NR 601 Midterm Exam: Primary Care of the Older Adult 2026
1. According to the Beers Criteria, which of the following medications should
generally be avoided in older adults due to high anticholinergic risk?
A. Metformin
B. Lisinopril
C. Atorvastatin
D. Amitriptyline
Answer: D
Rationale: Amitriptyline is a tricyclic antidepressant with strong anticholinergic
properties, which increases the risk of sedation, confusion, and falls in the elderly.
2. Which assessment tool is specifically designed to evaluate a patient’s ability
to perform Instrumental Activities of Daily Living (IADLs)?
A. Katz Index
B. Lawton Scale
C. Mini-Mental State Exam
D. Geriatric Depression Scale
Answer: B
Rationale: The Lawton IADL Scale assesses complex activities like managing finances,
shopping, and using the telephone, whereas the Katz Index focuses on basic ADLs like
bathing and dressing.
,3. In the management of hypertension for an 80-year-old patient without major
comorbidities, the ACC/AHA guidelines generally recommend a target blood
pressure of:
A. Less than 120/80 mmHg
B. Less than 150/95 mmHg
C. Less than 140/90 mmHg
D. Less than 130/80 mmHg
Answer: D
Rationale: Current ACC/AHA guidelines suggest a target of less than 130/80 mmHg for
most older adults, though clinical judgment regarding frailty is required.
4. Which of the following is considered a hallmark clinical feature of delirium
that distinguishes it from dementia?
A. Slow, progressive memory loss
B. Preserved level of consciousness
C. Acute onset and fluctuating course
D. Absence of hallucinations
Answer: C
Rationale: Delirium is characterized by an acute change in mental status, inattention, and a
fluctuating course, whereas dementia is typically gradual and progressive.
5. A 72-year-old male presents with a T-score of -2.6 on a DXA scan. This result is
interpreted as:
A. Osteoporosis
B. Osteopenia
C. Normal bone density
D. Severe Osteoarthritis
Answer: A
Rationale: According to the WHO, a T-score of -2.5 or lower is diagnostic of osteoporosis.
, 6. Which of the following is the first-line pharmacologic treatment for an older
male with symptomatic Benign Prostatic Hyperplasia (BPH)?
A. Anticholinergics
B. Phosphodiesterase-5 inhibitors
C. Loop diuretics
D. Alpha-1 blockers like Tamsulosin
Answer: D
Rationale: Alpha-1 blockers are the first-line treatment for BPH symptoms as they relax
the smooth muscle of the prostate and bladder neck.
7. A common side effect of prescribing a proton pump inhibitor (PPI) long-term
in the elderly is:
A. Improved absorption of Vitamin B12
B. Iron overload
C. Increased risk of Clostridium difficile infection
D. Decreased risk of fractures
Answer: C
Rationale: Long-term PPI use is associated with C. diff infection, bone fractures (due to
malabsorption of calcium), and Vitamin B12 deficiency.
8. The ‘Timed Up and Go’ (TUG) test is primarily used to assess which of the
following?
A. Fall risk and mobility
B. Nutritional status
C. Cognitive function
D. Visual acuity
Answer: A
Rationale: The TUG test measures the time it takes for a patient to stand from a chair, walk
3 meters, turn, and sit back down, serving as a predictor for fall risk.
1. According to the Beers Criteria, which of the following medications should
generally be avoided in older adults due to high anticholinergic risk?
A. Metformin
B. Lisinopril
C. Atorvastatin
D. Amitriptyline
Answer: D
Rationale: Amitriptyline is a tricyclic antidepressant with strong anticholinergic
properties, which increases the risk of sedation, confusion, and falls in the elderly.
2. Which assessment tool is specifically designed to evaluate a patient’s ability
to perform Instrumental Activities of Daily Living (IADLs)?
A. Katz Index
B. Lawton Scale
C. Mini-Mental State Exam
D. Geriatric Depression Scale
Answer: B
Rationale: The Lawton IADL Scale assesses complex activities like managing finances,
shopping, and using the telephone, whereas the Katz Index focuses on basic ADLs like
bathing and dressing.
,3. In the management of hypertension for an 80-year-old patient without major
comorbidities, the ACC/AHA guidelines generally recommend a target blood
pressure of:
A. Less than 120/80 mmHg
B. Less than 150/95 mmHg
C. Less than 140/90 mmHg
D. Less than 130/80 mmHg
Answer: D
Rationale: Current ACC/AHA guidelines suggest a target of less than 130/80 mmHg for
most older adults, though clinical judgment regarding frailty is required.
4. Which of the following is considered a hallmark clinical feature of delirium
that distinguishes it from dementia?
A. Slow, progressive memory loss
B. Preserved level of consciousness
C. Acute onset and fluctuating course
D. Absence of hallucinations
Answer: C
Rationale: Delirium is characterized by an acute change in mental status, inattention, and a
fluctuating course, whereas dementia is typically gradual and progressive.
5. A 72-year-old male presents with a T-score of -2.6 on a DXA scan. This result is
interpreted as:
A. Osteoporosis
B. Osteopenia
C. Normal bone density
D. Severe Osteoarthritis
Answer: A
Rationale: According to the WHO, a T-score of -2.5 or lower is diagnostic of osteoporosis.
, 6. Which of the following is the first-line pharmacologic treatment for an older
male with symptomatic Benign Prostatic Hyperplasia (BPH)?
A. Anticholinergics
B. Phosphodiesterase-5 inhibitors
C. Loop diuretics
D. Alpha-1 blockers like Tamsulosin
Answer: D
Rationale: Alpha-1 blockers are the first-line treatment for BPH symptoms as they relax
the smooth muscle of the prostate and bladder neck.
7. A common side effect of prescribing a proton pump inhibitor (PPI) long-term
in the elderly is:
A. Improved absorption of Vitamin B12
B. Iron overload
C. Increased risk of Clostridium difficile infection
D. Decreased risk of fractures
Answer: C
Rationale: Long-term PPI use is associated with C. diff infection, bone fractures (due to
malabsorption of calcium), and Vitamin B12 deficiency.
8. The ‘Timed Up and Go’ (TUG) test is primarily used to assess which of the
following?
A. Fall risk and mobility
B. Nutritional status
C. Cognitive function
D. Visual acuity
Answer: A
Rationale: The TUG test measures the time it takes for a patient to stand from a chair, walk
3 meters, turn, and sit back down, serving as a predictor for fall risk.
