NR 601 Chamberlain Geriatric Class chapter questions
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for the final Exam all with precise solutions ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Terms in this set (99) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Original
. An 86-year-old female comes to your office for a wellness visit. Her blood pressure is
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125/70 mmHg, pulse 69 beats per min, and respiratory rate 18 breaths per min. She is well
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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
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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? ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Advise them to complete a POLST.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b. Advise them that they have adequate documentation to be recognized legally.
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c. Advise them to file an advanced directive.
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d. Respond that although they lack documentation, her partner will be recognized de facto
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c
. An 81-year-old transgender female with history of depression and hyperlipidemia presents
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to your clinic for routine care. She endorses a history of smoking, currently smoking 1 pack
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per day, and occasionally drinks a glass of wine, although she denies illicit drug use. She
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reports she takes atorvastatin 20 mg and subcutaneous estrogen therapy. Which of the
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following is the most important next step in this patient's primary care? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Counseling on starting aspirin
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b. Counseling on alcohol cessation
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c. Counseling on smoking cessation
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,d. Counseling on mammogram
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c
3. An 84-year-old male with history of stroke without residual deficit, systolic heart failure,
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and type 2 diabetes presents to clinic for follow-up. He is independently living in a
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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
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mg daily. He reports his last colonoscopy was 8 years ago, with no abnormality. He reports
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he is sexually active with men and women, engaging in receptive oral, receptive anal, and
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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? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Urine testing
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b. Urine testing, blood testing
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c. Urine testing, blood testing, anal swab
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d. Urine testing, blood testing, anal swab, and oropharyngeal swab
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d
1. Which of the following is true about tolterodine?
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a. It should be avoided in men with prostatic hypertrophy.
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b. It increases the risk of constipation compared with oral oxybutynin.
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c. It acts by ablating detrusor spasms.
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d. It has greater risk of adverse effects with its twice-daily formulation.
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d
2. An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per
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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
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81 mg daily. Amlodipine 5 mg daily was recently added by his cardiologist. On review of
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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
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next step in management should be:
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a. Stop hydrocodone-acetaminophen and add naproxen
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b. Stop amlodipine and increase lisinopril.
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c. Add afternoon furosemide.
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d. Add tamsulosin.
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b
3. The daughter of a 79-year-old woman notes that her mother, who has dementia and lives
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with her, is wetting herself when she attends her new day program. Program staff have
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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."
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Leakage is uncommon at home. Her medications include donepezil and acetaminophen. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Physical examination is normal. Initial treatment approach will require intervention by which
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of the following?
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a. Mrs. A's physician
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b. Mrs. A's daughter
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c. Day program staff
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d. Physical therapist through a home care agency
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c
, 4. Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten
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worse over the past year, and she rarely makes it through nine holes without feeling like she
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needs to "run into the bushes and go." Leakage is usually small volume, but causes her
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extreme embarrassment because she is afraid she will smell of urine. She has tried limiting
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caffeine in the morning before she golfs and avoiding drinking water while playing, to no
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effect. She also tried "those Kegler" exercises in the past without success. Which of the
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following is the most appropriate recommendation for Ms. J? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Bladder training
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b. Referral for biofeedback training in pelvic muscle exercise
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c. Trial of solifenacin
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d. Trial of topical estrogen
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a
1. What is the most common cause of erectile dysfunction in older men?
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a. Psychological stress
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b. Adverse drug reaction
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c. Atherosclerosis
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d. Autonomic neuropathy
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c
We have an expert-written solution to this problem!
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2. Which is the most reasonable first step in the treatment of older men with erectile
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dysfunction?
a. Sex therapy
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b. Testosterone
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c. Yohimbine
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||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
for the final Exam all with precise solutions ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Terms in this set (99) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Original
. 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
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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? ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Advise them to complete a POLST.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b. Advise them that they have adequate documentation to be recognized legally.
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c. Advise them to file an advanced directive.
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d. Respond that although they lack documentation, her partner will be recognized de facto
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c
. 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
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reports she takes atorvastatin 20 mg and subcutaneous estrogen therapy. Which of the
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following is the most important next step in this patient's primary care? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Counseling on starting aspirin
||\\//|| ||\\//|| ||\\//|| ||\\//||
b. Counseling on alcohol cessation
||\\//|| ||\\//|| ||\\//|| ||\\//||
c. Counseling on smoking cessation
||\\//|| ||\\//|| ||\\//|| ||\\//||
,d. Counseling on mammogram
||\\//|| ||\\//|| ||\\//||
c
3. 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
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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
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he is sexually active with men and women, engaging in receptive oral, receptive anal, and
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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? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Urine testing
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b. Urine testing, blood testing
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c. Urine testing, blood testing, anal swab
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d. Urine testing, blood testing, anal swab, and oropharyngeal swab
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d
1. Which of the following is true about tolterodine?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. It should be avoided in men with prostatic hypertrophy.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
b. It increases the risk of constipation compared with oral oxybutynin.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c. It acts by ablating detrusor spasms.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d. It has greater risk of adverse effects with its twice-daily formulation.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
d
2. 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:
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Stop hydrocodone-acetaminophen and add naproxen
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b. Stop amlodipine and increase lisinopril.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c. Add afternoon furosemide.
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d. Add tamsulosin.
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b
3. The daughter of a 79-year-old woman notes that her mother, who has dementia and lives
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with her, is wetting herself when she attends her new day program. Program staff have
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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."
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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?
||\\//|| ||\\//||
a. Mrs. A's physician
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b. Mrs. A's daughter
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c. Day program staff
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d. Physical therapist through a home care agency
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c
, 4. Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten
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worse over the past year, and she rarely makes it through nine holes without feeling like she
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needs to "run into the bushes and go." Leakage is usually small volume, but causes her
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extreme embarrassment because she is afraid she will smell of urine. She has tried limiting
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caffeine in the morning before she golfs and avoiding drinking water while playing, to no
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effect. She also tried "those Kegler" exercises in the past without success. Which of the
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following is the most appropriate recommendation for Ms. J? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Bladder training
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b. Referral for biofeedback training in pelvic muscle exercise
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
c. Trial of solifenacin
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d. Trial of topical estrogen
||\\//|| ||\\//|| ||\\//|| ||\\//||
a
1. What is the most common cause of erectile dysfunction in older men?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
a. Psychological stress
||\\//|| ||\\//||
b. Adverse drug reaction
||\\//|| ||\\//|| ||\\//||
c. Atherosclerosis
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d. Autonomic neuropathy
||\\//|| ||\\//||
c
We have an expert-written solution to this problem!
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
2. Which is the most reasonable first step in the treatment of older men with erectile
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dysfunction?
a. Sex therapy
||\\//|| ||\\//||
b. Testosterone
||\\//||
c. Yohimbine
||\\//||
