NR-601 Primary Care of the Maturing & Aged Family
Practicum 2024-2025 NUR 601 Final Exam(All correctly
answered)
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? correct
answersAdvise 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. correct answersCounseling 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? correct answersUrine testing, blood
testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine? correct answersIt 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: correct answersStop
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? correct
answersDay 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? correct answersBladder training
What is the most common cause of erectile dysfunction in older men? correct
answersAtherosclerosis
Which is the most reasonable first step in the treatment of older men with erectile dysfunction?
correct answersSildenafil
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? correct
answersStop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely
cause of her problem? correct answersHigh-tone pelvic floor dysfunction
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? correct answersHormonal therapy only
An 86-year-old man with no ADL deficits who has stopped driving because of macular
degeneration is evaluated for a urinary tract infection associated with urinary retention. The
consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level that
comes back 12 ng/mL. Three months later after the Foley has been removed and he has had a
good response to tamsulosin, his PSA is still 10 ng/mL. What is the appropriate next step in
managing this man's prostate problem? correct answersRepeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival?
correct answersA 78-year-old man who had a radical prostatectomy and external beam radiation
therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an
enlarged pelvic lymph node, and a bone scan is positive in the pelvis.
Practicum 2024-2025 NUR 601 Final Exam(All correctly
answered)
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? correct
answersAdvise 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. correct answersCounseling 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? correct answersUrine testing, blood
testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine? correct answersIt 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: correct answersStop
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? correct
answersDay 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? correct answersBladder training
What is the most common cause of erectile dysfunction in older men? correct
answersAtherosclerosis
Which is the most reasonable first step in the treatment of older men with erectile dysfunction?
correct answersSildenafil
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? correct
answersStop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely
cause of her problem? correct answersHigh-tone pelvic floor dysfunction
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? correct answersHormonal therapy only
An 86-year-old man with no ADL deficits who has stopped driving because of macular
degeneration is evaluated for a urinary tract infection associated with urinary retention. The
consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level that
comes back 12 ng/mL. Three months later after the Foley has been removed and he has had a
good response to tamsulosin, his PSA is still 10 ng/mL. What is the appropriate next step in
managing this man's prostate problem? correct answersRepeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival?
correct answersA 78-year-old man who had a radical prostatectomy and external beam radiation
therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an
enlarged pelvic lymph node, and a bone scan is positive in the pelvis.
