Adult-Gerontology Primary Care Nurse Practitioner Exam Chronic Disease Management in Older Adults 2 — Questions and Answers
Question 1: In managing osteoporosis in a 72-year-old postmenopausal woman with a T-score of -2.8, the first-line pharmacological treatment is:
- Teriparatide
- Denosumab
- Alendronate (bisphosphonate) (Correct answer)
- Raloxifene
Correct answer: Alendronate (bisphosphonate)
Bisphosphonates such as alendronate are the first-line pharmacotherapy for osteoporosis due to their proven efficacy in reducing vertebral and hip fractures.
Question 2: The AGPCNP is managing a 78-year-old with chronic pain from osteoarthritis. Which of the following is the preferred first-line pharmacological option?
- Opioid analgesics
- Acetaminophen (Correct answer)
- NSAIDs
- Tramadol
Correct answer: Acetaminophen
Acetaminophen is recommended as the first-line oral analgesic for osteoarthritis pain in older adults due to its favorable safety profile compared to NSAIDs and opioids.
Question 3: A 68-year-old with atrial fibrillation has a CHA₂DS₂-VASc score of 4. The most appropriate management is:
- Aspirin only
- No anticoagulation needed
- Oral anticoagulation with DOAC or warfarin (Correct answer)
- Rate control only
Correct answer: Oral anticoagulation with DOAC or warfarin
A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates high stroke risk; oral anticoagulation is strongly recommended to reduce thromboembolic events.
Question 4: For an older adult with hypothyroidism, the TSH target during levothyroxine therapy is:
- 0.5–2.5 mIU/L
- 1.0–2.0 mIU/L
- 1.0–4.0 mIU/L (or slightly higher for elderly) (Correct answer)
- 5.0–10.0 mIU/L
Correct answer: 1.0–4.0 mIU/L (or slightly higher for elderly)
For older adults, particularly those with cardiovascular disease or osteoporosis risk, a TSH target in the upper-normal range (1.0–4.0 or slightly higher) is often acceptable to avoid overtreatment.
Question 5: Which vaccine is specifically recommended for adults aged 65 and older to prevent severe pneumococcal disease?
- PCV15 or PCV20 (pneumococcal conjugate vaccine) (Correct answer)
- PPSV23 alone
- Pneumovax 23 only
- No pneumococcal vaccine is needed after age 65
Correct answer: PCV15 or PCV20 (pneumococcal conjugate vaccine)
Current CDC recommendations for adults ≥65 who have not previously been vaccinated include PCV15 followed by PPSV23, or a single dose of PCV20.
Question 6: An 80-year-old with moderate Alzheimer's disease and new behavioral symptoms (agitation, aggression) should first be evaluated for:
- Antipsychotic medication initiation
- Reversible causes such as pain, infection, medication side effects (Correct answer)
- Immediate nursing facility placement
- Sedative-hypnotic therapy
Correct answer: Reversible causes such as pain, infection, medication side effects
Before initiating pharmacotherapy for dementia-related behavioral symptoms, all potentially reversible triggers (pain, UTI, constipation, medication toxicity) must be identified and addressed.
Adult-Gerontology Primary Care Nurse Practitioner Exam Chronic Disease Management in Older Adults 2
In managing osteoporosis in a 72-year-old postmenopausal woman with a T-score of -2.8, the first-line pharmacological treatment is: