NR601 Midterm Exam ACTUAL EXAM
2026/2027 | Chamberlain University
Weeks 1-4 | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: WEEK 1 – GERIATRIC ASSESSMENT & AGE-RELATED PHYSIOLOGIC CHANGES (20 Questions)
Q1: An 82-year-old female is brought to clinic by her daughter who reports that her mother has become
increasingly forgetful over the past year, sometimes forgetting appointments and repeating questions.
The patient scores 24/30 on the MoCA, with deficits noted in delayed recall and visuospatial function.
Which is the most appropriate next step?
A. Diagnose Alzheimer's disease and start donepezil
B. Order brain MRI before any further cognitive testing
C. Screen for reversible causes of cognitive impairment [CORRECT]
D. Refer to neurology for definitive diagnosis
Rationale: Before diagnosing dementia or referring to specialty care, it is essential to screen for
reversible causes including vitamin B12 deficiency, hypothyroidism, depression, medication effects, and
normal pressure hydrocephalus. Treatment should not be initiated without a full diagnostic evaluation,
and MRI is not the immediate first step. A MoCA score of 24 is borderline, and cognitive changes may
have treatable etiologies.
Q2: A 78-year-old male with a history of benign prostatic hyperplasia and hypertension reports two falls
in the past three months. His blood pressure is 142/88 mmHg sitting and 118/72 mmHg standing. His
medications include lisinopril 20 mg daily, hydrochlorothiazide 25 mg daily, and tamsulosin 0.4 mg daily.
Which medication is most likely contributing to his falls?
A. Lisinopril
B. Hydrochlorothiazide
C. Tamsulosin [CORRECT]
D. None of the medications are contributing
,Rationale: Tamsulosin, an alpha-1 blocker, causes orthostatic hypotension and dizziness, significantly
increasing fall risk in older adults. The patient's orthostatic blood pressure drop (24 mmHg systolic)
combined with BPH medication suggests tamsulosin is a primary contributor. While diuretics can
contribute, the timing and mechanism of alpha-blockade make tamsulosin the most likely culprit per
Beer's Criteria.
Q3: An 85-year-old female lives alone and manages her medications independently. Her daughter
expresses concern about her ability to perform daily tasks. Which assessment tool best evaluates her
ability to manage complex daily activities such as medication management, finances, and
transportation?
A. Katz Activities of Daily Living (ADL) Scale
B. Lawton Instrumental Activities of Daily Living (IADL) Scale [CORRECT]
C. Mini-Mental State Examination (MMSE)
D. Geriatric Depression Scale (GDS)
Rationale: The Lawton IADL Scale specifically assesses complex activities required for independent
community living: using telephone, shopping, food preparation, housekeeping, laundry, transportation,
medication management, and finances. Katz ADLs assess basic self-care (bathing, dressing, toileting,
transferring, continence, feeding). MMSE assesses cognition, and GDS screens for depression.
Q4: A 76-year-old male with type 2 diabetes, hypertension, and osteoarthritis is being evaluated for
overall functional status. He reports no difficulty with bathing, dressing, or toileting but states he has
stopped driving and needs help with grocery shopping and managing his medications since his wife died
six months ago. How should this be documented?
A. Independent in all activities
B. Dependent in ADLs only
C. Independent in ADLs, impaired in IADLs [CORRECT]
D. Requires full-time assistance
Rationale: The patient demonstrates the classic pattern of preserved basic ADLs (bathing, dressing,
toileting, transferring, continence, feeding) with impairment in IADLs (transportation, shopping,
medication management). This pattern is common in early functional decline and may indicate need for
supportive services while maintaining independence in self-care. Accurate documentation guides care
planning and resource allocation.
Q5: An 80-year-old female is found to have a blood pressure of 138/82 mmHg during her annual
wellness visit. She has no history of cardiovascular disease, diabetes, or chronic kidney disease.
According to current ACC/AHA guidelines, what is the appropriate classification and management?
, A. Stage 1 hypertension; start antihypertensive medication
B. Stage 1 hypertension; lifestyle modification only [CORRECT]
C. Normal blood pressure; routine follow-up
D. Stage 2 hypertension; start two antihypertensive medications
Rationale: ACC/AHA 2017 guidelines classify 130-139/80-89 as Stage 1 hypertension. For older adults
without cardiovascular disease or 10-year risk <10%, lifestyle modification is first-line. Medication is
indicated for established CVD, diabetes, CKD, or 10-year ASCVD risk ≥10%. Over-treatment in low-risk
older adults can cause harm (orthostasis, falls, cognitive impairment).
Q6: A 72-year-old male reports increasing shortness of breath when climbing stairs and difficulty
sleeping flat. Physical examination reveals bilateral lower extremity edema and an S3 gallop on cardiac
auscultation. Which age-related cardiovascular change contributes to his presentation?
A. Decreased arterial stiffness
B. Increased left ventricular compliance
C. Impaired early diastolic filling [CORRECT]
D. Decreased systolic blood pressure
Rationale: Age-related cardiovascular changes include increased arterial stiffness, decreased ventricular
compliance (stiff heart), and impaired early diastolic filling requiring greater atrial contribution. These
changes predispose to heart failure with preserved ejection fraction (HFpEF), common in older adults. S3
gallop and symptoms suggest fluid overload from diastolic dysfunction, not systolic failure.
Q7: An 81-year-old female with mild cognitive impairment is prescribed metformin for newly diagnosed
type 2 diabetes. Her eGFR is 48 mL/min/1.73m². Which modification is necessary for safe metformin
use?
A. Metformin is contraindicated at this eGFR
B. No modification is necessary
C. Reduce maximum daily dose and monitor renal function closely [CORRECT]
D. Switch to insulin immediately
Rationale: FDA guidelines allow metformin use down to eGFR 30 mL/min/1.73m² with dose reduction
and monitoring. At eGFR 30-45, maximum dose is 1,000 mg/day (vs. 2,000 mg/day normal). At eGFR
<30, metformin is contraindicated due to lactic acidosis risk. This patient can continue metformin with
dose adjustment and close monitoring, avoiding unnecessary insulin initiation.
2026/2027 | Chamberlain University
Weeks 1-4 | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: WEEK 1 – GERIATRIC ASSESSMENT & AGE-RELATED PHYSIOLOGIC CHANGES (20 Questions)
Q1: An 82-year-old female is brought to clinic by her daughter who reports that her mother has become
increasingly forgetful over the past year, sometimes forgetting appointments and repeating questions.
The patient scores 24/30 on the MoCA, with deficits noted in delayed recall and visuospatial function.
Which is the most appropriate next step?
A. Diagnose Alzheimer's disease and start donepezil
B. Order brain MRI before any further cognitive testing
C. Screen for reversible causes of cognitive impairment [CORRECT]
D. Refer to neurology for definitive diagnosis
Rationale: Before diagnosing dementia or referring to specialty care, it is essential to screen for
reversible causes including vitamin B12 deficiency, hypothyroidism, depression, medication effects, and
normal pressure hydrocephalus. Treatment should not be initiated without a full diagnostic evaluation,
and MRI is not the immediate first step. A MoCA score of 24 is borderline, and cognitive changes may
have treatable etiologies.
Q2: A 78-year-old male with a history of benign prostatic hyperplasia and hypertension reports two falls
in the past three months. His blood pressure is 142/88 mmHg sitting and 118/72 mmHg standing. His
medications include lisinopril 20 mg daily, hydrochlorothiazide 25 mg daily, and tamsulosin 0.4 mg daily.
Which medication is most likely contributing to his falls?
A. Lisinopril
B. Hydrochlorothiazide
C. Tamsulosin [CORRECT]
D. None of the medications are contributing
,Rationale: Tamsulosin, an alpha-1 blocker, causes orthostatic hypotension and dizziness, significantly
increasing fall risk in older adults. The patient's orthostatic blood pressure drop (24 mmHg systolic)
combined with BPH medication suggests tamsulosin is a primary contributor. While diuretics can
contribute, the timing and mechanism of alpha-blockade make tamsulosin the most likely culprit per
Beer's Criteria.
Q3: An 85-year-old female lives alone and manages her medications independently. Her daughter
expresses concern about her ability to perform daily tasks. Which assessment tool best evaluates her
ability to manage complex daily activities such as medication management, finances, and
transportation?
A. Katz Activities of Daily Living (ADL) Scale
B. Lawton Instrumental Activities of Daily Living (IADL) Scale [CORRECT]
C. Mini-Mental State Examination (MMSE)
D. Geriatric Depression Scale (GDS)
Rationale: The Lawton IADL Scale specifically assesses complex activities required for independent
community living: using telephone, shopping, food preparation, housekeeping, laundry, transportation,
medication management, and finances. Katz ADLs assess basic self-care (bathing, dressing, toileting,
transferring, continence, feeding). MMSE assesses cognition, and GDS screens for depression.
Q4: A 76-year-old male with type 2 diabetes, hypertension, and osteoarthritis is being evaluated for
overall functional status. He reports no difficulty with bathing, dressing, or toileting but states he has
stopped driving and needs help with grocery shopping and managing his medications since his wife died
six months ago. How should this be documented?
A. Independent in all activities
B. Dependent in ADLs only
C. Independent in ADLs, impaired in IADLs [CORRECT]
D. Requires full-time assistance
Rationale: The patient demonstrates the classic pattern of preserved basic ADLs (bathing, dressing,
toileting, transferring, continence, feeding) with impairment in IADLs (transportation, shopping,
medication management). This pattern is common in early functional decline and may indicate need for
supportive services while maintaining independence in self-care. Accurate documentation guides care
planning and resource allocation.
Q5: An 80-year-old female is found to have a blood pressure of 138/82 mmHg during her annual
wellness visit. She has no history of cardiovascular disease, diabetes, or chronic kidney disease.
According to current ACC/AHA guidelines, what is the appropriate classification and management?
, A. Stage 1 hypertension; start antihypertensive medication
B. Stage 1 hypertension; lifestyle modification only [CORRECT]
C. Normal blood pressure; routine follow-up
D. Stage 2 hypertension; start two antihypertensive medications
Rationale: ACC/AHA 2017 guidelines classify 130-139/80-89 as Stage 1 hypertension. For older adults
without cardiovascular disease or 10-year risk <10%, lifestyle modification is first-line. Medication is
indicated for established CVD, diabetes, CKD, or 10-year ASCVD risk ≥10%. Over-treatment in low-risk
older adults can cause harm (orthostasis, falls, cognitive impairment).
Q6: A 72-year-old male reports increasing shortness of breath when climbing stairs and difficulty
sleeping flat. Physical examination reveals bilateral lower extremity edema and an S3 gallop on cardiac
auscultation. Which age-related cardiovascular change contributes to his presentation?
A. Decreased arterial stiffness
B. Increased left ventricular compliance
C. Impaired early diastolic filling [CORRECT]
D. Decreased systolic blood pressure
Rationale: Age-related cardiovascular changes include increased arterial stiffness, decreased ventricular
compliance (stiff heart), and impaired early diastolic filling requiring greater atrial contribution. These
changes predispose to heart failure with preserved ejection fraction (HFpEF), common in older adults. S3
gallop and symptoms suggest fluid overload from diastolic dysfunction, not systolic failure.
Q7: An 81-year-old female with mild cognitive impairment is prescribed metformin for newly diagnosed
type 2 diabetes. Her eGFR is 48 mL/min/1.73m². Which modification is necessary for safe metformin
use?
A. Metformin is contraindicated at this eGFR
B. No modification is necessary
C. Reduce maximum daily dose and monitor renal function closely [CORRECT]
D. Switch to insulin immediately
Rationale: FDA guidelines allow metformin use down to eGFR 30 mL/min/1.73m² with dose reduction
and monitoring. At eGFR 30-45, maximum dose is 1,000 mg/day (vs. 2,000 mg/day normal). At eGFR
<30, metformin is contraindicated due to lactic acidosis risk. This patient can continue metformin with
dose adjustment and close monitoring, avoiding unnecessary insulin initiation.
