standing, and the
patient develops lightheadedness. Which diagnosis is most consistent?
A. Orthostatic hypotension
B. Essential hypertension
C. Hyperthyroidism
D. Increased intracranial pressure
Answer: A
8.
An older adult reports a recent decline in appetite, difficulty preparing meals, and
a 10-pound unintentional weight loss. Which additional assessment is most
important?
A. Preferred television programs
B. Dietary intake, dentition, swallowing ability, food access, mood, and medication
effects
C. Childhood vaccination history
D. Previous orthopedic injuries only
Answer: B
9.
, 4
A 68-year-old patient with obesity, hypertension, dyslipidemia, and a fasting
glucose of 116 mg/dL asks about cardiovascular risk. Which counseling approach
is most appropriate?
A. Explain that cardiovascular risk is determined only by cholesterol
B. Tell the patient that risk cannot be changed after age 65
C. Explain the importance of weight management, physical activity, blood-
pressure control, glucose management, and lipid management
D. Recommend avoiding all carbohydrates permanently
Answer: C
10.
A 66-year-old patient with a 40-pack-year smoking history presents for an annual
primary-care visit and states that he has no respiratory symptoms. Which
preventive approach is most appropriate?
A. Avoid discussing smoking because the patient is asymptomatic
B. Recommend routine antibiotics to prevent pneumonia
C. Recommend complete inactivity to prevent dyspnea
D. Assess smoking status and readiness to quit and provide evidence-based
cessation support
Answer: D
11.
A 72-year-old patient reports difficulty sleeping and requests a prescription for a
sedative-hypnotic. The patient already takes several medications that cause
sedation and has fallen twice in the previous year. Which response is most
appropriate?
A. Evaluate reversible causes of insomnia and medication-related risks before
prescribing a sedative
B. Prescribe the strongest available sedative
C. Recommend taking two sedative medications together
D. Tell the patient that insomnia is unavoidable in older adults
