NR-601 Primary Care of the Maturing & Aged Family Practicum

Midterm Exam Study Set [260 Q & A]

1. The percentage of the FVC expired in one second is:

- FEV1/FVC ratio

2. The aging process causes what normal physiological changes in the heart?

- The heart valve thickens and becomes rigid, secondary to fibrosis and

sclerosis.

3. 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?

- Lisinopril

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4. 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:

- Heart healthy lifestyle

5. MJ presents with h/o structural damage with current s/s of HF. Treatment will

be based on his stage of HF, which is:

- Stage C

6. 65yo Caucasian female presents with mitral valve stenosis, physical exam

unremarkable. You know her stage of HF is:

- B

7. 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 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?

- Coronary artery dz w/angina pectoris

8. The best way to dx structural heart dz/dysfunction non-invasively is:

- Echocardiogram

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9. 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:

- Depression, sleep disturbance, decreased socialization

10. The Beers criteria are appropriate for use in evaluating use of certain meds in

pts:

- >65yo

11. 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:

- <100

12. 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

13. 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:

- <140/80

14. The pathophysiology of HF is due to:

- Inadequate cardiac output to meet the metabolic and O2 demands of

the body

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15. 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?

- Chronic bronchitis

16. JM is a 68yo man who presents for a physical. He has T2DM x5yrs, diet

controlled. His BMI is 32. He has HTN, smoker (10 cigs/day x20yrs). He denies

other medical problems. Fam hx includes CAD, CABG x4 for dad, now

deceased; CHF, T2DM, HTN for mom. He is asymptomatic today, exam is

normal, EKG NSR. According to AHA/ACC guidelines, JM is at risk for what

stage of HF?

- Stage A

17. The volume of air a pt is able to exhale for total duration of the test during

maximal effort is:

- FVC

18. According to the 2017 ACC HTN guidelines, normal BP is:

- <120/80

19. Functional abilities are best assessed by:

- Observed assessment of function

20. LB is a 77yo pt w/chronic poorly controlled HTN. You know that goals include

prevention of target organ damage. During your eval you will assess for

evidence of:

- L ventricular hypertrophy

21. Aortic regurgitation requires medical treatment for early signs of HF with:

- ACEi

22. The volume of air in the lungs at max inflation is:

- TLC (total lung capacity)

23. Preferred amount of exercise for older adults is:

- 30min/day of aerobic activity 5 days/wk

24. The total volume of air a pt is able to exhale in the first second during max

effort is:

- FEV1

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25. You know the following statements regarding the pain of acute coronary

syndrome are true except:

- Present atypically more often in men than women

26. 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?

- Hyperthyroidism

27. 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?

- Hypothyroidism

28. 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:

- Order TSH

29. Which pt is most likely to have osteoporosis?

- 80yo underweight male who smokes and has been on steroids for

psoriasis

30. When evaluating the expected outcome for hypothyroid elderly pt on

levothyroxine, you will:

- Assess TSH in 4-6wks

31. Postmenopausal woman w/osteoporosis is taking bisphosphonate daily PO.

What action info statement would indicate she understood your instructions

regarding this med?

- Take med w/full glass of water when up in the AM 30min before other

food and meds

32. Primary reason levothyroxine sodium is initiated at low dose in elderly pt

w/hypothyroidism is to prevent which of the following untoward effects?

- Angina and arrhythmia

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33. 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?

- Double the dose

34. A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should you

teach him regarding this med?

- Its effectiveness is decreased by antacids, iron, or caffeine