NR580 Exam 4 Actual Exam Style V3 | NR
580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. A 75-year-old male presents with a new onset of urinary frequency, urgency, and a
weakened stream. On digital rectal exam (DRE), the prostate is found to be symmetrically
enlarged, firm, and non-tender. What is the most likely diagnosis?
A. Prostate Cancer
B. Benign Prostatic Hyperplasia (BPH)
C. Acute Prostatitis
D. Urinary Tract Infection
Answer: B
Rationale: Benign Prostatic Hyperplasia typically presents with lower urinary tract
symptoms and a symmetrically enlarged prostate. Acute prostatitis would present with a
boggy, tender prostate and systemic symptoms like fever. The absence of nodules or
asymmetry on DRE makes prostate cancer less likely as a primary diagnosis.
2. Which of the following is considered a ‘red flag’ symptom in an older adult presenting with
new-onset constipation?
A. Unexplained weight loss
B. Occasional bloating
,C. Harder stool consistency
D. Increased gas
Answer: A
Rationale: Unexplained weight loss in an older adult with bowel changes is highly
suggestive of potential malignancy, such as colorectal cancer. While bloating and gas are
common, they are usually benign functional symptoms. The nurse practitioner must order
further diagnostic testing, such as a colonoscopy, when weight loss or rectal bleeding is
present.
3. According to the Beers Criteria, which of the following medications should be avoided in
older adults due to the risk of falls and delirium?
A. Lisinopril
B. Metformin
C. Diphenhydramine
D. Atorvastatin
Answer: C
Rationale: Diphenhydramine is a first-generation antihistamine with strong
anticholinergic properties that significantly increase the risk of confusion and falls. The
Beers Criteria advises against its use in the elderly for treating insomnia or allergic
reactions. Safer alternatives should always be considered to maintain patient safety and
cognitive function.
, 4. A 68-year-old female reports persistent joint pain in her hands, specifically in the distal
interphalangeal (DIP) joints. You observe Heberden’s nodes. What is the most likely
condition?
A. Rheumatoid Arthritis
B. Systemic Lupus Erythematosus
C. Gouty Arthritis
D. Osteoarthritis
Answer: D
Rationale: Heberden’s nodes are classic physical exam findings located at the DIP joints in
patients with Osteoarthritis. Rheumatoid arthritis typically affects the proximal joints and
presents with systemic inflammation. Management usually involves topical or oral NSAIDs
and physical therapy to maintain joint mobility.
5. Which Medicare part covers outpatient provider visits and many preventive services?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Answer: B
580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. A 75-year-old male presents with a new onset of urinary frequency, urgency, and a
weakened stream. On digital rectal exam (DRE), the prostate is found to be symmetrically
enlarged, firm, and non-tender. What is the most likely diagnosis?
A. Prostate Cancer
B. Benign Prostatic Hyperplasia (BPH)
C. Acute Prostatitis
D. Urinary Tract Infection
Answer: B
Rationale: Benign Prostatic Hyperplasia typically presents with lower urinary tract
symptoms and a symmetrically enlarged prostate. Acute prostatitis would present with a
boggy, tender prostate and systemic symptoms like fever. The absence of nodules or
asymmetry on DRE makes prostate cancer less likely as a primary diagnosis.
2. Which of the following is considered a ‘red flag’ symptom in an older adult presenting with
new-onset constipation?
A. Unexplained weight loss
B. Occasional bloating
,C. Harder stool consistency
D. Increased gas
Answer: A
Rationale: Unexplained weight loss in an older adult with bowel changes is highly
suggestive of potential malignancy, such as colorectal cancer. While bloating and gas are
common, they are usually benign functional symptoms. The nurse practitioner must order
further diagnostic testing, such as a colonoscopy, when weight loss or rectal bleeding is
present.
3. According to the Beers Criteria, which of the following medications should be avoided in
older adults due to the risk of falls and delirium?
A. Lisinopril
B. Metformin
C. Diphenhydramine
D. Atorvastatin
Answer: C
Rationale: Diphenhydramine is a first-generation antihistamine with strong
anticholinergic properties that significantly increase the risk of confusion and falls. The
Beers Criteria advises against its use in the elderly for treating insomnia or allergic
reactions. Safer alternatives should always be considered to maintain patient safety and
cognitive function.
, 4. A 68-year-old female reports persistent joint pain in her hands, specifically in the distal
interphalangeal (DIP) joints. You observe Heberden’s nodes. What is the most likely
condition?
A. Rheumatoid Arthritis
B. Systemic Lupus Erythematosus
C. Gouty Arthritis
D. Osteoarthritis
Answer: D
Rationale: Heberden’s nodes are classic physical exam findings located at the DIP joints in
patients with Osteoarthritis. Rheumatoid arthritis typically affects the proximal joints and
presents with systemic inflammation. Management usually involves topical or oral NSAIDs
and physical therapy to maintain joint mobility.
5. Which Medicare part covers outpatient provider visits and many preventive services?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Answer: B
