Adult-Gerontology Primary Care Nurse Practitioner Exam Health Promotion & Disease Prevention 2 — Questions and Answers
Question 1: Which validated screening tool is most commonly recommended by the USPSTF for depression screening in older adults in the primary care setting?
- Hamilton Depression Rating Scale (HAM-D)
- Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
- Montgomery-Åsberg Depression Rating Scale (MADRS)
- Geriatric Depression Scale-15 (GDS-15) only
Correct answer: Patient Health Questionnaire-9 (PHQ-9)
The PHQ-9 is the USPSTF-recommended, widely validated tool for depression screening in primary care across adult populations, including older adults.
Question 2: The USPSTF recommends one-time abdominal aortic aneurysm (AAA) screening with abdominal ultrasound for which specific population?
- All adults aged 65 and older
- Men aged 65–75 who have ever smoked (Correct answer)
- Women aged 65–75 who currently smoke
- All adults with a family history of AAA
Correct answer: Men aged 65–75 who have ever smoked
USPSTF recommends one-time AAA screening ultrasound only for men aged 65–75 who have a history of ever smoking (≥100 cigarettes lifetime).
Question 3: What is the USPSTF's current stance on routine cognitive impairment screening in older adults who have no signs or symptoms of cognitive decline?
- Screen all adults annually starting at age 65 using the MMSE
- Screen every 3 years using the Montreal Cognitive Assessment (MoCA)
- The current evidence is insufficient to recommend for or against routine screening (Correct answer)
- Screening is not recommended because treatment does not alter outcomes
Correct answer: The current evidence is insufficient to recommend for or against routine screening
As of the most recent USPSTF statement, the evidence is insufficient (I statement) to assess the balance of benefits and harms of routine cognitive impairment screening in asymptomatic older adults.
Question 4: Which herpes zoster vaccine is preferred by ACIP for adults aged 50 and older, and what is the recommended schedule?
- Zostavax (live attenuated) — one dose
- Shingrix (recombinant subunit) — two doses given 2–6 months apart (Correct answer)
- Shingrix — one dose annually
- Either vaccine — single dose based on patient preference
Correct answer: Shingrix (recombinant subunit) — two doses given 2–6 months apart
Shingrix (RZV) is the ACIP-preferred herpes zoster vaccine for adults 50 and older, administered as two doses separated by 2–6 months due to its superior efficacy and durability compared to Zostavax.
Question 5: Regarding PSA-based prostate cancer screening, which statement best reflects USPSTF guidance for men aged 55–69 years?
- Annual PSA testing is recommended for all men in this age group
- PSA screening should be offered based on individualized decision-making after discussing benefits and harms (Correct answer)
- PSA screening is not recommended because harms clearly outweigh benefits
- PSA testing is recommended only for men with a family history of prostate cancer
Correct answer: PSA screening should be offered based on individualized decision-making after discussing benefits and harms
USPSTF (2018) gives a 'C' recommendation for PSA screening in men aged 55–69, meaning individual decision-making after clinician-patient discussion of benefits and harms is appropriate.
Question 6: According to USPSTF, when is it appropriate to discontinue cervical cancer screening in women aged 65 and older?
- At exactly age 65 regardless of prior screening history
- When adequate prior screening shows no high-grade precancerous lesions and the patient is not at high risk (Correct answer)
- After three consecutive negative annual Pap smears
- Only after total hysterectomy including cervix removal
Correct answer: When adequate prior screening shows no high-grade precancerous lesions and the patient is not at high risk
USPSTF recommends against cervical cancer screening in women 65 and older who have had adequate prior screening (three consecutive negative Pap tests or two negative co-tests in 10 years) and are not at high risk.
Question 7: The AUDIT-C is a three-question validated tool used in primary care to screen for which condition?
- Cognitive impairment
- Unhealthy alcohol use (Correct answer)
- Depression and anxiety
- Functional decline and frailty
Correct answer: Unhealthy alcohol use
The AUDIT-C (Alcohol Use Disorders Identification Test-Concise) is a validated 3-question screening tool specifically designed to detect unhealthy alcohol use in primary care settings.
Adult-Gerontology Primary Care Nurse Practitioner Exam Health Promotion & Disease Prevention 2
Which validated screening tool is most commonly recommended by the USPSTF for depression screening in older adults in the primary care setting?