Adult-Gerontology Primary Care Nurse Practitioner Exam Risk Assessment & Management 3 — Questions and Answers
Question 1: A 76-year-old man with a BMI of 18.5 and recent 10 lb unintentional weight loss over 3 months is evaluated. Which screening tool best quantifies his malnutrition risk?
- Barthel Index
- Mini Nutritional Assessment (MNA) (Correct answer)
- PHQ-9
- FRAX Score
Correct answer: Mini Nutritional Assessment (MNA)
The Mini Nutritional Assessment (MNA) is the gold-standard validated tool for identifying malnutrition and nutritional risk in older adults.
Question 2: A 68-year-old postmenopausal woman has a FRAX 10-year major osteoporotic fracture risk of 22%. What is the recommended management?
- Reassure and repeat DEXA in 5 years
- Initiate pharmacologic therapy (Correct answer)
- Recommend weight-bearing exercise only
- Obtain a CT scan of the spine
Correct answer: Initiate pharmacologic therapy
A FRAX major osteoporotic fracture probability ≥20% or hip fracture ≥3% meets the threshold for initiating pharmacologic treatment per NOF guidelines.
Question 3: Which component of the Timed Up and Go (TUG) test result MOST directly indicates increased fall risk?
- Completing the test in under 10 seconds
- Requiring verbal cues to begin
- Taking longer than 12 seconds to complete (Correct answer)
- Using a walker during the test
Correct answer: Taking longer than 12 seconds to complete
A TUG time greater than 12 seconds is the validated cut-off associated with increased fall risk in community-dwelling older adults.
Question 4: A 72-year-old patient on warfarin for DVT has a new prescription for fluconazole for a vaginal yeast infection. What is the primary risk management concern?
- Azole antifungals reduce warfarin efficacy
- Fluconazole inhibits CYP2C9, increasing warfarin levels and bleeding risk (Correct answer)
- Warfarin accelerates fluconazole clearance
- There is no significant interaction at standard doses
Correct answer: Fluconazole inhibits CYP2C9, increasing warfarin levels and bleeding risk
Fluconazole inhibits CYP2C9, the primary enzyme metabolizing warfarin, leading to elevated INR and significantly increased bleeding risk.
Question 5: An older adult is assessed with the AUDIT-C alcohol screening tool and scores 5. What does this indicate?
- No alcohol use disorder
- Low-risk alcohol use
- Positive screen for hazardous or harmful drinking (Correct answer)
- Alcohol dependence requiring detox
Correct answer: Positive screen for hazardous or harmful drinking
An AUDIT-C score of ≥4 in men or ≥3 in women is a positive screen indicating hazardous or harmful drinking patterns.
Question 6: A 79-year-old man is started on opioids for chronic pain. Which risk assessment tool should be used BEFORE initiating opioid therapy?
- PHQ-2
- Opioid Risk Tool (ORT) (Correct answer)
- CAGE questionnaire
- Morse Fall Scale
Correct answer: Opioid Risk Tool (ORT)
The Opioid Risk Tool (ORT) is a validated 5-item tool used to stratify patients' risk for opioid misuse or aberrant behaviors before initiating opioid therapy.
Question 7: Which of the following best defines the concept of 'polypharmacy risk' in an older adult?
- Taking any medication for more than 5 years
- Concurrent use of 5 or more medications, increasing risk of adverse drug events (Correct answer)
- Use of two or more drugs from the same class
- Taking medications prescribed by more than one provider
Correct answer: Concurrent use of 5 or more medications, increasing risk of adverse drug events
Polypharmacy is defined as concurrent use of 5 or more medications and is associated with increased risk of drug-drug interactions, falls, and adverse drug events in older adults.
Adult-Gerontology Primary Care Nurse Practitioner Exam Risk Assessment & Management 3
A 76-year-old man with a BMI of 18.5 and recent 10 lb unintentional weight loss over 3 months is evaluated.
Which screening tool best quantifies his malnutrition risk?