NR 601: Chamberlain Geriatric Class
chapter questions for the final
1. 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
Answer: c
. 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
,Answer: c
3. 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
Answer: d
1. 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.
Answer: d
2. 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 hydrocodone-acetaminophen and add naproxen
b. Stop amlodipine and increase lisinopril.
c. Add afternoon furosemide.
d. Add tamsulosin.
Answer: b
3. 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
Answer: c
, 4. 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
Answer: a
1. What is the most common cause of erectile dysfunction in older men?
a. Psychological stress
b. Adverse drug reaction
c. Atherosclerosis
d. Autonomic neuropathy
Answer: c
2. Which is the most reasonable first step in the treatment of older men with erectile
dysfunction?
a. Sex therapy
b. Testosterone
c. Yohimbine
d. Sildenafil
chapter questions for the final
1. 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
Answer: c
. 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
,Answer: c
3. 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
Answer: d
1. 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.
Answer: d
2. 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 hydrocodone-acetaminophen and add naproxen
b. Stop amlodipine and increase lisinopril.
c. Add afternoon furosemide.
d. Add tamsulosin.
Answer: b
3. 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
Answer: c
, 4. 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
Answer: a
1. What is the most common cause of erectile dysfunction in older men?
a. Psychological stress
b. Adverse drug reaction
c. Atherosclerosis
d. Autonomic neuropathy
Answer: c
2. Which is the most reasonable first step in the treatment of older men with erectile
dysfunction?
a. Sex therapy
b. Testosterone
c. Yohimbine
d. Sildenafil
