Case Studies & Practical Application Flashcards

An 82-year-old woman with hypertension and diabetes presents with acute confusion, fever of 101.8°F, and suprapubic discomfort. Urinalysis shows pyuria and bacteriuria. Which is the most appropriate next step?

Answer: Obtain urine culture and initiate empiric antibiotics appropriate for her age and comorbidities

In an elderly patient with systemic signs of infection (fever, altered mental status), urine culture should be obtained but empiric antibiotics should be started immediately without waiting for results.

A 74-year-old man on warfarin for atrial fibrillation presents with an INR of 5.8 but no active bleeding. What is the most appropriate management?

Answer: Hold 1-2 doses of warfarin and recheck INR in 1-2 days

For an elevated INR without bleeding, holding 1-2 doses and rechecking INR is appropriate management unless the patient has high bleeding risk factors.

A 68-year-old woman with osteoporosis has been on alendronate for 5 years. She reports new jaw pain and her dentist found an exposed area of bone. Which complication should the NP consider?

Answer: Osteonecrosis of the jaw

Osteonecrosis of the jaw (ONJ) is a rare but recognized complication of bisphosphonate therapy, especially following dental procedures.

A 79-year-old man is brought in by his daughter who reports he has been confused at home for the past 3 days. He is on multiple medications including anticholinergics. His MMSE score today is 18. Which tool best identifies whether this is delirium superimposed on dementia?

Answer: Confusion Assessment Method (CAM)

The Confusion Assessment Method (CAM) is the validated tool for detecting delirium, including when superimposed on underlying dementia.

A 71-year-old woman with type 2 diabetes and CKD stage 3b (eGFR 32) presents for medication review. Which diabetes medication should be avoided given her renal function?

Answer: Metformin

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² and should be used with caution and dose reduction at eGFR 30-45, making it inappropriate at eGFR of 32.

A 77-year-old man presents with a 6-month history of urinary frequency, hesitancy, and nocturia three times per night. PSA is 2.1 ng/mL, DRE reveals a smooth, enlarged prostate. His AUA symptom score is 18. What is the first-line treatment?

Answer: Alpha-1 blocker (tamsulosin)

Alpha-1 blockers such as tamsulosin are first-line pharmacological treatment for moderate to severe BPH symptoms.

A 65-year-old woman presents with a 2-week history of fatigue, weight loss of 8 lbs, night sweats, and a firm, non-tender left supraclavicular lymph node. The NP's primary concern should be:

Answer: Malignancy requiring urgent evaluation

A firm, non-tender supraclavicular lymph node with constitutional symptoms (weight loss, night sweats, fatigue) is highly concerning for malignancy and requires urgent workup.