NR 601 Primary Care of the Maturity& Aged
Family |NUR 601 Final Exam Questions and
Answers |Frequently Most Tested Questions
and 100% Pass | High Yield Questions and
Answers |Graded A + , Rationalised and
Reviewed|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?
ANSWER:<<Advise them to file an advanced directive.
What is the most common cause of erectile dysfunction in older men?
ANSWER:<<Atherosclerosis
Which is the most reasonable first step in the treatment of older men with
erectile dysfunction?
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?
,ANSWER:<<Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the
most likely cause of her problem?
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?
ANSWER:<<Hormonal therapy only
. 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.
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?
ANSWER:<<Urine testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine?
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:
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?
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?
ANSWER:<<Bladder training
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?
, ANSWER:<<Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to
prolong survival?
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
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?
ANSWER:<<No because he can be followed with serial carcinoembryonic
antigens and CT scans.
An 80-year-old woman has no weight loss, no pain, and no distention but over 2
years increasingly complains of constipation despite adequate medical
treatment. A colonoscopy is negative. An abdominal CT is performed. It reveals
well-circumscribed pelvic masses, the largest adherent to the ovarian ligament.
The best first step is:
ANSWER:<<Invite her to return with a family member and have a long talk about
the diagnostic and therapeutic options.
Family |NUR 601 Final Exam Questions and
Answers |Frequently Most Tested Questions
and 100% Pass | High Yield Questions and
Answers |Graded A + , Rationalised and
Reviewed|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?
ANSWER:<<Advise them to file an advanced directive.
What is the most common cause of erectile dysfunction in older men?
ANSWER:<<Atherosclerosis
Which is the most reasonable first step in the treatment of older men with
erectile dysfunction?
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?
,ANSWER:<<Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the
most likely cause of her problem?
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?
ANSWER:<<Hormonal therapy only
. 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.
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?
ANSWER:<<Urine testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine?
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:
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?
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?
ANSWER:<<Bladder training
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?
, ANSWER:<<Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to
prolong survival?
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
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?
ANSWER:<<No because he can be followed with serial carcinoembryonic
antigens and CT scans.
An 80-year-old woman has no weight loss, no pain, and no distention but over 2
years increasingly complains of constipation despite adequate medical
treatment. A colonoscopy is negative. An abdominal CT is performed. It reveals
well-circumscribed pelvic masses, the largest adherent to the ovarian ligament.
The best first step is:
ANSWER:<<Invite her to return with a family member and have a long talk about
the diagnostic and therapeutic options.
