NR580 Exam 3 Actual Exam Style V1 | NR
580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. A 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril and Carvedilol. Which of the
following physical exam findings would most strongly suggest a need to adjust his diuretic
therapy?
A. The presence of a new S3 gallop and bilateral crackles at the lung bases
B. A lateral displacement of the point of maximal impulse (PMI)
C. A blood pressure reading of 118/74 mmHg
D. Trace pedal edema after a long day of standing
Answer: A
Rationale: The presence of an S3 gallop and pulmonary crackles are definitive signs of
volume overload in a patient with heart failure. Diuretics are the primary treatment for
managing fluid status and reducing symptoms of congestion. Frequent monitoring of
weight and physical signs is essential to prevent acute decompensation.
,2. An 80-year-old female patient is being evaluated for new-onset confusion and agitation.
She was recently treated for a urinary tract infection. Which of the following is the most likely
diagnosis given the acute change in mental status?
A. Delirium
B. Vascular Dementia
C. Alzheimer’s Disease
D. Major Depressive Disorder
Answer: A
Rationale: Delirium is characterized by an acute, fluctuating change in mental status and
attention, often triggered by an underlying medical condition like an infection. Unlike
dementia, which is a slow, progressive decline, delirium has a rapid onset. Identifying and
treating the underlying cause, such as the UTI, is the cornerstone of management.
3. According to the JNC 8 guidelines, what is the target blood pressure for a 68-year-old
patient with no history of diabetes or chronic kidney disease?
A. < 120/80 mmHg
B. < 130/80 mmHg
C. < 150/90 mmHg
D. < 140/90 mmHg
Answer: C
,Rationale: The JNC 8 guidelines suggest a higher threshold for initiating treatment and a
higher target in patients aged 60 and older. Specifically, the goal is less than 150/90 mmHg
for this age group unless comorbidities like diabetes or CKD are present. These guidelines
emphasize balancing the benefits of blood pressure reduction with the risks of
polypharmacy and side effects in the elderly.
4. A 65-year-old patient with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m². Which of
the following management steps is most appropriate regarding their Metformin therapy?
A. Continue the current dose and monitor eGFR every 6 months
B. Reduce the dose by 50% immediately
C. Switch the patient to a sulfonylurea
D. Discontinue Metformin due to the risk of lactic acidosis
Answer: D
Rationale: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m² because of the increased risk of lactic acidosis. If the eGFR falls below 45
mL/min/1.73m², the dose should be assessed, and initiating Metformin is not
recommended. For this patient, alternative glucose-lowering therapies that are safe for
stage 4 CKD must be explored.
5. Which of the following is considered the gold standard for diagnosing Chronic Obstructive
Pulmonary Disease (COPD)?
A. Post-bronchodilator spirometry showing FEV1/FVC < 0.70
, B. Chest X-ray showing hyperinflation
C. Elevated Alpha-1 Antitrypsin levels
D. Arterial blood gas (ABG) analysis
Answer: A
Rationale: Spirometry is the required test to establish a clinical diagnosis of COPD. A post-
bronchodilator ratio of FEV1 to FVC less than 0.70 confirms the presence of persistent
airflow limitation. While imaging can support the diagnosis, it cannot replace the objective
measurement of lung function provided by spirometry.
6. A 75-year-old female presents with sudden onset of severe right eye pain, blurred vision,
and seeing ‘halos’ around lights. Her eye is red, and the pupil is mid-dilated and non-reactive.
What is the most likely diagnosis?
A. Retinal Detachment
B. Acute Angle-Closure Glaucoma
C. Cataracts
D. Macular Degeneration
Answer: B
Rationale: Acute angle-closure glaucoma is an ophthalmic emergency characterized by a
rapid increase in intraocular pressure. Symptoms include severe ocular pain, headache, and
580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. A 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril and Carvedilol. Which of the
following physical exam findings would most strongly suggest a need to adjust his diuretic
therapy?
A. The presence of a new S3 gallop and bilateral crackles at the lung bases
B. A lateral displacement of the point of maximal impulse (PMI)
C. A blood pressure reading of 118/74 mmHg
D. Trace pedal edema after a long day of standing
Answer: A
Rationale: The presence of an S3 gallop and pulmonary crackles are definitive signs of
volume overload in a patient with heart failure. Diuretics are the primary treatment for
managing fluid status and reducing symptoms of congestion. Frequent monitoring of
weight and physical signs is essential to prevent acute decompensation.
,2. An 80-year-old female patient is being evaluated for new-onset confusion and agitation.
She was recently treated for a urinary tract infection. Which of the following is the most likely
diagnosis given the acute change in mental status?
A. Delirium
B. Vascular Dementia
C. Alzheimer’s Disease
D. Major Depressive Disorder
Answer: A
Rationale: Delirium is characterized by an acute, fluctuating change in mental status and
attention, often triggered by an underlying medical condition like an infection. Unlike
dementia, which is a slow, progressive decline, delirium has a rapid onset. Identifying and
treating the underlying cause, such as the UTI, is the cornerstone of management.
3. According to the JNC 8 guidelines, what is the target blood pressure for a 68-year-old
patient with no history of diabetes or chronic kidney disease?
A. < 120/80 mmHg
B. < 130/80 mmHg
C. < 150/90 mmHg
D. < 140/90 mmHg
Answer: C
,Rationale: The JNC 8 guidelines suggest a higher threshold for initiating treatment and a
higher target in patients aged 60 and older. Specifically, the goal is less than 150/90 mmHg
for this age group unless comorbidities like diabetes or CKD are present. These guidelines
emphasize balancing the benefits of blood pressure reduction with the risks of
polypharmacy and side effects in the elderly.
4. A 65-year-old patient with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m². Which of
the following management steps is most appropriate regarding their Metformin therapy?
A. Continue the current dose and monitor eGFR every 6 months
B. Reduce the dose by 50% immediately
C. Switch the patient to a sulfonylurea
D. Discontinue Metformin due to the risk of lactic acidosis
Answer: D
Rationale: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m² because of the increased risk of lactic acidosis. If the eGFR falls below 45
mL/min/1.73m², the dose should be assessed, and initiating Metformin is not
recommended. For this patient, alternative glucose-lowering therapies that are safe for
stage 4 CKD must be explored.
5. Which of the following is considered the gold standard for diagnosing Chronic Obstructive
Pulmonary Disease (COPD)?
A. Post-bronchodilator spirometry showing FEV1/FVC < 0.70
, B. Chest X-ray showing hyperinflation
C. Elevated Alpha-1 Antitrypsin levels
D. Arterial blood gas (ABG) analysis
Answer: A
Rationale: Spirometry is the required test to establish a clinical diagnosis of COPD. A post-
bronchodilator ratio of FEV1 to FVC less than 0.70 confirms the presence of persistent
airflow limitation. While imaging can support the diagnosis, it cannot replace the objective
measurement of lung function provided by spirometry.
6. A 75-year-old female presents with sudden onset of severe right eye pain, blurred vision,
and seeing ‘halos’ around lights. Her eye is red, and the pupil is mid-dilated and non-reactive.
What is the most likely diagnosis?
A. Retinal Detachment
B. Acute Angle-Closure Glaucoma
C. Cataracts
D. Macular Degeneration
Answer: B
Rationale: Acute angle-closure glaucoma is an ophthalmic emergency characterized by a
rapid increase in intraocular pressure. Symptoms include severe ocular pain, headache, and
