ADULT-GERONTLGY NURSE PRACTITIONERAGNP

ADULT-GERONTLGY NURSE PRACTITIONER{AGNP}

ACTUAL EXAM 130 QUESTIONS AND CORRECT

ANSWERS -

An 84-year-old woman, lives independently, concerned about driving. On 2 occasions, she had minor collisions when she was backing up her car (she dislodged rearview mirror and struck a fire hydrant, each time on the passenger side).• History: osteoarthritis of the cervical and lumbar spine and mild hearing impairment

• Medications: acetaminophen and calcium plus vitamin D

• Functional assessment: intact cognition and vision, with near-visual acuity 20/30 in each eye. She fails the whisper test.• Physical examination: Decreased range of motion in neck and back in all planes (unchanged from previous findings); Diffuse osteoarthritic deformities in the knees and hands; Decreased range of motion at the hips; Mild kyphosis; Motor strength and deep tendon reflexes are symmetric and intact Which one of the following is the most appropriate next step?

• Obtain radiography of the cervical spine in 3 views.
• Recommend that she no longer drive.
• Refer to physical therapy.
• Refer to audiology.
• Refer to occupational therapy.
• Refer to occupational therapy.

An 80-year-old woman hospitalized after fall and hip fracture

• History: stable osteoarthritis of the knees, peripheral neuropathy

• Prior to fall, she lived alone and managed all instrumental activities of daily living; occasionally used cane or walker for mild problems with balance • Current status, 4 days after surgery: Needs assistance of 2 persons for transfer; Frequently incontinent of urine; Eating very little Which one of the following is the most likely outcome for this patient 6 months after the fracture?

• Continued slow functional decline
• Recovery to her pre-fracture level of function
• Partial recovery of function 1 / 4

• Stability at the level of function on hospital discharge
• Death
• Recovery to her pre-fracture level of function

An 85-year-old man with 2 episodes of low-volume urinary incontinence in the last year, when he "waited too long" • Functional assessment: Near-visual acuity of 20/50 on the right and 20/60 on the left with correction; Fails whisper test in right ear ; Gait speed at usual pace is 0.9 m/sec ; Mini-Cog screen: 2 of 3 items on recall, completes an accurate clock 36 CASE 3 (2 of 3) Which one of the following is the most appropriate next step for evaluation of functional disability?

• Refer to audiology.
• Refer to ophthalmology.
• Refer to physical therapy.
• Complete additional cognitive testing.
• Complete an incontinence evaluation.
• Refer to ophthalmology.

A 68-year-old woman describes vision problems.• Progressive blurring of distance vision • Increased difficulty with nighttime driving, which she attributes to worsening glare and haloes around lights • She no longer needs glasses for reading.

• History: hypertension, hypercholesterolemia

Which one of the following is the most likely cause of the changes in her vision?

• Uncontrolled hypertension
• Poorly controlled blood glucose C. Choroidal neovascularization
• Cataract progression
• Increased intraocular pressure
• Cataract progression
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A 72-year-old black man has right shoulder trauma after he fell in a parking lot. He states that he was walking to his car when he suddenly tripped and fell forward onto his arm. He subsequently learned that he had tripped over a curb.

• History: hypertension, high cholesterol, glaucoma

Which one of the following most likely contributed to his fall?

• Acute glaucoma
• Failure to use glaucoma drops that morning
• Poor peripheral vision
• Retinal embolus from a carotid plaque
• Poor peripheral vision

An 88-year-old woman comes to the office for an urgent visit because, when she awoke this morning, she found that she could no longer see to read. She depends on her left eye for vision because she lost her right eye in an accident when she was a child.• On examination, vision is 20/400 in the left eye. She does not perceive light in the right eye. She is referred emergently to an ophthalmologist, who diagnoses neovascular age-related macular degeneration.Which one of the following is the most appropriate therapy?

• Topical prostaglandin analog
• Phacoemulsification with intraocular lens implantation
• Intravitreal vascular endothelial growth factor inhibitor
• Glasses with updated refraction E. Oral lutein, zeaxanthin, and omega-3 eye nutrients
• Intravitreal vascular endothelial growth factor inhibitor

An 80-year-old woman comes to the office with her daughter. The daughter is concerned that her mother has recently begun to withdraw from former activities (attending book clubs, lectures).• Patient's self-reported health status has changed from "excellent" last year to "average" today.• During the appointment she misunderstands some questions, and she appears to struggle to understand some of what is said. Her memory does not seem as keen as on previous visits.• In response to direct questions, she states that over the past 2 weeks she has felt a little down. 3 / 4

• She says that if people would include her in conversation, she would probably feel better and be more inclined to engage in the activities she previously enjoyed.

• Medications: daily multivitamin, daily aspirin

• Physical examination: Normal blood pressure and EKG; MMSE score is 26 of 30; Findings from routine laboratory tests are normal.Which one of the following is the most appropriate next step?

• Begin antidepressant therapy.
• Refer for psychiatry consultation.
• Refer for neurologic evaluation.
• Administer in-office hearing screen.
• Administer in-office hearing screen.

A 75-year-old man has age-related hearing loss, diagnosed by an audiologist. The patient requests advice regarding hearing interventions.• He has difficulty understanding speech at meetings and in restaurants; he describes "hearing people talk but not making out the words." • Score on the Hearing Handicap Inventory for the Elderly (short form) is 25, consistent with significant self-reported handicap. (HHIE-S is a self-reported questionnaire that quantifies the handicapping effects of hearing loss.) • Pure-tone test indicates a mild sloping to moderate sensorineural hearing loss most pronounced in high frequencies.• Speech understanding in quiet environment is excellent, but decreases to fair in a noisy environment.Which one of the following is the most suitable intervention for this patient?

• Cochlear implant
• Bone-anchored hearing aid
• Environmental modifications
• Hearing aid and counseling on communication strategies
• Hearing aid and counseling on communication strategies

A 65-year-old male presents to the outpatient office for a routine health evaluation.The patient has a history of hypertension (HTN), for which he takes medications.

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