NR580 Exam 4 Actual Exam Style V1 | NR
580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. A 75-year-old male with a history of hypertension and Type 2 Diabetes presents for a
routine follow-up. His current A1C is 7.9%. According to the American Diabetes Association
(ADA) guidelines for older adults with multiple chronic conditions, what is the most
appropriate A1C goal for this patient?
A. Less than 8.0%
B. Less than 7.0%
C. Less than 6.5%
D. Less than 9.0%
Answer: A
Rationale: For older adults with complex or intermediate health status and multiple
chronic conditions, an A1C goal of less than 8.0% is generally recommended. This approach
balances the risks of hypoglycemia with the benefits of glycemic control in a population
that may have a shorter life expectancy. Stricter goals are reserved for those who are
healthy with few co-morbidities.
,2. When prescribing medications for an 82-year-old patient, the nurse practitioner refers to
the Beers Criteria. Which of the following medication classes is primarily flagged for increased
risk of falls and fractures in the elderly?
A. Biguanides
B. HMG-CoA Reductase Inhibitors
C. Proton Pump Inhibitors
D. Benzodiazepines
Answer: D
Rationale: Benzodiazepines are associated with an increased risk of cognitive impairment,
delirium, falls, and fractures in older adults. The Beers Criteria recommends avoiding these
medications for the treatment of insomnia or agitation in the elderly when possible.
Alternative non-pharmacological treatments or safer pharmacological options should be
considered to improve patient safety.
3. An 68-year-old female presents with complaints of fatigue, cold intolerance, and
constipation. Laboratory results reveal an elevated TSH and a low Free T4. What is the most
likely diagnosis?
A. Secondary Hypothyroidism
B. Primary Hypothyroidism
C. Subclinical Hypothyroidism
D. Hyperthyroidism
,Answer: B
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low Free T4
level, indicating the thyroid gland is failing to produce sufficient hormone despite
stimulation. Secondary hypothyroidism would typically show a low TSH and low T4. These
findings in an older adult require careful levothyroxine titration starting at a low dose.
4. Which of the following physical exam findings is most characteristic of Heberden’s nodes in
a patient with Osteoarthritis?
A. Swelling of the proximal interphalangeal (PIP) joints
B. Swelling of the distal interphalangeal (DIP) joints
C. Ulnar deviation of the metacarpophalangeal (MCP) joints
D. Boutonniere deformity
Answer: B
Rationale: Heberden’s nodes are bony overgrowths located at the distal interphalangeal
(DIP) joints, which are classic signs of osteoarthritis. In contrast, Bouchard’s nodes affect
the proximal interphalangeal (PIP) joints. Recognizing these distinct nodes helps clinicians
differentiate osteoarthritis from other forms of inflammatory arthritis like rheumatoid
arthritis.
, 5. A 70-year-old patient with COPD is being evaluated for worsening shortness of breath. The
FEV1/FVC ratio is 0.65, and the FEV1 is 45% of predicted. According to GOLD guidelines, which
category does this patient fall into?
A. GOLD 1: Mild
B. GOLD 2: Moderate
C. GOLD 4: Very Severe
D. GOLD 3: Severe
Answer: D
Rationale: GOLD 3 (Severe) classification is defined by an FEV1/FVC ratio less than 0.70
and an FEV1 between 30% and 49% of the predicted value. This patient’s FEV1 of 45%
clearly places them in the severe category. Management for this stage often includes long-
acting bronchodilators and potentially inhaled corticosteroids if exacerbations are
frequent.
6. Which screening tool is most appropriate for a nurse practitioner to use when assessing an
older adult for depression in a primary care setting?
A. CAGE questionnaire
B. PHQ-9
C. Mini-Mental State Exam (MMSE)
D. CHADS2-VASc
580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. A 75-year-old male with a history of hypertension and Type 2 Diabetes presents for a
routine follow-up. His current A1C is 7.9%. According to the American Diabetes Association
(ADA) guidelines for older adults with multiple chronic conditions, what is the most
appropriate A1C goal for this patient?
A. Less than 8.0%
B. Less than 7.0%
C. Less than 6.5%
D. Less than 9.0%
Answer: A
Rationale: For older adults with complex or intermediate health status and multiple
chronic conditions, an A1C goal of less than 8.0% is generally recommended. This approach
balances the risks of hypoglycemia with the benefits of glycemic control in a population
that may have a shorter life expectancy. Stricter goals are reserved for those who are
healthy with few co-morbidities.
,2. When prescribing medications for an 82-year-old patient, the nurse practitioner refers to
the Beers Criteria. Which of the following medication classes is primarily flagged for increased
risk of falls and fractures in the elderly?
A. Biguanides
B. HMG-CoA Reductase Inhibitors
C. Proton Pump Inhibitors
D. Benzodiazepines
Answer: D
Rationale: Benzodiazepines are associated with an increased risk of cognitive impairment,
delirium, falls, and fractures in older adults. The Beers Criteria recommends avoiding these
medications for the treatment of insomnia or agitation in the elderly when possible.
Alternative non-pharmacological treatments or safer pharmacological options should be
considered to improve patient safety.
3. An 68-year-old female presents with complaints of fatigue, cold intolerance, and
constipation. Laboratory results reveal an elevated TSH and a low Free T4. What is the most
likely diagnosis?
A. Secondary Hypothyroidism
B. Primary Hypothyroidism
C. Subclinical Hypothyroidism
D. Hyperthyroidism
,Answer: B
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low Free T4
level, indicating the thyroid gland is failing to produce sufficient hormone despite
stimulation. Secondary hypothyroidism would typically show a low TSH and low T4. These
findings in an older adult require careful levothyroxine titration starting at a low dose.
4. Which of the following physical exam findings is most characteristic of Heberden’s nodes in
a patient with Osteoarthritis?
A. Swelling of the proximal interphalangeal (PIP) joints
B. Swelling of the distal interphalangeal (DIP) joints
C. Ulnar deviation of the metacarpophalangeal (MCP) joints
D. Boutonniere deformity
Answer: B
Rationale: Heberden’s nodes are bony overgrowths located at the distal interphalangeal
(DIP) joints, which are classic signs of osteoarthritis. In contrast, Bouchard’s nodes affect
the proximal interphalangeal (PIP) joints. Recognizing these distinct nodes helps clinicians
differentiate osteoarthritis from other forms of inflammatory arthritis like rheumatoid
arthritis.
, 5. A 70-year-old patient with COPD is being evaluated for worsening shortness of breath. The
FEV1/FVC ratio is 0.65, and the FEV1 is 45% of predicted. According to GOLD guidelines, which
category does this patient fall into?
A. GOLD 1: Mild
B. GOLD 2: Moderate
C. GOLD 4: Very Severe
D. GOLD 3: Severe
Answer: D
Rationale: GOLD 3 (Severe) classification is defined by an FEV1/FVC ratio less than 0.70
and an FEV1 between 30% and 49% of the predicted value. This patient’s FEV1 of 45%
clearly places them in the severe category. Management for this stage often includes long-
acting bronchodilators and potentially inhaled corticosteroids if exacerbations are
frequent.
6. Which screening tool is most appropriate for a nurse practitioner to use when assessing an
older adult for depression in a primary care setting?
A. CAGE questionnaire
B. PHQ-9
C. Mini-Mental State Exam (MMSE)
D. CHADS2-VASc
