NR 601 FINAL EXAM QUESTIONS &
VERIFIED UPDATED ANSWERS
A 69-year-old female presents to your office for routine primary care. Her elder sister was
recently diagnosed with Alzheimer disease, and she wonders what steps she can take to reduce
her own risk of developing dementia. Which of the following statements about the prevention
of dementia is true?
a. There is moderate quality evidence to support daily use of vitamin B12 and fish oil to prevent
risk of cognitive decline.
b. Risk of dementia is modulated by nonmodifiable risk factors, such as genetics, family history,
and educational attainment, and there are no behavioral interventions that can be taken to
reduce risk of developing dementia.
c. There is moderate quality evidence to suggest control of cardiovascular and metabolic risk
factors, such as blood pressure, weight, and blood sugar, may reduce risk of dementia.
d. There is moderate to low quality evidence supporting cannabinoids maementia.y reduce
rates of pro - correct answer ✔✔c. There is moderate quality evidence to suggest control of
cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may
reduce risk of dementia.
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?
a. Advise them to complete a POLST.
b. Advise them that they have adequate documentation to be recognized legally.
,c. Advise them to file an advanced directive.
d. Respond that although they lack documentation, her partner will be recognized de facto. -
correct answer ✔✔c. Advise them to file an advanced directive.
Healthcare providers should recommend that older adults engage in which one of the
following?
a. 150 minutes of moderate intensity physical activity weekly
b. 20 minutes of moderate intensity physical activity 3 days per week
c. 10 minutes of vigorous physical activity most days of the week
d. 30 minutes of vigorous physical activity 3 days per week - correct answer ✔✔a. 150 minutes
of moderate intensity physical activity weekly
A 78-year-old male was recently diagnosed with Alzheimer disease. He scored 23/30 on his
Montreal Cognitive Assessment (MoCA) and his clinical presentation is consistent with mild
disease. He returns to clinic with his family to discuss possible initiation of pharmacotherapy.
You consider beginning donepezil 5 mg daily for 4 weeks, with a plan to increase to 10 mg daily
if he tolerates the lower dose. Which of the following is not a common side effect of donepezil?
a. Thrombocytopenia
b. Bradycardia
c. Vivid dreams
d. Gastrointestinal distress - correct answer ✔✔a. Thrombocytopenia
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?
a. Urine testing
b. Urine testing, blood testing
c. Urine testing, blood testing, anal swab
d. Urine testing, blood testing, anal swab, and oropharyngeal swab - correct answer ✔✔d. Urine
testing, blood testing, anal swab, and oropharyngeal swab
2. 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.
Which of the following is the most important next step in this patient's primary care?
a. Counseling on starting aspirin
b. Counseling on alcohol cessation
c. Counseling on smoking cessation
d. Counseling on mammogram - correct answer ✔✔c. Counseling on smoking cessation
Which of the following is true about tolterodine?
a. It should be avoided in men with prostatic hypertrophy.
b. It increases the risk of constipation compared with oral oxybutynin.
c. It acts by ablating detrusor spasms.
d. It has greater risk of adverse effects with its twice-daily formulation. - correct answer ✔✔d. 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:
a. Stop hydroc - correct answer ✔✔b. 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?
a. Mrs. A's physician
b. Mrs. A's daughter
c. Day program staff
d. Physical therapist through a home care agency - correct answer ✔✔c. 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?
a. Bladder training
b. Referral for biofeedback training in pelvic muscle exercise
c. Trial of solifenacin
d. Trial of topical estrogen - correct answer ✔✔a. Bladder training
What is the most common cause of erectile dysfunction in older men?
VERIFIED UPDATED ANSWERS
A 69-year-old female presents to your office for routine primary care. Her elder sister was
recently diagnosed with Alzheimer disease, and she wonders what steps she can take to reduce
her own risk of developing dementia. Which of the following statements about the prevention
of dementia is true?
a. There is moderate quality evidence to support daily use of vitamin B12 and fish oil to prevent
risk of cognitive decline.
b. Risk of dementia is modulated by nonmodifiable risk factors, such as genetics, family history,
and educational attainment, and there are no behavioral interventions that can be taken to
reduce risk of developing dementia.
c. There is moderate quality evidence to suggest control of cardiovascular and metabolic risk
factors, such as blood pressure, weight, and blood sugar, may reduce risk of dementia.
d. There is moderate to low quality evidence supporting cannabinoids maementia.y reduce
rates of pro - correct answer ✔✔c. There is moderate quality evidence to suggest control of
cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may
reduce risk of dementia.
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?
a. Advise them to complete a POLST.
b. Advise them that they have adequate documentation to be recognized legally.
,c. Advise them to file an advanced directive.
d. Respond that although they lack documentation, her partner will be recognized de facto. -
correct answer ✔✔c. Advise them to file an advanced directive.
Healthcare providers should recommend that older adults engage in which one of the
following?
a. 150 minutes of moderate intensity physical activity weekly
b. 20 minutes of moderate intensity physical activity 3 days per week
c. 10 minutes of vigorous physical activity most days of the week
d. 30 minutes of vigorous physical activity 3 days per week - correct answer ✔✔a. 150 minutes
of moderate intensity physical activity weekly
A 78-year-old male was recently diagnosed with Alzheimer disease. He scored 23/30 on his
Montreal Cognitive Assessment (MoCA) and his clinical presentation is consistent with mild
disease. He returns to clinic with his family to discuss possible initiation of pharmacotherapy.
You consider beginning donepezil 5 mg daily for 4 weeks, with a plan to increase to 10 mg daily
if he tolerates the lower dose. Which of the following is not a common side effect of donepezil?
a. Thrombocytopenia
b. Bradycardia
c. Vivid dreams
d. Gastrointestinal distress - correct answer ✔✔a. Thrombocytopenia
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?
a. Urine testing
b. Urine testing, blood testing
c. Urine testing, blood testing, anal swab
d. Urine testing, blood testing, anal swab, and oropharyngeal swab - correct answer ✔✔d. Urine
testing, blood testing, anal swab, and oropharyngeal swab
2. 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.
Which of the following is the most important next step in this patient's primary care?
a. Counseling on starting aspirin
b. Counseling on alcohol cessation
c. Counseling on smoking cessation
d. Counseling on mammogram - correct answer ✔✔c. Counseling on smoking cessation
Which of the following is true about tolterodine?
a. It should be avoided in men with prostatic hypertrophy.
b. It increases the risk of constipation compared with oral oxybutynin.
c. It acts by ablating detrusor spasms.
d. It has greater risk of adverse effects with its twice-daily formulation. - correct answer ✔✔d. 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:
a. Stop hydroc - correct answer ✔✔b. 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?
a. Mrs. A's physician
b. Mrs. A's daughter
c. Day program staff
d. Physical therapist through a home care agency - correct answer ✔✔c. 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?
a. Bladder training
b. Referral for biofeedback training in pelvic muscle exercise
c. Trial of solifenacin
d. Trial of topical estrogen - correct answer ✔✔a. Bladder training
What is the most common cause of erectile dysfunction in older men?
