NR605 Advanced Nursing Practice — Primary Care of
Adults and Older Adults Comprehensive Study Guide Exam
2025
Exam Description
This comprehensive NR605 Exam is designed for advanced practice nursing students and
certified nurse practitioner (CNP/FNP) candidates focusing on Primary Care of Adults and
Older Adults. The exam evaluates clinical decision-making, diagnostic reasoning, evidence-
based management, and preventive care strategies for adult and geriatric populations across
diverse healthcare settings.
Topics Covered:
1. Advanced health assessment and differential diagnosis
2. Management of chronic diseases (diabetes, hypertension, COPD, heart failure, etc.)
3. Acute care management (infections, pain, GI, GU, musculoskeletal issues)
4. Geriatric syndromes and functional assessments
5. Pharmacotherapeutics and prescribing for adults and older adults
6. Preventive health, screening, and patient education
7. Mental health and cognitive disorders in older adults
8. Professional, ethical, and legal considerations in primary care
1|Page
,NR605 Advanced Nursing Practice — Primary Care of
Adults and Older Adults Comprehensive Study Guide Exam
2025
NR605 Comprehensive Exam Questions and Answers
1. Which of the following findings is most characteristic of type 2 diabetes mellitus?
A. Autoimmune destruction of beta cells
B. Insulin resistance with relative insulin deficiency
C. Low fasting C-peptide levels
D. Ketone production and DKA
Answer: B. Insulin resistance with relative insulin deficiency
Explanation: Type 2 diabetes involves insulin resistance and a gradual decline in pancreatic
beta-cell function. Unlike type 1, it’s not autoimmune-mediated and usually presents with
hyperglycemia without ketoacidosis.
2. An older adult with COPD presents with increased sputum production and dyspnea. The
first-line antibiotic recommended for a mild acute exacerbation is:
A. Amoxicillin
B. Azithromycin
C. Ceftriaxone
D. Levofloxacin
Answer: B. Azithromycin
Explanation: For mild COPD exacerbations, a macrolide like azithromycin is often preferred
due to coverage against common respiratory pathogens and fewer adverse effects compared to
fluoroquinolones.
2|Page
,NR605 Advanced Nursing Practice — Primary Care of
Adults and Older Adults Comprehensive Study Guide Exam
2025
3. A 68-year-old man with hypertension reports a persistent dry cough after starting
medication. Which drug is most likely responsible?
A. Losartan
B. Amlodipine
C. Lisinopril
D. Metoprolol
Answer: C. Lisinopril
Explanation: ACE inhibitors (like Lisinopril) commonly cause a dry cough due to bradykinin
accumulation. Switching to an ARB (like Losartan) can resolve the issue.
4. In evaluating an elderly patient with confusion and lethargy, the most common
reversible cause to assess first is:
A. Stroke
B. Urinary tract infection
C. Dementia
D. Parkinson’s disease
Answer: B. Urinary tract infection
Explanation: UTIs are a frequent cause of acute delirium in older adults. Early detection and
antibiotic therapy usually restore mental status.
5. Which of the following vaccines is recommended for adults over 65 years old?
A. HPV vaccine
B. MMR booster
C. Pneumococcal conjugate vaccine
D. Varicella vaccine
3|Page
, NR605 Advanced Nursing Practice — Primary Care of
Adults and Older Adults Comprehensive Study Guide Exam
2025
Answer: C. Pneumococcal conjugate vaccine
Explanation: The CDC recommends both pneumococcal conjugate (PCV15 or PCV20) and
polysaccharide (PPSV23) vaccines for adults ≥65 to prevent pneumococcal infections.
6. When performing a physical exam on a 70-year-old female, which finding requires
urgent evaluation?
A. Systolic murmur at the left sternal border
B. Asymmetrical pupils with new-onset headache
C. Bilateral ankle edema
D. Mild fine tremor of the hand
Answer: B. Asymmetrical pupils with new-onset headache
Explanation: This could indicate intracranial pathology such as hemorrhage or increased ICP;
it’s a neurological emergency requiring immediate imaging.
7. The best diagnostic test to confirm iron deficiency anemia is:
A. Serum ferritin
B. Hemoglobin
C. RBC count
D. Total bilirubin
Answer: A. Serum ferritin
Explanation: Ferritin reflects iron stores and is the most specific marker for iron deficiency
anemia; low levels confirm the diagnosis.
8. An adult patient presents with acute right lower quadrant pain, fever, and elevated
WBC count. The most likely diagnosis is:
4|Page
Adults and Older Adults Comprehensive Study Guide Exam
2025
Exam Description
This comprehensive NR605 Exam is designed for advanced practice nursing students and
certified nurse practitioner (CNP/FNP) candidates focusing on Primary Care of Adults and
Older Adults. The exam evaluates clinical decision-making, diagnostic reasoning, evidence-
based management, and preventive care strategies for adult and geriatric populations across
diverse healthcare settings.
Topics Covered:
1. Advanced health assessment and differential diagnosis
2. Management of chronic diseases (diabetes, hypertension, COPD, heart failure, etc.)
3. Acute care management (infections, pain, GI, GU, musculoskeletal issues)
4. Geriatric syndromes and functional assessments
5. Pharmacotherapeutics and prescribing for adults and older adults
6. Preventive health, screening, and patient education
7. Mental health and cognitive disorders in older adults
8. Professional, ethical, and legal considerations in primary care
1|Page
,NR605 Advanced Nursing Practice — Primary Care of
Adults and Older Adults Comprehensive Study Guide Exam
2025
NR605 Comprehensive Exam Questions and Answers
1. Which of the following findings is most characteristic of type 2 diabetes mellitus?
A. Autoimmune destruction of beta cells
B. Insulin resistance with relative insulin deficiency
C. Low fasting C-peptide levels
D. Ketone production and DKA
Answer: B. Insulin resistance with relative insulin deficiency
Explanation: Type 2 diabetes involves insulin resistance and a gradual decline in pancreatic
beta-cell function. Unlike type 1, it’s not autoimmune-mediated and usually presents with
hyperglycemia without ketoacidosis.
2. An older adult with COPD presents with increased sputum production and dyspnea. The
first-line antibiotic recommended for a mild acute exacerbation is:
A. Amoxicillin
B. Azithromycin
C. Ceftriaxone
D. Levofloxacin
Answer: B. Azithromycin
Explanation: For mild COPD exacerbations, a macrolide like azithromycin is often preferred
due to coverage against common respiratory pathogens and fewer adverse effects compared to
fluoroquinolones.
2|Page
,NR605 Advanced Nursing Practice — Primary Care of
Adults and Older Adults Comprehensive Study Guide Exam
2025
3. A 68-year-old man with hypertension reports a persistent dry cough after starting
medication. Which drug is most likely responsible?
A. Losartan
B. Amlodipine
C. Lisinopril
D. Metoprolol
Answer: C. Lisinopril
Explanation: ACE inhibitors (like Lisinopril) commonly cause a dry cough due to bradykinin
accumulation. Switching to an ARB (like Losartan) can resolve the issue.
4. In evaluating an elderly patient with confusion and lethargy, the most common
reversible cause to assess first is:
A. Stroke
B. Urinary tract infection
C. Dementia
D. Parkinson’s disease
Answer: B. Urinary tract infection
Explanation: UTIs are a frequent cause of acute delirium in older adults. Early detection and
antibiotic therapy usually restore mental status.
5. Which of the following vaccines is recommended for adults over 65 years old?
A. HPV vaccine
B. MMR booster
C. Pneumococcal conjugate vaccine
D. Varicella vaccine
3|Page
, NR605 Advanced Nursing Practice — Primary Care of
Adults and Older Adults Comprehensive Study Guide Exam
2025
Answer: C. Pneumococcal conjugate vaccine
Explanation: The CDC recommends both pneumococcal conjugate (PCV15 or PCV20) and
polysaccharide (PPSV23) vaccines for adults ≥65 to prevent pneumococcal infections.
6. When performing a physical exam on a 70-year-old female, which finding requires
urgent evaluation?
A. Systolic murmur at the left sternal border
B. Asymmetrical pupils with new-onset headache
C. Bilateral ankle edema
D. Mild fine tremor of the hand
Answer: B. Asymmetrical pupils with new-onset headache
Explanation: This could indicate intracranial pathology such as hemorrhage or increased ICP;
it’s a neurological emergency requiring immediate imaging.
7. The best diagnostic test to confirm iron deficiency anemia is:
A. Serum ferritin
B. Hemoglobin
C. RBC count
D. Total bilirubin
Answer: A. Serum ferritin
Explanation: Ferritin reflects iron stores and is the most specific marker for iron deficiency
anemia; low levels confirm the diagnosis.
8. An adult patient presents with acute right lower quadrant pain, fever, and elevated
WBC count. The most likely diagnosis is:
4|Page
