,
,
,(a) create stand-alone clinics.
(b) decrease billable visits.
(c) increase risks to patients.
(d) open access to care.
(d) open access to care.
The adult-gerontology primary care nurse practitioner evaluates an 80-year-old patient with
cognitive deficits, who is unaccompanied by the adult child who typically is present. The patient
has urinary symptoms, for which the nurse practitioner considers ordering sulfamethoxazole-
trimethoprim (Bactrim). The patient's previous medical record is unavailable. Before prescribing
the medication, the nurse practitioner:
(a) contacts the patient's adult child.
(b) queries the other staff members.
(c) relies on the patient's self-report.
(d) waits until the patient's chart is available.
(a) contacts the patient's adult child.
The adult-gerontology primary care nurse practitioner conducts a small group class on weight
management. The nurse practitioner anticipates that the patient who may have the greatest
difficulty implementing the counseling is the:
(a) extroverted patient raising his or her grandchildren.
(b) introverted patient who does not speak in the group.
(c) personable patient who lives with his or her children.
(d) worried patient whose son is serving in military conflict.
(d) worried patient whose son is serving in military conflict.
The adult-gerontology primary care nurse practitioner evaluates a patient with cold symptoms
who reports smoking half a pack of cigarettes a day and shows no interest in quitting. The nurse
practitioner's most appropriate approach is to treat the cold symptoms and:
(a) advise the patient to stop smoking.
,(b) prescribe bupropion (Zyban).
(c) raise the issue of smoking cessation at the next visit.
(d) recommend that the patient select a low nicotine cigarette.
(a) advise the patient to stop smoking.
The adult-gerontology primary care nurse practitioner plans to provide smoking cessation
education at a community center to older adults and their families. The nurse practitioner designs
the program based on knowledge that older adult smokers:
(a) are likely to be optimistic about their ability to quit.
(b) are more likely to be successful at quitting than younger smokers.
(c) have a decreased risk of morbidity and mortality than do younger smokers.
(d) receive more instruction to quit from health care providers than younger smokers.
(b) are more likely to be successful at quitting than younger smokers.
An 84-year-old patient arrives at the office for an initial visit. The patient questions the need for
colorectal screening, since 10 years have passed since the last colonoscopy. The adult-
gerontology primary care nurse practitioner recommends:
(a) a colonoscopy.
(b) a fecal DNA test.
(c) flexible sigmoidoscopy.
(d) watchful waiting.
(d) watchful waiting.
To evaluate for heart failure, which diagnostic test does the adult-gerontology primary care nurse
practitioner order for a patient with swelling in the lower extremities?
(a) Ankle-brachial index.
(b) Brain natriuretic peptide test.
(c) D-dimer assay.
(d) Spirometry study.
(b) Brain natriuretic peptide test.
,Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which
laboratory values does the adult-gerontology primary care nurse practitioner obtain?
(a) Liver function studies.
(b) Platelet count.
(c) Renal function studies.
(d) White blood cell count.
(a) Liver function studies.
A 30-year-old, female patient has a two-week history of nausea, vomiting, decreased weight,
abdominal pain, and a long-term history of multiple sexual partners. The patient's physical
examination reveals abdominal tenderness with icteric sclerae and skin. Which laboratory test
confirms active hepatitis B?
(a) Antibody.
(b) Enzyme-linked immunosorbent assay.
(c) Immune globulin G.
(d) Surface antigen.
(d) Surface antigen.
For two to three months, a 78-year-old patient has not been taking levothyroxine (Synthroid) as
prescribed. The patient now has symptoms of increasing constipation, lethargy, and weakness.
The adult-gerontology primary care nurse practitioner anticipates that laboratory tests will show
that the patient's:
(a) T4 level decreased, and TSH level increased.
(b) T4 level increased, and TSH level decreased.
(c) T4 level increased, and TSH level is unchanged.
(d) T4 level is unchanged, and TSH level decreased.
(a) T4 level decreased, and TSH level increased.
A 68-year-old patient has sustained an unintended weight loss of 15 lb (6.8 kg) over the last two
months but reports feeling well. The patient's problems include depression, tobacco abuse,
obesity, and dyslipidemia. His or her medications are sertralizine (Zoloft), simvastatin (Zocor),
,and famotidine (Pepcid). The adult-gerontology primary care nurse practitioner performs which
THREE actions?
(a) Adds a probiotic.
(b) Conducts a depression screening.
(c) Decreases the dosage of the statin medication.
(d) Obtains a chest x-ray.
(e) Orders a thyroid-stimulating hormone.
(b) Conducts a depression screening.
(d) Obtains a chest x-ray.
(e) Orders a thyroid-stimulating hormone.
Preparing to implement an incontinence reduction program at a nursing home, the adult-
gerontology primary care nurse practitioner reviews several studies. Place the studies in
sequential order of the strength of evidence for this population from strongest to weakest.
(a) A case report of an experimental incontinence reduction program in older adults.
(b) A consensus statement from the urologic association regarding the use of scheduled toileting.
(c) A systematic review of nonrandomized trials concerning the use of vaginal estrogen.
Strongest evidence: (c) a systematic review
...then: (b) a consensus statement
Weakest evidence: (a) a case report
What factors does the adult-gerontology primary care nurse practitioner need to consider when
discussing advanced care planning with a patient?
(a) Autonomy and patient safety are rarely competitive considerations.
(b) Decisions regarding a health care representative are a family group decision.
,(c) Family members are not integral components in care planning.
(d) Trust and rapport with patients are key to patient satisfaction in decisions for care.
(d) Trust and rapport with patients are key to patient satisfaction in decisions for care.
The adult-gerontology primary care nurse practitioner working in an urban community health
center recognizes that asthma-related health issues commonly result in higher morbidity and
mortality for persons with:
(a) alcohol dependency.
(b) lower socioeconomic status.
(c) persistent social isolation.
(d) recent immigrant status.
(b) lower socioeconomic status.
During an annual health visit, a 15-year-old female patient is found to have grown 5 in (12.7 cm)
over the past year. She has not reached menarche. Her mother is concerned because the patient's
sister reached menarche at age 11 and the mother reached menarche at age 12. Examination
reveals that the patient's breasts are enlarged, with the areolae forming a mound above the
general contour of each breast, and that the left breast is larger than the right. Axillary hair is
absent and the pubic hair is dark, coarse, curly, dense, and similar in pattern to that of an adult
female. These findings are consistent with a diagnosis of:
(a) hypothyroidism.
(b) normal development.
(c) polycystic ovary syndrome.
(d) Turner syndrome.
(b) normal development.
A pale, thin 54-year-old male patient reports a two-month history of numbness in his feet. Past
medical history includes hypertension and a subtotal gastrectomy. An examination reveals a
decreased vibratory sensation and position sense. Blood tests indicate a hematocrit of 27%, mean
corpuscular volume of 105 fL, mean corpuscular hemoglobin of 45 pg, and reticulocytes of
1.5%. The diagnosis is:
(a) chronic simple anemia.
(b) folate deficiency anemia.
,(c) iron deficiency anemia.
(d) vitamin B12 deficiency anemia.
(d) vitamin B12 deficiency anemia.
Upon referral from a gynecologist, an adult nurse practitioner evaluates an 89-year-old female
nursing home resident for vaginal bleeding. The patient has a history of occasional periods of
confusion and memory loss. The gynecologist recommended dilation and curettage and the
patient consented to the procedure after the gynecologist answered her questions, but the
patient's daughter protests. The nurse practitioner's ethical duty is to support the:
(a) daughter, because she might file a lawsuit over unsatisfactory care.
(b) daughter, because the patient is occasionally confused and incapable of granting informed
consent.
(c) nursing home administration, which may choose to support either the patient or the daughter.
(d) patient, who has given informed consent.
(d) patient, who has given informed consent.
A 16-year-old patient has been diagnosed with mononucleosis and has a positive throat culture
for group Alpha-hemolytic streptococcal infection. The medication of choice for this patient is:
(a) amoxicillin (Amoxil).
(b) doxycycline (Vibramycin).
(c) erythromycin (E-Mycin).
(d) trimethoprim-sulfamethoxazole (Bactrim).
(c) erythromycin (E-Mycin).
A 70-year-old patient reports fatigue and a nonproductive cough with pain on inspiration and
expiration. The patient denies a sore throat, fever, nasal congestion, or postnasal drip.
Examination reveals a well-developed patient in no acute distress who is afebrile and has
respirations of 32 breaths/min. The patient's lungs have diminished breath sounds. The heart rate
is 70 beats/min, regular with no murmur. There is no edema of the extremities. An adult nurse
practitioner orders:
(a) a chest x-ray.
, (b) a lung perfusion scan.
(c) over-the-counter treatments for symptomatic relief.
(d) pulmonary function tests.
(a) a chest x-ray.
An adult nurse practitioner is educating a female patient about her newly diagnosed phobia. The
nurse practitioner explains that phobias differ from other anxiety disorders in that phobias:
(a) are innate and can be prevented.
(b) are related to specific trigger experiences.
(c) occur at a later age.
(d) often involve depressive symptoms.
(b) are related to specific trigger experiences.
A 78-year-old male patient comes to the ambulatory care clinic and reports an inability to void.
The adult nurse practitioner has difficulty inserting a urinary catheter due to an obstruction. The
nurse practitioner's action is to:
(a) obtain consent from the patient to perform prostatic massage.
(b) perform a suprapubic aspiration to relieve bladder distention.
(c) prescribe an oral loop diuretic.
(d) refer the patient to a urologist for further treatment.
(d) refer the patient to a urologist for further treatment.
A patient comes to the clinic with reports of acute pain and loss of vision in the right eye. The
adult nurse practitioner informs the patient that these symptoms require:
(a) assessment with a split lamp.
(b) examination with an otoscope.
,
,(a) create stand-alone clinics.
(b) decrease billable visits.
(c) increase risks to patients.
(d) open access to care.
(d) open access to care.
The adult-gerontology primary care nurse practitioner evaluates an 80-year-old patient with
cognitive deficits, who is unaccompanied by the adult child who typically is present. The patient
has urinary symptoms, for which the nurse practitioner considers ordering sulfamethoxazole-
trimethoprim (Bactrim). The patient's previous medical record is unavailable. Before prescribing
the medication, the nurse practitioner:
(a) contacts the patient's adult child.
(b) queries the other staff members.
(c) relies on the patient's self-report.
(d) waits until the patient's chart is available.
(a) contacts the patient's adult child.
The adult-gerontology primary care nurse practitioner conducts a small group class on weight
management. The nurse practitioner anticipates that the patient who may have the greatest
difficulty implementing the counseling is the:
(a) extroverted patient raising his or her grandchildren.
(b) introverted patient who does not speak in the group.
(c) personable patient who lives with his or her children.
(d) worried patient whose son is serving in military conflict.
(d) worried patient whose son is serving in military conflict.
The adult-gerontology primary care nurse practitioner evaluates a patient with cold symptoms
who reports smoking half a pack of cigarettes a day and shows no interest in quitting. The nurse
practitioner's most appropriate approach is to treat the cold symptoms and:
(a) advise the patient to stop smoking.
,(b) prescribe bupropion (Zyban).
(c) raise the issue of smoking cessation at the next visit.
(d) recommend that the patient select a low nicotine cigarette.
(a) advise the patient to stop smoking.
The adult-gerontology primary care nurse practitioner plans to provide smoking cessation
education at a community center to older adults and their families. The nurse practitioner designs
the program based on knowledge that older adult smokers:
(a) are likely to be optimistic about their ability to quit.
(b) are more likely to be successful at quitting than younger smokers.
(c) have a decreased risk of morbidity and mortality than do younger smokers.
(d) receive more instruction to quit from health care providers than younger smokers.
(b) are more likely to be successful at quitting than younger smokers.
An 84-year-old patient arrives at the office for an initial visit. The patient questions the need for
colorectal screening, since 10 years have passed since the last colonoscopy. The adult-
gerontology primary care nurse practitioner recommends:
(a) a colonoscopy.
(b) a fecal DNA test.
(c) flexible sigmoidoscopy.
(d) watchful waiting.
(d) watchful waiting.
To evaluate for heart failure, which diagnostic test does the adult-gerontology primary care nurse
practitioner order for a patient with swelling in the lower extremities?
(a) Ankle-brachial index.
(b) Brain natriuretic peptide test.
(c) D-dimer assay.
(d) Spirometry study.
(b) Brain natriuretic peptide test.
,Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which
laboratory values does the adult-gerontology primary care nurse practitioner obtain?
(a) Liver function studies.
(b) Platelet count.
(c) Renal function studies.
(d) White blood cell count.
(a) Liver function studies.
A 30-year-old, female patient has a two-week history of nausea, vomiting, decreased weight,
abdominal pain, and a long-term history of multiple sexual partners. The patient's physical
examination reveals abdominal tenderness with icteric sclerae and skin. Which laboratory test
confirms active hepatitis B?
(a) Antibody.
(b) Enzyme-linked immunosorbent assay.
(c) Immune globulin G.
(d) Surface antigen.
(d) Surface antigen.
For two to three months, a 78-year-old patient has not been taking levothyroxine (Synthroid) as
prescribed. The patient now has symptoms of increasing constipation, lethargy, and weakness.
The adult-gerontology primary care nurse practitioner anticipates that laboratory tests will show
that the patient's:
(a) T4 level decreased, and TSH level increased.
(b) T4 level increased, and TSH level decreased.
(c) T4 level increased, and TSH level is unchanged.
(d) T4 level is unchanged, and TSH level decreased.
(a) T4 level decreased, and TSH level increased.
A 68-year-old patient has sustained an unintended weight loss of 15 lb (6.8 kg) over the last two
months but reports feeling well. The patient's problems include depression, tobacco abuse,
obesity, and dyslipidemia. His or her medications are sertralizine (Zoloft), simvastatin (Zocor),
,and famotidine (Pepcid). The adult-gerontology primary care nurse practitioner performs which
THREE actions?
(a) Adds a probiotic.
(b) Conducts a depression screening.
(c) Decreases the dosage of the statin medication.
(d) Obtains a chest x-ray.
(e) Orders a thyroid-stimulating hormone.
(b) Conducts a depression screening.
(d) Obtains a chest x-ray.
(e) Orders a thyroid-stimulating hormone.
Preparing to implement an incontinence reduction program at a nursing home, the adult-
gerontology primary care nurse practitioner reviews several studies. Place the studies in
sequential order of the strength of evidence for this population from strongest to weakest.
(a) A case report of an experimental incontinence reduction program in older adults.
(b) A consensus statement from the urologic association regarding the use of scheduled toileting.
(c) A systematic review of nonrandomized trials concerning the use of vaginal estrogen.
Strongest evidence: (c) a systematic review
...then: (b) a consensus statement
Weakest evidence: (a) a case report
What factors does the adult-gerontology primary care nurse practitioner need to consider when
discussing advanced care planning with a patient?
(a) Autonomy and patient safety are rarely competitive considerations.
(b) Decisions regarding a health care representative are a family group decision.
,(c) Family members are not integral components in care planning.
(d) Trust and rapport with patients are key to patient satisfaction in decisions for care.
(d) Trust and rapport with patients are key to patient satisfaction in decisions for care.
The adult-gerontology primary care nurse practitioner working in an urban community health
center recognizes that asthma-related health issues commonly result in higher morbidity and
mortality for persons with:
(a) alcohol dependency.
(b) lower socioeconomic status.
(c) persistent social isolation.
(d) recent immigrant status.
(b) lower socioeconomic status.
During an annual health visit, a 15-year-old female patient is found to have grown 5 in (12.7 cm)
over the past year. She has not reached menarche. Her mother is concerned because the patient's
sister reached menarche at age 11 and the mother reached menarche at age 12. Examination
reveals that the patient's breasts are enlarged, with the areolae forming a mound above the
general contour of each breast, and that the left breast is larger than the right. Axillary hair is
absent and the pubic hair is dark, coarse, curly, dense, and similar in pattern to that of an adult
female. These findings are consistent with a diagnosis of:
(a) hypothyroidism.
(b) normal development.
(c) polycystic ovary syndrome.
(d) Turner syndrome.
(b) normal development.
A pale, thin 54-year-old male patient reports a two-month history of numbness in his feet. Past
medical history includes hypertension and a subtotal gastrectomy. An examination reveals a
decreased vibratory sensation and position sense. Blood tests indicate a hematocrit of 27%, mean
corpuscular volume of 105 fL, mean corpuscular hemoglobin of 45 pg, and reticulocytes of
1.5%. The diagnosis is:
(a) chronic simple anemia.
(b) folate deficiency anemia.
,(c) iron deficiency anemia.
(d) vitamin B12 deficiency anemia.
(d) vitamin B12 deficiency anemia.
Upon referral from a gynecologist, an adult nurse practitioner evaluates an 89-year-old female
nursing home resident for vaginal bleeding. The patient has a history of occasional periods of
confusion and memory loss. The gynecologist recommended dilation and curettage and the
patient consented to the procedure after the gynecologist answered her questions, but the
patient's daughter protests. The nurse practitioner's ethical duty is to support the:
(a) daughter, because she might file a lawsuit over unsatisfactory care.
(b) daughter, because the patient is occasionally confused and incapable of granting informed
consent.
(c) nursing home administration, which may choose to support either the patient or the daughter.
(d) patient, who has given informed consent.
(d) patient, who has given informed consent.
A 16-year-old patient has been diagnosed with mononucleosis and has a positive throat culture
for group Alpha-hemolytic streptococcal infection. The medication of choice for this patient is:
(a) amoxicillin (Amoxil).
(b) doxycycline (Vibramycin).
(c) erythromycin (E-Mycin).
(d) trimethoprim-sulfamethoxazole (Bactrim).
(c) erythromycin (E-Mycin).
A 70-year-old patient reports fatigue and a nonproductive cough with pain on inspiration and
expiration. The patient denies a sore throat, fever, nasal congestion, or postnasal drip.
Examination reveals a well-developed patient in no acute distress who is afebrile and has
respirations of 32 breaths/min. The patient's lungs have diminished breath sounds. The heart rate
is 70 beats/min, regular with no murmur. There is no edema of the extremities. An adult nurse
practitioner orders:
(a) a chest x-ray.
, (b) a lung perfusion scan.
(c) over-the-counter treatments for symptomatic relief.
(d) pulmonary function tests.
(a) a chest x-ray.
An adult nurse practitioner is educating a female patient about her newly diagnosed phobia. The
nurse practitioner explains that phobias differ from other anxiety disorders in that phobias:
(a) are innate and can be prevented.
(b) are related to specific trigger experiences.
(c) occur at a later age.
(d) often involve depressive symptoms.
(b) are related to specific trigger experiences.
A 78-year-old male patient comes to the ambulatory care clinic and reports an inability to void.
The adult nurse practitioner has difficulty inserting a urinary catheter due to an obstruction. The
nurse practitioner's action is to:
(a) obtain consent from the patient to perform prostatic massage.
(b) perform a suprapubic aspiration to relieve bladder distention.
(c) prescribe an oral loop diuretic.
(d) refer the patient to a urologist for further treatment.
(d) refer the patient to a urologist for further treatment.
A patient comes to the clinic with reports of acute pain and loss of vision in the right eye. The
adult nurse practitioner informs the patient that these symptoms require:
(a) assessment with a split lamp.
(b) examination with an otoscope.
