NR 601: Primary Care of the Maturing and
Aged Family
Midterm Examination Preparation
Chamberlain University | 2026/2027
125 Questions with Expert Rationales
Instructions
• This examination covers primary care of older adults, including age-related
physiologic changes, geriatric syndromes, chronic disease management,
pharmacology considerations, and health promotion.
• Select the single best answer for each question.
• Rationales provide evidence-based explanations for clinical decision-making in the
care of maturing and aged individuals.
Section 1: Age-Related Physiologic Changes and Geriatric
Assessment (Questions 1-20)
1. A 75-year-old male presents for an annual physical. Which of the following
age-related physiologic changes would the NP expect to find?
A. Increased glomerular filtration rate
B. Decreased gastric acid secretion
C. Increased hepatic blood flow
D. Increased total body water
Answer: B
Expert Rationale: Aging is associated with decreased gastric acid secretion
,(hypochlorhydria or achlorhydria), which can affect the absorption of medications
such as calcium carbonate, iron, and ketoconazole. GFR decreases, hepatic blood
flow decreases, and total body water decreases with age.
2. A 78-year-old female is concerned about memory changes. Which of the
following findings would be considered a normal age-related cognitive change
rather than a sign of dementia?
A. Forgetting the names of close family members
B. Getting lost in familiar neighborhoods
C. Occasionally misplacing car keys
D. Inability to manage finances independently
Answer: C
Expert Rationale: Normal age-related cognitive changes include occasional
misplacement of items, slower processing speed, and mild forgetfulness. Inability to
manage finances, getting lost in familiar areas, and forgetting close family members
are concerning for cognitive impairment/dementia.
3. An 80-year-old male reports feeling dizzy when standing up from a seated
position. This symptom is most consistent with which age-related physiologic
change?
A. Decreased baroreceptor sensitivity
B. Increased cardiac output
C. Decreased peripheral vascular resistance
D. Increased plasma volume
Answer: A
Expert Rationale: Age-related decreased baroreceptor sensitivity impairs the
compensatory response to positional changes, leading to orthostatic hypotension.
This is a common cause of dizziness and falls in older adults.
4. A 72-year-old female has a serum creatinine of 1.1 mg/dL. The NP
understands that in older adults, serum creatinine may:
A. Overestimate renal function due to decreased muscle mass
B. Underestimate renal function due to increased muscle mass
C. Accurately reflect renal function regardless of age
D. Be unreliable for estimating renal function in all older adults
Answer: A
Expert Rationale: Serum creatinine is a product of muscle metabolism. With age-
related sarcopenia, creatinine production decreases, so a normal serum creatinine
may mask significantly reduced GFR. eGFR should be calculated using CKD-EPI or
MDRD equations.
,5. A 68-year-old female reports dry eyes and dry mouth. These symptoms are
most likely due to age-related changes in which system?
A. Cardiovascular
B. Endocrine
C. Exocrine gland function
D. Neurologic
Answer: C
Expert Rationale: Aging is associated with decreased exocrine gland function,
including reduced tear production (keratoconjunctivitis sicca) and reduced salivary
flow (xerostomia). These changes can contribute to discomfort and increased risk of
dental caries and corneal abrasions.
6. A 76-year-old male reports decreased hearing. Which type of hearing loss is
most common in older adults?
A. Conductive hearing loss
B. Sensorineural hearing loss (presbycusis)
C. Mixed hearing loss
D. Central auditory processing disorder
Answer: B
Expert Rationale: Presbycusis is age-related sensorineural hearing loss, typically
affecting high-frequency sounds first. It is characterized by difficulty hearing in noisy
environments and understanding consonants.
7. A 70-year-old female has a blood pressure of 142/88 mmHg. Which of the
following age-related vascular changes contributes to increased systolic blood
pressure?
A. Decreased arterial stiffness
B. Increased arterial compliance
C. Increased arterial stiffness and decreased compliance
D. Decreased peripheral vascular resistance
Answer: C
Expert Rationale: Aging causes arterial stiffening and decreased compliance,
leading to increased systolic blood pressure and widened pulse pressure. Isolated
systolic hypertension is common in older adults.
8. An 82-year-old male reports constipation. Which age-related change
contributes to this condition?
A. Increased gastrointestinal motility
B. Decreased gastric acid secretion only
C. Decreased colonic motility and delayed transit time
D. Increased fluid absorption in the colon
, Answer: C
Expert Rationale: Aging is associated with decreased colonic motility and
delayed transit time, contributing to constipation. Additional factors include
decreased physical activity, medications, and inadequate fluid/fiber intake.
9. A 73-year-old female has a BMI of 22 kg/m². Which of the following is true
regarding weight changes in older adults?
A. Weight loss in older adults is always benign
B. Unintentional weight loss should always be evaluated
C. Obesity is not a concern in older adults
D. Muscle mass increases with age
Answer: B
Expert Rationale: Unintentional weight loss in older adults is never normal and
should be evaluated for underlying causes (malignancy, depression, gastrointestinal
disease, medication side effects). Sarcopenia (age-related muscle loss) is common.
10. A 79-year-old male reports difficulty with balance and a fear of falling.
Which of the following is the most appropriate initial assessment?
A. Order a brain MRI
B. Perform a gait and balance assessment (Timed Up and Go test)
C. Prescribe a walker
D. Refer to physical therapy
Answer: B
Expert Rationale: The Timed Up and Go (TUG) test is a simple, validated
screening tool for balance and fall risk. Patients who take >12-15 seconds are at
increased fall risk. Assessment should precede intervention.
11. A 77-year-old female is noted to have a systolic murmur on examination.
Which of the following age-related valvular changes is most common?
A. Mitral stenosis
B. Aortic stenosis secondary to calcific degeneration
C. Tricuspid regurgitation
D. Pulmonic stenosis
Answer: B
Expert Rationale: Calcific aortic stenosis is the most common valvular
abnormality in older adults, resulting from age-related calcification and degeneration
of the aortic valve. Symptoms include dyspnea, syncope, and angina.
12. An 85-year-old male reports that his skin bruises easily. Which of the
following age-related skin changes contributes to this finding?
A. Increased collagen production
Aged Family
Midterm Examination Preparation
Chamberlain University | 2026/2027
125 Questions with Expert Rationales
Instructions
• This examination covers primary care of older adults, including age-related
physiologic changes, geriatric syndromes, chronic disease management,
pharmacology considerations, and health promotion.
• Select the single best answer for each question.
• Rationales provide evidence-based explanations for clinical decision-making in the
care of maturing and aged individuals.
Section 1: Age-Related Physiologic Changes and Geriatric
Assessment (Questions 1-20)
1. A 75-year-old male presents for an annual physical. Which of the following
age-related physiologic changes would the NP expect to find?
A. Increased glomerular filtration rate
B. Decreased gastric acid secretion
C. Increased hepatic blood flow
D. Increased total body water
Answer: B
Expert Rationale: Aging is associated with decreased gastric acid secretion
,(hypochlorhydria or achlorhydria), which can affect the absorption of medications
such as calcium carbonate, iron, and ketoconazole. GFR decreases, hepatic blood
flow decreases, and total body water decreases with age.
2. A 78-year-old female is concerned about memory changes. Which of the
following findings would be considered a normal age-related cognitive change
rather than a sign of dementia?
A. Forgetting the names of close family members
B. Getting lost in familiar neighborhoods
C. Occasionally misplacing car keys
D. Inability to manage finances independently
Answer: C
Expert Rationale: Normal age-related cognitive changes include occasional
misplacement of items, slower processing speed, and mild forgetfulness. Inability to
manage finances, getting lost in familiar areas, and forgetting close family members
are concerning for cognitive impairment/dementia.
3. An 80-year-old male reports feeling dizzy when standing up from a seated
position. This symptom is most consistent with which age-related physiologic
change?
A. Decreased baroreceptor sensitivity
B. Increased cardiac output
C. Decreased peripheral vascular resistance
D. Increased plasma volume
Answer: A
Expert Rationale: Age-related decreased baroreceptor sensitivity impairs the
compensatory response to positional changes, leading to orthostatic hypotension.
This is a common cause of dizziness and falls in older adults.
4. A 72-year-old female has a serum creatinine of 1.1 mg/dL. The NP
understands that in older adults, serum creatinine may:
A. Overestimate renal function due to decreased muscle mass
B. Underestimate renal function due to increased muscle mass
C. Accurately reflect renal function regardless of age
D. Be unreliable for estimating renal function in all older adults
Answer: A
Expert Rationale: Serum creatinine is a product of muscle metabolism. With age-
related sarcopenia, creatinine production decreases, so a normal serum creatinine
may mask significantly reduced GFR. eGFR should be calculated using CKD-EPI or
MDRD equations.
,5. A 68-year-old female reports dry eyes and dry mouth. These symptoms are
most likely due to age-related changes in which system?
A. Cardiovascular
B. Endocrine
C. Exocrine gland function
D. Neurologic
Answer: C
Expert Rationale: Aging is associated with decreased exocrine gland function,
including reduced tear production (keratoconjunctivitis sicca) and reduced salivary
flow (xerostomia). These changes can contribute to discomfort and increased risk of
dental caries and corneal abrasions.
6. A 76-year-old male reports decreased hearing. Which type of hearing loss is
most common in older adults?
A. Conductive hearing loss
B. Sensorineural hearing loss (presbycusis)
C. Mixed hearing loss
D. Central auditory processing disorder
Answer: B
Expert Rationale: Presbycusis is age-related sensorineural hearing loss, typically
affecting high-frequency sounds first. It is characterized by difficulty hearing in noisy
environments and understanding consonants.
7. A 70-year-old female has a blood pressure of 142/88 mmHg. Which of the
following age-related vascular changes contributes to increased systolic blood
pressure?
A. Decreased arterial stiffness
B. Increased arterial compliance
C. Increased arterial stiffness and decreased compliance
D. Decreased peripheral vascular resistance
Answer: C
Expert Rationale: Aging causes arterial stiffening and decreased compliance,
leading to increased systolic blood pressure and widened pulse pressure. Isolated
systolic hypertension is common in older adults.
8. An 82-year-old male reports constipation. Which age-related change
contributes to this condition?
A. Increased gastrointestinal motility
B. Decreased gastric acid secretion only
C. Decreased colonic motility and delayed transit time
D. Increased fluid absorption in the colon
, Answer: C
Expert Rationale: Aging is associated with decreased colonic motility and
delayed transit time, contributing to constipation. Additional factors include
decreased physical activity, medications, and inadequate fluid/fiber intake.
9. A 73-year-old female has a BMI of 22 kg/m². Which of the following is true
regarding weight changes in older adults?
A. Weight loss in older adults is always benign
B. Unintentional weight loss should always be evaluated
C. Obesity is not a concern in older adults
D. Muscle mass increases with age
Answer: B
Expert Rationale: Unintentional weight loss in older adults is never normal and
should be evaluated for underlying causes (malignancy, depression, gastrointestinal
disease, medication side effects). Sarcopenia (age-related muscle loss) is common.
10. A 79-year-old male reports difficulty with balance and a fear of falling.
Which of the following is the most appropriate initial assessment?
A. Order a brain MRI
B. Perform a gait and balance assessment (Timed Up and Go test)
C. Prescribe a walker
D. Refer to physical therapy
Answer: B
Expert Rationale: The Timed Up and Go (TUG) test is a simple, validated
screening tool for balance and fall risk. Patients who take >12-15 seconds are at
increased fall risk. Assessment should precede intervention.
11. A 77-year-old female is noted to have a systolic murmur on examination.
Which of the following age-related valvular changes is most common?
A. Mitral stenosis
B. Aortic stenosis secondary to calcific degeneration
C. Tricuspid regurgitation
D. Pulmonic stenosis
Answer: B
Expert Rationale: Calcific aortic stenosis is the most common valvular
abnormality in older adults, resulting from age-related calcification and degeneration
of the aortic valve. Symptoms include dyspnea, syncope, and angina.
12. An 85-year-old male reports that his skin bruises easily. Which of the
following age-related skin changes contributes to this finding?
A. Increased collagen production
