NR580 Exam 3 Actual Exam Style V3 | NR
580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. An 82-year-old female with multiple comorbidities, including mild cognitive impairment,
has a current HbA1c of 8.2%. What is the most appropriate management goal for this patient
based on current geriatric guidelines?
A. Intensify therapy to achieve an HbA1c below 7.0%
B. Maintain the current regimen with a goal HbA1c of 8.0% to 8.5%
C. Switch all oral agents to insulin for better glycemic control
D. Aim for an HbA1c of 6.5% to prevent microvascular complications
Answer: B
Rationale: In older adults with multiple chronic illnesses and cognitive impairment, a less
stringent HbA1c goal of 8.0% to 8.5% is recommended to avoid hypoglycemia. Aggressive
control in this population often leads to increased risks of falls and cardiovascular events.
The clinical focus should be on safety and quality of life rather than preventing long-term
microvascular complications.
2. Which of the following medications is listed on the Beers Criteria as potentially
inappropriate for older adults due to its high anticholinergic burden?
A. Amitriptyline
,B. Metformin
C. Lisinopril
D. Atorvastatin
Answer: A
Rationale: Amitriptyline is a tricyclic antidepressant with significant anticholinergic
properties that increase the risk of confusion, blurred vision, and urinary retention in older
adults. The Beers Criteria specifically advise against its use in this population because safer
alternatives are available for both depression and neuropathic pain. Clinicians should
evaluate the total anticholinergic load when prescribing for geriatric patients to prevent
delirium.
3. A 75-year-old male presents for a routine visit and asks about Medicare coverage. Which of
the following is primarily covered under Medicare Part B?
A. Outpatient provider visits and preventive services
B. Prescription drug coverage
C. Inpatient hospital stays
D. Long-term nursing home care
Answer: A
Rationale: Medicare Part B covers medically necessary services like doctors’ services and
outpatient care. It also includes preventive services such as screenings and annual wellness
, visits. Understanding the components of Medicare is essential for the AGPCNP to help
patients navigate their healthcare benefits.
4. An older adult patient presents with a sudden onset of confusion, fluctuating
consciousness, and inattention over the last 24 hours. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Delirium
C. Vascular Dementia
D. Major Depressive Disorder
Answer: B
Rationale: Delirium is characterized by an acute onset and a fluctuating course of cognitive
impairment. This is often triggered by an underlying medical condition, infection, or
medication change. Distinguishing delirium from dementia is critical as delirium is
potentially reversible if the underlying cause is treated promptly.
5. A 70-year-old female has a DXA scan T-score of -2.6 at the lumbar spine. How should this
result be interpreted?
A. Normal bone density
B. Osteopenia
C. Severe Osteoarthritis
D. Osteoporosis
580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. An 82-year-old female with multiple comorbidities, including mild cognitive impairment,
has a current HbA1c of 8.2%. What is the most appropriate management goal for this patient
based on current geriatric guidelines?
A. Intensify therapy to achieve an HbA1c below 7.0%
B. Maintain the current regimen with a goal HbA1c of 8.0% to 8.5%
C. Switch all oral agents to insulin for better glycemic control
D. Aim for an HbA1c of 6.5% to prevent microvascular complications
Answer: B
Rationale: In older adults with multiple chronic illnesses and cognitive impairment, a less
stringent HbA1c goal of 8.0% to 8.5% is recommended to avoid hypoglycemia. Aggressive
control in this population often leads to increased risks of falls and cardiovascular events.
The clinical focus should be on safety and quality of life rather than preventing long-term
microvascular complications.
2. Which of the following medications is listed on the Beers Criteria as potentially
inappropriate for older adults due to its high anticholinergic burden?
A. Amitriptyline
,B. Metformin
C. Lisinopril
D. Atorvastatin
Answer: A
Rationale: Amitriptyline is a tricyclic antidepressant with significant anticholinergic
properties that increase the risk of confusion, blurred vision, and urinary retention in older
adults. The Beers Criteria specifically advise against its use in this population because safer
alternatives are available for both depression and neuropathic pain. Clinicians should
evaluate the total anticholinergic load when prescribing for geriatric patients to prevent
delirium.
3. A 75-year-old male presents for a routine visit and asks about Medicare coverage. Which of
the following is primarily covered under Medicare Part B?
A. Outpatient provider visits and preventive services
B. Prescription drug coverage
C. Inpatient hospital stays
D. Long-term nursing home care
Answer: A
Rationale: Medicare Part B covers medically necessary services like doctors’ services and
outpatient care. It also includes preventive services such as screenings and annual wellness
, visits. Understanding the components of Medicare is essential for the AGPCNP to help
patients navigate their healthcare benefits.
4. An older adult patient presents with a sudden onset of confusion, fluctuating
consciousness, and inattention over the last 24 hours. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Delirium
C. Vascular Dementia
D. Major Depressive Disorder
Answer: B
Rationale: Delirium is characterized by an acute onset and a fluctuating course of cognitive
impairment. This is often triggered by an underlying medical condition, infection, or
medication change. Distinguishing delirium from dementia is critical as delirium is
potentially reversible if the underlying cause is treated promptly.
5. A 70-year-old female has a DXA scan T-score of -2.6 at the lumbar spine. How should this
result be interpreted?
A. Normal bone density
B. Osteopenia
C. Severe Osteoarthritis
D. Osteoporosis
