NR 509 FINAL EXAM PAPER 2026 QUESTIONS
WITH ANSWERS GRADED A+
◉ 2. A 72-year-old retired truck driver comes to the clinic with his wife
for evaluation of hearing loss. He has noticed some decreased ability to
hear what his wife and grandchildren are saying to him. He admits to
lip-reading more. He has a history of noise exposure in his young adult
years: He worked as a sound engineer at a local arena and had to attend a
lot of concerts. Based on this information, what is the most likely
finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds . Ans: A
Human speech is considered to be a middle-range sound. During the
aging process there is a loss of acuity, starting with high-pitched sounds
but extending to the middle range and then into the low range.
◉ 3. A 79-year-old retired banker comes to your office for evaluation of
difficulty with urination; he gets up five to six times per night to urinate
and has to go at least that often in the daytime. He does not feel as if his
bladder empties completely; the strength of the urinary stream is
diminished. He denies dysuria or hematuria. This problem has been
present for several years but has worsened over the last 8 months. You
,palpate his prostate. What is your expected physical examination
finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy . Ans: C
This is the expected physical examination finding in benign prostatic
hyperplasia (BPH).
◉ 4. A 70-year-old retired auto mechanic comes to your office because
his neighbor is concerned about his memory. The patient himself admits
to misplacing his keys more often and forgets what he is supposed to
buy from the grocery store and where he has parked the car. He denies
getting lost in familiar places. Upon further questioning, he states that
his wife of 40 years died 8 months ago; his three children live in three
different states; and he has limited his activities because the people he
interacted with were "his wife's friends, not his." He drinks a six-pack of
beer daily; he does not smoke or use illicit drugs. You perform a mini-
mental state examination and obtain a total score of 24 out of 28. Based
on this information, what is your most likely diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression . Ans: D
The patient has symptoms of depression: His wife died, he has no real
social support system, and he has isolated himself from his usual
, activities. He also drinks a considerable amount of alcohol on a daily
basis, which can further depress his mood. Depression can masquerade
as dementia in the elderly and must be considered in a patient with
memory loss.
◉ 5. An 85-year-old retired teacher comes to your office for evaluation
of weakness. You obtain a complete history, perform a thorough physical
examination, and order laboratory tests. You diagnose her with
hyperthyroidism. Based on her age, which of the atypical symptoms of
hyperthyroidism is more likely to be seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia . Ans: D
This is an atypical symptom of hyperthyroidism that is more likely to be
seen in the older patient.
◉ 6. A 78-year-old retired seamstress comes to the office for a routine
check-up. You obtain an ECG (electrocardiogram) because of her history
of hypertension. You diagnose a previous myocardial infarction and ask
her if she had any symptoms related to this. Which of the following
symptoms would be more common in this patient's age group for an
acute myocardial infarction?
A) Chest pain
B) Syncope
WITH ANSWERS GRADED A+
◉ 2. A 72-year-old retired truck driver comes to the clinic with his wife
for evaluation of hearing loss. He has noticed some decreased ability to
hear what his wife and grandchildren are saying to him. He admits to
lip-reading more. He has a history of noise exposure in his young adult
years: He worked as a sound engineer at a local arena and had to attend a
lot of concerts. Based on this information, what is the most likely
finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds . Ans: A
Human speech is considered to be a middle-range sound. During the
aging process there is a loss of acuity, starting with high-pitched sounds
but extending to the middle range and then into the low range.
◉ 3. A 79-year-old retired banker comes to your office for evaluation of
difficulty with urination; he gets up five to six times per night to urinate
and has to go at least that often in the daytime. He does not feel as if his
bladder empties completely; the strength of the urinary stream is
diminished. He denies dysuria or hematuria. This problem has been
present for several years but has worsened over the last 8 months. You
,palpate his prostate. What is your expected physical examination
finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy . Ans: C
This is the expected physical examination finding in benign prostatic
hyperplasia (BPH).
◉ 4. A 70-year-old retired auto mechanic comes to your office because
his neighbor is concerned about his memory. The patient himself admits
to misplacing his keys more often and forgets what he is supposed to
buy from the grocery store and where he has parked the car. He denies
getting lost in familiar places. Upon further questioning, he states that
his wife of 40 years died 8 months ago; his three children live in three
different states; and he has limited his activities because the people he
interacted with were "his wife's friends, not his." He drinks a six-pack of
beer daily; he does not smoke or use illicit drugs. You perform a mini-
mental state examination and obtain a total score of 24 out of 28. Based
on this information, what is your most likely diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression . Ans: D
The patient has symptoms of depression: His wife died, he has no real
social support system, and he has isolated himself from his usual
, activities. He also drinks a considerable amount of alcohol on a daily
basis, which can further depress his mood. Depression can masquerade
as dementia in the elderly and must be considered in a patient with
memory loss.
◉ 5. An 85-year-old retired teacher comes to your office for evaluation
of weakness. You obtain a complete history, perform a thorough physical
examination, and order laboratory tests. You diagnose her with
hyperthyroidism. Based on her age, which of the atypical symptoms of
hyperthyroidism is more likely to be seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia . Ans: D
This is an atypical symptom of hyperthyroidism that is more likely to be
seen in the older patient.
◉ 6. A 78-year-old retired seamstress comes to the office for a routine
check-up. You obtain an ECG (electrocardiogram) because of her history
of hypertension. You diagnose a previous myocardial infarction and ask
her if she had any symptoms related to this. Which of the following
symptoms would be more common in this patient's age group for an
acute myocardial infarction?
A) Chest pain
B) Syncope
