Adult-Gerontology Primary Care Nurse Practitioner Exam Risk Assessment & Management 5

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?

Accepted Answer

PAINAD (Pain Assessment in Advanced Dementia)

Answer

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?

Accepted Answer

Initiate anticoagulation but address modifiable bleeding risk factors and monitor closely

Answer

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?

Accepted Answer

Annual low-dose CT of the chest

Answer

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?

Accepted Answer

Anticholinergic toxicity including confusion, urinary retention, and fall risk

Answer

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?

Accepted Answer

Aspirin for primary prevention is not recommended for adults 60 and older due to bleeding risk outweighing benefit

Answer

The 2022 USPSTF guidelines recommend against initiating aspirin for primary CVD prevention in adults aged 60 and older, as bleeding risk outweighs cardiovascular benefit.

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 Risk Assessment & Management 5