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NR 601 MIDTERM EXAM
1. Elderly pt presents w/new onset of feeling heart race, fatigue. EKG reveals afib
w/rate >100. Pt also has a new tremor in both hands. Which of the following
would you suspect?
a. Hyperthyroidism
2. 62yo female c/o fatigue, lack of energy. Constipation increased, pt gained 10lbs
in past 3mo. Depression is denied although pt reports lack of interest in usual
hobbies. VS are WNL, skin is dry/cool. Which of the following must be
included in the DD?
a. Hypothyroidism
3. Mrs. Black, 87yo, has been taking 100mcg Synthroid x10yrs. She comes for
routine follow-up, feeling well. HR is 90. Your first response is to:
a. Order TSH
4. Which pt is most likely to have osteoporosis?
5. 80yo underweight male who smokes and has been on steroids for psoriasis
6. When evaluating the expected outcome for hypothyroid elderly pt on
levothyroxine, you will:
a. Assess TSH in 4-6wks
7. Postmenopausal woman w/osteoporosis is taking bisphosphonate daily PO.
What action info statement would indicate she understood your instructions
regarding this med?
a. Take med w/full glass of water when up in the AM 30min before
other food and meds
8. Primary reason levothyroxine sodium is initiated at low dose in elderly pt
w/hypothyroidism is to prevent which of the following untoward effects?
a. Angina and arrhythmia
9. 6mo ago an elderly pt was dx'd w/subclinical hypothyroidism. Today the pt
returns and has TSH of 11 and c/o fatigue. He has taken Synthroid 25mcg daily
as prescribed. What is the best course of action?
a. Double the dose
10.A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should
you teach him regarding this med?
,2
a. Its effectiveness is decreased by antacids, iron, or caffeine
11.Pt has been rx'd metformin (Glucophage). One wk later, he returns w/lowered
BGL but c/o loose stools during the week. How should you respond?
a. Reassure him that this is an anticipated SE
12.Which of the following s/s of hyperthyroidism commonly manifest in younger
populations, but is notably lacking in elderly?
a. Exopthalmos
13.60yo obese male has T2DM and lipid panel of TC = 250, HDL = 32, LDL =
165. You teach him about his modifiable cardiac risk factors, which include:
a. DM, obesity, hyperlipidemia
14.Diabetic pt presents w/R foot pain but denies any recent known injury. He
states it has gotten progressively worse over past few months. On exam,
vibratory sense, as well as sensation tested w/monofilament, was abnormal. Pt's
foot is warm, edematous, misshapen. You suspect Charcot foot. What
intervention is indicated?
a. Referral to orthopedist
15.What is a s/s of insulin resistance that can present in African Americans?
a. Acanthosis Nigricans
16.During routine exam of 62yo female, you ID xanthelasma around both eyes.
What is the significance of this?
a. Abnormal lipid metabolism requiring medical management
17.Mr. White is 62yo, had CKD that has been relatively stable. He also has h/o
hyperlipidemia, OA, HTN. He is compliant w/meds, BP has been well
controlled on CCB. Last lipids showed: TC = 201, HDL = 40, TG = 180, LDL
= 98. He currently takes Crestor 20mg daily. Today his BP is 188/90 and urine
dip shows significant proteinuria. He denies changes in dietary habits or med
regimen. What would be the best med change at this point?
a. Change CCB to ACEi
18.You are working as NP in Fast Track of ER. 76yo male presents w/LUQ pain.
There can be many conditions that present as LUQ pain, but which of the
following is least likely to cause pain here?
a. Acute pancreatitis
,3
19.Which is cardinal feature of failure to thrive?
a. Poor nutritional status
20.The percentage of the FVC expired in one second is:
a. FEV1/FVC ratio
21.The aging process causes what normal physiological changes in the heart?
a. The heart valve thickens and becomes rigid, secondary to fibrosis and
sclerosis.
22.A 55yo Caucasian male follows up after referral to cardiologist. He thinks his
med is causing a cough and sometimes he has difficulty breathing. Which med
was most likely prescribed?
a. Lisinopril
23.JM is a 68yo man who presents for a physical. He has T2DM x5yrs, smokes 1/2
PPD, BMI is 30. No other previous medical dx, no current complaints.
According to the AHA/ACC guidelines, JM is stage A HF. Treatment goals for
him include:
a. Heart healthy lifestyle
24.MJ presents with h/o structural damage with current s/s of HF. Treatment will
be based on his stage of HF, which is:
a. Stage C
25.65yo Caucasian female presents with mitral valve stenosis, physical exam
unremarkable. You know her stage of HF is:
a. B
26.DG, 65yo man, presents for eval of CP and L-sided shoulder pain, beginning
after strenuous activity, including walking. Pain is dull, aching, 8/10 during
activity, otherwise 0/10. Began few mo ago, intermittent, aggravated by
exercise, relieved by rest. Occasional nausea. Pain is retrosternal, radiating to
L shoulder, affects QOL by limiting activity. Pain is worse today, did not go
, 4
away after stopped walking. BP 120/80, HR 72 and regular. Normal heart
sounds, no murmur, S1, S2. Which differential dx would be most likely?
a. Coronary artery dz w/angina pectoris
27.The best way to dx structural heart dz/dysfunction non-invasively is:
a. Echocardiogram
28.Chronic pain can have major impact on pt's ability to function and have
profound impact on overall QOL. Ongoing pain may be linked to:
a. Depression, sleep disturbance, decreased socialization
29.The Beers criteria are appropriate for use in evaluating use of certain meds in
pts:
a. >65yo
30.Pt presents with c/o increasing SOB, cough w/occasional white sputum, fatigue.
As part of the plan you order labs. You know the likelihood of HF is low if the
BNP is:
a. <100
31.All of the following statements are true about lab values in older adults except:
a. Normal ranges may not be applicable to older adults
b. Abnormal findings are often due to physiological aging
c. Reference ranges are preferable
d. References values are not necessarily acceptable values
a. B
32.According to the 2017 ACC HTN guidelines, the recommended BP goal for a
65yo African American woman w/a h/o HTN and DM and no h/o CKD is:
a. <140/80
33.The pathophysiology of HF is due to:
a. Inadequate cardiac output to meet the metabolic and O2 demands of
the body
34.A 60yo woman w/30 pack yr hx, presents for eval of persistent, daily cough
w/increased sputum, worse in the AM, occurring over past 3 months. She tells
you, "I have the same thing year after year." Which of the following choices
would you consider strongly in your critical thinking process?
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