Final Exam: NR601/ NR 601 Primary Care
of the Maturing & Aged Family Practicum
Final Exam| Questions and Verified Answers|
2023/ 2024 New Update
Q: An 85-year-old man with chronic obstructive pulmonary disease presents to your office with
his daughter with the complaint of new onset chest pain, shortness of breath, and cough. He is
clearly tachypneic and has tactile fremitus and egophany and crackles heard at the right lung
base. His daughter just wants you to give him an antibiotic pill so that she can take him home.
You are concerned that he might need to be hospitalized and require IV antibiotics. What
statement is true?
a. All older adults with pneumonia must be treated for methicillin-resistant
Staphylococcus aureus (MRSA) and Pseudomonas infection.
b. Treatment decisions for pneumonia are based on its severity, the presence of comorbid
illnesses, and a prior history of MRSA or Pseudomonas respiratory infection.
c. All older adults with pneumonia must be treated in hospital.
d. Pulse oximetry, respiratory rate, and chest radiography would not be helpful for the diagnosis
and management of pneumonia in older adults.
Answer:
b. Treatment decisions for pneumonia are based on its severity, the presence of comorbid
illnesses, and a prior history of MRSA or Pseudomonas respiratory infection.
Q: An 80-year-old woman that you follow in a nursing home has an acute decline in her mental
status. She has a fever >100° F, but no other focal complaints or findings on physical
examination except for a chronic indwelling urinary catheter. What statement is true?
a. Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start
empiric antibiotic therapy.
b. Older adults with an indwelling urinary catheter are less likely to have bloodstream infection
than older adults without a catheter.
c. It is not necessary to obtain a urine culture; empiric antibiotic treatment is sufficient.
d. She only needs antibiotic treatment for 3 days.
Answer:
a. Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start
empiric antibiotic therapy.
Q: An 82-year-old woman receives oral amoxicillin-clavulate for a skin abscess on her leg. She
develops new onset of frequent watery stool that persists for several days after the antibiotic is
stopped.You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction
(PCR). The antigen and PCR are both positive. She has never had C. difficile infection before.
What one statement is the best answer regarding her management?
a. Metronidazole is the treatment of choice for C. difficile infection.
b. Older adults with their first episode of C. difficile require a longer duration of treatment with
vancomycin.
c. Fecal transplantation is the treatment of choice for C. difficile infection.
d. Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile
infection.
Answer:
d. Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile
infection
Q: A 75-year-old man presents with the chief concern, “I may have a bladder infection.” Further
questioning reveals for several months he has been needing to void every couple of hours (can’t
sit through a whole ball game), feels he must go as soon as he feels the urge (he tried putting it
off and had urinary leakage), and is getting up two to three times at night to void. He denies
delay in voiding or straining to initiate voiding, slow stream, feeling of incomplete emptying, or
dribbling after completion of urination. He also denies dysuria and abdominal pain. Which of the
following best describes the category or type of his lower urinary tract symptoms?
a. Prostatism
b. Overactive bladder c. Postmicturition
d. Storage (irritative)
e. Voiding (obstructive)
Answer:
d. Storage (irritative)
Q: A 70-year-old man has bothersome lower urinary tract syndrome (LUTS) associated with
benign prostatic hyperplasia (BPH). His symptoms are no longer well managed with lifestyle
modifications. He is interested in medication to reduce his urinary symptoms but is concerned
about possible side effects. He notes that he is recently married and sexual activity is
very important to him. Which of the following medications would be most appropriate for this
patient?
a. Alfusozin b. Ditropan
c. Dutasteride d. Tamsulosin
e. Tadalafil
Answer:
a. Alfusozin
Q: A 66-year-old man complains of nocturia (three to four times a night), hesitancy, and
incomplete emptying of the bladder. Physical examination reveals an enlarged, nontender
prostate, about 40 g in size without discrete nodules. Urinalysis reveals hematuria without
leukocyte esterase. Upon further evaluation, the hematuria is attributed to his BPH. The patient
declines surgical options at this time. Which of the following medications would be most
appropriate?
a. Oxybutynin
b. Doxazosin
c. Finasteride
d. Silodosin
e. Tadalafil
Answer:
c. Finasteride
Q: Mr. Quince is a 68-year-old patient who describes several months of urinary frequency and a
sensation of incomplete emptying with no associated dysuria, hematuria, or fever. Physical
examination reveals a slightly enlarged but nontender prostate, a postvoid residual urine volume
of 20 mL, and a urinalysis with 15 white blood cells (WBCs) and 5 red blood cells (RBCs).
Urine culture reveals 30,000 colony-forming units of Escherichia coli.You see a report from last
year that shows urinalysis with 10 WBCs and 4 RBCs that was obtained as part of a routine
evaluation. What is the most appropriate next step in the management of Mr. Quince’s
symptoms?
a. Start an alpha-blocker.
b. Start a 5-alpha-reductase inhibitor.
c. Start combination therapy with an alpha-blocker and a 5-alpha-reductase inhibitor.
d. Start a 4-week course of ciprofloxacin.
Answer:
d. Start a 4-week course of ciprofloxacin.
Q: Mr. Roberts, a 72-year-old patient who has sought medical care on an intermittent basis in
the past, complains of aching discomfort in his perineal area, urinary urgency, and frequency for
the past few years. He also complains of insomnia and intermittent anxiety that he attributes to
loneliness after his wife’s death about a year ago. Digital rectal examination (DRE) reveals a
slightly enlarged, nontender prostate with no palpable nodules. Perineal examination is normal.
Bladder scan is unremarkable and postvoid residual urine volume is 50 mL. Urinalysis shows no
WBCs or RBCs. Urine culture is negative. Previous treatment has included dietary modification
and alpha-blocker medication. What is the most appropriate next step?
a. Start an 8-week course of ciprofloxacin.
b. Start a 5-alpha-reductase inhibitor.
c. Perform urodynamic testing.
d. Screen for depression.
Answer:
d. Screen for depression.
Q: Mr. Hunter, a 69-year-old man, complains of urinary frequency and urgency that have
increased over the past several months. There is no dysuria, hematuria, or sensation of
incomplete voiding. He drinks 2 cups of coffee daily and diet cola multiple times a day. His
International Prostate Symptom Score (IPSS) is 6, with a bother score of 1 indicating mild
voiding symptoms with low impact on his quality of life. His medical history includes
hypertension, coronary artery disease, and benign prostatic hyperplasia. Current medications are
aspirin, metoprolol, and hydrochlorothiazide. Physical examination reveals normal sized
prostate. Which of the following is the best next step?
a. Urinalysis
b. Cystoscopy
c. Lifestyle modifications
d. Tamsulosin
e. Finasteride