NR-601 PRIMARY CARE OF THE
MATURING & AGED FAMILY
PRACTICUM UPDATE VERIFIED
QUESTIONS & DETAILED
EXPLANATIONS GRADED A+
Professional Academic Assistance Services
An 86-year-old female comes to your office for a wellness visit.
Her blood pressure is 125/70 mmHg, pulse 69 beats per min,
and respiratory rate 18 breaths per min. She is well appearing
and reports she is up to date on her routine vaccinations. She
introduces her partner of 35 years whom she would like to make
medical decisions for her in case she becomes unable to make
decisions for herself. She reports that she and her partner are
not married. She asks if she needs any further documentation to
ensure her goals of care are followed. Which one of the
following would be the most appropriate recommendation for
this patient and her partner? - Answer: Advise them to file an
advanced directive.
. An 81-year-old transgender female with history of depression
and hyperlipidemia presents to your clinic for routine care. She
endorses a history of smoking, currently smoking 1 pack per day,
and occasionally drinks a glass of wine, although she denies illicit
,drug use. She reports she takes atorvastatin 20 mg and
subcutaneous estrogen therapy. - Answer: Counseling on
smoking cessation
An 84-year-old male with history of stroke without residual
deficit, systolic heart failure, and type 2 diabetes presents to
clinic for follow-up. He is independently living in a retirement
community and still works part time on a golf course. He
currently takes aspirin 81 mg, metoprolol tartrate 25 mg BID
(twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily.
He reports his last colonoscopy was 8 years ago, with no
abnormality. He reports he is sexually active with men and
women, engaging in receptive oral, receptive anal, and
penetrative sex. He states he has had over three sexual partners
in the last year with intermittent condom use. What sexually
transmitted infection testing should be offered? - Answer: Urine
testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine? - Answer: It
has greater risk of adverse effects with its twice-daily
formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia,
occurring four times per night. His other lower urinary tract
symptoms are slow stream, occasional urgency, and urgency-
related leakage once weekly. Medical problems include poorly
,controlled hypertension, diastolic heart failure, hyperlipidemia,
osteoarthritis, and prediabetes. His medications include
lisinopril 20 mg daily, metoprolol succinate 75 mg daily,
atorvastatin 10 mg daily, metformin 500 mg twice daily,
hydrocodone-acetaminophen as needed, and aspirin 81 mg
daily. Amlodipine 5 mg daily was recently added by his
cardiologist. On review of systems, Mr. A complains that
nocturia is causing daytime fatigue, and he is more constipated.
Physical examination is notable for blood pressure 162/83
mmHg, heart rate 60 beats per minute, clear lungs, soft
abdomen, enlarged prostate, and 21 pretibial edema. Your next
step in management should be: - Answer: Stop amlodipine and
increase lisinopril.
The daughter of a 79-year-old woman notes that her mother,
who has dementia and lives with her, is wetting herself when
she attends her new day program. Program staff have requested
that "something be done" as she is requiring a clothes change
nearly every time she is there. She cannot describe the
circumstances of leakage, saying "it just comes." Leakage is
uncommon at home. Her medications include donepezil and
acetaminophen. Physical examination is normal. Initial
treatment approach will require intervention by which of the
following? - Answer: Day program staff
. Ms. J, who is 82 years old, complains of urine leakage while
playing golf. This has gotten worse over the past year, and she
, rarely makes it through nine holes without feeling like she needs
to "run into the bushes and go." Leakage is usually small
volume, but causes her extreme embarrassment because she is
afraid she will smell of urine. She has tried limiting caffeine in
the morning before she golfs and avoiding drinking water while
playing, to no effect. She also tried "those Kegler" exercises in
the past without success. Which of the following is the most
appropriate recommendation for Ms. J? - Answer: Bladder
training
What is the most common cause of erectile dysfunction in older
men? - Answer: Atherosclerosis
Which is the most reasonable first step in the treatment of older
men with erectile dysfunction? - Answer: Sildenafil
A 72-year-old woman reports vaginal dryness that interferes
with coitus. Her medical history includes type 2 diabetes,
hypertension, and osteoarthritis. Medications are glyburide,
chlorthalidone, and acetaminophen. What would be your first
step in therapy? - Answer: Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration
only. What is the most likely cause of her problem? - Answer:
High-tone pelvic floor dysfunction
MATURING & AGED FAMILY
PRACTICUM UPDATE VERIFIED
QUESTIONS & DETAILED
EXPLANATIONS GRADED A+
Professional Academic Assistance Services
An 86-year-old female comes to your office for a wellness visit.
Her blood pressure is 125/70 mmHg, pulse 69 beats per min,
and respiratory rate 18 breaths per min. She is well appearing
and reports she is up to date on her routine vaccinations. She
introduces her partner of 35 years whom she would like to make
medical decisions for her in case she becomes unable to make
decisions for herself. She reports that she and her partner are
not married. She asks if she needs any further documentation to
ensure her goals of care are followed. Which one of the
following would be the most appropriate recommendation for
this patient and her partner? - Answer: Advise them to file an
advanced directive.
. An 81-year-old transgender female with history of depression
and hyperlipidemia presents to your clinic for routine care. She
endorses a history of smoking, currently smoking 1 pack per day,
and occasionally drinks a glass of wine, although she denies illicit
,drug use. She reports she takes atorvastatin 20 mg and
subcutaneous estrogen therapy. - Answer: Counseling on
smoking cessation
An 84-year-old male with history of stroke without residual
deficit, systolic heart failure, and type 2 diabetes presents to
clinic for follow-up. He is independently living in a retirement
community and still works part time on a golf course. He
currently takes aspirin 81 mg, metoprolol tartrate 25 mg BID
(twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily.
He reports his last colonoscopy was 8 years ago, with no
abnormality. He reports he is sexually active with men and
women, engaging in receptive oral, receptive anal, and
penetrative sex. He states he has had over three sexual partners
in the last year with intermittent condom use. What sexually
transmitted infection testing should be offered? - Answer: Urine
testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine? - Answer: It
has greater risk of adverse effects with its twice-daily
formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia,
occurring four times per night. His other lower urinary tract
symptoms are slow stream, occasional urgency, and urgency-
related leakage once weekly. Medical problems include poorly
,controlled hypertension, diastolic heart failure, hyperlipidemia,
osteoarthritis, and prediabetes. His medications include
lisinopril 20 mg daily, metoprolol succinate 75 mg daily,
atorvastatin 10 mg daily, metformin 500 mg twice daily,
hydrocodone-acetaminophen as needed, and aspirin 81 mg
daily. Amlodipine 5 mg daily was recently added by his
cardiologist. On review of systems, Mr. A complains that
nocturia is causing daytime fatigue, and he is more constipated.
Physical examination is notable for blood pressure 162/83
mmHg, heart rate 60 beats per minute, clear lungs, soft
abdomen, enlarged prostate, and 21 pretibial edema. Your next
step in management should be: - Answer: Stop amlodipine and
increase lisinopril.
The daughter of a 79-year-old woman notes that her mother,
who has dementia and lives with her, is wetting herself when
she attends her new day program. Program staff have requested
that "something be done" as she is requiring a clothes change
nearly every time she is there. She cannot describe the
circumstances of leakage, saying "it just comes." Leakage is
uncommon at home. Her medications include donepezil and
acetaminophen. Physical examination is normal. Initial
treatment approach will require intervention by which of the
following? - Answer: Day program staff
. Ms. J, who is 82 years old, complains of urine leakage while
playing golf. This has gotten worse over the past year, and she
, rarely makes it through nine holes without feeling like she needs
to "run into the bushes and go." Leakage is usually small
volume, but causes her extreme embarrassment because she is
afraid she will smell of urine. She has tried limiting caffeine in
the morning before she golfs and avoiding drinking water while
playing, to no effect. She also tried "those Kegler" exercises in
the past without success. Which of the following is the most
appropriate recommendation for Ms. J? - Answer: Bladder
training
What is the most common cause of erectile dysfunction in older
men? - Answer: Atherosclerosis
Which is the most reasonable first step in the treatment of older
men with erectile dysfunction? - Answer: Sildenafil
A 72-year-old woman reports vaginal dryness that interferes
with coitus. Her medical history includes type 2 diabetes,
hypertension, and osteoarthritis. Medications are glyburide,
chlorthalidone, and acetaminophen. What would be your first
step in therapy? - Answer: Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration
only. What is the most likely cause of her problem? - Answer:
High-tone pelvic floor dysfunction
