NR 601 FINAL EXAM LATEST CONTAINS
QUESTIONS & ANSWERS| NEWEST VERSION
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? - CORRECT ANSWER >> Advise them to file an
advanced directive.
. 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. - CORRECT ANSWER >> Counseling on
smoking cessation
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? - CORRECT ANSWER >> Urine testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine? - CORRECT ANSWER >> 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: - CORRECT ANSWER >> 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? - CORRECT ANSWER >> 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? -
CORRECT ANSWER
>> Bladder training
What is the most common cause of erectile dysfunction in older men? - CORRECT ANSWER >>
Atherosclerosis
Which is the most reasonable first step in the treatment of older men with erectile dysfunction? -
CORRECT ANSWER >> Sildenafil
A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history includes
type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide, chlorthalidone, and
acetaminophen. What would be your first step in therapy? - CORRECT ANSWER >> Stop
chlorthalidone
, A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of
her problem? - CORRECT ANSWER >> High-tone pelvic floor dysfunction
A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed
ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor
1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with cancer. Sentinel
lymph node sampling was negative for lymph node involvement. She has good performance status
and no activities of daily living (ADL) or instrumental (IADL) dependencies. What treatment would
you recommend? - CORRECT ANSWER >> Hormonal therapy only
An 86-year-old man with no ADL deficits who has stopped driving because of macular degeneration is
evaluated for a urinary tract infection associated with urinary retention. The consulting urologist
places a Foley catheter and sends a prostate-specific antigen (PSA) level that comes back 12 ng/mL.
Three months later after the Foley has been removed and he has had a good response to tamsulosin,
his PSA is still 10 ng/mL. What is the appropriate next step in managing this man's prostate problem?
- CORRECT ANSWER >> Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival? -
CORRECT ANSWER >> A 78-year-old man who had a radical prostatectomy and external beam
radiation therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows
an enlarged pelvic lymph node, and a bone scan is positive in the pelvis.
On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her right
breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the arm and
obvious pain. The patient has no children and had lived alone until recently, when a neighbor became
concerned for what appeared to be a progressive loss of memory and neglect of the house. A nephew
living in another city eventually came to take care of the situation and arranged for the admission.
The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be
independent in her ADLs. The medical history is negative for any serious illnesses. She was able to
drive her own car until shortly before this admission. The nephew does not wish to authorize hospice
"right now." A positron-emission tomography scan was negative for metastatic disease. In addition to
determining the cause of her deliri - CORRECT ANSWER >> The mass should be biopsied to study
hormone receptor and HER2/neu antigen status.
A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized
colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for
metastatic sampling. The patient wants to know if he should have chemotherapy. Should he? -
CORRECT ANSWER
>> No because he can be followed with serial carcinoembryonic antigens and CT scans.
QUESTIONS & ANSWERS| NEWEST VERSION
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? - CORRECT ANSWER >> Advise them to file an
advanced directive.
. 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. - CORRECT ANSWER >> Counseling on
smoking cessation
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? - CORRECT ANSWER >> Urine testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine? - CORRECT ANSWER >> 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: - CORRECT ANSWER >> 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? - CORRECT ANSWER >> 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? -
CORRECT ANSWER
>> Bladder training
What is the most common cause of erectile dysfunction in older men? - CORRECT ANSWER >>
Atherosclerosis
Which is the most reasonable first step in the treatment of older men with erectile dysfunction? -
CORRECT ANSWER >> Sildenafil
A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history includes
type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide, chlorthalidone, and
acetaminophen. What would be your first step in therapy? - CORRECT ANSWER >> Stop
chlorthalidone
, A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of
her problem? - CORRECT ANSWER >> High-tone pelvic floor dysfunction
A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed
ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor
1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with cancer. Sentinel
lymph node sampling was negative for lymph node involvement. She has good performance status
and no activities of daily living (ADL) or instrumental (IADL) dependencies. What treatment would
you recommend? - CORRECT ANSWER >> Hormonal therapy only
An 86-year-old man with no ADL deficits who has stopped driving because of macular degeneration is
evaluated for a urinary tract infection associated with urinary retention. The consulting urologist
places a Foley catheter and sends a prostate-specific antigen (PSA) level that comes back 12 ng/mL.
Three months later after the Foley has been removed and he has had a good response to tamsulosin,
his PSA is still 10 ng/mL. What is the appropriate next step in managing this man's prostate problem?
- CORRECT ANSWER >> Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival? -
CORRECT ANSWER >> A 78-year-old man who had a radical prostatectomy and external beam
radiation therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows
an enlarged pelvic lymph node, and a bone scan is positive in the pelvis.
On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her right
breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the arm and
obvious pain. The patient has no children and had lived alone until recently, when a neighbor became
concerned for what appeared to be a progressive loss of memory and neglect of the house. A nephew
living in another city eventually came to take care of the situation and arranged for the admission.
The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be
independent in her ADLs. The medical history is negative for any serious illnesses. She was able to
drive her own car until shortly before this admission. The nephew does not wish to authorize hospice
"right now." A positron-emission tomography scan was negative for metastatic disease. In addition to
determining the cause of her deliri - CORRECT ANSWER >> The mass should be biopsied to study
hormone receptor and HER2/neu antigen status.
A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized
colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for
metastatic sampling. The patient wants to know if he should have chemotherapy. Should he? -
CORRECT ANSWER
>> No because he can be followed with serial carcinoembryonic antigens and CT scans.
