NR580 Final Exam Actual Exam Style V2 |
NR 580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. A 78-year-old male with a history of hypertension and falls is prescribed a new medication
for insomnia. According to the Beers Criteria, which class of medication should be avoided in
this patient?
A. Melatonin receptor agonists
B. Proton pump inhibitors
C. Short-acting beta-agonists
D. Benzodiazepines
Answer: D
Rationale: The Beers Criteria identifies benzodiazepines as potentially inappropriate for
older adults because they increase the risk of cognitive impairment, delirium, and falls. In a
patient with a prior history of falls, these medications significantly elevate the hazard for
fractures. Alternative non-pharmacological treatments or safer agents like melatonin
should be considered first.
2. Which physical examination finding is most characteristic of a patient with aortic stenosis?
A. Holosystolic murmur at the apex
B. Diastolic decrescendo murmur at the left sternal border
,C. Crescendo-decrescendo systolic murmur at the right upper sternal border
D. Mid-systolic click with a late systolic murmur
Answer: C
Rationale: Aortic stenosis typically presents as a harsh, crescendo-decrescendo systolic
murmur heard best at the right second intercostal space. This murmur often radiates to the
carotid arteries as the valve narrowing progresses. Clinicians should monitor these
patients for symptoms such as syncope, chest pain, and heart failure.
3. A 66-year-old female presents for a follow-up on her Type 2 Diabetes. Her current A1c is
8.2% despite Metformin 1000mg BID. Her eGFR is 35 mL/min/1.73m2. Which medication
change is most appropriate?
A. Reduce Metformin dose and consider an SGLT2 inhibitor
B. Add a high-dose Sulfonylurea
C. Increase Metformin to 2550mg daily
D. Discontinue Metformin and start Insulin
Answer: A
Rationale: Metformin dosage should be adjusted when the eGFR falls between 30 and 45
mL/min/1.73m2 to reduce the risk of lactic acidosis. While SGLT2 inhibitors provide
cardiovascular and renal benefits, they must also be used cautiously based on specific eGFR
thresholds. Monitoring renal function every 3 to 6 months is standard practice for geriatric
patients on these agents.
, 4. Which assessment tool is considered the gold standard for identifying delirium in the
clinical setting?
A. Confusion Assessment Method (CAM)
B. Mini-Mental State Examination (MMSE)
C. PHQ-9
D. Geriatric Depression Scale (GDS)
Answer: A
Rationale: The Confusion Assessment Method (CAM) is specifically designed to distinguish
delirium from other types of cognitive impairment. It focuses on four features: acute onset
and fluctuating course, inattention, disorganized thinking, and altered level of
consciousness. Identifying the underlying cause of delirium is a priority for the primary
care provider to prevent permanent decline.
5. A 72-year-old patient has a DEXA scan result showing a T-score of -2.6 at the femoral neck.
How should this be classified?
A. Normal bone density
B. Osteoporosis
C. Osteopenia
D. Severe Osteoporosis
Answer: B
NR 580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. A 78-year-old male with a history of hypertension and falls is prescribed a new medication
for insomnia. According to the Beers Criteria, which class of medication should be avoided in
this patient?
A. Melatonin receptor agonists
B. Proton pump inhibitors
C. Short-acting beta-agonists
D. Benzodiazepines
Answer: D
Rationale: The Beers Criteria identifies benzodiazepines as potentially inappropriate for
older adults because they increase the risk of cognitive impairment, delirium, and falls. In a
patient with a prior history of falls, these medications significantly elevate the hazard for
fractures. Alternative non-pharmacological treatments or safer agents like melatonin
should be considered first.
2. Which physical examination finding is most characteristic of a patient with aortic stenosis?
A. Holosystolic murmur at the apex
B. Diastolic decrescendo murmur at the left sternal border
,C. Crescendo-decrescendo systolic murmur at the right upper sternal border
D. Mid-systolic click with a late systolic murmur
Answer: C
Rationale: Aortic stenosis typically presents as a harsh, crescendo-decrescendo systolic
murmur heard best at the right second intercostal space. This murmur often radiates to the
carotid arteries as the valve narrowing progresses. Clinicians should monitor these
patients for symptoms such as syncope, chest pain, and heart failure.
3. A 66-year-old female presents for a follow-up on her Type 2 Diabetes. Her current A1c is
8.2% despite Metformin 1000mg BID. Her eGFR is 35 mL/min/1.73m2. Which medication
change is most appropriate?
A. Reduce Metformin dose and consider an SGLT2 inhibitor
B. Add a high-dose Sulfonylurea
C. Increase Metformin to 2550mg daily
D. Discontinue Metformin and start Insulin
Answer: A
Rationale: Metformin dosage should be adjusted when the eGFR falls between 30 and 45
mL/min/1.73m2 to reduce the risk of lactic acidosis. While SGLT2 inhibitors provide
cardiovascular and renal benefits, they must also be used cautiously based on specific eGFR
thresholds. Monitoring renal function every 3 to 6 months is standard practice for geriatric
patients on these agents.
, 4. Which assessment tool is considered the gold standard for identifying delirium in the
clinical setting?
A. Confusion Assessment Method (CAM)
B. Mini-Mental State Examination (MMSE)
C. PHQ-9
D. Geriatric Depression Scale (GDS)
Answer: A
Rationale: The Confusion Assessment Method (CAM) is specifically designed to distinguish
delirium from other types of cognitive impairment. It focuses on four features: acute onset
and fluctuating course, inattention, disorganized thinking, and altered level of
consciousness. Identifying the underlying cause of delirium is a priority for the primary
care provider to prevent permanent decline.
5. A 72-year-old patient has a DEXA scan result showing a T-score of -2.6 at the femoral neck.
How should this be classified?
A. Normal bone density
B. Osteoporosis
C. Osteopenia
D. Severe Osteoporosis
Answer: B
