Adult-Gerontology Primary Care Nurse Practitioner Exam Risk Assessment & Management 4 — Questions and Answers
Question 1: A 65-year-old female smoker with hypertension has a 10-year ASCVD risk of 12% calculated by the Pooled Cohort Equations. How should this risk be classified?
- Low risk (<5%)
- Borderline risk (5-7.4%)
- Intermediate risk (7.5-19.9%) (Correct answer)
- High risk (≥20%)
Correct answer: Intermediate risk (7.5-19.9%)
A 10-year ASCVD risk of 7.5–19.9% is classified as intermediate risk per 2019 ACC/AHA guidelines, and statin therapy discussion is recommended.
Question 2: Which of the following older adult patients has the HIGHEST priority for pneumococcal vaccination reassessment?
- 72-year-old who received PPSV23 at age 65 and PCV15 at age 70
- 67-year-old who received PCV20 at age 65
- 75-year-old with asplenia who received only PPSV23 at age 60 (Correct answer)
- 80-year-old who is up to date on all recommended pneumococcal vaccines
Correct answer: 75-year-old with asplenia who received only PPSV23 at age 60
Patients with asplenia are immunocompromised and require a complete pneumococcal series; one dose of PPSV23 alone 15 years ago without a PCV leaves them under-protected.
Question 3: A 73-year-old man with CKD stage 3b (eGFR 38) is prescribed metformin for type 2 diabetes. What is the appropriate risk management action?
- Continue metformin without adjustment
- Reduce metformin dose and monitor eGFR every 3 months (Correct answer)
- Discontinue metformin immediately as it is absolutely contraindicated
- Switch to a sulfonylurea without further evaluation
Correct answer: Reduce metformin dose and monitor eGFR every 3 months
Metformin can be continued with dose reduction at eGFR 30–45 (Stage 3b) with close renal monitoring, but should be stopped if eGFR falls below 30.
Question 4: The STOP-BANG questionnaire is used in clinical practice to assess risk for which condition?
- Obstructive sleep apnea (Correct answer)
- Chronic obstructive pulmonary disease
- Pulmonary hypertension
- Narcolepsy
Correct answer: Obstructive sleep apnea
The STOP-BANG is an 8-item validated screening tool for obstructive sleep apnea, with scores ≥3 indicating high risk.
Question 5: A 70-year-old patient with stage 3 CKD, diabetes, and hypertension is at risk for which complication that requires regular ophthalmologic monitoring?
- Macular degeneration
- Diabetic retinopathy (Correct answer)
- Glaucoma from antihypertensives
- Cataracts from statin use
Correct answer: Diabetic retinopathy
Diabetic retinopathy is a major microvascular complication of diabetes that requires annual dilated fundus examination to detect early changes.
Question 6: Which of the following patients requires IMMEDIATE risk stratification and same-day evaluation for cardiovascular disease?
- 68-year-old with chronic stable angina and unchanged symptoms
- 74-year-old with new-onset exertional chest pressure radiating to the left arm (Correct answer)
- 71-year-old with atypical chest pain lasting seconds and reproducible on palpation
- 66-year-old with known GERD reporting heartburn after eating
Correct answer: 74-year-old with new-onset exertional chest pressure radiating to the left arm
New-onset exertional chest pressure radiating to the arm is classic for unstable angina or ACS, requiring immediate evaluation and risk stratification.
Question 7: Which risk stratification model is used to estimate 30-day mortality risk in community-acquired pneumonia?
- Wells Score
- CURB-65 (Correct answer)
- Ranson Criteria
- HEART Score
Correct answer: CURB-65
CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, age ≥65) is a validated tool for risk-stratifying CAP severity and guiding inpatient vs. outpatient treatment decisions.
Adult-Gerontology Primary Care Nurse Practitioner Exam Risk Assessment & Management 4
A 65-year-old female smoker with hypertension has a 10-year ASCVD risk of 12% calculated by the Pooled Cohort Equations.
How should this risk be classified?