Adult-Gerontology Primary Care Nurse Practitioner Exam Case Studies & Practical Application 4

Question 1

An 84-year-old woman with advanced dementia is brought in by her son. She has lost 15% of body weight in 3 months and can no longer swallow safely. Her son asks about placing a feeding tube. What is the evidence-based recommendation?

Accepted Answer

Advise that feeding tubes do not improve survival or comfort in advanced dementia and discuss hand-feeding

Answer

Evidence does not support feeding tube use in advanced dementia; hand-feeding with comfort-focused care is the recommended approach endorsed by major geriatric societies.

Question 2

A 72-year-old man presents with a serum sodium of 128 mEq/L, euvolemic exam, urine sodium of 42 mEq/L, and urine osmolality of 520 mOsm/kg. He takes an SSRI. What is the most likely diagnosis?

Accepted Answer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer

Euvolemic hyponatremia with elevated urine sodium and urine osmolality in a patient on an SSRI is consistent with SIADH, a known adverse effect of SSRIs.

Question 3

A 67-year-old woman with newly diagnosed stage I hypertension (BP 142/88) has no diabetes, CKD, or cardiovascular disease. She is African American. Which first-line antihypertensive is most appropriate per JNC/ACC guidelines?

Accepted Answer

Thiazide diuretic (chlorthalidone) or calcium channel blocker (amlodipine)

Answer

In Black patients without compelling indications, thiazide diuretics and calcium channel blockers are preferred as first-line agents due to better efficacy in this population.

Question 4

A 78-year-old man with chronic low back pain has been on hydrocodone/acetaminophen for 2 years. He now requests dose escalation. A urine drug screen is negative for opioids. What is the most appropriate interpretation?

Accepted Answer

The patient may not be taking the medication as prescribed; this warrants a careful conversation

Answer

A urine drug screen negative for prescribed opioids suggests the patient may be diverting or not taking the medication, requiring a direct and non-confrontational clinical conversation.

Question 5

A 65-year-old woman has a DEXA scan T-score of -2.8 at the femoral neck. She has no prior fractures. Her 10-year FRAX probability is 22% for major osteoporotic fracture. What is the recommended treatment?

Accepted Answer

Initiate bisphosphonate therapy plus calcium and vitamin D

Answer

A FRAX 10-year probability ≥20% for major osteoporotic fracture or a T-score ≤-2.5 with no other risk factors meets the threshold to initiate pharmacological therapy with bisphosphonates.

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 4