NR 601 Study Guide
The pathophysiology that underlies the formation of atherosclerotic plaque in coronary arteries is primarily
associated with which the following mechanisms? -Inflammation
An 80 year old woman is evaluated in your clinic for muscle aches. Her daughter, who is a nurse, states
that her symptoms worsened after recently starting atorvastatin 80 mg daily. This medication and dose
was selected based on the patient wanting to reduce her chance of a heart attack or stroke. She has a
known history of stable coronary artery disease, without prior coronary revascularization. She takes low
dose aspirin and her blood pressure is well controlled on lisinopril 20 mg once daily. You recognize that
myalgia and myopathic symptoms are dose related and more common in older adults prescribed statins.
Which of the following recommendations would be appropriate at this time? -Discontinue atorvastatin until
the myopathy has resolved, then consider restarting atorvastatin at a low dose, such as 10 mg once daily
or an alternative statin.
A 75 year old man with stable ischemic heart disease and moderate angina returns for follow up. Prior
stress testing has documented myocardial ischemia. A coronary angiogram performed 6 months ago
showed that he has few options for revascularization and should be managed medically, although
high0risk percutaneous coronary intervention can be performed for lifestyle limiting symptoms. Reviewing
his medications, it appears that has been taking amlodipine 10mg daily, in addition to statin, aspiring, and
as needed sublingual nitroglycerin. What would be the most appropriate next step in his management? -
His antianginal regimen should be improved to include the addition of a beta blocker and/or a long acting
nitrate.
A 88 year old femal patient with Parkinson disease presents to clinic for hospital follow up for atrial Fib
with rapid RVR. Home heart rate monitoring shows good rate control of her AF ventricular rates. She has
a history of falls and labile international normalized ration with irregular adherence with blood draws. Her
current medications include carbidopa-levodopa, metoprolol, and warfarin and she has a robust drug plan
that allowed for a variety of medications choices. What changes would you recommend to her
medications regimen? -Convert warfarin to a direct oral anticoagulant
In patient with heart failure, the most useful initial imaging modality is -Transthoracic echocardiogram
Compared with angiotensin-converting enzyme (ACE) inhibitors angiotensin receptor blocker are less
likely to be associated with -Angioedema
Which class of drug has not been shown to provide a mortality benefit in heart failure patients with
reduced ejection fraction -Diuretics
Which of the following would be consistent with the new onset of heart failure in an older patient -
Dyspnea, worsening ability to self care, anorexia, confusion (all of the above)
A 65 year old male is evaluated in a follow up examination for worsening dyspnea and chronic cough
productive of mucoid sputum for the past 6 months. He is otherwise healthy but was diagnosed with
COPD 3 years ago and needed inhaled albuterol as needed. The patient has a 40 pack year history but
quit 8 months ago. ON PE VS are normal and the patient is not in any respiratory distress. Breath sounds
, are decreased but there is no edema or jugular venous distention. Spirometry shows a forced expiratory
volume in the first second FEV1 of 58% of predicted with no reversibility of FEV1/forced vital capacity
(FVC) ration of 65%. His COPD symptoms seem poorly controlled and he has one exacerbation in the
past year. A chest radiograph is obtained and showed mild hyperinflation. Which of the following is the
most appropriate therapy for this patient? -Add a long acting inhaled bronchodialator
A 65 year old female is evaluated for dyspnea, chronic cough, and mucoid sputum for the past 4 months.
She has noticed that she has to walk slower that she used to and has to stop to catch her breath after
walking 5-6 city blocks. The patient has a 40 pack year smoking but quit 1 year ago. Otherwise healthy.
On PE VS and normal. Breath sounds decreased, no edema or jugular distention. What is the next best
test to make a diagnosis? -Obtain spirometry
A 77 year old female with asthma is evaluated for a very slow increase in the frequency of episodes of
wheezing and dyspnea not relieved by short acting beat agonist therapy. She states that she uses her
controller medications regularly with good inhaler technique, which include and inhaled long acting beta-
agonist and inhaled low dose corticoid-steroid. she has daily daytime and frequent nocturnal symptoms of
chest tightness and wheezing. She does not feel acutely ill. On PE, the patient is not in any respiratory
distress -Step up to medium-dose inhaled corticoidsteroid and have her return in 4-6 weeks for re-eval
Constipation in older adults may result from many factors. Which of the following is not considered a
common contributing factor to constipation in older adults. -Obesity
Risk factors associated with constipation in older women are -All of these: high # of medications, multiple
comorbidities, female gender, black american
The first step in developing a treatment strategy for physically active patient with constipation symptoms
that are not caused by other potential causes is to -recommend higher fiber and water intake
Over the counter milk of mag and miralax improve constipation by -Promoting secretion of water into
intestinal lumen
Supplemental fiber treatment can improve symptoms related to constipation -True
Mr Lee is an 80 year old man who lives along who comes to the office for routine visit. He lost 10 lbs in
the last 3 months and complains of fatigue, poor appetite, and trouble sleeping. Which of the following is
least useful during his initial assessment. -Vaccination history
During the physical assessment, you notice Mr. Lee has temporal wasting, loss of subcutanious fat, and
decreased handgrip strength. He also complains of dry mouth. His C-reactive protein is within normals
limits. What additional lab are most useful for evaluating his nutritional status? -Serum Albumin
While discussing Mr. Lee's diet, he states that his wife did all the cooking and since she passed away 5
months ago, he eats mostly soups and sandwiches. He does not drive, and he does not like to ask his
son to take him to the story because he doesn't want to be a burden. What nutrition intervention would
you recommend -Consult dietician to determine nutrial needs
Mrs. Miller is a 78 year old female admitted to the -Consult speech therapy for a swallowing eval
Mrs. Green is an 88 year old female discharging home from the hospital after sustaining a right hip
fracture from a fall. She requires surgery to fix the fracture and is not ambulating using a walker. her MNA
in the hospital was positive for malnutrition risk. She lives alone and has one family member who lives
nearby. What nutrition interventions is least helpful once she dc home? -Recommend she move into a
retirement community
you are seeing an 85 year old gentleman with a 15 year of DM, CAD, and a bypass graft 7 years ago.
mild COPD. He lives in a senior living in an independent apartment and gets help from family with
The pathophysiology that underlies the formation of atherosclerotic plaque in coronary arteries is primarily
associated with which the following mechanisms? -Inflammation
An 80 year old woman is evaluated in your clinic for muscle aches. Her daughter, who is a nurse, states
that her symptoms worsened after recently starting atorvastatin 80 mg daily. This medication and dose
was selected based on the patient wanting to reduce her chance of a heart attack or stroke. She has a
known history of stable coronary artery disease, without prior coronary revascularization. She takes low
dose aspirin and her blood pressure is well controlled on lisinopril 20 mg once daily. You recognize that
myalgia and myopathic symptoms are dose related and more common in older adults prescribed statins.
Which of the following recommendations would be appropriate at this time? -Discontinue atorvastatin until
the myopathy has resolved, then consider restarting atorvastatin at a low dose, such as 10 mg once daily
or an alternative statin.
A 75 year old man with stable ischemic heart disease and moderate angina returns for follow up. Prior
stress testing has documented myocardial ischemia. A coronary angiogram performed 6 months ago
showed that he has few options for revascularization and should be managed medically, although
high0risk percutaneous coronary intervention can be performed for lifestyle limiting symptoms. Reviewing
his medications, it appears that has been taking amlodipine 10mg daily, in addition to statin, aspiring, and
as needed sublingual nitroglycerin. What would be the most appropriate next step in his management? -
His antianginal regimen should be improved to include the addition of a beta blocker and/or a long acting
nitrate.
A 88 year old femal patient with Parkinson disease presents to clinic for hospital follow up for atrial Fib
with rapid RVR. Home heart rate monitoring shows good rate control of her AF ventricular rates. She has
a history of falls and labile international normalized ration with irregular adherence with blood draws. Her
current medications include carbidopa-levodopa, metoprolol, and warfarin and she has a robust drug plan
that allowed for a variety of medications choices. What changes would you recommend to her
medications regimen? -Convert warfarin to a direct oral anticoagulant
In patient with heart failure, the most useful initial imaging modality is -Transthoracic echocardiogram
Compared with angiotensin-converting enzyme (ACE) inhibitors angiotensin receptor blocker are less
likely to be associated with -Angioedema
Which class of drug has not been shown to provide a mortality benefit in heart failure patients with
reduced ejection fraction -Diuretics
Which of the following would be consistent with the new onset of heart failure in an older patient -
Dyspnea, worsening ability to self care, anorexia, confusion (all of the above)
A 65 year old male is evaluated in a follow up examination for worsening dyspnea and chronic cough
productive of mucoid sputum for the past 6 months. He is otherwise healthy but was diagnosed with
COPD 3 years ago and needed inhaled albuterol as needed. The patient has a 40 pack year history but
quit 8 months ago. ON PE VS are normal and the patient is not in any respiratory distress. Breath sounds
, are decreased but there is no edema or jugular venous distention. Spirometry shows a forced expiratory
volume in the first second FEV1 of 58% of predicted with no reversibility of FEV1/forced vital capacity
(FVC) ration of 65%. His COPD symptoms seem poorly controlled and he has one exacerbation in the
past year. A chest radiograph is obtained and showed mild hyperinflation. Which of the following is the
most appropriate therapy for this patient? -Add a long acting inhaled bronchodialator
A 65 year old female is evaluated for dyspnea, chronic cough, and mucoid sputum for the past 4 months.
She has noticed that she has to walk slower that she used to and has to stop to catch her breath after
walking 5-6 city blocks. The patient has a 40 pack year smoking but quit 1 year ago. Otherwise healthy.
On PE VS and normal. Breath sounds decreased, no edema or jugular distention. What is the next best
test to make a diagnosis? -Obtain spirometry
A 77 year old female with asthma is evaluated for a very slow increase in the frequency of episodes of
wheezing and dyspnea not relieved by short acting beat agonist therapy. She states that she uses her
controller medications regularly with good inhaler technique, which include and inhaled long acting beta-
agonist and inhaled low dose corticoid-steroid. she has daily daytime and frequent nocturnal symptoms of
chest tightness and wheezing. She does not feel acutely ill. On PE, the patient is not in any respiratory
distress -Step up to medium-dose inhaled corticoidsteroid and have her return in 4-6 weeks for re-eval
Constipation in older adults may result from many factors. Which of the following is not considered a
common contributing factor to constipation in older adults. -Obesity
Risk factors associated with constipation in older women are -All of these: high # of medications, multiple
comorbidities, female gender, black american
The first step in developing a treatment strategy for physically active patient with constipation symptoms
that are not caused by other potential causes is to -recommend higher fiber and water intake
Over the counter milk of mag and miralax improve constipation by -Promoting secretion of water into
intestinal lumen
Supplemental fiber treatment can improve symptoms related to constipation -True
Mr Lee is an 80 year old man who lives along who comes to the office for routine visit. He lost 10 lbs in
the last 3 months and complains of fatigue, poor appetite, and trouble sleeping. Which of the following is
least useful during his initial assessment. -Vaccination history
During the physical assessment, you notice Mr. Lee has temporal wasting, loss of subcutanious fat, and
decreased handgrip strength. He also complains of dry mouth. His C-reactive protein is within normals
limits. What additional lab are most useful for evaluating his nutritional status? -Serum Albumin
While discussing Mr. Lee's diet, he states that his wife did all the cooking and since she passed away 5
months ago, he eats mostly soups and sandwiches. He does not drive, and he does not like to ask his
son to take him to the story because he doesn't want to be a burden. What nutrition intervention would
you recommend -Consult dietician to determine nutrial needs
Mrs. Miller is a 78 year old female admitted to the -Consult speech therapy for a swallowing eval
Mrs. Green is an 88 year old female discharging home from the hospital after sustaining a right hip
fracture from a fall. She requires surgery to fix the fracture and is not ambulating using a walker. her MNA
in the hospital was positive for malnutrition risk. She lives alone and has one family member who lives
nearby. What nutrition interventions is least helpful once she dc home? -Recommend she move into a
retirement community
you are seeing an 85 year old gentleman with a 15 year of DM, CAD, and a bypass graft 7 years ago.
mild COPD. He lives in a senior living in an independent apartment and gets help from family with
