NR 509 EXAM
1. Which of the following changes are expected in vision as part of the normal aging
process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision
Ans: D
The lens loses its elasticity over time as part of the normal aging process, and the eye
is less able to accommodate and focus on near objects; therefore, the patient will be
expected to have blurring of near vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of
hearing loss. He has noticed some decreased ability to hear what his wife and
grandchildren are saying to him. He admits to lip-reading more. He has a history of
noise exposure in his young adult years: He worked as a sound engineer at a local
arena and had to attend a lot of concerts. Based on this information, what is the
most likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
,D) Increase of acuity for high-range sounds
Ans: A
Human speech is considered to be a middle-range sound. During the aging process
there is a loss of acuity, starting with high-pitched sounds but extending to the
middle range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with
urination; he gets up five to six times per night to urinate and has to go at least that
often in the daytime. He does not feel as if his bladder empties completely; the
strength of the urinary stream is diminished. He denies dysuria or hematuria. This
problem has been present for several years but has worsened over the last 8 months.
You palpate his prostate. What is your expected physical examination finding, based
on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy
Ans: C
This is the expected physical examination finding in benign prostatic hyperplasia
(BPH).
, 4. A 70-year-old retired auto mechanic comes to your office because his neighbor is
concerned about his memory. The patient himself admits to misplacing his keys
more often and forgets what he is supposed to buy from the grocery store and where
he has parked the car. He denies getting lost in familiar places. Upon further
questioning, he states that his wife of 40 years died 8 months ago; his three children
live in three different states; and he has limited his activities because the people he
interacted with were "his wife's friends, not his." He drinks a six-pack of beer daily; he
does not smoke or use illicit drugs. You perform a mini-mental state examination and
obtain a total score of 24 out of 28. Based on this information, what is your most
likely diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression
Ans: D
The patient has symptoms of depression: His wife died, he has no real social support
system, and he has isolated himself from his usual activities. He also drinks a
considerable amount of alcohol on a daily basis, which can further depress his
mood. Depression can masquerade as dementia in the elderly and must be
considered in a patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness.
You obtain a complete history, perform a thorough physical examination, and order
laboratory tests. You diagnose her with hyperthyroidism. Based on her age, which of
the atypical symptoms of hyperthyroidism is more likely to be seen?
A) Fatigue
1. Which of the following changes are expected in vision as part of the normal aging
process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision
Ans: D
The lens loses its elasticity over time as part of the normal aging process, and the eye
is less able to accommodate and focus on near objects; therefore, the patient will be
expected to have blurring of near vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of
hearing loss. He has noticed some decreased ability to hear what his wife and
grandchildren are saying to him. He admits to lip-reading more. He has a history of
noise exposure in his young adult years: He worked as a sound engineer at a local
arena and had to attend a lot of concerts. Based on this information, what is the
most likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
,D) Increase of acuity for high-range sounds
Ans: A
Human speech is considered to be a middle-range sound. During the aging process
there is a loss of acuity, starting with high-pitched sounds but extending to the
middle range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with
urination; he gets up five to six times per night to urinate and has to go at least that
often in the daytime. He does not feel as if his bladder empties completely; the
strength of the urinary stream is diminished. He denies dysuria or hematuria. This
problem has been present for several years but has worsened over the last 8 months.
You palpate his prostate. What is your expected physical examination finding, based
on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy
Ans: C
This is the expected physical examination finding in benign prostatic hyperplasia
(BPH).
, 4. A 70-year-old retired auto mechanic comes to your office because his neighbor is
concerned about his memory. The patient himself admits to misplacing his keys
more often and forgets what he is supposed to buy from the grocery store and where
he has parked the car. He denies getting lost in familiar places. Upon further
questioning, he states that his wife of 40 years died 8 months ago; his three children
live in three different states; and he has limited his activities because the people he
interacted with were "his wife's friends, not his." He drinks a six-pack of beer daily; he
does not smoke or use illicit drugs. You perform a mini-mental state examination and
obtain a total score of 24 out of 28. Based on this information, what is your most
likely diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression
Ans: D
The patient has symptoms of depression: His wife died, he has no real social support
system, and he has isolated himself from his usual activities. He also drinks a
considerable amount of alcohol on a daily basis, which can further depress his
mood. Depression can masquerade as dementia in the elderly and must be
considered in a patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness.
You obtain a complete history, perform a thorough physical examination, and order
laboratory tests. You diagnose her with hyperthyroidism. Based on her age, which of
the atypical symptoms of hyperthyroidism is more likely to be seen?
A) Fatigue
