NR 509 Exam Test Question and Answers
1. Which of the following changes are expected in vision as part of the normal aging process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision
Answer: Ans: D
The lens loses its elasticity over time as part of the normal aging process, and the eye is less able to
accommodate and focus on near objects; therefore, the patient will be expected to have blurring of near
vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He
has noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits
to lip-reading more. He has a history of noise exposure in his young adult years: He worked as a sound
engineer at a local arena and had to attend a lot of concerts. Based on this information, what is the most
likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds
Answer: Ans: A
Human speech is considered to be a middle-range sound. During the aging process there is a loss of
acuity, starting with high-pitched sounds but extending to the middle range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with urination; he gets up
five to six times per night to urinate and has to go at least that often in the daytime. He does not feel as
if his bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or
hematuria. This problem has been present for several years but has worsened over the last 8 months.
You palpate his prostate. What is your expected physical examination finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy
Answer: Ans: C
This is the expected physical examination finding in benign prostatic hyperplasia (BPH).
4. A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned about his
memory. The patient himself admits to misplacing his keys more often and forgets what he is supposed
to buy from the grocery store and where he has parked the car. He denies getting lost in familiar places.
Upon further questioning, he states that his wife of 40 years died 8 months ago; his three children live in
three different states; and he has limited his activities because the people he interacted with were "his
wife's friends, not his." He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. You
perform a mini-mental state examination and obtain a total score of 24 out of 28. Based on this
information, what is your most likely diagnosis?
A) Benign forgetfulness
B) Dementia
, C) Meningitis
D) Depression
Answer: Ans: D
The patient has symptoms of depression: His wife died, he has no real social support system, and he has
isolated himself from his usual activities. He also drinks a considerable amount of alcohol on a daily
basis, which can further depress his mood. Depression can masquerade as dementia in the elderly and
must be considered in a patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness. You obtain a
complete history, perform a thorough physical examination, and order laboratory tests. You diagnose
her with hyperthyroidism. Based on her age, which of the atypical symptoms of hyperthyroidism is more
likely to be seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia
Answer: Ans: D
This is an atypical symptom of hyperthyroidism that is more likely to be seen in the older patient.
6. A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an ECG
(electrocardiogram) because of her history of hypertension. You diagnose a previous myocardial
infarction and ask her if she had any symptoms related to this. Which of the following symptoms would
be more common in this patient's age group for an acute myocardial infarction?
A) Chest pain
B) Syncope
C) Pain radiating into the left arm
D) Pain radiating into the jaw
Answer: Ans: B
This is an atypical symptom and more likely to be seen in this patient's age group.
7. An 88-year-old retired piano teacher comes for evaluation of fatigue. You notice that her clothes are
hanging loosely off her frame and that she has lost 15 pounds. She is unaware of this. Her husband of 63
years died a few months ago. You ask the patient to complete a Rapid Screen for Dietary Intake. Which
of the following statements is considered to be part of this rapid screen?
A) I eat more than two meals per day.
B) I drink one glass of alcohol every day.
C) Without wanting to, I have lost or gained 10 pounds in the last 6 months.
D) I eat with at least one other person most of the time.
Answer: Ans: C
This is part of the Rapid Screen for Dietary Intake.
8. An 89-year-old retired school principal comes for an annual check-up. She would like to know
whether or not she should undergo a screening colonoscopy. She has never done this before. Which of
the following factors should not be considered when discussing whether she should go for this screening
test?
A) Life expectancy
B) Time interval until benefit from screening accrues
C) Patient preference
1. Which of the following changes are expected in vision as part of the normal aging process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision
Answer: Ans: D
The lens loses its elasticity over time as part of the normal aging process, and the eye is less able to
accommodate and focus on near objects; therefore, the patient will be expected to have blurring of near
vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He
has noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits
to lip-reading more. He has a history of noise exposure in his young adult years: He worked as a sound
engineer at a local arena and had to attend a lot of concerts. Based on this information, what is the most
likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds
Answer: Ans: A
Human speech is considered to be a middle-range sound. During the aging process there is a loss of
acuity, starting with high-pitched sounds but extending to the middle range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with urination; he gets up
five to six times per night to urinate and has to go at least that often in the daytime. He does not feel as
if his bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or
hematuria. This problem has been present for several years but has worsened over the last 8 months.
You palpate his prostate. What is your expected physical examination finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy
Answer: Ans: C
This is the expected physical examination finding in benign prostatic hyperplasia (BPH).
4. A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned about his
memory. The patient himself admits to misplacing his keys more often and forgets what he is supposed
to buy from the grocery store and where he has parked the car. He denies getting lost in familiar places.
Upon further questioning, he states that his wife of 40 years died 8 months ago; his three children live in
three different states; and he has limited his activities because the people he interacted with were "his
wife's friends, not his." He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. You
perform a mini-mental state examination and obtain a total score of 24 out of 28. Based on this
information, what is your most likely diagnosis?
A) Benign forgetfulness
B) Dementia
, C) Meningitis
D) Depression
Answer: Ans: D
The patient has symptoms of depression: His wife died, he has no real social support system, and he has
isolated himself from his usual activities. He also drinks a considerable amount of alcohol on a daily
basis, which can further depress his mood. Depression can masquerade as dementia in the elderly and
must be considered in a patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness. You obtain a
complete history, perform a thorough physical examination, and order laboratory tests. You diagnose
her with hyperthyroidism. Based on her age, which of the atypical symptoms of hyperthyroidism is more
likely to be seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia
Answer: Ans: D
This is an atypical symptom of hyperthyroidism that is more likely to be seen in the older patient.
6. A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an ECG
(electrocardiogram) because of her history of hypertension. You diagnose a previous myocardial
infarction and ask her if she had any symptoms related to this. Which of the following symptoms would
be more common in this patient's age group for an acute myocardial infarction?
A) Chest pain
B) Syncope
C) Pain radiating into the left arm
D) Pain radiating into the jaw
Answer: Ans: B
This is an atypical symptom and more likely to be seen in this patient's age group.
7. An 88-year-old retired piano teacher comes for evaluation of fatigue. You notice that her clothes are
hanging loosely off her frame and that she has lost 15 pounds. She is unaware of this. Her husband of 63
years died a few months ago. You ask the patient to complete a Rapid Screen for Dietary Intake. Which
of the following statements is considered to be part of this rapid screen?
A) I eat more than two meals per day.
B) I drink one glass of alcohol every day.
C) Without wanting to, I have lost or gained 10 pounds in the last 6 months.
D) I eat with at least one other person most of the time.
Answer: Ans: C
This is part of the Rapid Screen for Dietary Intake.
8. An 89-year-old retired school principal comes for an annual check-up. She would like to know
whether or not she should undergo a screening colonoscopy. She has never done this before. Which of
the following factors should not be considered when discussing whether she should go for this screening
test?
A) Life expectancy
B) Time interval until benefit from screening accrues
C) Patient preference
