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NR 601 FINAL EXAM
CHAMBERLAIN UNIVERSITY 2025
LATEST UPDATED GRADED A+
A 56-year old male patient screened for diabetes has a fasting plasma glucose level of 96mg/dl. The nurse practitioner management plan includes: a. repeat fasting plasma glucose in three years b. prescribe Metformin 500mg po BID c. repeat fasting plasma glucose in one year d. refer to ophthalmology for eye exam - Solution a. repeat fasting plasma glucose in three years According to the Sexually presentation, atrophic vaginitis a. the symptoms are the same for each woman b. creates a more acidic vaginal environment c. is a contributing factor for frequent urinary tract infections d. is not treated with vaginal lubricants - Solution c. is a contributing factor for frequent urinary tract infections Which of the following would you recommend annually for the elderly type 2 diabetic? a. periodic visits to a gastroenterologist b. colonoscopy c. follow up with a urologist d. eye exam with an ophthalmologist - Solution d. eye exam with an ophthalmologist The majority of patients enrolled in hospice care die: a. in the hospital b. in an inpatient hospice facility c. in a nursing home d. at home - Solution d. at home Which of the following is a role of the advanced practice nurse in palliative cancer care?
a. detecting cancer in asymptomatic patients or those with specific symptoms b. arranging for follow up including patients c. identifying and managing complications of care d. all of the above - Solution d. all of the above A 58 year old Caucasian mane with type 2 diabetes mellitus presents to the clinic as a new patient. He takes metformin 500mg twice a day. His last Hgb A1c was 7%. He is up to date on eye and foot examinations. His BP is 142/96. According to ACC 2017 guidelines for high blood pressure in adults, what is the most appropriate first line medication? a. lisinopril b. furosemide c. amlodipine d. clonidine - Solution a. lisinopril A 68 year old woman presents with a complaint of urine leakage whenever she sneezes, laughs or strains for the past 4 months. She denies dysuria, frequency and nocturia. US dipstick is negative for RBC's leukocyte esterase, nitrates, ketones and urobilinogen. What is the diagnosis? a. stress incontinence b. urinary incontinence c. urge incontinence d. overflow incontinence - Solution a. stress incontinence A 52 year old female patient screened for diabetes has a fasting plasma glucose level of 123 mg/dl. The nurse practitioners plan includes: a. repeat fasting glucose in 1 month b. prescribe metformin 500mg BID po c. repeat fasting plasma glucose in one year d. repeat fasting glucose in three years - Solution c. repeat fasting plasma glucose in one year According to the palliative care presentation, most elderly patients die: a. alone b. at home c. in institutions d. in pain - Solution c. in institutions
menopaused 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 87 years of age. The patient's most recent mammogram was 7 years ago and no known family history of breast cancer. She is not taking any medications. Her physical exam is unremarkable except for findings consistent with atrophic vaginitis. You prescribed topical hormone replacement therapy today. Which of the following evaluations should also be ordered today a. bone mineral density measurement b. mammogram - Solution b. mammogram All of the following patients should be screened for diabetes except: a. a 44 year old Caucasian male with hypertension. b. a 42 year old female on disability from back injury from back injury who is unable to exercise c. an overweight middle aged African American woman with a family history of type 2 diabetes mellitus d. an obese Hispanic man - Solution a. a 44 year old Caucasian male with hypertension. A 60 year old obese male client has type 2 diabetes mellitus and a lipid panel of TC=250 HDL=32 LDL=165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include: a. diabetes, obesity and hyperlipidemia b. advancing age, diabetes, hyperlipidemia, and male gender c. hyperlipidemia, smoking and family history of heart disease d. male with age >45, diabetes mellites and hyperlipidemia - Solution a. diabetes, obesity and hyperlipidemia Which of the following is the most appropriate screening tool for delirium? a. St Louis University Mental Status Exam (SLUMS) b. Montreal Cognitive Assessment c. Lawton Scale of instrumental Activities of Daily Living d. Confusion Assessment Model - Solution d. Confusion Assessment Model A drug that can be used to treat two very common symptoms in a dying patient (pain and dyspnea) is: a. lorazepam b. Gabapentin c. Methadone
d. Morphine - Solution d. Morphine Which characteristic of delirium helps to distinguish it from dementia? A. short term memory impairment b. personality changes c. acute onset d. impaired attention - Solution c. acute onset Older adults with dementia sometimes suffer from agnosia, which is defined as the inability to a. remember events and places b. understand language c. use language d. recognize objects - Solution d. recognize objects When treating depression associated with dementia, which of the following would be a poor choice and not be prescribed a. desipramine b. amitriptyline c. fluoxetine d. mirtazapine - Solution b. amitriptyline The most common neurological cause of seizures in an older adult is: a. multiple sclerosis b. stroke c. Alzheimer's disease d. peripheral neuropathy - Solution b. stroke Periods of increased activity, when the patient did not seem to need to sleep or reports being very productive not needing sleep are: a. symptoms of schizophrenia b. symptoms of worsening depression c. symptoms of unipolar depression d. symptoms of hypomania or mania - Solution d. symptoms of hypomania or mania Terazosin, an alpha blocker, is prescribed to treat the following conditions: a. benign prostatic hypertrophy and hypertension b. benign prostatic hypertrophy and hypotension c. urinary tract infection and arrhythmia
c. patients with alcoholic disorder d. patients with hypoxia - Solution b. patients with BMI > According to the ADA guidelines, which of the following are screening tests for type 2 diabetes mellitus? a. all options are appropriate b. fasting plasma glucose c. two-hour OGTT d. Hemoglobin A1C - Solution a. all options are appropriate The first step in treating delirium is to: a. use side rails and/or wrist restraints to keep the patients safe b. give low dose Haldol if the patient has psychosis c. identify the cause d. provide reality orientation - Solution c. identify the cause According to the genitourinary presentation, the number 1 risk factor for urinary incontinence is: a. smoking and caffeine levels b. uncontrolled diabetes c. aging d. obesity - Solution c. aging Which of the following would be an appropriate treatment for a patient with moderated bothersome symptoms of BPH. a. recommend cranberry supplements b. reevaluate symptoms in 1 to 3 months c. prescribe finasteride and saw palmetto d. prescribe Tamsulosin - Solution d. prescribe Tamsulosin Acanthosis nigricans is associated with all of the following conditions except: a. tinea versicolor b. diabetes c. obesity d. colon cancer - Solution a. tinea versicolor Which of the following medications can blunt the signs of hypoglycemia in diabetics? a. beta blockers
b. calcium channel blockers c. angiotensin receptor blockers (ARB's) d diuretics - Solution a. beta blockers The cornerstone of pharmacotherapy in treating Alzheimer's disease is :a. NMDA receptor antagonist b. Psychotropic medications c. Cholinesterase inhibitors d. Anxiolytics - Solution c. Cholinesterase inhibitors A 56 year old man is diagnosed with acute prostatitis, he is afebrile without severe pain and will be managed outpatient. He should initially be treated with antibiotics for how long? a. 6-12 weeks b. 14-21 days c. 3-6 weeks d. 10-14 days - Solution d. 10-14 days An 80 year old female widow asks her nurse practitioner about her end of life options. Her diagnosis include congestive heart failure, hypertension and type 2 diabetes mellitus. She has noticed that in the last month she has lower extremity edema and she if finding it difficult to walk to the grocery store and church. She does not use oxygen. She is able to maintain her home but requires more frequent rests after vacuuming. She does not wish to be admitted to the hospital again in the future but if admitted wants to maintain full code status. How should the NP address this patients concerns today? a. start her on a medication for depression b provide her with information for senior day care services c. offer the patient a palliative care referral - Solution c. offer the patient a palliative care referral Hospice services and palliative care services are underutilized due to a. denial of impending death b. confusion remains over when it is appropriate to consult palliative care c. services are not understood d. all options are appropriate - Solution d. all options are appropriate Jean, a 47 year old presents to the clinic with complaints of dysuria, frequency and strong odor of her urine for 5 days. This is the second
d. sudden, compelling desire to pass urine that is difficult to prevent - Solution a. unintentional voiding, loss or leakage of urine A patient has been prescribed metformin (Glucophage). One week later he returns with complaints of some loose stools during the week. How should the nurse practitioner respond? a. double the dosage of medication and have patient return in one week b. order a chem. 7 to check for lactic acidosis c. discontinue the medication immediately d. reassure the patient that this is an anticipated side effect - Solution d. reassure the patient that this is an anticipated side effect An 82 year old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnosis. a. Parkinson's disease b. prostate cancer c. all options are appropriate d. benign prostatic hyperplasia (BPH) - Solution c. all options are appropriate A 67 year old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis? a. psychogenic nocturia b. benign prostatic hypertrophy c. drug induced impotence d. irritative posterior urethral lesion - Solution b. benign prostatic hypertrophy Which of the following maneuvers is contraindicated in acute prostatitis a. palpation of the epididymis b. massaging the infected prostate c. serial urine samples d. rectal exams - Solution b. massaging the infected prostate You are working up a 52 year old patient for microscopic hematuria. Your differential diagnosis list includes all of the following except: a. nephrocalcinosis b. acute pyelonephritis
c. renal stenosis d. bladder cancer - Solution c. renal stenosis A 48 year old male patient screened for diabetes has a fasting plasma glucose level of 120mg/dl (6.7mmol/L). The nurse practitioner plan includes: a. prescribe metformin 500mg po BID b. educate the patient on lifestyle changes to lower blood glucose c. initiate self monitoring of blood glucose d. review the effects of oral hypoglycemic medications - Solution b. educate the patient on lifestyle changes to lower blood glucose Terazosin, an alpha blocker, is prescribed to treat the following conditions: a. benign prostatic hypertrophy and hypertension b. benign prostatic hypertrophy and hypotension c. urinary tract infection and arrhythmia d. chronic prostatitis and atrial fibrillation - Solution a. benign prostatic hypertrophy and hypertension A 65 year old Hispanic woman presents to the office for routine follow up for her type 2 diabetes mellitus. Her routine UA reveals few epithelial cells, negative leukocytes, negative nitrates, negative protein, no ketones. Which of the following tests should also be ordered annually for diabetic patients: a. result is normal, no further testing is necessary b. urine for culture and sensitivity c. recommend a screening intravenous pyelogram (IVP) d. microalbumin - Solution d. microalbumin Age-related changes in the bladder, urethra and ureters include all of the following in older women except: a. decline in ureteral resistance pressure b. increased estrogen production's influence on the bladder and ureter c. laxity of the pelvic muscle d. decline in bladder outlet function. - Solution b. increased estrogen production's influence on the bladder and ureter Which of the listed conditions is most likely to cause delirium? a. acute infection b. multiple brain infarcts c. malnutrition
c. those with a life expectancy > 6 months d. those with a life expectancy< 6 months - Solution b. anyone regardless of their life expectancy or disease progression The highest level of evidence with the use of adjuvant analgesics is with: a. therapeutic trials before discontinuing drugs b. patients with fibromyalgia are candidates for adjuvant analgesics c. tricyclic antidepressants avoided due to high adverse affects d. neuropathic pain patients are candidates for adjuvant analgesia - Solution d. neuropathic pain patients are candidates for adjuvant analgesia According o the Sexuality presentation, the biggest barrier to appropriate sexual evaluation in the older patient: a. older people don't talk about sex b. most elderly patients are not interested in sex c. ageist attitudes d. female post menopausal changes - Solution c. ageist attitudes The patient with BPH is seen for follow-up.. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects? a. headache b. urinary incontinence c. hypotension d. impotence - Solution d. impotence The highest level of evidence to support interventions at the end of life is with: a. hyposaline for respiratory secretions b. stimulant laxatives for treating constipation c. opioids for pain control d. opioids for dyspnea - Solution d. opioids for dyspnea The comorbid psychiatric problem with the highest frequency in dementia is: a. depression b. agitation and aggression c. psychosis d. anxiety - Solution a. depression
According to the World Health Organization's analgesic ladder, which drug would be most appropriate in opiate-naïve patient who presents with moderate pain: a. naproxen/morphine b. aspirin/fentanyl c. acetaminophen/hydrocodone d. ibuprofen/imipramine - Solution c. acetaminophen/hydrocodone K B age 54 presents to your office. her husband has just died suddenly and she states she cannot function. She is crying all the time, cant seem to focus and she has so much she needs to do to plan the funeral service and get through the next few days. You decide to prescribe a benzodiazepine. Please choose the correct treatment decision statements below. a. benzodiazepines are safe to prescribe long term b. benzodiazepines should not be stopped abruptly if taken for > 1 month c. benzodiazepines are first line treatment for anxiety in the elderly d. benzodiazepines should be prescribed at the highest dose tolerated for the best effect - Solution b. benzodiazepines should not be stopped abruptly if taken for > 1 month Pain which results from pathology or damage to the nervous system is classified as a. chronic b. neuropathic c. acute d. nociceptive - Solution b. neuropathic You are reviewing a patient chart before the exam. You note that the patient is using topical capsaicin. You know that topical capsaicin is often used for tx of: a. Diabetic neuropathy b. Stress reduction c. All answers are appropriate d. Depression - Solution a. Diabetic neuropathy Symptoms of depression distinct to elderly include: a. Loss of pleasure in usual activities b. Lack of emotions c. Flat affect d. Appetite/weight disturbances - Solution b. Lack of emotions
According to ADA guidelines, which of the following are appropriate screening tests for T2DM? a. Fasting plasma glucose b. 2-hour OGTT c. HgbA1C d. All of the above - Solution d. All of the above Which dx should be considered in a pt presenting with erectile dysfunction? a. HTN b. DM c. Atherosclerosis d. All of the above - Solution d. All of the above Which would be an appropriate tx for pt. with minimal symptoms of BPH? a. Watchful waiting b. Refer to urology for surgery c. Prescribe trial of tamsulosin d. Recommend cranberry supplements - Solution a. Watchful waiting Lifestyle approaches to postmenopausal symptom management include: a. Avoiding sugar, caffeine, chocolate, ETOH b. Sleeping more than 8hrs per night c. Decreasing levels of physical activity d. More than 1000 iu/day of Vit E - Solution a. Avoiding sugar, caffeine, chocolate, ETOH 59yo female c/o pain when she urinates. She has been seen three times for this in the last 3mo. Each time, dx'd with UTI, given abx. She carefully followed instructions, but has no relief of symptoms. Last UA:WBC: 2- 3RBC: 0-2Epithelial cells: few Nitrite: neg Leuk: neg Which should be done next? a. Perform pelvic exam b. Reassure the pt. that she has asymptomatic bacteriuria and does not need abx c. Obtain clean catch urine for UA and C&S d. Order pelvic ultrasound - Solution a. Perform pelvic exam Which pt should be screened for DM? a. 47yo Caucasian male w/HTN b. 45yo female on disability from back injury, unable to exercise
c. Hispanic man, BMI 26 d. Overweight middle-aged African American woman w/fam h/o T2DM e. All of the above - Solution e. All of the above What is a sign of insulin resistance that can present in African American pts? a. Seborrheic Nigricans b. Psoriasis Nigricans c. Bulimic Nigricans d. Acanthosis Nigricans - Solution d. Acanthosis Nigricans Pt presents with sudden, compelling desire to pass urine that is difficult to prevent. This type of incontinence is cause by: a. Impaired mobility b. Detrusor overactivity c. Urethral hypermobility d. Weakness of the pelvic floor muscle - Solution b. Detrusor overactivity 55yo woman w/BMI of 28, has 20yr h/o primary HTN, has been on HCTZ 25mg for years w/excellent response. During this follow up visit, she reports that for the last 6mo she has felt thirsty all of the time even though she drinks at least 10 glasses of water/day. Previous fasting BGL was 136. No further testing was done at that time. You check random BGL now, is 210. What is the next appropriate step? a. Order 3hr OGTT b. Order another random BGL in 2wks c. Order A1C d. Prescribe metformin XR 500mg PO - Solution d. Prescribe metformin XR 500mg PO 66yo dx with acute prostatitis, afebrile w/out severe pain, deemed appropriate to be managed output. An appropriate initial treatment option for mild case is: a. Septra x6wks b. Cipro x10-14 days c. Bactrim x14 days d. Levaquin x3wks - Solution b. Cipro x10-14 days 76yo man seen for c/o UI. You should explore which of these causes of UI in men?
Term "geriatric syndrome" is best described as: - Solution Condition that has multiple underlying factors and involves multiple systems. Which of the following statements about fluid balance in elderly is false? - Solution Assessment of skin turgor at the sternum is a reliable indicator of dehydration in elderly Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the DD is: - Solution Rapid change and fluctuating course of cognitive function Presbystasis is best described as: - Solution Age-related disequilibrium of unknown pathology characterized by gradual onset of difficulty walking If dizziness has a predictable patter associated w/it, the clinician should first consider: - Solution Hypoglycemia The most common cause of disability in elderly is due to: - Solution Arthritis Overflow incontinence is usually associated with: - Solution Bladder outlet obstruction Consistent finding in delirium, regardless of cause, is: - Solution Reduction in regional cerebral perfusion Of the following, which one is most useful clinical evaluation tool to assist in dx of dementia? - Solution St. Louis University Mental Status Exams (SLUMS) Post-menopausal woman w/osteoporosis is taking bisphosphonate daily PO. What action info statement would indicate the pt. understood your instructions regarding this med? - Solution Take w/full glass of water when up in the AM 30min before other food and meds. A fluoroquinolone (Cipro) is prescribed for a male pt. w/a UTI. What should you teach the pt. regarding taking this med? - Solution Its effectiveness is decreased by antacids, iron, or caffeine
60yo obese male has T2DM and lipid panel of TC 250, HDL 32, LDL 165. You teach the pt. about his modifiable cardiac risk factors, which include? - Solution DM, obesity, hyperlipidemia Diabetic pt presents w/the c/o R foot pain but denies recent known injury. He states it has gotten progressively worse over the past few months. On exam, vibratory sense as well as sensation tested w/a monofilament was abnormal. Pt's foot is warm, edematous, misshapen. You suspect Charcot foot. What intervention is indicated? - Solution Refer to podiatry Feeding gastrostomy tubes at end-of-life Alzheimer's pts have been associated with: - Solution Aspiration Pna Which of the following nutritional indicators is not an indication of poor nutritional status in elderly? - Solution BMI 25 Men w/an initial PSA <2.5 can reduce their screening frequency to what intervals? - Solution Every 2yrs All of the following may be reasons associated w/an elevated PSA besides prostate ca except: - Solution UTI In dx'ing acute bacterial prostatitis, a midstream urine cx is of benefit. To be diagnostic, the specimen should reveal how many WBCs per high-power field? - Solution 10 In chronic bacterial prostatitis, what is the organism most commonly associated with the dx? - Solution E Coli In acute prostatitis, an exam of the prostate may find it to be: - Solution Swollen and tender All of the following antimicrobials may be indicated in chronic bacterial prostatitis except: - Solution Azithromycin Age-related changes in the bladder, urethra, and ureters include all of the following in older women except - Solution Increased estrogen production's influence on the bladder and ureter
