NR 509final exam with explanations
1. Which of the following changes are expected in vision as part of the normal aging
process?
A) Cataracts
B)
... [Show More] Glaucoma
C) Macular degeneration
D) Blurring of near vision - Ans: D
The lens loses its elasticity over time as part of the normal aging process, and the eye is
less able to accommodate and focus on near objects; therefore, the patient will be
expected to have blurring of near vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of
hearing loss. He has noticed some decreased ability to hear what his wife and
grandchildren are saying to him. He admits to lip-reading more. He has a history of
noise exposure in his young adult years: He worked as a sound engineer at a local
arena and had to attend a lot of concerts. Based on this information, what is the most
likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds - Ans: A
Human speech is considered to be a middle-range sound. During the aging process
there is a loss of acuity, starting with high-pitched sounds but extending to the middle
range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with
urination; he gets up five to six times per night to urinate and has to go at least that
often in the daytime. He does not feel as if his bladder empties completely; the strength
of the urinary stream is diminished. He denies dysuria or hematuria. This problem has
been present for several years but has worsened over the last 8 months. You palpate
his prostate. What is your expected physical examination finding, based on this
description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy - Ans: C
This is the expected physical examination finding in benign prostatic hyperplasia (BPH).
4. A 70-year-old retired auto mechanic comes to your office because his neighbor is
concerned about his memory. The patient himself admits to misplacing his keys more
often and forgets what he is supposed to buy from the grocery store and where he has
parked the car. He denies getting lost in familiar places. Upon further questioning, he
states that his wife of 40 years died 8 months ago; his three children live in three
different states; and he has limited his activities because the people he interacted with
were "his wife's friends, not his." He drinks a six-pack of beer daily; he does not smoke
or use illicit drugs. You perform a mini-mental state examination and obtain a total score
of 24 out of 28. Based on this information, what is your most likely diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression - Ans: D
The patient has symptoms of depression: His wife died, he has no real social support
system, and he has isolated himself from his usual activities. He also drinks a
considerable amount of alcohol on a daily basis, which can further depress his mood.
Depression can masquerade as dementia in the elderly and must be considered in a
patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness. You
obtain a complete history, perform a thorough physical examination, and order
laboratory tests. You diagnose her with hyperthyroidism. Based on her age, which of the
atypical symptoms of hyperthyroidism is more likely to be seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia - Ans: D
This is an atypical symptom of hyperthyroidism that is more likely to be seen in the older
patient.
6. A 78-year-old retired seamstress comes to the office for a routine check-up. You
obtain an ECG (electrocardiogram) because of her history of hypertension. You
diagnose a previous myocardial infarction and ask her if she had any symptoms related
to this. Which of the following symptoms would be more common in this patient's age
group for an acute myocardial infarction?
A) Chest pain
B) Syncope
C) Pain radiating into the left arm
D) Pain radiating into the jaw - Ans: B
This is an atypical symptom and more likely to be seen in this patient's age group.
7. An 88-year-old retired piano teacher comes for evaluation of fatigue. You notice that
her clothes are hanging loosely off her frame and that she has lost 15 pounds. She is
unaware of this. Her husband of 63 years died a few months ago. You ask the patient to
complete a Rapid Screen for Dietary Intake. Which of the following statements is
considered to be part of this rapid screen?
A) I eat more than two meals per day.
B) I drink one glass of alcohol every day.
C) Without wanting to, I have lost or gained 10 pounds in the last 6 months.
D) I eat with at least one other person most of the time. - Ans: C
This is part of the Rapid Screen for Dietary Intake.
8. An 89-year-old retired school principal comes for an annual check-up. She would like
to know whether or not she should undergo a screening colonoscopy. She has never
done this before. Which of the following factors should not be considered when
discussing whether she should go for this screening test?
A) Life expectancy
B) Time interval until benefit from screening accrues
C) Patient preference
D) Current age of patient - Ans: D
The current age of the patient is not as important as her actual life expectancy and
current health status.
9. Which of the following booster immunizations is recommended in the older adult
population?
A) Tetanus
B) Diphtheria
C) Measles
D) Mumps - Ans: A
Older adults who have received the primary series of three tetanus immunizations
should receive the single booster dose of tetanus immunization every 10 years.
10. You are asked to perform a home safety assessment for an 87-year-old retired
farmer who lives by himself. Which of the following is not considered to be an increased
risk for falls?
A) Loose electrical cords
B) Slippery or irregular surfaces
C) Chairs at awkward angles
D) Bright lighting - Ans: D
Bright lighting is a recommendation to improve an older person's ability to see all
possible things that could result [Show Less]