Adult-Gerontology Primary Care Nurse Practitioner Exam Risk Assessment & Management 5 — Questions and Answers
Question 1: An 80-year-old woman with moderate dementia is unable to reliably report pain. Which validated tool is MOST appropriate for pain assessment?
- Numeric Rating Scale (NRS 0-10)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Wong-Baker FACES scale
- McGill Pain Questionnaire
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
The PAINAD scale assesses behavioral indicators of pain (breathing, vocalization, facial expression, body language, consolability) in patients with advanced dementia who cannot self-report.
Question 2: A 77-year-old man with atrial fibrillation and a HAS-BLED score of 4 is being considered for anticoagulation. What is the MOST appropriate clinical approach?
- Anticoagulation is absolutely contraindicated with any HAS-BLED score above 3
- Initiate anticoagulation but address modifiable bleeding risk factors and monitor closely (Correct answer)
- Use aspirin monotherapy instead
- Defer the decision indefinitely until all bleeding risks are resolved
Correct answer: Initiate anticoagulation but address modifiable bleeding risk factors and monitor closely
A high HAS-BLED score should prompt correction of modifiable bleeding risks (hypertension, INR lability, interacting drugs), but does not override the benefit of anticoagulation in high stroke-risk patients.
Question 3: A 69-year-old patient with a 40 pack-year smoking history presents for a routine visit. Which cancer screening is specifically recommended based on this risk factor?
- Annual mammography
- Annual low-dose CT of the chest (Correct answer)
- Annual chest X-ray
- Sputum cytology every 6 months
Correct answer: Annual low-dose CT of the chest
Annual low-dose CT (LDCT) chest screening is recommended by USPSTF for adults aged 50-80 with a 20+ pack-year history who currently smoke or quit within the past 15 years.
Question 4: During a medication review, a 74-year-old patient is found to be taking diphenhydramine nightly for sleep. What is the PRIMARY risk concern in this older adult?
- Serotonin syndrome
- Anticholinergic toxicity including confusion, urinary retention, and fall risk (Correct answer)
- Renal toxicity from chronic NSAID-like effects
- QTc prolongation
Correct answer: Anticholinergic toxicity including confusion, urinary retention, and fall risk
Diphenhydramine has strong anticholinergic activity and is on the Beers Criteria list; risks include cognitive impairment, delirium, urinary retention, constipation, and falls in older adults.
Question 5: A 73-year-old woman with hypertension asks about aspirin for primary prevention of cardiovascular disease. Per current USPSTF guidelines, what is the BEST response?
- Recommend aspirin 81 mg daily because she has hypertension
- Aspirin is recommended for all adults over 70 for primary prevention
- Aspirin for primary prevention is not recommended for adults 60 and older due to bleeding risk outweighing benefit (Correct answer)
- Aspirin 325 mg daily is preferred over low-dose aspirin
Correct answer: Aspirin for primary prevention is not recommended for adults 60 and older due to bleeding risk outweighing benefit
The 2022 USPSTF guidelines recommend against initiating aspirin for primary CVD prevention in adults aged 60 and older, as bleeding risk outweighs cardiovascular benefit.
Question 6: Which assessment finding in a 78-year-old patient is MOST consistent with high risk for hospital-associated delirium?
- Well-controlled hypertension on two medications
- Baseline mild cognitive impairment, dehydration, and recent bladder catheterization (Correct answer)
- Controlled type 2 diabetes with an A1c of 7.2%
- Stable chronic low back pain managed with acetaminophen
Correct answer: Baseline mild cognitive impairment, dehydration, and recent bladder catheterization
Baseline cognitive impairment, dehydration, and urinary catheterization are three of the most potent precipitating risk factors for hospital-associated delirium.
Question 7: A 71-year-old man with type 2 diabetes has a urine albumin-to-creatinine ratio (UACR) of 320 mg/g. What does this indicate and what is the primary management risk to address?
- Normal result; no action needed
- Macroalbuminuria indicating significant diabetic kidney disease; prioritize RAAS blockade and glycemic control (Correct answer)
- Mild microalbuminuria; lifestyle modification only is appropriate
- Nephrotic syndrome requiring immediate nephrology referral for biopsy
Correct answer: Macroalbuminuria indicating significant diabetic kidney disease; prioritize RAAS blockade and glycemic control
A UACR of 300+ mg/g indicates macroalbuminuria (severely increased albuminuria), a marker of established diabetic kidney disease requiring RAAS inhibition, tight glycemic control, and close monitoring.
Adult-Gerontology Primary Care Nurse Practitioner Exam Risk Assessment & Management 5
An 80-year-old woman with moderate dementia is unable to reliably report pain.
Which validated tool is MOST appropriate for pain assessment?