NR 509 Final Exam (3 Versions) Questions and Correct
Answers, Updated 2024/2025 Solved 100%
Which of the following is true about the presentation of pain in the older adult?
a. Older patients are more likely to report pain symptoms than younger patients.
b. The prevalence of pain is greater in community-dwelling older adults compared to
those living in nursing homes.
c. The American Geriatrics Society (AGS) prefers the term "persistent pain" over the
term "chronic pain."
d. Pain is often overtreated in the aging population due to overreporting and
exaggeration of symptoms.
e. The majority of pain complaints in this population are due to cardiac or
gastrointestinal (GI) syndromes. - answers-c. The American Geriatrics Society (AGS)
prefers the term "persistent pain" over the term "chronic pain."
Rationale: Because of the negative connotations associated with the phrase "chronic
pain," "persistent pain" is preferred by the AGS as a means of removing stigma from a
serious condition.
Concerning alcohol consumption in older adults, which of the following is true?
a. The CAGE screening for alcohol abuse retains the same sensitivity and specificity it
has for younger populations.
b. The detection of alcohol abuse is higher in older patients than younger patients due
to more frequent ambulatory interactions with health care providers.
c. Symptoms and signs of alcohol abuse are more overt and easier to notice during
outpatient encounters in older patients than in younger patients.
d. Alcohol alone does not cause cognitive impairment in older patients.
e. Alcohol consumption is responsible for 10% of all hospitalizations in patients age >65
years. - answers-a. The CAGE screening for alcohol abuse retains the same sensitivity
and specificity it has for younger populations.
Rationale: This screening tool retains its strong predictive value for detecting alcohol
use in older patients. Only two of four questions must return a "yes" answer for the
screening to be positive. (The CAGE questions ask about Cutting down, Annoyance
when criticized for drinking, Guilty feelings about drinking, and needing Eye openers to
start the day.)
An 80-year-old woman who lives alone at home presents with concerns about
maintaining her independent living status. She continues to drive and care for herself
and her pet dog but reports two falls over the past 4 months. During one fall, she struck
her head, causing a bruise over the right eye. She attributes these episodes to
environmental factors: Once she tripped over a rug, and once she misjudged the depth
of the curb while crossing the street. Which of the following would be the best approach
to this patient?
a. Advise the patient to be more careful and attentive to her surroundings and provide
reassurance that two episodes is not a cause for concern.
,b. Advise her that she may require a walker or a cane to provide better balance.
c. Advise her that falls are associated with aging and that no preventive measures have
proven effective.
d. Perform a comprehensive assessment of fall risk and plan preventive inter - answers-
d. Perform a comprehensive assessment of fall risk and plan preventive interventions.
Rationale: Falls are the leading cause of fatal and nonfatal injuries in patients age >65
years. This patient meets high-risk criteria with two falls in the last year and as such
should undergo a comprehensive evaluation and multi-modal intervention to prevent
future falls.
A 44-year-old female mathematician presents to clinic with a complaint of a mass in the
right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty
because she has only had one mammogram and does not engage in breast self-
examination (BSE) on any regular basis. She has no family history of breast cancer,
and her prior mammogram was ordered as a routine screening test at age 43 years
after a brief discussion with her primary care provider. After a thorough investigation
reveals a benign cyst, what advice should be given to this patient about screening for
breast cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught
and reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of
annual examinations starting at age 30 years.
c. This patient was in compliance with the U.S. Preventive Services Task Fo - answers-
C. This patient was in compliance with the U.S. Preventive Services Task Force
(USPSTF) recommendations for her age group and risk factors prior to her current
complaint.
The USPSTF recommends that women age <50 years discuss risks and benefits with
their provider and decide on appropriate screening for their individual preferences and
needs
A 42-year-old female website developer presents for an annual preventive examination
with questions about breast cancer screening. She is concerned about the radiation
exposure associated with mammography and is interested in magnetic resonance
imaging (MRI) as a possible alternative for routine screening. She is otherwise healthy
with no family history of breast, ovarian, or colon cancer. Which of the following is true
about MRI as a screening modality for breast cancer in the general population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of
specificity.
c. This patient is an ideal candidate for screening via breast MRI based on current
evidence.
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo
screening MRI.
,e. Known BRCA1 or BRCA2 mutation is insufficient cr - answers-b. Sensitivity of
screening for breast cancer increases with breast MRI at the expense of specificity.
Rationale: Sensitivity of screening for breast cancer increases with breast MRI at the
expense of specificity. Increased sensitivity (in this case, higher-resolution imaging to
pick up subtler disease) is often traded for reduced specificity (in the form of discovering
many small items of no pathological significance).
A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple
discharge. This discharge started several weeks ago and has occurred at irregular
intervals since that time. She does not complain of local tenderness, redness, fever, or
any other systemic symptoms aside from slightly irregular periods over the last few
months. On examination, she is able to express a small amount of discharge, which is
sent to the laboratory and found to be consistent with breast milk but without any signs
of blood or pus. Screening laboratories are also sent, which reveal a normal blood
count, metabolic panel, thyroid-stimulating hormone, and human chorionic gonadotropin
(HCG) level. Further laboratories are still pending. Which of the following is the most
likely diagnosis?
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma - answers-e. Prolactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which causes the
production of breast milk and can suppress menstruation.
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass
on breast self-examination (BSE) at home. The mass is nontender without skin
changes, erythema, or overlying swelling. She has heard that most breast cancers are
found by patients themselves, and she is very concerned that she may have breast
cancer. Which of the following is true about BSE and self-detection of breast cancer?
a. Most masses that women find at home and bring to a provider's attention turn out to
be malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess
complicating underlying mastitis.
d. Because of this patient's age, breast masses should not be pursued with imaging and
diagnosis because the risk of cancer is so low.
e. BSE is universally recommended because of very high sensitivity - answers-b. This
patient is more likely to find a fibroadenoma than a cancer on self-examination.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on self-
examination. In this patient's age range (15-25 years), palpable masses are most likely
to be benign fibroadenomas.
, A 48-year-old female psychologist presents to clinic with concerns about her breast
cancer risk after an age-matched cousin was recently diagnosed with this disease. This
cousin is the third family member on her father's side in as many years to be diagnosed
with breast cancer, including the patient's own father, who had surgery and subsequent
treatment 3 years ago for breast cancer. The patient has little other knowledge of her
family history, only that her grandparents independently arrived from Eastern Europe
near the end of World War II and were among very few members of their family that
survived the war. The patient has read about testing for the breast cancer genes
(BRCA1 and BRCA2) and desires further information about whether this would be
appropriate for her. Which of the following is true about this patient's indications for
BRCA testing?
a. Her familial lineage is irrelevant to her risk of BRCA genes and - answers-d. This
patient carries several risk factors that together justify BRCA testing.
Rationale: This patient has both a first-degree male relative with breast cancer and
several relatives in the same lineage with breast cancer. Both of these suggest risk for
the BRCA genes, but the BRCAPRO calculator can further refine the numerical risk and
help decide if screening might be helpful.
A 68-year-old former paleontologist presents to clinic with concerns about her breast
cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A
younger cousin developed the disease a few years ago before the age of 50 years, but
this individual was not tested for the BRCA1 and BRCA2 genes. In addition, the patient
suffered from lymphoma in her 20s and had radiation to the chest. She did take
hormone replacement therapy for a few years before data emerged that this may
contribute to breast cancer risk. She has had several abnormal mammograms in her
50s for persistently dense breasts with subtle findings, but follow-up biopsies never
showed any malignant pathology. Which of the following is true regarding magnetic
resonance imaging (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient such as this one, who has
moderately but not extraordinary risk factors for br - answers-c. Regardless of
recommendations, the high sensitivity of breast MRI comes at the expense of markedly
decreased specificity (i.e., the ability to rule out disease in healthy breasts).
Rationale: Regardless of recommendations, the high sensitivity of breast MRI comes at
the expense of markedly decreased specificity (i.e., the ability to rule out disease in
health breasts). Sensitivity and specificity of screening test are almost always trade-offs;
that is, a test that picks up more true cases is also very likely to then pick up more false
positives, and vice versa.
A 66-year-old female museum curator presents for a routine annual examination. On
examination, a notably enlarged supraclavicular lymph node is appreciated on the right
side. The lymph node is nontender and feels firm and rubbery. She denies any localized
or systemic symptoms such as breast lumps, fevers, or night sweats. She has been
taking conjugated estrogen tablets for 9 years since menopause, though she has not
Answers, Updated 2024/2025 Solved 100%
Which of the following is true about the presentation of pain in the older adult?
a. Older patients are more likely to report pain symptoms than younger patients.
b. The prevalence of pain is greater in community-dwelling older adults compared to
those living in nursing homes.
c. The American Geriatrics Society (AGS) prefers the term "persistent pain" over the
term "chronic pain."
d. Pain is often overtreated in the aging population due to overreporting and
exaggeration of symptoms.
e. The majority of pain complaints in this population are due to cardiac or
gastrointestinal (GI) syndromes. - answers-c. The American Geriatrics Society (AGS)
prefers the term "persistent pain" over the term "chronic pain."
Rationale: Because of the negative connotations associated with the phrase "chronic
pain," "persistent pain" is preferred by the AGS as a means of removing stigma from a
serious condition.
Concerning alcohol consumption in older adults, which of the following is true?
a. The CAGE screening for alcohol abuse retains the same sensitivity and specificity it
has for younger populations.
b. The detection of alcohol abuse is higher in older patients than younger patients due
to more frequent ambulatory interactions with health care providers.
c. Symptoms and signs of alcohol abuse are more overt and easier to notice during
outpatient encounters in older patients than in younger patients.
d. Alcohol alone does not cause cognitive impairment in older patients.
e. Alcohol consumption is responsible for 10% of all hospitalizations in patients age >65
years. - answers-a. The CAGE screening for alcohol abuse retains the same sensitivity
and specificity it has for younger populations.
Rationale: This screening tool retains its strong predictive value for detecting alcohol
use in older patients. Only two of four questions must return a "yes" answer for the
screening to be positive. (The CAGE questions ask about Cutting down, Annoyance
when criticized for drinking, Guilty feelings about drinking, and needing Eye openers to
start the day.)
An 80-year-old woman who lives alone at home presents with concerns about
maintaining her independent living status. She continues to drive and care for herself
and her pet dog but reports two falls over the past 4 months. During one fall, she struck
her head, causing a bruise over the right eye. She attributes these episodes to
environmental factors: Once she tripped over a rug, and once she misjudged the depth
of the curb while crossing the street. Which of the following would be the best approach
to this patient?
a. Advise the patient to be more careful and attentive to her surroundings and provide
reassurance that two episodes is not a cause for concern.
,b. Advise her that she may require a walker or a cane to provide better balance.
c. Advise her that falls are associated with aging and that no preventive measures have
proven effective.
d. Perform a comprehensive assessment of fall risk and plan preventive inter - answers-
d. Perform a comprehensive assessment of fall risk and plan preventive interventions.
Rationale: Falls are the leading cause of fatal and nonfatal injuries in patients age >65
years. This patient meets high-risk criteria with two falls in the last year and as such
should undergo a comprehensive evaluation and multi-modal intervention to prevent
future falls.
A 44-year-old female mathematician presents to clinic with a complaint of a mass in the
right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty
because she has only had one mammogram and does not engage in breast self-
examination (BSE) on any regular basis. She has no family history of breast cancer,
and her prior mammogram was ordered as a routine screening test at age 43 years
after a brief discussion with her primary care provider. After a thorough investigation
reveals a benign cyst, what advice should be given to this patient about screening for
breast cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught
and reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of
annual examinations starting at age 30 years.
c. This patient was in compliance with the U.S. Preventive Services Task Fo - answers-
C. This patient was in compliance with the U.S. Preventive Services Task Force
(USPSTF) recommendations for her age group and risk factors prior to her current
complaint.
The USPSTF recommends that women age <50 years discuss risks and benefits with
their provider and decide on appropriate screening for their individual preferences and
needs
A 42-year-old female website developer presents for an annual preventive examination
with questions about breast cancer screening. She is concerned about the radiation
exposure associated with mammography and is interested in magnetic resonance
imaging (MRI) as a possible alternative for routine screening. She is otherwise healthy
with no family history of breast, ovarian, or colon cancer. Which of the following is true
about MRI as a screening modality for breast cancer in the general population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of
specificity.
c. This patient is an ideal candidate for screening via breast MRI based on current
evidence.
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo
screening MRI.
,e. Known BRCA1 or BRCA2 mutation is insufficient cr - answers-b. Sensitivity of
screening for breast cancer increases with breast MRI at the expense of specificity.
Rationale: Sensitivity of screening for breast cancer increases with breast MRI at the
expense of specificity. Increased sensitivity (in this case, higher-resolution imaging to
pick up subtler disease) is often traded for reduced specificity (in the form of discovering
many small items of no pathological significance).
A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple
discharge. This discharge started several weeks ago and has occurred at irregular
intervals since that time. She does not complain of local tenderness, redness, fever, or
any other systemic symptoms aside from slightly irregular periods over the last few
months. On examination, she is able to express a small amount of discharge, which is
sent to the laboratory and found to be consistent with breast milk but without any signs
of blood or pus. Screening laboratories are also sent, which reveal a normal blood
count, metabolic panel, thyroid-stimulating hormone, and human chorionic gonadotropin
(HCG) level. Further laboratories are still pending. Which of the following is the most
likely diagnosis?
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma - answers-e. Prolactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which causes the
production of breast milk and can suppress menstruation.
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass
on breast self-examination (BSE) at home. The mass is nontender without skin
changes, erythema, or overlying swelling. She has heard that most breast cancers are
found by patients themselves, and she is very concerned that she may have breast
cancer. Which of the following is true about BSE and self-detection of breast cancer?
a. Most masses that women find at home and bring to a provider's attention turn out to
be malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess
complicating underlying mastitis.
d. Because of this patient's age, breast masses should not be pursued with imaging and
diagnosis because the risk of cancer is so low.
e. BSE is universally recommended because of very high sensitivity - answers-b. This
patient is more likely to find a fibroadenoma than a cancer on self-examination.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on self-
examination. In this patient's age range (15-25 years), palpable masses are most likely
to be benign fibroadenomas.
, A 48-year-old female psychologist presents to clinic with concerns about her breast
cancer risk after an age-matched cousin was recently diagnosed with this disease. This
cousin is the third family member on her father's side in as many years to be diagnosed
with breast cancer, including the patient's own father, who had surgery and subsequent
treatment 3 years ago for breast cancer. The patient has little other knowledge of her
family history, only that her grandparents independently arrived from Eastern Europe
near the end of World War II and were among very few members of their family that
survived the war. The patient has read about testing for the breast cancer genes
(BRCA1 and BRCA2) and desires further information about whether this would be
appropriate for her. Which of the following is true about this patient's indications for
BRCA testing?
a. Her familial lineage is irrelevant to her risk of BRCA genes and - answers-d. This
patient carries several risk factors that together justify BRCA testing.
Rationale: This patient has both a first-degree male relative with breast cancer and
several relatives in the same lineage with breast cancer. Both of these suggest risk for
the BRCA genes, but the BRCAPRO calculator can further refine the numerical risk and
help decide if screening might be helpful.
A 68-year-old former paleontologist presents to clinic with concerns about her breast
cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A
younger cousin developed the disease a few years ago before the age of 50 years, but
this individual was not tested for the BRCA1 and BRCA2 genes. In addition, the patient
suffered from lymphoma in her 20s and had radiation to the chest. She did take
hormone replacement therapy for a few years before data emerged that this may
contribute to breast cancer risk. She has had several abnormal mammograms in her
50s for persistently dense breasts with subtle findings, but follow-up biopsies never
showed any malignant pathology. Which of the following is true regarding magnetic
resonance imaging (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient such as this one, who has
moderately but not extraordinary risk factors for br - answers-c. Regardless of
recommendations, the high sensitivity of breast MRI comes at the expense of markedly
decreased specificity (i.e., the ability to rule out disease in healthy breasts).
Rationale: Regardless of recommendations, the high sensitivity of breast MRI comes at
the expense of markedly decreased specificity (i.e., the ability to rule out disease in
health breasts). Sensitivity and specificity of screening test are almost always trade-offs;
that is, a test that picks up more true cases is also very likely to then pick up more false
positives, and vice versa.
A 66-year-old female museum curator presents for a routine annual examination. On
examination, a notably enlarged supraclavicular lymph node is appreciated on the right
side. The lymph node is nontender and feels firm and rubbery. She denies any localized
or systemic symptoms such as breast lumps, fevers, or night sweats. She has been
taking conjugated estrogen tablets for 9 years since menopause, though she has not
