Case Studies & Practical Application Flashcards

A 73-year-old woman with a history of GERD and osteoporosis is taking omeprazole daily for 4 years. At her annual visit, which monitoring concern is most relevant to her long-term PPI use?

Answer: Hypomagnesemia and vitamin B12 deficiency

Long-term PPI use is associated with hypomagnesemia, vitamin B12 deficiency, and increased fracture risk, warranting periodic monitoring.

An 80-year-old man with heart failure (EF 35%) is started on carvedilol. At his 2-week follow-up, he reports feeling much more fatigued and his BP is 88/54. What should the NP do?

Answer: Reduce the carvedilol dose and optimize volume status before uptitration

Symptomatic hypotension and fatigue during beta-blocker initiation in HFrEF warrants dose reduction and volume optimization before attempting uptitration.

A 69-year-old woman presents with 4 months of progressive dysphagia to solids, unintentional weight loss of 12 lbs, and occasional regurgitation. What is the most appropriate next diagnostic step?

Answer: Upper endoscopy (EGD)

Progressive dysphagia with weight loss in an older adult is a red flag alarm symptom requiring urgent upper endoscopy to rule out esophageal malignancy.

A 76-year-old man with COPD uses a long-acting beta-agonist and long-acting muscarinic antagonist. He reports 3 exacerbations last year. According to GOLD guidelines, what therapy should be added?

Answer: Inhaled corticosteroid (ICS)

GOLD guidelines recommend adding an inhaled corticosteroid to dual bronchodilator therapy in COPD patients with frequent exacerbations (≥2/year or ≥1 hospitalization).

A 70-year-old woman presents with sudden-onset severe headache she describes as 'the worst headache of my life,' with neck stiffness and photophobia. Vital signs show BP 162/94, temperature 98.6°F. What is the most urgent action?

Answer: Order an urgent non-contrast CT head and call 911/transfer to ED

A thunderclap headache with meningeal signs is a medical emergency; immediate CT head to rule out subarachnoid hemorrhage and ED transfer are required.

A 68-year-old man with type 2 diabetes and a BMI of 34 presents for follow-up. His A1C is 7.9%, and he has a history of ASCVD. Which medication addition would provide both glycemic control and cardiovascular benefit?

Answer: Semaglutide (GLP-1 RA)

GLP-1 receptor agonists such as semaglutide have demonstrated cardiovascular outcome benefits and are preferred in patients with T2DM and established ASCVD.

A 75-year-old woman with moderate Alzheimer's disease and agitation is prescribed low-dose quetiapine by a consultant. She has a history of falls. What must the NP document when prescribing an atypical antipsychotic to this patient?

Answer: Informed consent regarding increased risk of mortality in elderly dementia patients

Atypical antipsychotics carry an FDA black box warning for increased mortality in elderly patients with dementia-related psychosis; informed consent must be documented.