NR601 final exam
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?
a. Advise them to complete a POLST.
b. Advise them that they have adequate documentation to be recognized legally.
c. Advise them to file an advanced directive.
d. Respond that although they lack documentation, her partner will be recognized de facto. ANS: C
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.
Which of the following is the most important next step in this patient's primary care?
a. Counseling on starting aspirin
b. Counseling on alcohol cessation
c. Counseling on smoking cessation
d. Counseling on mammogram ANS: C
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?
a. Urine testing
b. Urine testing, blood testing
c. Urine testing, blood testing, anal swab
d. Urine testing, blood testing, anal swab, and oropharyngeal swab ANS: D
Which of the following is true about tolterodine?
a. It should be avoided in men with prostatic hypertrophy.
b. It increases the risk of constipation compared with oral oxybutynin.
c. It acts by ablating detrusor spasms.
d. It has greater risk of adverse effects with its twice-daily formulation. ANS: D
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:
a. Stop hydroc ANS: B
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?
a. Mrs. A's physician
b. Mrs. A's daughter
c. Day program staff
d. Physical therapist through a home care agency ANS: C
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?
a. Bladder training
b. Referral for biofeedback training in pelvic muscle exercise
c. Trial of solifenacin
d. Trial of topical estrogen ANS: A
What is the most common cause of erectile dysfunction in older men?
a. Psychological stress
b. Adverse drug reaction
c. Atherosclerosis
d. Autonomic neuropathy ANS: C
Which is the most reasonable first step in the treatment of older men with erectile dysfunction?
a. Sex therapy
b. Testosterone
c. Yohimbine
, d. Sildenafil ANS: D
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?
a. Stop glyburide
b. Stop chlorthalidone
c. Stop acetaminophen
d. Start topical vaginal lubricant ANS: B
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of
her problem?
a. Vaginal atrophy
b. Provoked vulvar vestibulodynia
c. High-tone pelvic floor dysfunction
d. Endometriosis ANS: C
A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed ductal
carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor 1%) and
HER2/neu negative. Surgical margins were adequate and uninvolved with cancer. Sentinel lymph node
sampling was negative for lymph node involvement. She has good performance status and no activities
of daily living (ADL) or instrumental (IADL) dependencies. What treatment would you recommend?
a. Adjuvant chemotherapy
b. Adjuvant chemotherapy with irradiation
c. Adjuvant irradiation only
d. Hormonal therapy only
e. None of the above ANS: D
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?
a. Advise them to complete a POLST.
b. Advise them that they have adequate documentation to be recognized legally.
c. Advise them to file an advanced directive.
d. Respond that although they lack documentation, her partner will be recognized de facto. ANS: C
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.
Which of the following is the most important next step in this patient's primary care?
a. Counseling on starting aspirin
b. Counseling on alcohol cessation
c. Counseling on smoking cessation
d. Counseling on mammogram ANS: C
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?
a. Urine testing
b. Urine testing, blood testing
c. Urine testing, blood testing, anal swab
d. Urine testing, blood testing, anal swab, and oropharyngeal swab ANS: D
Which of the following is true about tolterodine?
a. It should be avoided in men with prostatic hypertrophy.
b. It increases the risk of constipation compared with oral oxybutynin.
c. It acts by ablating detrusor spasms.
d. It has greater risk of adverse effects with its twice-daily formulation. ANS: D
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:
a. Stop hydroc ANS: B
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?
a. Mrs. A's physician
b. Mrs. A's daughter
c. Day program staff
d. Physical therapist through a home care agency ANS: C
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?
a. Bladder training
b. Referral for biofeedback training in pelvic muscle exercise
c. Trial of solifenacin
d. Trial of topical estrogen ANS: A
What is the most common cause of erectile dysfunction in older men?
a. Psychological stress
b. Adverse drug reaction
c. Atherosclerosis
d. Autonomic neuropathy ANS: C
Which is the most reasonable first step in the treatment of older men with erectile dysfunction?
a. Sex therapy
b. Testosterone
c. Yohimbine
, d. Sildenafil ANS: D
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?
a. Stop glyburide
b. Stop chlorthalidone
c. Stop acetaminophen
d. Start topical vaginal lubricant ANS: B
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of
her problem?
a. Vaginal atrophy
b. Provoked vulvar vestibulodynia
c. High-tone pelvic floor dysfunction
d. Endometriosis ANS: C
A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed ductal
carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor 1%) and
HER2/neu negative. Surgical margins were adequate and uninvolved with cancer. Sentinel lymph node
sampling was negative for lymph node involvement. She has good performance status and no activities
of daily living (ADL) or instrumental (IADL) dependencies. What treatment would you recommend?
a. Adjuvant chemotherapy
b. Adjuvant chemotherapy with irradiation
c. Adjuvant irradiation only
d. Hormonal therapy only
e. None of the above ANS: D
