Nokea
Barriers to detecting elder mistreatment include all except:
- A. The tendency for many older adults to falsely claim they are being abused
- B. The fear that one might be institutionalized if one admits to being abused
- C. The shame that older adults feel if they have been a victim of abuse
- D. The difficulty that healthcare providers have making a determination regarding abuse if the victim has dementia
Correct Answer: A
Rationale: Many older adults do not falsely claim abuse, so this is not a significant barrier.
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Several years later, Mr. Hunter, who is now 75 years old, seeks additional intervention for his urinary symptoms that have progressed further. He now experiences slow urinary stream, hesitancy, straining, and a feeling of incomplete emptying in addition to the previous urinary urgency and frequency. At times, he has noted blood in his urine. He has had five urinary tract infections (UTIs) in the past 2 years. His current IPSS is 24, with a bother score of 5 indicating severe voiding symptoms with high impact on his quality of life. Mr. Hunter’s updated medical history includes hypertension, coronary artery disease, benign prostatic hyperplasia, cataract surgery 4 years ago, and two falls within the past year while rushing to the bathroom during the night. Current medications are aspirin, metoprolol, finasteride, and tamsulosin. Physical examination reveals an enlarged, nontender prostate, about 50 g in size without discrete nodules. Upon further evaluation, the intermittent hematuria is attributed to BPH. Postvoid residual volume is 110 mL. Uroflowmetry reveals urinary flow rate of 12 mL/s. Which of the following is the best next step in management?
- A. Start tadalafil.
- B. Switch from tamsulosin to silodosin.
- C. Switch from finasteride to dutasteride.
- D. Perform surgical resection of prostate.
Correct Answer: D
Rationale: Given the severity of his symptoms and the failure of medical therapy, surgical resection of the prostate is the best option.
On examination, a patient is noted to have a "mask-like" face with decreased blinking and a characteristic stare. These features may be characteristic of:
- A. Nephrotic syndrome
- B. Myxedema
- C. Cushing’s syndrome
- D. Parkinson disease
Correct Answer: D
Rationale: A "mask-like" face is a classic feature of Parkinson’s disease.
A 42-year-old woman with a history of migraine headaches is requesting prophylactic medication treatment. Which medication should the Nurse Practitioner prescribe?
- A. Sumatriptan (Imitrex)
- B. Amitriptyline (Elavil)
- C. Verapamil (Verelan)
- D. Metoprolol (Lopressor)
Correct Answer: B
Rationale: Amitriptyline is used off-label for migraine prophylaxis.
The most common treatment for Helicobacter pylori is a triple therapy, interpreted as
- A. 2 antibiotics and proton pump inhibitor for 7-14 days
- B. 3 different antibiotics for 7-20 days
- C. 3 rounds of the same antibiotic over 3 weeks
- D. 2 proton pump inhibitors and 1 antibiotic for 7-14 days
Correct Answer: A
Rationale: Triple therapy for H. pylori typically includes 2 antibiotics and a proton pump inhibitor for 7-14 days.
A patient calls the nurse practitioner and states that he missed his morning daily dose of warfarin, 5 mg, yesterday and today. The nurse practitioner instructs the patient to:
- A. Wait until tomorrow and resume daily dosing of warfarin 5 mg
- B. Take warfarin 10 mg now
- C. Take warfarin 5 mg now, warfarin 5 mg at 5 pm today, and resume the daily warfarin 5 mg dose in the morning as scheduled
- D. Take warfarin 5 mg now and resume the warfarin 5 mg daily dose in the morning as scheduled
Correct Answer: D
Rationale: The patient should resume the usual warfarin dose and avoid doubling it.