NR601 FINAL EXAM WITH ALL CORRECT ANSWERS RECENTLY UPDATED 2025
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?
Advise 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.
Counseling 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?
Urine testing, blood testing, anal swab, and oropharyngeal swab
,Which of the following is true about tolterodine?
It 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:
Stop 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?
Day 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?
Bladder training
What is the most common cause of erectile dysfunction in older men?
Atherosclerosis
Which is the most reasonable first step in the treatment of older men with
erectile dysfunction?
Sildenafil
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?
Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is
the most likely cause of her problem?
High-tone pelvic floor dysfunction
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?
Advise 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.
Counseling 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?
Urine testing, blood testing, anal swab, and oropharyngeal swab
,Which of the following is true about tolterodine?
It 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:
Stop 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?
Day 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?
Bladder training
What is the most common cause of erectile dysfunction in older men?
Atherosclerosis
Which is the most reasonable first step in the treatment of older men with
erectile dysfunction?
Sildenafil
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?
Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is
the most likely cause of her problem?
High-tone pelvic floor dysfunction
