NR 601 MIDTERM EXAM QUESTIONS
AND ANSWERS
What are treatments for nociceptive pain? ✅✅ANSW-Nonopioid (APAP, ibuprofen)
Weak opioids (Tramadol, tapentadol)
Antidepressants (TCAs, SNRIs)
Opioids
What are treatments for neuropathic pain? ✅✅ANSW-Characteristically more resistant to
opioids and to pharm interventions in general than nociceptive pain.
Antidepressants (TCAs, SNRIs)
Anticonvulsants (gabapentin, pregabalin, carbamazepine, oxcarbazepine)
Opioids
Topical agents
The percentage of the FVC expired in one second is: ✅✅ANSW-FEV1/FVC ratio
The aging process causes what normal physiological changes in the heart? ✅✅ANSW-The heart
valve thickens and becomes rigid, secondary to fibrosis and sclerosis.
A 55yo Caucasian male follows up after referral to cardiologist. He thinks his med is causing a cough
and sometimes he has difficulty breathing. Which med was most likely prescribed? ✅✅ANSW-
Lisinopril
JM is a 68yo man who presents for a physical. He has T2DM x5yrs, smokes 1/2 PPD, BMI is 30. No
other previous medical dx, no current complaints. According to the AHA/ACC guidelines, JM is stage
A HF. Treatment goals for him include: ✅✅ANSW-Heart healthy lifestyle
MJ presents with h/o structural damage with current s/s of HF. Treatment will be based on his stage
of HF, which is: ✅✅ANSW-Stage C
,65yo Caucasian female presents with mitral valve stenosis, physical exam unremarkable. You know
her stage of HF is: ✅✅ANSW-B
DG, 65yo man, presents for eval of CP and L-sided shoulder pain, beginning after strenuous activity,
including walking. Pain is dull, aching, 8/10 during activity, otherwise 0/10. Began few mo ago,
intermittent, aggravated by exercise, relieved by rest. Occasional nausea. Pain is retrosternal,
radiating to L shoulder, affects QOL by limiting activity. Pain is worse today, did not go away after
stopped walking. BP 120/80, HR 72 and regular. Normal heart sounds, no murmur, S1, S2. Which
differential dx would be most likely? ✅✅ANSW-Coronary artery dz w/angina pectoris
The best way to dx structural heart dz/dysfunction non-invasively is: ✅✅ANSW-Echocardiogram
Chronic pain can have major impact on pt's ability to function and have profound impact on overall
QOL. Ongoing pain may be linked to: ✅✅ANSW-Depression, sleep disturbance, decreased
socialization
The Beers criteria are appropriate for use in evaluating use of certain meds in pts: ✅✅ANSW-
>65yo
Pt presents with c/o increasing SOB, cough w/occasional white sputum, fatigue. As part of the plan
you order labs. You know the likelihood of HF is low if the BNP is: ✅✅ANSW-<100
All of the following statements are true about lab values in older adults except:
a. Normal ranges may not be applicable to older adults
b. Abnormal findings are often due to physiological aging
c. Reference ranges are preferable
d. References values are not necessarily acceptable values ✅✅ANSW-B
According to the 2017 ACC HTN guidelines, the recommended BP goal for a 65yo African American
woman w/a h/o HTN and DM and no h/o CKD is: ✅✅ANSW-<140/80
The pathophysiology of HF is due to: ✅✅ANSW-Inadequate cardiac output to meet the metabolic
and O2 demands of the body
,A 60yo woman w/30 pack yr hx, presents for eval of persistent, daily cough w/increased sputum,
worse in the AM, occurring over past 3 months. She tells you, "I have the same thing year after
year." Which of the following choices would you consider strongly in your critical thinking process?
✅✅ANSW-Chronic bronchitis
JM is a 68yo man who presents for a physical. He has T2DM x5yrs, diet controlled. His BMI is 32. He
has HTN, smoker (10 cigs/day x20yrs). He denies other medical problems. Fam hx includes CAD,
CABG x4 for dad, now deceased; CHF, T2DM, HTN for mom. He is asymptomatic today, exam is
normal, EKG NSR. According to AHA/ACC guidelines, JM is at risk for what stage of HF?
✅✅ANSW-Stage A
The volume of air a pt is able to exhale for total duration of the test during maximal effort is:
✅✅ANSW-FVC
According to the 2017 ACC HTN guidelines, normal BP is: ✅✅ANSW-<120/80
Functional abilities are best assessed by: ✅✅ANSW-Observed assessment of function
LB is a 77yo pt w/chronic poorly controlled HTN. You know that goals include prevention of target
organ damage. During your eval you will assess for evidence of: ✅✅ANSW-L ventricular
hypertrophy
Aortic regurgitation requires medical treatment for early signs of HF with: ✅✅ANSW-ACEi
The volume of air in the lungs at max inflation is: ✅✅ANSW-TLC (total lung capacity)
Preferred amount of exercise for older adults is: ✅✅ANSW-30min/day of aerobic activity 5
days/wk
The total volume of air a pt is able to exhale in the first second during max effort is: ✅✅ANSW-
FEV1
You know the following statements regarding the pain of acute coronary syndrome are true except:
a. Present atypically more often in men than women
, b. May be retrosternal or poorly localized
c. May last longer than 20min
d. May radiate to arms, back, neck, jaw ✅✅ANSW-A
Elderly pt presents w/new onset of feeling heart race, fatigue. EKG reveals afib w/rate >100. Pt also
has a new tremor in both hands. Which of the following would you suspect? ✅✅ANSW-
Hyperthyroidism
62yo female c/o fatigue, lack of energy. Constipation increased, pt gained 10lbs in past 3mo.
Depression is denied although pt reports lack of interest in usual hobbies. VS are WNL, skin is
dry/cool. Which of the following must be included in the DD? ✅✅ANSW-Hypothyroidism
Mrs. Black, 87yo, has been taking 100mcg Synthroid x10yrs. She comes for routine follow-up, feeling
well. HR is 90. Your first response is to: ✅✅ANSW-Order TSH
Which pt is most likely to have osteoporosis? ✅✅ANSW-80yo underweight male who smokes
and has been on steroids for psoriasis
When evaluating the expected outcome for hypothyroid elderly pt on levothyroxine, you will:
✅✅ANSW-Assess TSH in 4-6wks
Postmenopausal woman w/osteoporosis is taking bisphosphonate daily PO. What action info
statement would indicate she understood your instructions regarding this med? ✅✅ANSW-Take
med w/full glass of water when up in the AM 30min before other food and meds
Primary reason levothyroxine sodium is initiated at low dose in elderly pt w/hypothyroidism is to
prevent which of the following untoward effects? ✅✅ANSW-Angina and arrhythmia
6mo ago an elderly pt was dx'd w/subclinical hypothyroidism. Today the pt returns and has TSH of
11 and c/o fatigue. He has taken Synthroid 25mcg daily as prescribed. What is the best course of
action? ✅✅ANSW-Double the dose
A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should you teach him regarding
this med? ✅✅ANSW-Its effectiveness is decreased by antacids, iron, or caffeine
AND ANSWERS
What are treatments for nociceptive pain? ✅✅ANSW-Nonopioid (APAP, ibuprofen)
Weak opioids (Tramadol, tapentadol)
Antidepressants (TCAs, SNRIs)
Opioids
What are treatments for neuropathic pain? ✅✅ANSW-Characteristically more resistant to
opioids and to pharm interventions in general than nociceptive pain.
Antidepressants (TCAs, SNRIs)
Anticonvulsants (gabapentin, pregabalin, carbamazepine, oxcarbazepine)
Opioids
Topical agents
The percentage of the FVC expired in one second is: ✅✅ANSW-FEV1/FVC ratio
The aging process causes what normal physiological changes in the heart? ✅✅ANSW-The heart
valve thickens and becomes rigid, secondary to fibrosis and sclerosis.
A 55yo Caucasian male follows up after referral to cardiologist. He thinks his med is causing a cough
and sometimes he has difficulty breathing. Which med was most likely prescribed? ✅✅ANSW-
Lisinopril
JM is a 68yo man who presents for a physical. He has T2DM x5yrs, smokes 1/2 PPD, BMI is 30. No
other previous medical dx, no current complaints. According to the AHA/ACC guidelines, JM is stage
A HF. Treatment goals for him include: ✅✅ANSW-Heart healthy lifestyle
MJ presents with h/o structural damage with current s/s of HF. Treatment will be based on his stage
of HF, which is: ✅✅ANSW-Stage C
,65yo Caucasian female presents with mitral valve stenosis, physical exam unremarkable. You know
her stage of HF is: ✅✅ANSW-B
DG, 65yo man, presents for eval of CP and L-sided shoulder pain, beginning after strenuous activity,
including walking. Pain is dull, aching, 8/10 during activity, otherwise 0/10. Began few mo ago,
intermittent, aggravated by exercise, relieved by rest. Occasional nausea. Pain is retrosternal,
radiating to L shoulder, affects QOL by limiting activity. Pain is worse today, did not go away after
stopped walking. BP 120/80, HR 72 and regular. Normal heart sounds, no murmur, S1, S2. Which
differential dx would be most likely? ✅✅ANSW-Coronary artery dz w/angina pectoris
The best way to dx structural heart dz/dysfunction non-invasively is: ✅✅ANSW-Echocardiogram
Chronic pain can have major impact on pt's ability to function and have profound impact on overall
QOL. Ongoing pain may be linked to: ✅✅ANSW-Depression, sleep disturbance, decreased
socialization
The Beers criteria are appropriate for use in evaluating use of certain meds in pts: ✅✅ANSW-
>65yo
Pt presents with c/o increasing SOB, cough w/occasional white sputum, fatigue. As part of the plan
you order labs. You know the likelihood of HF is low if the BNP is: ✅✅ANSW-<100
All of the following statements are true about lab values in older adults except:
a. Normal ranges may not be applicable to older adults
b. Abnormal findings are often due to physiological aging
c. Reference ranges are preferable
d. References values are not necessarily acceptable values ✅✅ANSW-B
According to the 2017 ACC HTN guidelines, the recommended BP goal for a 65yo African American
woman w/a h/o HTN and DM and no h/o CKD is: ✅✅ANSW-<140/80
The pathophysiology of HF is due to: ✅✅ANSW-Inadequate cardiac output to meet the metabolic
and O2 demands of the body
,A 60yo woman w/30 pack yr hx, presents for eval of persistent, daily cough w/increased sputum,
worse in the AM, occurring over past 3 months. She tells you, "I have the same thing year after
year." Which of the following choices would you consider strongly in your critical thinking process?
✅✅ANSW-Chronic bronchitis
JM is a 68yo man who presents for a physical. He has T2DM x5yrs, diet controlled. His BMI is 32. He
has HTN, smoker (10 cigs/day x20yrs). He denies other medical problems. Fam hx includes CAD,
CABG x4 for dad, now deceased; CHF, T2DM, HTN for mom. He is asymptomatic today, exam is
normal, EKG NSR. According to AHA/ACC guidelines, JM is at risk for what stage of HF?
✅✅ANSW-Stage A
The volume of air a pt is able to exhale for total duration of the test during maximal effort is:
✅✅ANSW-FVC
According to the 2017 ACC HTN guidelines, normal BP is: ✅✅ANSW-<120/80
Functional abilities are best assessed by: ✅✅ANSW-Observed assessment of function
LB is a 77yo pt w/chronic poorly controlled HTN. You know that goals include prevention of target
organ damage. During your eval you will assess for evidence of: ✅✅ANSW-L ventricular
hypertrophy
Aortic regurgitation requires medical treatment for early signs of HF with: ✅✅ANSW-ACEi
The volume of air in the lungs at max inflation is: ✅✅ANSW-TLC (total lung capacity)
Preferred amount of exercise for older adults is: ✅✅ANSW-30min/day of aerobic activity 5
days/wk
The total volume of air a pt is able to exhale in the first second during max effort is: ✅✅ANSW-
FEV1
You know the following statements regarding the pain of acute coronary syndrome are true except:
a. Present atypically more often in men than women
, b. May be retrosternal or poorly localized
c. May last longer than 20min
d. May radiate to arms, back, neck, jaw ✅✅ANSW-A
Elderly pt presents w/new onset of feeling heart race, fatigue. EKG reveals afib w/rate >100. Pt also
has a new tremor in both hands. Which of the following would you suspect? ✅✅ANSW-
Hyperthyroidism
62yo female c/o fatigue, lack of energy. Constipation increased, pt gained 10lbs in past 3mo.
Depression is denied although pt reports lack of interest in usual hobbies. VS are WNL, skin is
dry/cool. Which of the following must be included in the DD? ✅✅ANSW-Hypothyroidism
Mrs. Black, 87yo, has been taking 100mcg Synthroid x10yrs. She comes for routine follow-up, feeling
well. HR is 90. Your first response is to: ✅✅ANSW-Order TSH
Which pt is most likely to have osteoporosis? ✅✅ANSW-80yo underweight male who smokes
and has been on steroids for psoriasis
When evaluating the expected outcome for hypothyroid elderly pt on levothyroxine, you will:
✅✅ANSW-Assess TSH in 4-6wks
Postmenopausal woman w/osteoporosis is taking bisphosphonate daily PO. What action info
statement would indicate she understood your instructions regarding this med? ✅✅ANSW-Take
med w/full glass of water when up in the AM 30min before other food and meds
Primary reason levothyroxine sodium is initiated at low dose in elderly pt w/hypothyroidism is to
prevent which of the following untoward effects? ✅✅ANSW-Angina and arrhythmia
6mo ago an elderly pt was dx'd w/subclinical hypothyroidism. Today the pt returns and has TSH of
11 and c/o fatigue. He has taken Synthroid 25mcg daily as prescribed. What is the best course of
action? ✅✅ANSW-Double the dose
A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should you teach him regarding
this med? ✅✅ANSW-Its effectiveness is decreased by antacids, iron, or caffeine
