Geriatric Medicine: Comprehensive Care for Older Adults, Exams of Nursing

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NR 601 Midterm Exam

A 65-year-old male patient presents with complaints of fatigue, weight gain, and cold intolerance. On examination, you note dry skin and bradycardia. Which of the following is the most likely diagnosis? A) Hyperthyroidism B) Hypothyroidism C) Addison's Disease D) Cushing's Syndrome Answer: B) Hypothyroidism Question 2: Which of the following is the recommended first-line treatment for a newly diagnosed patient with type 2 diabetes mellitus? A) Insulin therapy B) Metformin C) Sulfonylureas D) Thiazolidinediones Answer: B) Metformin Question 3: A 70-year-old woman with a history of osteoporosis is at an increased risk for which of the following? A) Stroke B) Myocardial infarction C) Hip fracture D) Chronic kidney disease Answer: C) Hip fracture

Question 4: Which of the following vaccines is recommended annually for all adults over the age of 65? A) Measles, Mumps, Rubella (MMR) B) Tetanus, Diphtheria, and Pertussis (Tdap) C) Influenza D) Varicella Answer: C) Influenza Question 5: A 75-year-old male presents with urinary frequency, urgency, and nocturia. The digital rectal examination reveals an enlarged, smooth, and firm prostate. What is the most likely diagnosis? A) Prostate cancer B) Benign prostatic hyperplasia (BPH) C) Urinary tract infection (UTI) D) Chronic prostatitis Answer: B) Benign prostatic hyperplasia (BPH) Question 6: Which of the following lifestyle modifications is most effective in managing hypertension in older adults? A) Increased alcohol consumption B) High-protein diet C) Regular aerobic exercise D) Low-fat diet Answer: C) Regular aerobic exercise Question 7:

A 68-year-old woman presents with sudden onset of right-sided weakness and slurred speech. Her past medical history includes hypertension and atrial fibrillation. What is the most likely diagnosis? A) Transient ischemic attack (TIA) B) Hemorrhagic stroke C) Ischemic stroke D) Bell's palsy Answer: C) Ischemic stroke Question 8: Which of the following is the most common cause of dementia in older adults? A) Vascular dementia B) Alzheimer's disease C) Parkinson's disease D) Huntington's disease Answer: B) Alzheimer's disease Question 9: A 72-year-old female with a history of chronic obstructive pulmonary disease (COPD) presents with increased dyspnea and a productive cough. She is afebrile, and her oxygen saturation is 88% on room air. What is the most appropriate initial management? A) Immediate intubation and mechanical ventilation B) Supplemental oxygen and bronchodilator therapy C) Antibiotics and corticosteroids D) Hospitalization for observation Answer: B) Supplemental oxygen and bronchodilator therapy Question 10:

Which of the following lab tests is most useful in diagnosing rheumatoid arthritis in older adults? A) Complete blood count (CBC) B) Rheumatoid factor (RF) C) Erythrocyte sedimentation rate (ESR) D) C-reactive protein (CRP) Answer: B) Rheumatoid factor (RF) Question 11: A 78-year-old male with a history of atrial fibrillation is being evaluated for anticoagulation therapy. Which of the following is a major contraindication to the use of warfarin in this patient? A) Hypertension B) History of gastrointestinal bleeding C) Type 2 diabetes mellitus D) Chronic kidney disease Answer: B) History of gastrointestinal bleeding Question 12: Which of the following is the most appropriate screening test for colorectal cancer in a 70-year-old asymptomatic patient? A) Fecal occult blood test (FOBT) annually B) Flexible sigmoidoscopy every 5 years C) Colonoscopy every 10 years D) Computed tomography (CT) colonography every 5 years Answer: C) Colonoscopy every 10 years Question 13:

A 65-year-old woman presents with joint pain and stiffness in her hands, especially in the morning. The physical exam reveals swollen and tender joints in her fingers. What is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Gout D) Systemic lupus erythematosus (SLE) Answer: B) Rheumatoid arthritis Question 14: A 70-year-old male complains of difficulty swallowing both solids and liquids. He has lost 10 pounds in the past two months. Which of the following conditions should be ruled out first? A) Gastroesophageal reflux disease (GERD) B) Esophageal cancer C) Achalasia D) Peptic ulcer disease Answer: B) Esophageal cancer Question 15: Which of the following is the most common cause of secondary hypertension in older adults? A) Renal artery stenosis B) Primary hyperaldosteronism C) Cushing's syndrome D) Pheochromocytoma Answer: A) Renal artery stenosis Question 16:

A 72-year-old woman with a history of osteoporosis is prescribed bisphosphonates. Which of the following instructions should be given to her regarding the administration of this medication? A) Take it with food to avoid gastrointestinal upset. B) Take it at bedtime to maximize absorption. C) Take it with a full glass of water and remain upright for 30 minutes. D) Take it with calcium supplements to enhance efficacy. Answer: C) Take it with a full glass of water and remain upright for 30 minutes. Question 17: A 68-year-old male patient with a history of chronic kidney disease presents with anemia. Which of the following is the most likely cause of his anemia? A) Iron deficiency B) Vitamin B12 deficiency C) Erythropoietin deficiency D) Folate deficiency Answer: C) Erythropoietin deficiency Question 18: Which of the following statements about the pharmacokinetics of medications in older adults is true? A) Drug absorption increases due to slower gastric emptying. B) Drug metabolism is generally faster due to increased liver function. C) Drug clearance decreases due to reduced renal function. D) Drug distribution is unaffected by changes in body composition. Answer: C) Drug clearance decreases due to reduced renal function. Question 19:

A 75-year-old female presents with a new onset of confusion, agitation, and urinary incontinence. Her family reports that she had a fall two days ago. Which of the following is the most likely diagnosis? A) Alzheimer's disease B) Delirium C) Urinary tract infection (UTI) D) Stroke Answer: B) Delirium Question 20: A 68-year-old man with chronic obstructive pulmonary disease (COPD) is started on long-term oxygen therapy. Which of the following is the primary indication for this therapy? A) Dyspnea on exertion B) Cyanosis at rest C) Oxygen saturation below 88% on room air D) Presence of hypercapnia Answer: C) Oxygen saturation below 88% on room air Question 21: A 70-year-old woman presents with persistent cough and shortness of breath. She has a 50-pack-year smoking history. A chest X-ray reveals a mass in the right upper lobe. Which of the following is the most likely diagnosis? A) Tuberculosis B) Chronic obstructive pulmonary disease (COPD) C) Pneumonia D) Lung cancer Answer: D) Lung cancer

Question 22: Which of the following is the most appropriate treatment for a 68-year-old male with acute gouty arthritis? A) Allopurinol B) Colchicine C) Methotrexate D) Hydroxychloroquine Answer: B) Colchicine Question 23: A 75-year-old woman is diagnosed with age-related macular degeneration (AMD). Which of the following is a hallmark sign of this condition? A) Peripheral vision loss B) Central vision loss C) Sudden onset of double vision D) Complete blindness Answer: B) Central vision loss Question 24: A 72-year-old male with a history of hypertension presents with severe headache, blurred vision, and a blood pressure of 210/120 mm Hg. What is the most appropriate next step in management? A) Oral antihypertensive therapy and close follow-up B) Immediate hospitalization and intravenous antihypertensive therapy C) Observation and repeat blood pressure in one hour D) Referral to a neurologist for evaluation Answer: B) Immediate hospitalization and intravenous antihypertensive therapy Question 25:

A 70-year-old female presents with postmenopausal vaginal bleeding. Which of the following is the most important condition to rule out? A) Endometrial cancer B) Atrophic vaginitis C) Uterine fibroids D) Cervical polyp Answer: A) Endometrial cancer Question 26: Which of the following medications is commonly associated with an increased risk of falls in older adults? A) Beta-blockers B) Calcium channel blockers C) Benzodiazepines D) ACE inhibitors Answer: C) Benzodiazepines Question 27: A 65-year-old man with a history of heart failure presents with worsening shortness of breath and lower extremity edema. Which of the following physical exam findings is most consistent with congestive heart failure? A) Hepatomegaly B) Systolic ejection murmur C) Jugular venous distention D) Decreased breath sounds Answer: C) Jugular venous distention Question 28:

A 68-year-old woman with a history of chronic kidney disease is found to have hyperkalemia. Which of the following medications is most likely to exacerbate this condition? A) Furosemide B) Lisinopril C) Metoprolol D) Calcium carbonate Answer: B) Lisinopril Question 29: Which of the following is the recommended screening test for osteoporosis in a 65- year-old female? A) Bone marrow biopsy B) Serum calcium level C) Dual-energy X-ray absorptiometry (DEXA) scan D) Magnetic resonance imaging (MRI) Answer: C) Dual-energy X-ray absorptiometry (DEXA) scan Question 30: A 75-year-old male is diagnosed with Parkinson's disease. Which of the following symptoms is most characteristic of this condition? A) Resting tremor B) Intention tremor C) Muscle spasticity D) Hyperreflexia Answer: A) Resting tremor Question 31:

A 68-year-old male presents with a complaint of new-onset lower back pain that worsens with activity and is relieved by rest. He denies any recent trauma. On examination, there is tenderness over the lumbar spine. Which of the following is the most likely diagnosis? A) Lumbar strain B) Vertebral compression fracture C) Degenerative disc disease D) Spinal stenosis Answer: C) Degenerative disc disease Question 32: Which of the following best describes the mechanism of action of statins in lowering cholesterol levels? A) Inhibition of dietary cholesterol absorption in the intestines B) Inhibition of the enzyme HMG-CoA reductase C) Activation of lipoprotein lipase to increase triglyceride clearance D) Increased excretion of bile acids Answer: B) Inhibition of the enzyme HMG-CoA reductase Question 33: A 70-year-old woman with a history of osteoporosis is concerned about the risk of hip fractures. Which of the following is the most important lifestyle modification to reduce her risk? A) Increasing dietary protein intake B) Regular weight-bearing exercise C) Taking daily calcium supplements without vitamin D D) Limiting exposure to sunlight Answer: B) Regular weight-bearing exercise

Question 34: A 75-year-old male patient with chronic kidney disease (CKD) presents with symptoms of uremia. Which of the following is a common symptom of uremia in advanced CKD? A) Persistent itching (pruritus) B) Increased energy levels C) Hypercalcemia D) Improved appetite Answer: A) Persistent itching (pruritus) Question 35: A 72-year-old female presents with a gradual onset of weakness, fatigue, and pallor. Laboratory tests reveal microcytic anemia. Which of the following is the most likely underlying cause? A) Iron deficiency anemia B) Vitamin B12 deficiency C) Folate deficiency D) Anemia of chronic disease Answer: A) Iron deficiency anemia Question 36: Which of the following vaccines is recommended for adults aged 65 and older to protect against shingles? A) Influenza vaccine B) Pneumococcal vaccine C) Zoster vaccine D) Hepatitis B vaccine Answer: C) Zoster vaccine

Question 37: A 70-year-old male with a history of atrial fibrillation presents with new-onset confusion and right-sided weakness. His current medications include warfarin. A CT scan of the head shows a hemorrhagic stroke. Which of the following is the most appropriate next step in managing his anticoagulation? A) Increase the dose of warfarin B) Continue the current dose of warfarin C) Discontinue warfarin and administer vitamin K D) Switch to a direct oral anticoagulant (DOAC) Answer: C) Discontinue warfarin and administer vitamin K Question 38: A 68-year-old woman is concerned about her risk of developing Alzheimer's disease, as her mother was diagnosed with it in her 70s. Which of the following is a known modifiable risk factor for Alzheimer's disease? A) Family history of dementia B) Advancing age C) Hypertension D) Female gender Answer: C) Hypertension Question 39: A 75-year-old male presents with a history of chronic obstructive pulmonary disease (COPD). He has had two exacerbations in the last year. Which of the following inhaler medications is recommended as maintenance therapy for this patient? A) Short-acting beta-agonist (SABA) B) Long-acting beta-agonist (LABA) C) Inhaled corticosteroid (ICS) D) Long-acting muscarinic antagonist (LAMA)

Answer: D) Long-acting muscarinic antagonist (LAMA) Question 40: A 70-year-old female presents with a complaint of frequent falls and imbalance. She denies any dizziness or vertigo. Which of the following conditions is most likely contributing to her falls? A) Benign paroxysmal positional vertigo (BPPV) B) Parkinson's disease C) Peripheral neuropathy D) Meniere's disease Answer: C) Peripheral neuropathy Question 41: A 76-year-old male with a history of coronary artery disease presents with new- onset chest pain that occurs at rest and lasts for 20 minutes. The pain is not relieved by nitroglycerin. What is the most likely diagnosis? A) Stable angina B) Unstable angina C) Myocardial infarction D) Pericarditis Answer: B) Unstable angina Question 42: A 65-year-old woman with a history of type 2 diabetes mellitus is being evaluated for diabetic nephropathy. Which of the following laboratory findings is most indicative of this condition? A) Elevated blood urea nitrogen (BUN) B) Proteinuria C) Hypokalemia

D) Hypercalcemia Answer: B) Proteinuria Question 43: A 78-year-old male presents with persistent fatigue, weakness, and pallor. Laboratory studies reveal a hemoglobin level of 8 g/dL and a mean corpuscular volume (MCV) of 110 fL. Which of the following is the most likely cause of his anemia? A) Iron deficiency anemia B) Vitamin B12 deficiency C) Hemolytic anemia D) Anemia of chronic disease Answer: B) Vitamin B12 deficiency Question 44: Which of the following is the most appropriate initial management for a 70-year-old female with a new diagnosis of osteoporosis and no prior fractures? A) Start on calcium and vitamin D supplementation B) Prescribe bisphosphonates C) Recommend hormone replacement therapy D) Increase weight-bearing exercises Answer: B) Prescribe bisphosphonates Question 45: A 68-year-old male with a history of hypertension presents with complaints of palpitations, dizziness, and shortness of breath. An electrocardiogram (ECG) reveals atrial fibrillation. Which of the following is the primary goal in the initial management of atrial fibrillation? A) Conversion to sinus rhythm

B) Rate control C) Anticoagulation D) Ablation therapy Answer: B) Rate control Question 46: A 75-year-old woman presents with complaints of dry mouth, dry eyes, and joint pain. Laboratory tests reveal a positive anti-Ro (SSA) antibody. What is the most likely diagnosis? A) Rheumatoid arthritis B) Sjogren's syndrome C) Systemic lupus erythematosus (SLE) D) Osteoarthritis Answer: B) Sjogren's syndrome Question 47: A 72-year-old male with a history of chronic obstructive pulmonary disease (COPD) is hospitalized for an acute exacerbation. Which of the following is the most appropriate initial treatment? A) Intravenous antibiotics B) Short-acting beta-agonist (SABA) via nebulizer C) Oral corticosteroids D) Non-invasive positive pressure ventilation (NIPPV) Answer: B) Short-acting beta-agonist (SABA) via nebulizer Question 48: A 70-year-old woman with a history of diabetes and hypertension presents with a painful, red, and swollen left leg. The pain is worse with walking and improves with rest. What is the most likely diagnosis?

A) Deep vein thrombosis (DVT) B) Cellulitis C) Peripheral arterial disease (PAD) D) Lymphedema Answer: C) Peripheral arterial disease (PAD) Question 49: Which of the following is the best diagnostic test to confirm a suspected diagnosis of pulmonary embolism in an older adult patient? A) Chest X-ray B) D-dimer assay C) Ventilation-perfusion (V/Q) scan D) CT pulmonary angiography Answer: D) CT pulmonary angiography Question 50: A 69-year-old male with a history of prostate cancer presents with severe back pain, lower extremity weakness, and urinary incontinence. What is the most likely cause of his symptoms? A) Spinal stenosis B) Vertebral compression fracture C) Spinal cord compression due to metastasis D) Degenerative disc disease Answer: C) Spinal cord compression due to metastasis Question 51: A 76-year-old woman presents with a complaint of progressive shortness of breath, fatigue, and swelling in her legs. Physical examination reveals bilateral pitting edema and jugular venous distention. Which of the following is the most likely diagnosis?

A) Chronic obstructive pulmonary disease (COPD) B) Congestive heart failure (CHF) C) Pulmonary embolism D) Chronic kidney disease (CKD) Answer: B) Congestive heart failure (CHF) Question 52: A 68-year-old male with a history of type 2 diabetes mellitus presents with numbness and tingling in his feet. Which of the following is the most likely cause of his symptoms? A) Peripheral neuropathy B) Peripheral artery disease (PAD) C) Sciatica D) Lumbar disc herniation Answer: A) Peripheral neuropathy Question 53: A 70-year-old woman presents with a new-onset headache, jaw claudication, and visual disturbances. Her erythrocyte sedimentation rate (ESR) is elevated. What is the most likely diagnosis? A) Temporal arteritis (Giant cell arteritis) B) Migraine headache C) Cluster headache D) Tension headache Answer: A) Temporal arteritis (Giant cell arteritis) Question 54: A 75-year-old male is evaluated for frequent falls. On examination, there is evidence of shuffling gait, bradykinesia, and resting tremor. Which of the following is the most likely diagnosis?

A) Parkinson's disease B) Alzheimer's disease C) Multiple sclerosis D) Amyotrophic lateral sclerosis (ALS) Answer: A) Parkinson's disease Question 55: A 72-year-old woman with a history of osteoporosis falls and sustains a hip fracture. Which of the following factors most likely contributed to her fracture? A) Increased bone density B) Low calcium intake C) Vitamin D deficiency D) Lack of weight-bearing exercise Answer: C) Vitamin D deficiency Question 56: A 68-year-old male with chronic kidney disease presents with anemia. Which of the following is the most appropriate treatment for anemia of chronic kidney disease? A) Iron supplementation B) Vitamin B12 supplementation C) Erythropoiesis-stimulating agents (ESAs) D) Folate supplementation Answer: C) Erythropoiesis-stimulating agents (ESAs) Question 57: A 75-year-old female presents with memory loss and difficulty performing daily activities. She has trouble recalling recent events but can remember things from her distant past. What is the most likely diagnosis?

A) Alzheimer's disease B) Vascular dementia C) Lewy body dementia D) Frontotemporal dementia Answer: A) Alzheimer's disease Question 58: A 70-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea and increased sputum production. What is the most likely cause of his symptoms? A) Pneumonia B) COPD exacerbation C) Pulmonary embolism D) Congestive heart failure (CHF) Answer: B) COPD exacerbation Question 59: A 74-year-old woman presents with complaints of urinary frequency, urgency, and dysuria. A urinalysis reveals pyuria and bacteriuria. What is the most likely diagnosis? A) Urinary tract infection (UTI) B) Interstitial cystitis C) Overactive bladder D) Stress incontinence Answer: A) Urinary tract infection (UTI) Question 60: A 78-year-old male with a history of hypertension presents with sudden-onset severe headache, nausea, and vomiting. His blood pressure is 220/130 mm Hg. A CT scan of the head shows an intracerebral hemorrhage. What is the most appropriate initial management?

A) Immediate surgery B) Lowering blood pressure with intravenous antihypertensive therapy C) Observation and repeat imaging in 24 hours D) Administration of thrombolytics Answer: B) Lowering blood pressure with intravenous antihypertensive therapy Question 61: A 69-year-old male with a history of chronic hypertension presents with complaints of vision changes and a “curtain coming down” over his right eye. What is the most likely diagnosis? A) Retinal detachment B) Cataract C) Glaucoma D) Macular degeneration Answer: A) Retinal detachment Question 62: A 72-year-old female presents with a history of recent weight loss, fatigue, and night sweats. Laboratory tests reveal hypercalcemia and anemia. What is the most likely diagnosis? A) Multiple myeloma B) Hyperparathyroidism C) Chronic lymphocytic leukemia (CLL) D) Rheumatoid arthritis Answer: A) Multiple myeloma Question 63:

A 68-year-old male presents with progressive difficulty swallowing both solids and liquids. He also reports unintentional weight loss over the past six months. Which of the following is the most likely diagnosis? A) Esophageal cancer B) Gastroesophageal reflux disease (GERD) C) Achalasia D) Peptic ulcer disease Answer: A) Esophageal cancer Question 64: A 75-year-old female is brought to the clinic by her daughter due to increasing forgetfulness and difficulty managing her finances. The patient has a Mini-Mental State Examination (MMSE) score of 22/30. What is the most likely diagnosis? A) Mild cognitive impairment (MCI) B) Alzheimer's disease C) Vascular dementia D) Delirium Answer: A) Mild cognitive impairment (MCI) Question 65: A 70-year-old man with a history of type 2 diabetes mellitus and hypertension presents with complaints of erectile dysfunction. Which of the following is the most appropriate initial management? A) Phosphodiesterase-5 (PDE-5) inhibitors B) Testosterone replacement therapy C) Psychotherapy D) Vacuum erection devices Answer: A) Phosphodiesterase-5 (PDE-5) inhibitors

Question 66: A 76-year-old woman presents with complaints of progressive hearing loss. On examination, there is bilateral cerumen impaction. What is the most appropriate initial management? A) Referral to an otolaryngologist B) Audiometry testing C) Cerumen removal D) Prescribing hearing aids Answer: C) Cerumen removal Question 67: A 68-year-old male with a history of coronary artery disease presents with sudden- onset sharp chest pain that radiates to his back. He is diaphoretic and hypotensive. A chest X-ray reveals a widened mediastinum. What is the most likely diagnosis? A) Aortic dissection B) Myocardial infarction C) Pulmonary embolism D) Tension pneumothorax Answer: A) Aortic dissection Question 68: A 72-year-old female presents with a history of recurrent urinary tract infections (UTIs). She is currently asymptomatic. Which of the following is the most appropriate management? A) Prescribe a course of antibiotics B) Perform a urine culture and treat if positive C) Start prophylactic antibiotics D) Encourage increased fluid intake and monitor Answer: D) Encourage increased fluid intake and monitor

Question 69: A 74-year-old male with a history of chronic obstructive pulmonary disease (COPD) is hospitalized with pneumonia. Which of the following is the most appropriate empiric antibiotic therapy? A) Amoxicillin B) Azithromycin C) Ciprofloxacin D) Vancomycin Answer: B) Azithromycin Question 70: A 78-year-old woman presents with a complaint of involuntary leakage of urine when she coughs, laughs, or sneezes. What is the most likely diagnosis? A) Stress incontinence B) Urge incontinence C) Overflow incontinence D) Functional incontinence Answer: A) Stress incontinence Question 71: A 70-year-old male presents with progressive weakness and difficulty walking. On examination, he has decreased deep tendon reflexes, muscle wasting, and fasciculations. What is the most likely diagnosis? A) Amyotrophic lateral sclerosis (ALS) B) Multiple sclerosis (MS) C) Guillain-Barré syndrome D) Myasthenia gravis Answer: A) Amyotrophic lateral sclerosis (ALS)

Question 72: A 77-year-old woman with a history of atrial fibrillation presents with sudden onset of slurred speech and right-sided weakness. What is the most appropriate initial imaging study? A) CT scan of the brain without contrast B) MRI of the brain with contrast C) Carotid ultrasound D) Echocardiogram Answer: A) CT scan of the brain without contrast Question 73: A 68-year-old male with a history of smoking presents with a chronic cough, hemoptysis, and unintentional weight loss. A chest X-ray shows a mass in the right lung. What is the most likely diagnosis? A) Lung cancer B) Tuberculosis C) Chronic obstructive pulmonary disease (COPD) D) Bronchiectasis Answer: A) Lung cancer Question 74: A 74-year-old female presents with sudden onset of visual loss in her left eye. She describes it as a "curtain coming down." There is no pain associated with the vision loss. What is the most likely cause? A) Retinal vein occlusion B) Retinal detachment C) Acute angle-closure glaucoma D) Central retinal artery occlusion