, NUR 253 EXAM 4PRIMARY CARE OF
OLDERADULTS LGBTQI+ HEALTH, BPH & GERIATRIC PRIMARY
CARE QUESTIONS WITH CORRCT ANSWERS GRADED A+ FOR 2026
1. An 81-year-old transgender female presents to establish primary care. Her medical history
includes hyperlipidemia and a 30-pack-year smoking history. She has been taking stable doses
of subcutaneous estrogen therapy for the last 30 years. Which of the following is the most
appropriate next step in managing her preventive care?
A) Immediately discontinue her estrogen therapy due to her advanced age.
B) Order a screening mammogram and provide intense smoking cessation counseling.
C) Initiate low-dose daily aspirin to mitigate her cardiovascular risk.
D) Order an abdominal ultrasound to screen for an abdominal aortic aneurysm.
Correct Answer: B
Clinical Rationale: Estrogen therapy places transgender women at an increased risk for VTE and
cardiovascular events, which is significantly worsened by smoking. Smoking cessation
counseling is an immediate priority. Standard screening guidelines (such as mammograms for
those on long-term hormones) must be maintained. Stopping hormones abruptly in an older
transgender woman can cause distress and rapid virilization; any modifications must involve
shared, patient-centered decision-making.
2. A 76-year-old gay male presents for a routine wellness visit. He lives with his unmarried
partner of 35 years whom he wishes to designate as his primary surrogate medical decision-
maker. The couple lacks any legal licenses or documentation. Which statement correctly
addresses their situation?
A) Because they have cohabitated for over three decades, his partner will be recognized as a de
facto surrogate in all medical jurisdictions.
B) A POLST form must be filled out immediately today to establish medical power of attorney.
C) They are legally vulnerable; the patient must complete and file an Advance Directive to
ensure his partner is recognized as his legal surrogate.
OLDERADULTS LGBTQI+ HEALTH, BPH & GERIATRIC PRIMARY
CARE QUESTIONS WITH CORRCT ANSWERS GRADED A+ FOR 2026
1. An 81-year-old transgender female presents to establish primary care. Her medical history
includes hyperlipidemia and a 30-pack-year smoking history. She has been taking stable doses
of subcutaneous estrogen therapy for the last 30 years. Which of the following is the most
appropriate next step in managing her preventive care?
A) Immediately discontinue her estrogen therapy due to her advanced age.
B) Order a screening mammogram and provide intense smoking cessation counseling.
C) Initiate low-dose daily aspirin to mitigate her cardiovascular risk.
D) Order an abdominal ultrasound to screen for an abdominal aortic aneurysm.
Correct Answer: B
Clinical Rationale: Estrogen therapy places transgender women at an increased risk for VTE and
cardiovascular events, which is significantly worsened by smoking. Smoking cessation
counseling is an immediate priority. Standard screening guidelines (such as mammograms for
those on long-term hormones) must be maintained. Stopping hormones abruptly in an older
transgender woman can cause distress and rapid virilization; any modifications must involve
shared, patient-centered decision-making.
2. A 76-year-old gay male presents for a routine wellness visit. He lives with his unmarried
partner of 35 years whom he wishes to designate as his primary surrogate medical decision-
maker. The couple lacks any legal licenses or documentation. Which statement correctly
addresses their situation?
A) Because they have cohabitated for over three decades, his partner will be recognized as a de
facto surrogate in all medical jurisdictions.
B) A POLST form must be filled out immediately today to establish medical power of attorney.
C) They are legally vulnerable; the patient must complete and file an Advance Directive to
ensure his partner is recognized as his legal surrogate.
