NR580 Final Exam Actual Exam Style V3 |
NR 580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. An 82-year-old patient presents with a history of hypertension and osteoarthritis.
According to the Beers Criteria, which of the following medications should be avoided in this
patient to reduce the risk of gastrointestinal bleeding?
A. Acetaminophen
B. Lisinopril
C. Naproxen
D. Amlodipine
Answer: C
Rationale: The Beers Criteria identifies nonsteroidal anti-inflammatory drugs like
naproxen as potentially inappropriate for older adults due to the high risk of GI bleeding
and peptic ulcer disease. Chronic use should be avoided unless other options are ineffective
and the patient can take a gastroprotective agent. For osteoarthritis in the elderly, safer
alternatives like acetaminophen are generally preferred as first-line therapy.
2. In the geriatric population, which of the following is considered a ‘basic’ Activity of Daily
Living (ADL) rather than an Instrumental Activity of Daily Living (IADL)?
A. Transferring from bed to chair
,B. Preparing meals
C. Managing finances
D. Using the telephone
Answer: A
Rationale: Basic Activities of Daily Living (ADLs) focus on self-care tasks such as bathing,
dressing, and transferring. Instrumental Activities of Daily Living (IADLs) involve more
complex tasks required for independent community living, such as managing finances or
medications. Assessing these functional levels is critical for determining the level of care
and support an older adult requires in the home environment.
3. A 67-year-old male with a history of COPD presents for a follow-up. According to the GOLD
2023 guidelines, which medication is the preferred initial treatment for a patient in Group B
(low exacerbation risk, high symptom burden)?
A. Short-acting beta-agonist (SABA) only
B. Theophylline
C. Inhaled corticosteroid (ICS) monotherapy
D. Long-acting muscarinic antagonist (LAMA) or LABA
Answer: D
Rationale: The GOLD guidelines recommend a long-acting bronchodilator, such as a LAMA
or LABA, for patients categorized in Group B. ICS monotherapy is explicitly discouraged in
,COPD management because it does not treat the underlying pathophysiology effectively
and increases pneumonia risk. Successful management for Group B focuses on symptom
reduction and improving exercise tolerance through long-acting agents.
4. A patient is diagnosed with Medicare Part B. Which of the following services is primarily
covered under this specific portion of Medicare?
A. Inpatient hospital stays
B. Nurse practitioner office visits
C. Skilled nursing facility care
D. Hospice care
Answer: B
Rationale: Medicare Part B covers medically necessary services like provider office visits,
outpatient care, and durable medical equipment. Part A is the portion responsible for
hospital insurance, including inpatient stays and hospice care. Understanding these
distinctions is vital for nurse practitioners to properly bill and advocate for their geriatric
patients’ coverage.
5. When evaluating an older adult for dementia, the ‘Mini-Cog’ tool is frequently used. What
are the two primary components of this screening instrument?
A. Orientation to time and place
B. 3-word recall and Clock Drawing Test
C. Serial 7s and naming objects
, D. Long-term memory and gait assessment
Answer: B
Rationale: The Mini-Cog consists of a three-item word recall task and a clock-drawing test
to screen for cognitive impairment quickly. It is highly sensitive and takes significantly less
time than the MMSE, making it ideal for primary care settings. A score of 0-2 on the recall
or an abnormal clock generally indicates the need for a more formal diagnostic workup for
dementia.
6. A 74-year-old female presents with fatigue and a pale complexion. Her labs show a Mean
Corpuscular Volume (MCV) of 72 fL and a low ferritin level. What is the most likely diagnosis?
A. Vitamin B12 deficiency
B. Folate deficiency
C. Anemia of chronic disease
D. Iron deficiency anemia
Answer: D
Rationale: Iron deficiency anemia is characterized by microcytic (low MCV) and
hypochromic red blood cells, often confirmed by a low serum ferritin level. In older adults,
iron deficiency should prompt a search for the underlying cause, frequently occult
gastrointestinal bleeding. Management involves iron supplementation and addressing the
source of blood loss to prevent recurrence.
NR 580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. An 82-year-old patient presents with a history of hypertension and osteoarthritis.
According to the Beers Criteria, which of the following medications should be avoided in this
patient to reduce the risk of gastrointestinal bleeding?
A. Acetaminophen
B. Lisinopril
C. Naproxen
D. Amlodipine
Answer: C
Rationale: The Beers Criteria identifies nonsteroidal anti-inflammatory drugs like
naproxen as potentially inappropriate for older adults due to the high risk of GI bleeding
and peptic ulcer disease. Chronic use should be avoided unless other options are ineffective
and the patient can take a gastroprotective agent. For osteoarthritis in the elderly, safer
alternatives like acetaminophen are generally preferred as first-line therapy.
2. In the geriatric population, which of the following is considered a ‘basic’ Activity of Daily
Living (ADL) rather than an Instrumental Activity of Daily Living (IADL)?
A. Transferring from bed to chair
,B. Preparing meals
C. Managing finances
D. Using the telephone
Answer: A
Rationale: Basic Activities of Daily Living (ADLs) focus on self-care tasks such as bathing,
dressing, and transferring. Instrumental Activities of Daily Living (IADLs) involve more
complex tasks required for independent community living, such as managing finances or
medications. Assessing these functional levels is critical for determining the level of care
and support an older adult requires in the home environment.
3. A 67-year-old male with a history of COPD presents for a follow-up. According to the GOLD
2023 guidelines, which medication is the preferred initial treatment for a patient in Group B
(low exacerbation risk, high symptom burden)?
A. Short-acting beta-agonist (SABA) only
B. Theophylline
C. Inhaled corticosteroid (ICS) monotherapy
D. Long-acting muscarinic antagonist (LAMA) or LABA
Answer: D
Rationale: The GOLD guidelines recommend a long-acting bronchodilator, such as a LAMA
or LABA, for patients categorized in Group B. ICS monotherapy is explicitly discouraged in
,COPD management because it does not treat the underlying pathophysiology effectively
and increases pneumonia risk. Successful management for Group B focuses on symptom
reduction and improving exercise tolerance through long-acting agents.
4. A patient is diagnosed with Medicare Part B. Which of the following services is primarily
covered under this specific portion of Medicare?
A. Inpatient hospital stays
B. Nurse practitioner office visits
C. Skilled nursing facility care
D. Hospice care
Answer: B
Rationale: Medicare Part B covers medically necessary services like provider office visits,
outpatient care, and durable medical equipment. Part A is the portion responsible for
hospital insurance, including inpatient stays and hospice care. Understanding these
distinctions is vital for nurse practitioners to properly bill and advocate for their geriatric
patients’ coverage.
5. When evaluating an older adult for dementia, the ‘Mini-Cog’ tool is frequently used. What
are the two primary components of this screening instrument?
A. Orientation to time and place
B. 3-word recall and Clock Drawing Test
C. Serial 7s and naming objects
, D. Long-term memory and gait assessment
Answer: B
Rationale: The Mini-Cog consists of a three-item word recall task and a clock-drawing test
to screen for cognitive impairment quickly. It is highly sensitive and takes significantly less
time than the MMSE, making it ideal for primary care settings. A score of 0-2 on the recall
or an abnormal clock generally indicates the need for a more formal diagnostic workup for
dementia.
6. A 74-year-old female presents with fatigue and a pale complexion. Her labs show a Mean
Corpuscular Volume (MCV) of 72 fL and a low ferritin level. What is the most likely diagnosis?
A. Vitamin B12 deficiency
B. Folate deficiency
C. Anemia of chronic disease
D. Iron deficiency anemia
Answer: D
Rationale: Iron deficiency anemia is characterized by microcytic (low MCV) and
hypochromic red blood cells, often confirmed by a low serum ferritin level. In older adults,
iron deficiency should prompt a search for the underlying cause, frequently occult
gastrointestinal bleeding. Management involves iron supplementation and addressing the
source of blood loss to prevent recurrence.
