NR 601 Final Exam Questions and Answers(Latest Update 2024)

NR 601 Final Exam Questions and AnsAn 86-year-old female comes to your office for a wellness visit. Her blood pressure is 125/70 mmHg, pulse 69 beats per min, and respiratory rate 18 breaths per min. She is well appearing and reports she is up to date on her routine vaccinations. She introduces her partner of 35 years whom she would like to make medical decisions for her in case she becomes unable to make decisions for herself. She reports that she and her partner are not married. She asks if she needs any further documentation to ensure her goals of care are followed. Which one of the following would be the most appropriate recommendation for this patient and her partner? - ANSWER Advise them to file an advanced directive. . An 81-year-old transgender female with history of depression and hyperlipidemia presents to your clinic for routine care. She endorses a history of smoking, currently smoking 1 pack per day, and occasionally drinks a glass of wine, although she denies illicit drug use. She reports she takes atorvastatin 20 mg and subcutaneous estrogen therapy. - ANSWER Counseling on smoking cessation An 84-year-old male with history of stroke without residual deficit, systolic heart failure, and type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement community and still works part time on a golf course. He currently takes aspirin 81 mg, metoprolol tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily. He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He states he has had over three sexual partners in the last year with intermittent condom use. What sexually transmitted infection testing should be offered? - ANSWER Urine testing, blood testing, anal swab, and oropharyngeal swab Which of the following is true about tolterodine? - ANSWER It has greater risk of adverse effects with its twice-daily formulation. An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night. His other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg daily, metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg twice daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily was recently added by his cardiologist. On review of systems, Mr. A complains that nocturia is causing daytime fatigue, and he is more constipated. Physical examination is notable for blood pressure 162/83 mmHg, heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged prostate, and 21 pretibial edema. Your next step in management should be: - ANSWER Stop amlodipine and increase lisinopril. The daughter of a 79-year-old woman notes that her mother, who has dementia and lives with her, is wetting herself when she attends her new day program. Program staff have requested that "something be done" as she is requiring a clothes change nearly every time she is there. She cannot describe the circumstances of leakage, saying "it just comes." Leakage is uncommon at home. Her medications include donepezil and acetaminophen. Physical examination is normal. Initial treatment approach will require intervention by which of the following? - ANSWER Day program staff . Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten worse over the past year, and she rarely makes it through nine holes without feeling like she needs to "run into the bushes and go." Leakage is usually small volume, but causes her extreme embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in the morning before she golfs and avoiding drinking water while playing, to no effect. She also tried "those Kegler" exercises in the past without success. Which of the following is the most appropriate recommendation for Ms. J? - ANSWER Bladder training What is the most common cause of erectile dysfunction in older men? - ANSWER Atherosclerosis Which is the most reasonable first step in the treatment of older men with erectile dysfunction? - ANSWER Sildenafil A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide, chlorthalidone, and acetaminophen. What would be your first step in therapy? - ANSWER Stop chlorthalidone A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of her problem? - ANSWER High-tone pelvic floor dysfunction A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor 1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with cancer. Sentinel lymph node sampling was negative for lymph node involvement. She has good performance status and no activities of daily living (ADL) or instrumental (IADL) dependencies. What treatment would you recommend? - ANSWER Hormonal therapy only An 86-year-old man with no ADL deficits who has stopped driving because of macular degeneration is evaluated for a urinary tract infection associated with urinary retention. The consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level that comes back 12 ng/mL. Three months later after the Foley has been removed and he has had a good response to tamsulosin, his PSA is still 10 ng/mL. What is the appropriate next step in managing this man's prostate problem? - ANSWER Repeat PSA in 6 months In which of the following patients is chemical or surgical castration likely to prolong survival? - ANSWER A 78-year-old man who had a radical prostatectomy and external beam radiation therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged pelvic lymph node, and a bone scan is positive in the pelvis. On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the arm and obvious pain. The patient has no children and had lived alone until recently, when a neighbor became concerned for what appeared to be a progressive loss of memory and neglect of the house. A nephew living in another city eventually came to take care of the situation and arranged for the admission. The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be independent in her ADLs. The medical history is negative for any serious illnesses. She was able to drive her own car until shortly before this admission. The nephew does not wish to authorize hospice "right now." A positron-emission tomography scan was negative for metastatic disease. In addition to determining the cause of her deliri - ANSWER The mass should be biopsied to study hormone receptor and HER2/neu antigen status. A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for metastatic sampling. The patient wants to know if he should have chemotherapy. Should he? - ANSWER No because he can be followed with serial carcinoembryonic antigens and CT scans. An 80-year-old woman has no weight loss, no pain, and no distention but over 2 years increasingly complains of constipation despite adequate medical treatment. A colonoscopy is negative. An abdominal CT is performed. It reveals well-circumscribed pelvic masses, the largest adherent to the ovarian ligament. The best first step is: - ANSWER Invite her to return with a family member and have a long talk about the diagnostic and therapeutic options. wers(Latest Update 2024)