AGNP Midterm Exams Questions And Answers .

AGNP Midterm Exams Questions And
Answers

1. An 84-year-old woman,lives independently,concerned about driving.On 2
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occasions, she had minor collisions when she was backing up her car (she
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dislodged rearview mirror and struck a fire hydrant, each time on the
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passenger side).
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• History:osteoarthritis of the cervical and lumbar spine and mild hearing
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impairment
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• Medications: acetaminophen and calcium plus vitamin D ji ji ji ji ji ji




• Functional assessment:intact cognition and vision,with near-visual acuity ji ji ji ji ji ji ji ji




20/30 in each eye. She fails the whisper test.
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• Physical examination: Decreased range of motion in neck and back in all
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planes(unchangedfrompreviousfindings);Diffuseosteoarthriticdeformities
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inthekneesandhands;Decreasedrangeofmotionatthehips;Mildkyphosis;
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Motor strength and deep tendon reflexes are symmetric and intact
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Which one of the following is the most appropriate next step?
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A. Obtain radiography of the cervical spine in 3 views. ji ji ji ji ji ji ji ji




B. Recommend that she no longer drive. ji ji ji ji ji




C. Refer to physical therapy. ji ji ji




D. Refer to audiology. ji ji




E. Refer to occupational therapy.:E.Refer to occupational therapy.
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2. An 80-year-old woman hospitalized after fall and hip fracture
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• History: stable osteoarthritis of the knees, peripheral neuropathy
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• Prior to fall,she lived alone and managed all instrumental activities of daily
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living; occasionally used cane or walker for mild problems with balance
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• Current status,4 days after surgery:Needs assistance of 2 persons for
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transfer; Frequently incontinent of urine; Eating very little
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Whichoneofthefollowingisthemostlikelyoutcomeforthispatient6months after th
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fracture?
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A. Continued slow functional decline ji ji ji




B. Recovery to her pre-fracture level of function ji ji ji ji ji ji




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,C. Partial recovery of function ji ji ji




D. Stability at the level of function on hospital discharge
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E. Death:B.Recovery to her pre-fracture level of function
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3. An 85-year-old man with 2 episodes of low-volume urinary incontinence in the
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last year, when he "waited too long"
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• Functional assessment: Near-visual acuity of 20/50 on the right and 20/60 on
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the left withcorrection; Fails whisper test in rightear ; Gait speed at usual pace is 0.9
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m/sec ; Mini-Cog screen: 2 of 3 items on recall, completes an accurate
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,clock 36 CASE 3 (2 of 3) ji ji ji ji ji ji




Which one of the following is the most appropriate next step for evaluation of
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functional disability? A. Refer to audiology.
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B. Refer to ophthalmology. ji ji




C. Refer to physical therapy. ji ji ji




D. Complete additional cognitive testing. ji ji ji




E. Complete an incontinence evaluation.:B.Refer to ophthalmology. ji ji ji ji ji ji ji




4. A 68-year-old woman describes vision problems.
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• Progressive blurring of distance vision ji ji ji ji




• Increaseddifficultywithnighttimedriving,whichsheattributestoworsening ji ji ji ji ji ji ji ji ji




glare and haloes around lights
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• She no longer needs glasses for reading.
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• History: hypertension, hypercholesterolemia ji ji




Which one of the following is the most likely cause of the changes in her vision?
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A. Uncontrolled hypertension ji




B. Poorly controlled blood glucose C.Choroidal neovascularization ji ji ji ji ji ji




D. Cataract progression ji




E. Increased intraocular pressure:D.Cataract progression ji ji ji ji ji




5. A 72-year-old black man has right shoulder trauma after he fell in a parking lot.
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He states that he was walking to his car when he suddenly tripped and fell
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forward onto his arm.He subsequently learned that he had tripped over a curb.
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• History:hypertension,high cholesterol,glaucoma ji ji ji ji




Which one of the following most likely contributed to his fall?
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A. Acute glaucoma ji




B. Failure to use glaucoma drops that morning ji ji ji ji ji ji




C. Poor peripheral vision ji ji




D. Retinal embolus from a carotid plaque:C.Poor peripheral vision ji ji ji ji ji ji ji ji ji




6. An 88-year-old woman comes to the office for an urgent visit because, when she
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awoke this morning, she found that she could no longer see to read. She
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depends on her left eye for vision because she lost her right eye in an accident when
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she was a child.
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• On examination, vision is 20/400 in the left eye. She does not perceive light in
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the right eye.She is referred emergently to an ophthalmologist,who diagnoses
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neovascular age-related macular degeneration.
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Study online at https://quizlet.com/_avp9gj ji ji ji




Which one of the following is the most appropriate therapy?
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A. Topicalprostaglandinanalog ji ji




B. Phacoemulsification with intraocular lens implantation ji ji ji ji




C. Intravitreal vascular endothelial growth factor inhibitor ji ji ji ji ji




D. GlasseswithupdatedrefractionE.Orallutein,zeaxanthin,andomega-3eye ji ji ji ji ji ji ji ji ji ji




nutrients: C. Intravitreal vascular endothelial growth factor inhibitor
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7. An 80-year-old woman comes to the office with her daughter.The daughter is
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concerned that her mother has recently begun to withdraw from former
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activities (attending book clubs, lectures).
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• Patient's self-reported health status has changed from "excellent" last year to ji ji ji ji ji ji ji ji ji ji




"average" today.
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• During the appointment she misunderstands some questions, and she ji ji ji ji ji ji ji ji




appears to struggle to understand some of what is said.Her memory does not
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seem as keen as on previous visits.
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• In response to direct questions,she states that over the past 2 weeks she has
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felt a little down.
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• She says that if people would include her in conversation, she would
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probably feel better and be more inclined to engage in the activities she
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previously enjoyed.
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• Medications:daily multivitamin,daily aspirin ji ji ji ji




• Physical examination:Normal blood pressure and EKG;MMSE score is 26 of ji ji ji ji ji ji ji ji ji ji ji




30; Findings from routine laboratory tests are normal.
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Which one of the following is the most appropriate next step?
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A. Begin antidepressant therapy. ji ji




B. Refer for psychiatry consultation.C.Refer for neurologic evaluation.D.
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Administer in-office hearing screen.: D.Administer in-office hearing screen.
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8. A 75-year-old man has age-related hearing loss,diagnosed by an audiolo-
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gist.The patient requests advice regarding hearing interventions.
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• He has difficulty understanding speech at meetings and in restaurants;he
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describes "hearing people talk but not making out the words."
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• Score on the Hearing Handicap Inventory for the Elderly (short form) is 25,
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consistent with significant self-reported handicap.(HHIE-S is a self-reported
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questionnaire that quantifies the handicapping effects of hearing loss.)
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• Pure-tone test indicates a mild sloping to moderate sensorineural hearing ji ji ji ji ji ji ji ji ji




loss most pronounced in high frequencies.
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• Speech understanding in quiet environment is excellent,but decreases to fair ji ji ji ji ji ji ji ji ji ji




in a noisy environment.
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