NR 601 Final Exam Latest Questions And Answers
Newest Versions
An 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?
ANS 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. ANS 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? ANS Urine testing, blood testing, anal swab, and
oropharyngeal swab
Which of the following is true about tolterodine? ANS 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: ANS 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?
ANS 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? ANS Bladder training
What is the most common cause of erectile dysfunction in older men? ANS Atherosclerosis
Which is the most reasonable first step in the treatment of older men with erectile dysfunction? ANS
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? ANS Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of her
problem? ANS 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? ANS 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? ANS Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival? ANS A 78-
year-old man who had a radical prostatectomy and external beam radiation therapy 10 years earlier now has a
Newest Versions
An 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?
ANS 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. ANS 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? ANS Urine testing, blood testing, anal swab, and
oropharyngeal swab
Which of the following is true about tolterodine? ANS 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: ANS 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?
ANS 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? ANS Bladder training
What is the most common cause of erectile dysfunction in older men? ANS Atherosclerosis
Which is the most reasonable first step in the treatment of older men with erectile dysfunction? ANS
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? ANS Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of her
problem? ANS 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? ANS 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? ANS Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival? ANS A 78-
year-old man who had a radical prostatectomy and external beam radiation therapy 10 years earlier now has a
