NR580 Final Exam Actual Exam Style V1
NR 580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. An 82-year-old male presents for a routine follow-up with a blood pressure of 152/94
mmHg. According to the JNC 8 guidelines, what is the blood pressure goal for this patient?
A. <150/90 mmHg
B. <130/80 mmHg
C. <140/90 mmHg
D. <120/80 mmHg
Answer: A
Rationale: The JNC 8 guidelines specify that for adults aged 60 years or older, the target
blood pressure is less than 150/90 mmHg. This higher threshold is intended to balance the
benefits of stroke reduction against the risks of hypotension and falls in the elderly. The NP
should monitor for orthostatic symptoms when initiating therapy in this age group.
2. A 65-year-old female with Type 2 Diabetes has an A1C of 8.2% despite being on Metformin
1000mg twice daily. She has a history of atherosclerotic cardiovascular disease (ASCVD).
What is the most appropriate next step?
A. Add Glipizide
B. Add a GLP-1 receptor agonist
,C. Add basal insulin
D. Increase Metformin dose
Answer: B
Rationale: The ADA Standards of Care recommend GLP-1 receptor agonists or SGLT2
inhibitors for patients with established ASCVD regardless of their baseline A1C. GLP-1
agonists have demonstrated significant cardiovascular benefit and weight loss advantages.
Adding a sulfonylurea like glipizide is generally avoided in this context due to the lack of CV
benefit and risk of hypoglycemia.
3. Which of the following is considered a positive ‘Screening for Depression in the Older
Adult’ using the Geriatric Depression Scale (GDS) short form?
A. A score of 5 or more
B. A score of 2 or more
C. A score of 10 or more
D. A score of 0
Answer: A
Rationale: The GDS Short Form consists of 15 questions, where a score of 5 or more is
suggestive of depression. This tool is specifically validated for the elderly population and
focuses on psychological symptoms rather than somatic ones. Scores above 10 almost
always indicate clinical depression requiring further diagnostic evaluation.
, 4. A 70-year-old patient presents with new-onset atrial fibrillation. What is the standard tool
used to assess the risk of stroke and determine the need for anticoagulation?
A. PHQ-9
B. HAS-BLED score
C. CHA2DS2-VASc score
D. CURB-65
Answer: C
Rationale: The CHA2DS2-VASc score is the clinical standard for estimating stroke risk in
patients with non-valvular atrial fibrillation. It considers factors such as age, sex, heart
failure, hypertension, and prior vascular disease. For most elderly patients with a score of 2
or higher, oral anticoagulation is recommended.
5. A patient with COPD is categorized as Group B under the GOLD guidelines. Which
treatment is most appropriate for initial maintenance?
A. SABA as needed only
B. Inhaled corticosteroid (ICS)
C. Theophylline
D. Long-acting bronchodilator (LAMA or LABA)
Answer: D
NR 580 Adult-Gerontology Primary Care
Capstone and Intensive | Chamberlain
1. An 82-year-old male presents for a routine follow-up with a blood pressure of 152/94
mmHg. According to the JNC 8 guidelines, what is the blood pressure goal for this patient?
A. <150/90 mmHg
B. <130/80 mmHg
C. <140/90 mmHg
D. <120/80 mmHg
Answer: A
Rationale: The JNC 8 guidelines specify that for adults aged 60 years or older, the target
blood pressure is less than 150/90 mmHg. This higher threshold is intended to balance the
benefits of stroke reduction against the risks of hypotension and falls in the elderly. The NP
should monitor for orthostatic symptoms when initiating therapy in this age group.
2. A 65-year-old female with Type 2 Diabetes has an A1C of 8.2% despite being on Metformin
1000mg twice daily. She has a history of atherosclerotic cardiovascular disease (ASCVD).
What is the most appropriate next step?
A. Add Glipizide
B. Add a GLP-1 receptor agonist
,C. Add basal insulin
D. Increase Metformin dose
Answer: B
Rationale: The ADA Standards of Care recommend GLP-1 receptor agonists or SGLT2
inhibitors for patients with established ASCVD regardless of their baseline A1C. GLP-1
agonists have demonstrated significant cardiovascular benefit and weight loss advantages.
Adding a sulfonylurea like glipizide is generally avoided in this context due to the lack of CV
benefit and risk of hypoglycemia.
3. Which of the following is considered a positive ‘Screening for Depression in the Older
Adult’ using the Geriatric Depression Scale (GDS) short form?
A. A score of 5 or more
B. A score of 2 or more
C. A score of 10 or more
D. A score of 0
Answer: A
Rationale: The GDS Short Form consists of 15 questions, where a score of 5 or more is
suggestive of depression. This tool is specifically validated for the elderly population and
focuses on psychological symptoms rather than somatic ones. Scores above 10 almost
always indicate clinical depression requiring further diagnostic evaluation.
, 4. A 70-year-old patient presents with new-onset atrial fibrillation. What is the standard tool
used to assess the risk of stroke and determine the need for anticoagulation?
A. PHQ-9
B. HAS-BLED score
C. CHA2DS2-VASc score
D. CURB-65
Answer: C
Rationale: The CHA2DS2-VASc score is the clinical standard for estimating stroke risk in
patients with non-valvular atrial fibrillation. It considers factors such as age, sex, heart
failure, hypertension, and prior vascular disease. For most elderly patients with a score of 2
or higher, oral anticoagulation is recommended.
5. A patient with COPD is categorized as Group B under the GOLD guidelines. Which
treatment is most appropriate for initial maintenance?
A. SABA as needed only
B. Inhaled corticosteroid (ICS)
C. Theophylline
D. Long-acting bronchodilator (LAMA or LABA)
Answer: D
