Adult-Gerontology Primary Care Nurse Practitioner Exam Case Studies & Practical Application 3

Question 1

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?

Accepted Answer

Hypomagnesemia and vitamin B12 deficiency

Answer

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

Question 2

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?

Accepted Answer

Reduce the carvedilol dose and optimize volume status before uptitration

Answer

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

Question 3

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?

Accepted Answer

Upper endoscopy (EGD)

Answer

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

Question 4

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?

Accepted Answer

Inhaled corticosteroid (ICS)

Answer

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

Question 5

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?

Accepted Answer

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

Answer

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

Adult-Gerontology Primary Care Nurse Practitioner Exam Practice Test

Adult-Gerontology Primary Care Nurse Practitioner Exam Practice Test

Adult-Gerontology Primary Care Nurse Practitioner Exam Case Studies & Practical Application 3