AGNP Midterm exam with correct ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
answers
An 84-year-old woman, lives independently, concerned
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
about driving. On 2 occasions, she had minor collisions
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
when she was backing up her car (she dislodged rearview
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
mirror and struck a fire hydrant, each time on the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
passenger side). ||\\||\\
• History: osteoarthritis of the cervical and lumbar spine
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
and mild hearing impairment
||\\||\\ ||\\||\\ ||\\||\\
• Medications: acetaminophen and calcium plus vitamin D
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• Functional assessment: intact cognition and vision, with
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
near-visual acuity 20/30 in each eye. She fails the whisper ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
test.
• Physical examination: Decreased range of motion in
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
neck and back in all planes (unchanged from previous
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
findings); Diffuse osteoarthritic deformities in the knees ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
and hands; Decreased range of motion at the hips; Mild
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
kyphosis; Motor strength and deep tendon reflexes are ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
symmetric and intact ||\\||\\ ||\\||\\
Which one of the following is the most appropriate next ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
,step?
A. Obtain radiography of the cervical spine in 3 views.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
B. Recommend that she no longer drive.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
C. Refer to physical therapy.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
D. Refer to audiology.
||\\||\\ ||\\||\\ ||\\||\\
E. Refer to occupational therapy.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
E. Refer to occupational therapy.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
An 80-year-old woman hospitalized after fall and hip
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
fracture
• History: stable osteoarthritis of the knees, peripheral
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
neuropathy
• Prior to fall, she lived alone and managed all
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
instrumental activities of daily living; occasionally used ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
cane or walker for mild problems with balance ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• Current status, 4 days after surgery: Needs assistance of
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
2 persons for transfer; Frequently incontinent of urine;
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Eating very little ||\\||\\ ||\\||\\
Which one of the following is the most likely outcome for ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
this patient 6 months after the fracture?
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
A. Continued slow functional decline
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
B. Recovery to her pre-fracture level of function
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
,C. Partial recovery of function
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
D. Stability at the level of function on hospital discharge
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
E. Death ||\\||\\
B. Recovery to her pre-fracture level of function
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
An 85-year-old man with 2 episodes of low-volume
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
urinary incontinence in the last year, when he "waited too ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
long"
• Functional assessment: Near-visual acuity of 20/50 on
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
the right and 20/60 on the left with correction; Fails
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
whisper test in right ear ; Gait speed at usual pace is 0.9 ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
m/sec ; Mini-Cog screen: 2 of 3 items on recall, completes ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
an accurate clock 36 CASE 3 (2 of 3)
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Which one of the following is the most appropriate next ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
step for evaluation of functional disability? A. Refer to
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
audiology.
B. Refer to ophthalmology.
||\\||\\ ||\\||\\ ||\\||\\
C. Refer to physical therapy.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
D. Complete additional cognitive testing.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
E. Complete an incontinence evaluation.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
B. Refer to ophthalmology.
||\\||\\ ||\\||\\ ||\\||\\
, A 68-year-old woman describes vision problems.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• Progressive blurring of distance vision
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• Increased difficulty with nighttime driving, which she
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
attributes to worsening glare and haloes around lights ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• She no longer needs glasses for reading.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• History: hypertension, hypercholesterolemia
||\\||\\ ||\\||\\ ||\\||\\
Which one of the following is the most likely cause of the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
changes in her vision? ||\\||\\ ||\\||\\ ||\\||\\
A. Uncontrolled hypertension
||\\||\\ ||\\||\\
B. Poorly controlled blood glucose C. Choroidal
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
neovascularization
D. Cataract progression
||\\||\\ ||\\||\\
E. Increased intraocular pressure
||\\||\\ ||\\||\\ ||\\||\\
D. Cataract progression
||\\||\\ ||\\||\\
A 72-year-old black man has right shoulder trauma after
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
he fell in a parking lot. He states that he was walking to his
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
car when he suddenly tripped and fell forward onto his
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
arm. He subsequently learned that he had tripped over a
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
curb.
• History: hypertension, high cholesterol, glaucoma
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
answers
An 84-year-old woman, lives independently, concerned
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
about driving. On 2 occasions, she had minor collisions
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
when she was backing up her car (she dislodged rearview
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
mirror and struck a fire hydrant, each time on the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
passenger side). ||\\||\\
• History: osteoarthritis of the cervical and lumbar spine
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
and mild hearing impairment
||\\||\\ ||\\||\\ ||\\||\\
• Medications: acetaminophen and calcium plus vitamin D
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• Functional assessment: intact cognition and vision, with
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
near-visual acuity 20/30 in each eye. She fails the whisper ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
test.
• Physical examination: Decreased range of motion in
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
neck and back in all planes (unchanged from previous
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
findings); Diffuse osteoarthritic deformities in the knees ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
and hands; Decreased range of motion at the hips; Mild
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
kyphosis; Motor strength and deep tendon reflexes are ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
symmetric and intact ||\\||\\ ||\\||\\
Which one of the following is the most appropriate next ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
,step?
A. Obtain radiography of the cervical spine in 3 views.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
B. Recommend that she no longer drive.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
C. Refer to physical therapy.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
D. Refer to audiology.
||\\||\\ ||\\||\\ ||\\||\\
E. Refer to occupational therapy.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
E. Refer to occupational therapy.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
An 80-year-old woman hospitalized after fall and hip
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
fracture
• History: stable osteoarthritis of the knees, peripheral
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
neuropathy
• Prior to fall, she lived alone and managed all
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
instrumental activities of daily living; occasionally used ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
cane or walker for mild problems with balance ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• Current status, 4 days after surgery: Needs assistance of
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
2 persons for transfer; Frequently incontinent of urine;
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Eating very little ||\\||\\ ||\\||\\
Which one of the following is the most likely outcome for ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
this patient 6 months after the fracture?
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
A. Continued slow functional decline
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
B. Recovery to her pre-fracture level of function
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
,C. Partial recovery of function
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
D. Stability at the level of function on hospital discharge
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
E. Death ||\\||\\
B. Recovery to her pre-fracture level of function
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
An 85-year-old man with 2 episodes of low-volume
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
urinary incontinence in the last year, when he "waited too ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
long"
• Functional assessment: Near-visual acuity of 20/50 on
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
the right and 20/60 on the left with correction; Fails
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
whisper test in right ear ; Gait speed at usual pace is 0.9 ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
m/sec ; Mini-Cog screen: 2 of 3 items on recall, completes ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
an accurate clock 36 CASE 3 (2 of 3)
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Which one of the following is the most appropriate next ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
step for evaluation of functional disability? A. Refer to
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
audiology.
B. Refer to ophthalmology.
||\\||\\ ||\\||\\ ||\\||\\
C. Refer to physical therapy.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
D. Complete additional cognitive testing.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
E. Complete an incontinence evaluation.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
B. Refer to ophthalmology.
||\\||\\ ||\\||\\ ||\\||\\
, A 68-year-old woman describes vision problems.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• Progressive blurring of distance vision
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• Increased difficulty with nighttime driving, which she
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
attributes to worsening glare and haloes around lights ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• She no longer needs glasses for reading.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
• History: hypertension, hypercholesterolemia
||\\||\\ ||\\||\\ ||\\||\\
Which one of the following is the most likely cause of the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
changes in her vision? ||\\||\\ ||\\||\\ ||\\||\\
A. Uncontrolled hypertension
||\\||\\ ||\\||\\
B. Poorly controlled blood glucose C. Choroidal
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
neovascularization
D. Cataract progression
||\\||\\ ||\\||\\
E. Increased intraocular pressure
||\\||\\ ||\\||\\ ||\\||\\
D. Cataract progression
||\\||\\ ||\\||\\
A 72-year-old black man has right shoulder trauma after
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
he fell in a parking lot. He states that he was walking to his
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
car when he suddenly tripped and fell forward onto his
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
arm. He subsequently learned that he had tripped over a
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
curb.
• History: hypertension, high cholesterol, glaucoma
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
