NR 601 Final Exam questions with verified answers
. A 72-year-old man with colonic diverticulosis was admitted to the hospital with
gastrointestinal bleeding and abdominal pain. He underwent colonoscopy under
conscious sedation using fentanyl and midazolam. The following day, the patient
was positive on the Confusion Assessment Method performed by the geriatric
consultation services. Presence of delirium in this patient predisposes him to all of
the following except: Ans✓✓✓ Shorter length of stay in the hospital
. 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. Ans✓✓✓ Counseling on smoking
cessation
. John P. is an 81-year-old male with extensive cardiac history, including three
vessel coronary artery bypass graft when he was in his 60s, hypertension,
diabetes mellitus, osteoarthritis, sciatica, and progressive macular degeneration.
His vitals today are blood pressure 146/86 mmHg, heart rate 67 beats per minute,
respiratory rate 21 breaths/min, and temperature 98.7° F. He is here with his only
son and has been living in an assisted living since his wife died 3 years ago. His
Montreal cognitive assessment (MoCA) 1 month ago was 23/30. He has no
advance directive in the chart. He tells you he's "been slowing down" a lot lately.
He does not go down to the dining room because it is too taxing, he has been
slowly losing weight because food does not taste good, he has fallen four times in
the last year. He has no specific concerns to discuss today. What is the most
important thing that can be addressed at today's vis Ans✓✓✓ Suggest
completion of an advance directive at visit with his goals of care in mind for
moving forward in his care.
,. 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? Ans✓✓✓ Bladder training
. Randall Johnson, an 80-year-old man with a history of high blood pressure and
hypothyroidism, presents to your office with ongoing dizziness. He feels it has
worsened since the summer months began. He states it is worst when he gets up
from his chair on his front porch to stand or when he is working in his garden. If
he stands still for a few minutes, the dizziness typically resolves on its own. If he
tries to move too quickly, he has felt like he may pass out, but has not yet done
so. He denies changes in vision or hearing. He has had no recent changes in his
medication. On examination today, he is a frail-appearing older man in no acute
distress. Vitals show a blood pressure of 118/71 mmHg with a pulse of 55 beats
per minute. Heart and lung exams are benign. What is the most likely cause of his
dizziness? Ans✓✓✓ Orthostatic hypotension
2. A 79-year-old woman was admitted to the hospital a month ago with an acute
left middle cerebral artery ischemic stroke. On examination, she had right
hemiparesis, mild motor aphasia, and dysphagia. After discharge, she was
transferred to a skilled nursing facility where she has been working with physical,
occupational, and speech therapy. Despite initial progress, in the last 2 weeks, she
has lost her appetite, and complains of insomnia and difficulty concentrating.
Which would be the next best step in management? Ans✓✓✓ Start escitalopram
5 mg orally daily.
A 66-year-old man complains of nocturia (three to four times a night), hesitancy,
and incomplete emptying of the bladder. Physical examination reveals an
, enlarged, nontender prostate, about 40 g in size without discrete nodules.
Urinalysis reveals hematuria without leukocyte esterase. Upon further evaluation,
the hematuria is attributed to his BPH. The patient declines surgical options at this
time. Which of the following medications would be most appropriate? Ans✓✓✓
Finasteride
A 67-year-old female with a history of congestive heart failure and myocardial
infarction is admitted to the hospital because of increasing altered mental status
and decreased arousal over the last week. Physical examination reveals a
confused woman with right lower lobe crackles and a pulse oximetry of 86% on
room air. While you are interviewing the patient, she is irritable, paranoid, and
inattentive, which her family tells you is out of character. You notice waxing and
waning in her alertness and impaired short-term memory during your
examination. Which one of the following features present in this patient best
distinguishes delirium from depression or dementia? Ans✓✓✓ Inattentiveness
A 69-year-old female presents to your office for routine primary care. Her elder
sister was recently diagnosed with Alzheimer disease, and she wonders what
steps she can take to reduce her own risk of developing dementia. Which of the
following statements about the prevention of dementia is true? Ans✓✓✓ There
is moderate quality evidence to suggest control of cardiovascular and metabolic
risk factors, such as blood pressure, weight, and blood sugar, may reduce risk of
dementia.
A 70-year-old man has bothersome lower urinary tract syndrome (LUTS)
associated with benign prostatic hyperplasia (BPH). His symptoms are no longer
well managed with lifestyle modifications. He is interested in medication to
reduce his urinary symptoms but is concerned about possible side effects. He
notes that he is recently married and sexual activity is very important to him.
Which of the following medications would be most appropriate for this patient?
Ans✓✓✓ Alfusozin
. A 72-year-old man with colonic diverticulosis was admitted to the hospital with
gastrointestinal bleeding and abdominal pain. He underwent colonoscopy under
conscious sedation using fentanyl and midazolam. The following day, the patient
was positive on the Confusion Assessment Method performed by the geriatric
consultation services. Presence of delirium in this patient predisposes him to all of
the following except: Ans✓✓✓ Shorter length of stay in the hospital
. 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. Ans✓✓✓ Counseling on smoking
cessation
. John P. is an 81-year-old male with extensive cardiac history, including three
vessel coronary artery bypass graft when he was in his 60s, hypertension,
diabetes mellitus, osteoarthritis, sciatica, and progressive macular degeneration.
His vitals today are blood pressure 146/86 mmHg, heart rate 67 beats per minute,
respiratory rate 21 breaths/min, and temperature 98.7° F. He is here with his only
son and has been living in an assisted living since his wife died 3 years ago. His
Montreal cognitive assessment (MoCA) 1 month ago was 23/30. He has no
advance directive in the chart. He tells you he's "been slowing down" a lot lately.
He does not go down to the dining room because it is too taxing, he has been
slowly losing weight because food does not taste good, he has fallen four times in
the last year. He has no specific concerns to discuss today. What is the most
important thing that can be addressed at today's vis Ans✓✓✓ Suggest
completion of an advance directive at visit with his goals of care in mind for
moving forward in his care.
,. 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? Ans✓✓✓ Bladder training
. Randall Johnson, an 80-year-old man with a history of high blood pressure and
hypothyroidism, presents to your office with ongoing dizziness. He feels it has
worsened since the summer months began. He states it is worst when he gets up
from his chair on his front porch to stand or when he is working in his garden. If
he stands still for a few minutes, the dizziness typically resolves on its own. If he
tries to move too quickly, he has felt like he may pass out, but has not yet done
so. He denies changes in vision or hearing. He has had no recent changes in his
medication. On examination today, he is a frail-appearing older man in no acute
distress. Vitals show a blood pressure of 118/71 mmHg with a pulse of 55 beats
per minute. Heart and lung exams are benign. What is the most likely cause of his
dizziness? Ans✓✓✓ Orthostatic hypotension
2. A 79-year-old woman was admitted to the hospital a month ago with an acute
left middle cerebral artery ischemic stroke. On examination, she had right
hemiparesis, mild motor aphasia, and dysphagia. After discharge, she was
transferred to a skilled nursing facility where she has been working with physical,
occupational, and speech therapy. Despite initial progress, in the last 2 weeks, she
has lost her appetite, and complains of insomnia and difficulty concentrating.
Which would be the next best step in management? Ans✓✓✓ Start escitalopram
5 mg orally daily.
A 66-year-old man complains of nocturia (three to four times a night), hesitancy,
and incomplete emptying of the bladder. Physical examination reveals an
, enlarged, nontender prostate, about 40 g in size without discrete nodules.
Urinalysis reveals hematuria without leukocyte esterase. Upon further evaluation,
the hematuria is attributed to his BPH. The patient declines surgical options at this
time. Which of the following medications would be most appropriate? Ans✓✓✓
Finasteride
A 67-year-old female with a history of congestive heart failure and myocardial
infarction is admitted to the hospital because of increasing altered mental status
and decreased arousal over the last week. Physical examination reveals a
confused woman with right lower lobe crackles and a pulse oximetry of 86% on
room air. While you are interviewing the patient, she is irritable, paranoid, and
inattentive, which her family tells you is out of character. You notice waxing and
waning in her alertness and impaired short-term memory during your
examination. Which one of the following features present in this patient best
distinguishes delirium from depression or dementia? Ans✓✓✓ Inattentiveness
A 69-year-old female presents to your office for routine primary care. Her elder
sister was recently diagnosed with Alzheimer disease, and she wonders what
steps she can take to reduce her own risk of developing dementia. Which of the
following statements about the prevention of dementia is true? Ans✓✓✓ There
is moderate quality evidence to suggest control of cardiovascular and metabolic
risk factors, such as blood pressure, weight, and blood sugar, may reduce risk of
dementia.
A 70-year-old man has bothersome lower urinary tract syndrome (LUTS)
associated with benign prostatic hyperplasia (BPH). His symptoms are no longer
well managed with lifestyle modifications. He is interested in medication to
reduce his urinary symptoms but is concerned about possible side effects. He
notes that he is recently married and sexual activity is very important to him.
Which of the following medications would be most appropriate for this patient?
Ans✓✓✓ Alfusozin
