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NR 601/ NR 601 Final Exam V1 | Latest
2026/2027 Update |Questions & verified
Answers – Primary Care of Adults & Older
Adults |100% correct
Key Concepts Covered:
Advanced Clinical Reasoning • Diagnostic Decision-Making • Evidence-Based Practice •
Pharmacology Essentials • Chronic & Acute Care Principles • Patient Assessment • Health
Promotion & Prevention Strategies
Introduction
This updated 2026/2027 [NR 601/ NR601] Final Exam Study Resource includes a complete
collection of verified practice questions, detailed explanations, and exam-focused summaries
designed to help students master key concepts quickly and confidently.
Each section is structured to support clear clinical reasoning, accurate decision-making, and
practical understanding of core course material. All content is organized for fast learning, making it
an ideal tool for exam preparation, tutoring, or independent study.
Answer Format
Correct answers in this guide are clearly marked using bold formatting, and each question includes
a short, easy-to-understand rationale that reinforces essential concepts and supports deeper
understanding.
An 86-year-old female comes to your office for a wellness visit. Her blood pressure is 125/70
mmHg, pulse 69 beats per min, and respiratory rate 18 breaths per min. She is well appearing
and reports she is up to date on her routine vaccinations. She introduces her partner of 35 years
whom she would like to make medical decisions for her in case she becomes unable to make
decisions for herself. She reports that she and her partner are not married. She asks if she needs
any further documentation to ensure her goals of care are followed. Which one of the following
would be the most appropriate recommendation for this patient and her partner?
Advise them to file an advanced directive.
,An 81-year-old transgender female with history of depression and hyperlipidemia presents to
your clinic for routine care. She endorses a history of smoking, currently smoking 1 pack per
day, and occasionally drinks a glass of wine, although she denies illicit drug use. She reports she
takes atorvastatin 20 mg and subcutaneous estrogen therapy.
Counseling on smoking cessation
An 84-year-old male with history of stroke without residual deficit, systolic heart failure, and
type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement
community and still works part time on a golf course. He currently takes aspirin 81 mg,
metoprolol tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily.
He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually
active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He
states he has had over three sexual partners in the last year with intermittent condom use. What
sexually transmitted infection testing should be offered?
Urine testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine?
It has greater risk of adverse effects with its twice-daily formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night.
His other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related
leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart
failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg
daily, metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg twice daily,
hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily was
recently added by his cardiologist. On review of systems, Mr. A complains that nocturia is
causing daytime fatigue, and he is more constipated. Physical examination is notable for blood
pressure 162/83 mmHg, heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged
prostate, and 21 pretibial edema. Your next step in management should be:
Stop amlodipine and increase lisinopril.
The daughter of a 79-year-old woman notes that her mother, who has dementia and lives with
her, is wetting herself when she attends her new day program. Program staff have requested that
"something be done" as she is requiring a clothes change nearly every time she is there. She
cannot describe the circumstances of leakage, saying "it just comes." Leakage is uncommon at
home. Her medications include donepezil and acetaminophen. Physical examination is normal.
Initial treatment approach will require intervention by which of the following?
Day program staff
. Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten
worse over the past year, and she rarely makes it through nine holes without feeling like she
needs to "run into the bushes and go." Leakage is usually small volume, but causes her extreme
embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in the
morning before she golfs and avoiding drinking water while playing, to no effect. She also tried
"those Kegler" exercises in the past without success. Which of the following is the most
appropriate recommendation for Ms. J?
Bladder training
,What is the most common cause of erectile dysfunction in older men?
Atherosclerosis
Which is the most reasonable first step in the treatment of older men with erectile dysfunction?
Sildenafil
A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history
includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide,
chlorthalidone, and acetaminophen. What would be your first step in therapy?
Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely
cause of her problem?
High-tone pelvic floor dysfunction
A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed
ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor
1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with cancer.
Sentinel lymph node sampling was negative for lymph node involvement. She has good
performance status and no activities of daily living (ADL) or instrumental (IADL) dependencies.
What treatment would you recommend?
Hormonal therapy only
An 86-year-old man with no ADL deficits who has stopped driving because of macular
degeneration is evaluated for a urinary tract infection associated with urinary retention. The
consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level that
comes back 12 ng/mL. Three months later after the Foley has been removed and he has had a
good response to tamsulosin, his PSA is still 10 ng/mL. What is the appropriate next step in
managing this man's prostate problem?
Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival?
A 78-year-old man who had a radical prostatectomy and external beam radiation therapy 10
years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged
pelvic lymph node, and a bone scan is positive in the pelvis.
On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her
right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the
arm and obvious pain. The patient has no children and had lived alone until recently, when a
neighbor became concerned for what appeared to be a progressive loss of memory and neglect of
the house. A nephew living in another city eventually came to take care of the situation and
arranged for the admission. The patient appears confused and withdrawn; her appearance is
disheveled, but she seems to be independent in her ADLs. The medical history is negative for
any serious illnesses. She was able to drive her own car until shortly before this admission. The
nephew does not wish to authorize hospice "right now." A positron-emission tomography scan
was negative for metastatic disease. In addition to determining the cause of her deliri
, The mass should be biopsied to study hormone receptor and HER2/neu antigen status.
A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A
localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph
nodes for metastatic sampling. The patient wants to know if he should have chemotherapy.
Should he?
No because he can be followed with serial carcinoembryonic antigens and CT scans.
An 80-year-old woman has no weight loss, no pain, and no distention but over 2 years
increasingly complains of constipation despite adequate medical treatment. A colonoscopy is
negative. An abdominal CT is performed. It reveals well-circumscribed pelvic masses, the
largest adherent to the ovarian ligament. The best first step is:
Invite her to return with a family member and have a long talk about the diagnostic and
therapeutic options.
An 85-year-old man with chronic obstructive pulmonary disease presents to your office with his
daughter with the complaint of new onset chest pain, shortness of breath, and cough. He is
clearly tachypneic and has tactile fremitus and egophany and crackles heard at the right lung
base. His daughter just wants you to give him an antibiotic pill so that she can take him home.
You are concerned that he might need to be hospitalized and require IV antibiotics. What
statement is true?
Treatment decisions for pneumonia are based on its severity, the presence of comorbid illnesses,
and a prior history of MRSA or Pseudomonas respiratory infection.
An 80-year-old woman that you follow in a nursing home has an acute decline in her mental
status. She has a fever >100° F, but no other focal complaints or findings on physical
examination except for a chronic indwelling urinary catheter. What statement is true?
Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start
empiric antibiotic therapy.
An 82-year-old woman receives oral amoxicillin-clavulate for a skin abscess on her leg. She
develops new onset of frequent watery stool that persists for several days after the antibiotic is
stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain
reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection
before. What one statement is the best answer regarding her management?
Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
A 75-year-old man presents with the chief concern, "I may have a bladder infection." Further
questioning reveals for several months he has been needing to void every couple of hours (can't
sit through a whole ball game), feels he must go as soon as he feels the urge (he tried putting it
off and had urinary leakage), and is getting up two to three times at night to void. He denies
delay in voiding or straining to initiate voiding, slow stream, feeling of incomplete emptying, or
dribbling after completion of urination. He also denies dysuria and abdominal pain. Which of the
following best describes the category or type of his lower urinary tract symptoms?
Storage (irritative)
A 70-year-old man has bothersome lower urinary tract syndrome (LUTS) associated with benign
NR 601/ NR 601 Final Exam V1 | Latest
2026/2027 Update |Questions & verified
Answers – Primary Care of Adults & Older
Adults |100% correct
Key Concepts Covered:
Advanced Clinical Reasoning • Diagnostic Decision-Making • Evidence-Based Practice •
Pharmacology Essentials • Chronic & Acute Care Principles • Patient Assessment • Health
Promotion & Prevention Strategies
Introduction
This updated 2026/2027 [NR 601/ NR601] Final Exam Study Resource includes a complete
collection of verified practice questions, detailed explanations, and exam-focused summaries
designed to help students master key concepts quickly and confidently.
Each section is structured to support clear clinical reasoning, accurate decision-making, and
practical understanding of core course material. All content is organized for fast learning, making it
an ideal tool for exam preparation, tutoring, or independent study.
Answer Format
Correct answers in this guide are clearly marked using bold formatting, and each question includes
a short, easy-to-understand rationale that reinforces essential concepts and supports deeper
understanding.
An 86-year-old female comes to your office for a wellness visit. Her blood pressure is 125/70
mmHg, pulse 69 beats per min, and respiratory rate 18 breaths per min. She is well appearing
and reports she is up to date on her routine vaccinations. She introduces her partner of 35 years
whom she would like to make medical decisions for her in case she becomes unable to make
decisions for herself. She reports that she and her partner are not married. She asks if she needs
any further documentation to ensure her goals of care are followed. Which one of the following
would be the most appropriate recommendation for this patient and her partner?
Advise them to file an advanced directive.
,An 81-year-old transgender female with history of depression and hyperlipidemia presents to
your clinic for routine care. She endorses a history of smoking, currently smoking 1 pack per
day, and occasionally drinks a glass of wine, although she denies illicit drug use. She reports she
takes atorvastatin 20 mg and subcutaneous estrogen therapy.
Counseling on smoking cessation
An 84-year-old male with history of stroke without residual deficit, systolic heart failure, and
type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement
community and still works part time on a golf course. He currently takes aspirin 81 mg,
metoprolol tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily.
He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually
active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He
states he has had over three sexual partners in the last year with intermittent condom use. What
sexually transmitted infection testing should be offered?
Urine testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine?
It has greater risk of adverse effects with its twice-daily formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night.
His other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related
leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart
failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg
daily, metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg twice daily,
hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily was
recently added by his cardiologist. On review of systems, Mr. A complains that nocturia is
causing daytime fatigue, and he is more constipated. Physical examination is notable for blood
pressure 162/83 mmHg, heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged
prostate, and 21 pretibial edema. Your next step in management should be:
Stop amlodipine and increase lisinopril.
The daughter of a 79-year-old woman notes that her mother, who has dementia and lives with
her, is wetting herself when she attends her new day program. Program staff have requested that
"something be done" as she is requiring a clothes change nearly every time she is there. She
cannot describe the circumstances of leakage, saying "it just comes." Leakage is uncommon at
home. Her medications include donepezil and acetaminophen. Physical examination is normal.
Initial treatment approach will require intervention by which of the following?
Day program staff
. Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten
worse over the past year, and she rarely makes it through nine holes without feeling like she
needs to "run into the bushes and go." Leakage is usually small volume, but causes her extreme
embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in the
morning before she golfs and avoiding drinking water while playing, to no effect. She also tried
"those Kegler" exercises in the past without success. Which of the following is the most
appropriate recommendation for Ms. J?
Bladder training
,What is the most common cause of erectile dysfunction in older men?
Atherosclerosis
Which is the most reasonable first step in the treatment of older men with erectile dysfunction?
Sildenafil
A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history
includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide,
chlorthalidone, and acetaminophen. What would be your first step in therapy?
Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely
cause of her problem?
High-tone pelvic floor dysfunction
A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed
ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor
1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with cancer.
Sentinel lymph node sampling was negative for lymph node involvement. She has good
performance status and no activities of daily living (ADL) or instrumental (IADL) dependencies.
What treatment would you recommend?
Hormonal therapy only
An 86-year-old man with no ADL deficits who has stopped driving because of macular
degeneration is evaluated for a urinary tract infection associated with urinary retention. The
consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level that
comes back 12 ng/mL. Three months later after the Foley has been removed and he has had a
good response to tamsulosin, his PSA is still 10 ng/mL. What is the appropriate next step in
managing this man's prostate problem?
Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival?
A 78-year-old man who had a radical prostatectomy and external beam radiation therapy 10
years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged
pelvic lymph node, and a bone scan is positive in the pelvis.
On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her
right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the
arm and obvious pain. The patient has no children and had lived alone until recently, when a
neighbor became concerned for what appeared to be a progressive loss of memory and neglect of
the house. A nephew living in another city eventually came to take care of the situation and
arranged for the admission. The patient appears confused and withdrawn; her appearance is
disheveled, but she seems to be independent in her ADLs. The medical history is negative for
any serious illnesses. She was able to drive her own car until shortly before this admission. The
nephew does not wish to authorize hospice "right now." A positron-emission tomography scan
was negative for metastatic disease. In addition to determining the cause of her deliri
, The mass should be biopsied to study hormone receptor and HER2/neu antigen status.
A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A
localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph
nodes for metastatic sampling. The patient wants to know if he should have chemotherapy.
Should he?
No because he can be followed with serial carcinoembryonic antigens and CT scans.
An 80-year-old woman has no weight loss, no pain, and no distention but over 2 years
increasingly complains of constipation despite adequate medical treatment. A colonoscopy is
negative. An abdominal CT is performed. It reveals well-circumscribed pelvic masses, the
largest adherent to the ovarian ligament. The best first step is:
Invite her to return with a family member and have a long talk about the diagnostic and
therapeutic options.
An 85-year-old man with chronic obstructive pulmonary disease presents to your office with his
daughter with the complaint of new onset chest pain, shortness of breath, and cough. He is
clearly tachypneic and has tactile fremitus and egophany and crackles heard at the right lung
base. His daughter just wants you to give him an antibiotic pill so that she can take him home.
You are concerned that he might need to be hospitalized and require IV antibiotics. What
statement is true?
Treatment decisions for pneumonia are based on its severity, the presence of comorbid illnesses,
and a prior history of MRSA or Pseudomonas respiratory infection.
An 80-year-old woman that you follow in a nursing home has an acute decline in her mental
status. She has a fever >100° F, but no other focal complaints or findings on physical
examination except for a chronic indwelling urinary catheter. What statement is true?
Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start
empiric antibiotic therapy.
An 82-year-old woman receives oral amoxicillin-clavulate for a skin abscess on her leg. She
develops new onset of frequent watery stool that persists for several days after the antibiotic is
stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain
reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection
before. What one statement is the best answer regarding her management?
Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
A 75-year-old man presents with the chief concern, "I may have a bladder infection." Further
questioning reveals for several months he has been needing to void every couple of hours (can't
sit through a whole ball game), feels he must go as soon as he feels the urge (he tried putting it
off and had urinary leakage), and is getting up two to three times at night to void. He denies
delay in voiding or straining to initiate voiding, slow stream, feeling of incomplete emptying, or
dribbling after completion of urination. He also denies dysuria and abdominal pain. Which of the
following best describes the category or type of his lower urinary tract symptoms?
Storage (irritative)
A 70-year-old man has bothersome lower urinary tract syndrome (LUTS) associated with benign
