NR 601 Comprehensive MIDTERM
[updated]
There are well described racial and socioeconomic disparities in diagnosis, the following
populations have the higher incidence and lower survival - answer black and Hispanic
older adults in general
A 72 yo female has residual effects from a stroke that includes memory loss and
apathy. Which intervention can best improve the brain's functional reserve? - answer
decrease over stimulating the patient to avoid agitation
Which of the following considerations is necessary for the NP who is evaluating the
effectiveness of a prescribed opioid for an elderly patient with chronic, debilitating pain?
- answer All of the above
The NP is providing chronic management for a 74-year-old male with longstanding
COPD. He presents to the primary care office with increased shortness of breath to the
point that he is unable to walk to the mailbox or send a flight of stairs in his home. He
reports that he still smokes 1/4 pack of cigarettes per day. He tells the NP I guess I'm
just getting too old to do normal things anymore. The NP recognizes that the decline in
the patient's physical function is due to: - answer disease-related disability
The physiologic eye changes that occur in adults between the ages of 42 to 50 years of
age that indicate the new reading glasses are due to - answerreduced lens elasticity
-year-old male reports to the primary care office with a complaint of feeling down since
the death of his spouse eight months ago. He has suppressed his depression through
the use of alcohol. His medical history includes gerd, atrial fibrillation, and chronic back
pain. His medications include:
Cyclobenzaprine 10 milligrams as needed for pain, warfarin 5 milligrams daily,
pantoprazole 40 milligrams daily, lisinopril 10 milligrams daily, Flomax 0.4 milligrams
daily, multivitamin daily, vitamin C 500 milligrams daily, and vitamin D 1000 IU daily.
The MP decides to perform the cage assessment to determine the patient's extent of
alcohol dependency and obtains a score of three which signifies alcohol use disorder.
The NP also performs a medication review and identifies that some of his medications
metabolic effects are altered by alcohol. Which of the medications should be of concern
for the NP? - answerCyclobenzaprine (Amrix), Warfarin, and Pantoprazole (Protonix)
A 68-year-old female presents to the primary care office as a new patient who recently
located from Florida. The patient reports a past medical history of vitamin B12
deficiency, hypertension, hyperlipidemia, and gerd. The patient reports that one year
ago she was seen by gastroenterologist for gerd symptoms where she was prescribed
,omeprazole 40 milligrams daily. She reports that after being on the omeprazole for two
months she stopped having guard symptoms. Therefore an endoscopy was not
indicated. Despite having no symptoms she continued to take omeprazole because she
did not want her symptoms to return. She also reports that diet modification has also
helped him reduce and gerd symptoms. The MP determines that omeprazole should be
prescribed. The best prescribing method for this patient is - answerReducing the
omeprazole from 40 mg to 20 mg
To ensure the older adults correct use of prescribed metered dose inhalers that NP
should - answerRecommend a spacer device
A 64 year old homeless female reports to the primary care clinic with shortness of
breath. Approximately one week the patient presented to the emergency room with mild
sternal chest pain. A cardiac workup revealed no abnormalities And the patient was
released. Today the patient reports that her breathlessness is worse. The pmh includes
hypertension, hyperlipidemia, atherosclerotic heart disease. The patient is also pack
year smoker. Other than seeking medical care at the ER last week the patient has not
seen a health care provider in five years period based on the patient's age and condition
what immunizations are most important for the MP to administer today? -
answerInfluenza, Prevnar-13
A 65 year old male patient is a 36 pack year smoker who is seeing the MP today for
smoking cessation intervention. The MPP plans to use the 5 A's in planning
interventions for this patient. In addition to prescribing a nicotine patch the patient has
also agreed to participate in intensive cessation counseling covered by Medicare. When
the NP scheduled future follow up visit for the patient which 5A is being utilized? -
answerArrange
The NP has diagnosed a 62-year-old female with Graves' disease. What lab value
below was used to diagnose? - answerDecreased TSH level
The NP is reviewing a 68-year-old males 2 fasting plasma glucose levels completed on
separate occasions. Diagnosing type 2 diabetes both plasma glucose levels must be
greater than - answer126 mg/dL
An older adult with type 2 diabetes presents to the primary care clinic with a report of
polyurea, polydipsia, and loss. Which of the following lab results requires immediate
intervention by the NP? - answerSerum glucose of 65 mg/dL
Mr. Gonzalez a 65-year-old patient with type 2 diabetes reported to the primary care
office with complaints of weakness, fatigue, and diaphoresis. A review of the patient's
blood sugars over the last seven days demonstrates 2 sugars of 58 mg/DL and 56 MG/
DL respectively period to narrow the differential diagnosis what should the NP do first? -
answerDetermine if the hypoglycemia is related to alcohol
, Clinical findings in a patient with hypothyroidism includes: - answerfacial and eyelid
edema
When prescribing oral medications for an overweight patient with type 2 diabetes who
also has a voracious appetite, the MP is likely to prescribe which medication to
encourage weight loss? - answerExenatide (Byetta)
Glargine (Lantus) is an insulin analog that essentially has no peak and is usually
administered: - answeronce daily
Patient started on metformin (glucophage) need to be monitored closely for which
potential side effect? - answerLactic acidosis
The NP is seeing a 64-year-old obese female for a follow up visit. She was diagnosed
with type 2 diabetes three months ago and started on a regimen of diet and exercise.
Today her fasting plasma glucose is 200 MG/ DL and A1C is 10%. She has lost two
pounds. She reports that her home glucose monitoring has ranged from 180-300 MG/
DL. The rest of the chemistry profile is within normal limits. What is the best treatment
choice for this patient? - answerinitiate treatment with metformin (glucophage)
An older adult male has recently been started on insulin. His regiment is two daily
injections with two daily insulin in the morning and 1/3 in the evening. He is using the
70/30 make sure intermediate insulin in both injections. He presents for a follow up visit
with his fasting blood sugar log. The NP recorded glucose level before the evening meal
has been 6070 MG/dL. Other checks during the day MG/dl. What adjustments need to
be made? - answerRegular insulin: change 70/30 combo to self mix and reduce AM
regular dose
A patient is diagnosed with hypothyroidism and is placed on levothyroxine 100 MCG
daily. What should the NP's approach to follow up? - answerThe patient should return to
the clinic withinn 4-6 wks for TSH measurement and determination of any improvements
in the symptoms
In caring for older adults with respiratory disease, the NP recognizes that there are age-
related changes in pulmonary function. When older adults present with chronic rhino
sinus drainage and post nasal drip the NP relates this to which of the following
physiologic change in the respiratory system? - answerNarrowed decreased collagen
A 60-year-old male patient presents with severe comorbidities that include history of MI,
hypertension, type 2 diabetes, and obesity. He reports feeling like his heart is skipping
beats. He is also experiencing dyspnea at rest and on exertion that is associated with
fatigue. He also reports two falls over the last month period on exam the NP notes and
irregular rhythm. Which of the following conditions should be included as a differential
diagnosis? - answerAtrial fibrillation
[updated]
There are well described racial and socioeconomic disparities in diagnosis, the following
populations have the higher incidence and lower survival - answer black and Hispanic
older adults in general
A 72 yo female has residual effects from a stroke that includes memory loss and
apathy. Which intervention can best improve the brain's functional reserve? - answer
decrease over stimulating the patient to avoid agitation
Which of the following considerations is necessary for the NP who is evaluating the
effectiveness of a prescribed opioid for an elderly patient with chronic, debilitating pain?
- answer All of the above
The NP is providing chronic management for a 74-year-old male with longstanding
COPD. He presents to the primary care office with increased shortness of breath to the
point that he is unable to walk to the mailbox or send a flight of stairs in his home. He
reports that he still smokes 1/4 pack of cigarettes per day. He tells the NP I guess I'm
just getting too old to do normal things anymore. The NP recognizes that the decline in
the patient's physical function is due to: - answer disease-related disability
The physiologic eye changes that occur in adults between the ages of 42 to 50 years of
age that indicate the new reading glasses are due to - answerreduced lens elasticity
-year-old male reports to the primary care office with a complaint of feeling down since
the death of his spouse eight months ago. He has suppressed his depression through
the use of alcohol. His medical history includes gerd, atrial fibrillation, and chronic back
pain. His medications include:
Cyclobenzaprine 10 milligrams as needed for pain, warfarin 5 milligrams daily,
pantoprazole 40 milligrams daily, lisinopril 10 milligrams daily, Flomax 0.4 milligrams
daily, multivitamin daily, vitamin C 500 milligrams daily, and vitamin D 1000 IU daily.
The MP decides to perform the cage assessment to determine the patient's extent of
alcohol dependency and obtains a score of three which signifies alcohol use disorder.
The NP also performs a medication review and identifies that some of his medications
metabolic effects are altered by alcohol. Which of the medications should be of concern
for the NP? - answerCyclobenzaprine (Amrix), Warfarin, and Pantoprazole (Protonix)
A 68-year-old female presents to the primary care office as a new patient who recently
located from Florida. The patient reports a past medical history of vitamin B12
deficiency, hypertension, hyperlipidemia, and gerd. The patient reports that one year
ago she was seen by gastroenterologist for gerd symptoms where she was prescribed
,omeprazole 40 milligrams daily. She reports that after being on the omeprazole for two
months she stopped having guard symptoms. Therefore an endoscopy was not
indicated. Despite having no symptoms she continued to take omeprazole because she
did not want her symptoms to return. She also reports that diet modification has also
helped him reduce and gerd symptoms. The MP determines that omeprazole should be
prescribed. The best prescribing method for this patient is - answerReducing the
omeprazole from 40 mg to 20 mg
To ensure the older adults correct use of prescribed metered dose inhalers that NP
should - answerRecommend a spacer device
A 64 year old homeless female reports to the primary care clinic with shortness of
breath. Approximately one week the patient presented to the emergency room with mild
sternal chest pain. A cardiac workup revealed no abnormalities And the patient was
released. Today the patient reports that her breathlessness is worse. The pmh includes
hypertension, hyperlipidemia, atherosclerotic heart disease. The patient is also pack
year smoker. Other than seeking medical care at the ER last week the patient has not
seen a health care provider in five years period based on the patient's age and condition
what immunizations are most important for the MP to administer today? -
answerInfluenza, Prevnar-13
A 65 year old male patient is a 36 pack year smoker who is seeing the MP today for
smoking cessation intervention. The MPP plans to use the 5 A's in planning
interventions for this patient. In addition to prescribing a nicotine patch the patient has
also agreed to participate in intensive cessation counseling covered by Medicare. When
the NP scheduled future follow up visit for the patient which 5A is being utilized? -
answerArrange
The NP has diagnosed a 62-year-old female with Graves' disease. What lab value
below was used to diagnose? - answerDecreased TSH level
The NP is reviewing a 68-year-old males 2 fasting plasma glucose levels completed on
separate occasions. Diagnosing type 2 diabetes both plasma glucose levels must be
greater than - answer126 mg/dL
An older adult with type 2 diabetes presents to the primary care clinic with a report of
polyurea, polydipsia, and loss. Which of the following lab results requires immediate
intervention by the NP? - answerSerum glucose of 65 mg/dL
Mr. Gonzalez a 65-year-old patient with type 2 diabetes reported to the primary care
office with complaints of weakness, fatigue, and diaphoresis. A review of the patient's
blood sugars over the last seven days demonstrates 2 sugars of 58 mg/DL and 56 MG/
DL respectively period to narrow the differential diagnosis what should the NP do first? -
answerDetermine if the hypoglycemia is related to alcohol
, Clinical findings in a patient with hypothyroidism includes: - answerfacial and eyelid
edema
When prescribing oral medications for an overweight patient with type 2 diabetes who
also has a voracious appetite, the MP is likely to prescribe which medication to
encourage weight loss? - answerExenatide (Byetta)
Glargine (Lantus) is an insulin analog that essentially has no peak and is usually
administered: - answeronce daily
Patient started on metformin (glucophage) need to be monitored closely for which
potential side effect? - answerLactic acidosis
The NP is seeing a 64-year-old obese female for a follow up visit. She was diagnosed
with type 2 diabetes three months ago and started on a regimen of diet and exercise.
Today her fasting plasma glucose is 200 MG/ DL and A1C is 10%. She has lost two
pounds. She reports that her home glucose monitoring has ranged from 180-300 MG/
DL. The rest of the chemistry profile is within normal limits. What is the best treatment
choice for this patient? - answerinitiate treatment with metformin (glucophage)
An older adult male has recently been started on insulin. His regiment is two daily
injections with two daily insulin in the morning and 1/3 in the evening. He is using the
70/30 make sure intermediate insulin in both injections. He presents for a follow up visit
with his fasting blood sugar log. The NP recorded glucose level before the evening meal
has been 6070 MG/dL. Other checks during the day MG/dl. What adjustments need to
be made? - answerRegular insulin: change 70/30 combo to self mix and reduce AM
regular dose
A patient is diagnosed with hypothyroidism and is placed on levothyroxine 100 MCG
daily. What should the NP's approach to follow up? - answerThe patient should return to
the clinic withinn 4-6 wks for TSH measurement and determination of any improvements
in the symptoms
In caring for older adults with respiratory disease, the NP recognizes that there are age-
related changes in pulmonary function. When older adults present with chronic rhino
sinus drainage and post nasal drip the NP relates this to which of the following
physiologic change in the respiratory system? - answerNarrowed decreased collagen
A 60-year-old male patient presents with severe comorbidities that include history of MI,
hypertension, type 2 diabetes, and obesity. He reports feeling like his heart is skipping
beats. He is also experiencing dyspnea at rest and on exertion that is associated with
fatigue. He also reports two falls over the last month period on exam the NP notes and
irregular rhythm. Which of the following conditions should be included as a differential
diagnosis? - answerAtrial fibrillation
