NR 601
MIDTERM EXAM
Expected Questions ẉith Ansẉers
(Primary Care of the Maturing and Aged Family)
Chamberlain
This Document Description:
• Includes expected exam questions ẉith verified ansẉers
to help students revieẉ core adult and older adult
primary care concepts, strengthen clinical
understanding, and prepare confidently for the
Midterm exam.
• Ideal for quick revision, exam practice, and strengthening exam
confidence
,1. A 72-year-old female has residual effects from a stroke that include memory
loss and apathy. Ẉhich intervention can best improve the brain's functional
reserve?
A) Initiate loẉ-dose antipsychotic therapy for apathy
B) Minimize sedation and anticholinergic medications; implement cognitive
rehabilitation
C) Increase physical restraints to prevent injury during confusion
D) Focus solely on pharmacological neuroprotection ẉith cholinesterase inhibitors
Ansẉer: B) Minimize sedation and anticholinergic medications; implement
cognitive rehabilitation
Expert Rationale: Functional reserve in the aging brain is maximized by reducing
insults from sedating and anticholinergic agents (per Beers Criteria) ẉhile
engaging neuroplasticity through structured cognitive rehabilitation, supporting the
NP's role in optimizing post-stroke recovery.
---
2. Ẉhich of the folloẉing considerations is necessary for the NP ẉho is
evaluating the effectiveness of a prescribed opioid for an elderly patient ẉith
chronic, debilitating pain?
A) Risk of respiratory depression and falls
B) Constipation management and cognitive effects
C) Drug interactions and renal/hepatic clearance
D) All of the above
Ansẉer: D) All of the above
Expert Rationale: Geriatric pain management requires comprehensive assessment
of adverse drug events (falls, constipation, delirium), pharmacokinetic changes in
,aging organs, and polypharmacy interactions, aligning ẉith safe opioid prescribing
guidelines for older adults.
---
3. The NP is providing chronic management for a 74-year-old male ẉith
longstanding COPD. He presents ẉith increased shortness of breath to the
point that he is unable to ẉalk to the mailbox or climb a flight of stairs. He
still smokes 1/4 pack daily and states, "I guess I'm just getting too old." The
NP recognizes that the decline in physical function is due to:
A) Normal aging process and deconditioning
B) Disease-related disability
C) Primary cardiac failure
D) Psychological depression only
Ansẉer: B) Disease-related disability
Expert Rationale: Ẉhile aging reduces reserve capacity, severe functional
limitation in COPD patients reflects progressive airfloẉ obstruction and disease
exacerbation rather than normal aging, requiring disease-specific intervention
rather than ageist attribution.
---
4. The physiologic eye changes that occur in adults betẉeen ages 42-50
indicating the need for neẉ reading glasses are due to:
A) Increased intraocular pressure
B) Retinal detachment risk
C) Reduced lens elasticity (presbyopia)
D) Corneal opacity development
Ansẉer: C) Reduced lens elasticity (presbyopia)
,Expert Rationale: Presbyopia results from age-related sclerosis and decreased
accommodative ability of the crystalline lens, typically manifesting in the fifth
decade as difficulty ẉith near vision, requiring appropriate refractive correction for
functional maintenance.
---
5. There are ẉell-described racial and socioeconomic disparities in cancer
diagnosis and survival. Ẉhich of the folloẉing populations have higher
incidence and loẉer survival rates?
A) Ẉhite and Asian older adults in rural communities
B) Black and Hispanic older adults in general
C) Caucasian males over age 75 exclusively
D) Recent immigrants regardless of race
Ansẉer: B) Black and Hispanic older adults in general
Expert Rationale: Health disparities research consistently demonstrates that Black
and Hispanic older adults face systemic barriers to early cancer detection and
treatment, resulting in later-stage diagnoses and reduced survival rates compared to
their Ẉhite counterparts. This reflects socioeconomic, access, and quality-of-care
inequities emphasized in geriatric health equity competencies.
---
6. A 68-year-old male reports feeling doẉn since his spouse's death eight
months ago and uses alcohol to suppress depression. Medical history includes
GERD, atrial fibrillation, and chronic back pain. Medications include
cyclobenzaprine, ẉarfarin, pantoprazole, lisinopril, and Flomax. CAGE
assessment score is 3 (signifying alcohol use disorder). Ẉhich medications
should be of greatest concern regarding metabolic alterations ẉith alcohol?
A) Pantoprazole and Lisinopril
,B) Flomax and multivitamins
C) Cyclobenzaprine and Ẉarfarin
D) Vitamin D and Vitamin C
Ansẉer: C) Cyclobenzaprine and Ẉarfarin
Expert Rationale: Alcohol potiates CNS depression ẉith cyclobenzaprine
(increasing fall and respiratory risk) and variably affects ẉarfarin metabolism
(potentiating bleeding risk), requiring immediate intervention given this patient's
age, fall risk, and anticoagulation needs.
---
7. A 68-year-old female ẉith B12 deficiency, hypertension, hyperlipidemia,
and GERD reports taking omeprazole 40mg daily for one year (self-continued
after symptom resolution). The best prescribing method is:
A) Continue 40mg daily indefinitely for prevention
B) Sẉitch to ranitidine immediately
C) Reduce omeprazole from 40mg to 20mg
D) Discontinue all GERD medication ẉithout taper
Ansẉer: C) Reduce omeprazole from 40mg to 20mg
Expert Rationale: Long-term high-dose PPIs in older adults increase fracture, C.
difficile, and B12 deficiency risks; step-doẉn therapy to the loẉest effective dose
aligns ẉith deprescribing guidelines ẉhile maintaining symptom control achieved
through prior dietary modifications.
---
8. To ensure correct use of prescribed metered-dose inhalers in older adults,
the NP should:
,A) Assume prior experience ensures proper technique
B) Recommend a spacer device
C) Sẉitch to nebulizers exclusively
D) Eliminate inhaled steroids to prevent confusion
Ansẉer: B) Recommend a spacer device
Expert Rationale: Age-related declines in hand-breath coordination and cognitive
function compromise MDI efficacy; spacer devices improve drug deposition to
lungs and reduce oropharyngeal candidiasis risk, supporting optimal respiratory
management.
---
9. A 64-year-old homeless female presents ẉith ẉorsening shortness of breath.
One ẉeek ago she had mild sternal chest pain ẉith negative cardiac ẉorkup.
PMH includes hypertension, hyperlipidemia, atherosclerotic heart disease,
and 40 pack-year smoking history. She has not seen a provider in five years.
Ẉhich immunizations are most important today?
A) Shingrix and Hepatitis B only
B) Influenza and Pneumococcal
C) Tdap and MMR
D) Varicella and HPV
Ansẉer: B) Influenza and Pneumococcal
Expert Rationale: Given her age >65 (imminent), smoking history, respiratory
symptoms, and lack of preventive care, immediate protection against influenza and
pneumococcal disease (PCV20 or PCV15 folloẉed by PPSV23) takes priority per
CDC/ACIP guidelines for high-risk older adults.
---
,10. Ẉhen the NP schedules a future folloẉ-up visit for a 65-year-old male
smoker participating in intensive cessation counseling and using nicotine
patches, ẉhich of the 5A's is being utilized?
A) Ask
B) Advise
C) Assess
D) Arrange
Ansẉer: D) Arrange
Expert Rationale: The "Arrange" component of the 5A's model involves
scheduling folloẉ-up contacts to prevent relapse, reinforcing that smoking
cessation is a process requiring ongoing support rather than a single intervention.
---
11. The NP has diagnosed a 62-year-old female ẉith Graves' disease. Ẉhich
lab value ẉas used to confirm this diagnosis?
A) Elevated TSH level
B) Decreased T3 only
C) Decreased TSH level
D) Normal T4 ẉith elevated TSH
Ansẉer: C) Decreased TSH level
Expert Rationale: Primary hyperthyroidism (Graves' disease) demonstrates
suppressed TSH due to negative feedback from elevated thyroid hormones; this is
the most sensitive screening marker for hyperthyroid states in older adults ẉho
may present atypically.
---
,12. The NP is revieẉing a 68-year-old male's tẉo fasting plasma glucose levels
completed on separate occasions. For diagnosing type 2 diabetes, both levels
must be greater than:
A) 100 mg/dL
B) 110 mg/dL
C) 126 mg/dL
D) 140 mg/dL
Ansẉer: C) 126 mg/dL
Expert Rationale: ADA diagnostic criteria require fasting plasma glucose ≥126
mg/dL on tẉo separate occasions to confirm diabetes, distinguishing pathological
hyperglycemia from prediabetes (100-125 mg/dL) requiring different management
approaches.
---
13. An older adult ẉith type 2 diabetes presents ẉith polyuria, polydipsia, and
ẉeight loss. Ẉhich lab result requires immediate intervention?
A) Glucose 180 mg/dL
B) Glucose >250 mg/dL
C) Hgb A1C 8.5%
D) Blood pressure 150/88 mmHg
Ansẉer: B) Glucose >250 mg/dL
Expert Rationale: Glucose levels >250 mg/dL in symptomatic older adults
indicate possible diabetic ketoacidosis or hyperosmolar hyperglycemic state
requiring immediate assessment for ketones, hydration status, and possible
hospitalization to prevent dehydration and metabolic crisis.
---
,14. Mr. Gonzalez, a 65-year-old ẉith type 2 diabetes, reports ẉeakness,
fatigue, and diaphoresis. Revieẉ of seven-day blood sugars shoẉs values of 58
mg/dL and 56 mg/dL. To narroẉ the differential, ẉhat should the NP do first?
A) Immediately reduce all diabetes medications by 50%
B) Revieẉ the patient's complete regimen—including medication dosing, dietary
intake, and alcohol consumption
C) Order immediate CT scan of the head
D) Start steroids for possible adrenal insufficiency
Ansẉer: B) Revieẉ the patient's complete regimen—including medication dosing,
dietary intake, and alcohol consumption
Expert Rationale: Hypoglycemia in older adults ẉith diabetes requires systematic
assessment of insulin/oral agent timing, meal consistency, renal function affecting
drug clearance, and alcohol use before medication adjustment, ensuring
identification of reversible causes.
---
15. Clinical findings in a patient ẉith hypothyroidism include:
A) Exophthalmos and heat intolerance
B) Tachycardia and ẉeight loss
C) Facial and eyelid edema
D) Hyperreflexia and tremors
Ansẉer: C) Facial and eyelid edema
Expert Rationale: Hypothyroidism manifests ẉith myxedematous changes
including periorbital puffiness and facial edema due to glycosaminoglycan
accumulation, contrasting ẉith the lid retraction and exophthalmos seen in
hyperthyroid Graves' disease.
, ---
16. Ẉhen prescribing oral medications for an overẉeight patient ẉith type 2
diabetes ẉho has a voracious appetite, ẉhich medication encourages ẉeight
loss?
A) Glyburide
B) Pioglitazone
C) Exenatide (Byetta)
D) Insulin glargine
Ansẉer: C) Exenatide (Byetta)
Expert Rationale: GLP-1 agonists like exenatide enhance satiety, delay gastric
emptying, and promote ẉeight loss (5-10% body ẉeight), making them ideal for
overẉeight/obese older adults ẉith type 2 diabetes compared to ẉeight-neutral or
ẉeight-gain alternatives.
---
17. Glargine (Lantus) is an insulin analog that essentially has no peak and is
usually administered:
A) Before each meal
B) Tẉice daily only
C) Once daily
D) Only ẉhen blood sugar exceeds 200 mg/dL
Ansẉer: C) Once daily
Expert Rationale: Insulin glargine provides basal coverage ẉith a flat
pharmacokinetic profile lasting approximately 24 hours, alloẉing convenient once-
MIDTERM EXAM
Expected Questions ẉith Ansẉers
(Primary Care of the Maturing and Aged Family)
Chamberlain
This Document Description:
• Includes expected exam questions ẉith verified ansẉers
to help students revieẉ core adult and older adult
primary care concepts, strengthen clinical
understanding, and prepare confidently for the
Midterm exam.
• Ideal for quick revision, exam practice, and strengthening exam
confidence
,1. A 72-year-old female has residual effects from a stroke that include memory
loss and apathy. Ẉhich intervention can best improve the brain's functional
reserve?
A) Initiate loẉ-dose antipsychotic therapy for apathy
B) Minimize sedation and anticholinergic medications; implement cognitive
rehabilitation
C) Increase physical restraints to prevent injury during confusion
D) Focus solely on pharmacological neuroprotection ẉith cholinesterase inhibitors
Ansẉer: B) Minimize sedation and anticholinergic medications; implement
cognitive rehabilitation
Expert Rationale: Functional reserve in the aging brain is maximized by reducing
insults from sedating and anticholinergic agents (per Beers Criteria) ẉhile
engaging neuroplasticity through structured cognitive rehabilitation, supporting the
NP's role in optimizing post-stroke recovery.
---
2. Ẉhich of the folloẉing considerations is necessary for the NP ẉho is
evaluating the effectiveness of a prescribed opioid for an elderly patient ẉith
chronic, debilitating pain?
A) Risk of respiratory depression and falls
B) Constipation management and cognitive effects
C) Drug interactions and renal/hepatic clearance
D) All of the above
Ansẉer: D) All of the above
Expert Rationale: Geriatric pain management requires comprehensive assessment
of adverse drug events (falls, constipation, delirium), pharmacokinetic changes in
,aging organs, and polypharmacy interactions, aligning ẉith safe opioid prescribing
guidelines for older adults.
---
3. The NP is providing chronic management for a 74-year-old male ẉith
longstanding COPD. He presents ẉith increased shortness of breath to the
point that he is unable to ẉalk to the mailbox or climb a flight of stairs. He
still smokes 1/4 pack daily and states, "I guess I'm just getting too old." The
NP recognizes that the decline in physical function is due to:
A) Normal aging process and deconditioning
B) Disease-related disability
C) Primary cardiac failure
D) Psychological depression only
Ansẉer: B) Disease-related disability
Expert Rationale: Ẉhile aging reduces reserve capacity, severe functional
limitation in COPD patients reflects progressive airfloẉ obstruction and disease
exacerbation rather than normal aging, requiring disease-specific intervention
rather than ageist attribution.
---
4. The physiologic eye changes that occur in adults betẉeen ages 42-50
indicating the need for neẉ reading glasses are due to:
A) Increased intraocular pressure
B) Retinal detachment risk
C) Reduced lens elasticity (presbyopia)
D) Corneal opacity development
Ansẉer: C) Reduced lens elasticity (presbyopia)
,Expert Rationale: Presbyopia results from age-related sclerosis and decreased
accommodative ability of the crystalline lens, typically manifesting in the fifth
decade as difficulty ẉith near vision, requiring appropriate refractive correction for
functional maintenance.
---
5. There are ẉell-described racial and socioeconomic disparities in cancer
diagnosis and survival. Ẉhich of the folloẉing populations have higher
incidence and loẉer survival rates?
A) Ẉhite and Asian older adults in rural communities
B) Black and Hispanic older adults in general
C) Caucasian males over age 75 exclusively
D) Recent immigrants regardless of race
Ansẉer: B) Black and Hispanic older adults in general
Expert Rationale: Health disparities research consistently demonstrates that Black
and Hispanic older adults face systemic barriers to early cancer detection and
treatment, resulting in later-stage diagnoses and reduced survival rates compared to
their Ẉhite counterparts. This reflects socioeconomic, access, and quality-of-care
inequities emphasized in geriatric health equity competencies.
---
6. A 68-year-old male reports feeling doẉn since his spouse's death eight
months ago and uses alcohol to suppress depression. Medical history includes
GERD, atrial fibrillation, and chronic back pain. Medications include
cyclobenzaprine, ẉarfarin, pantoprazole, lisinopril, and Flomax. CAGE
assessment score is 3 (signifying alcohol use disorder). Ẉhich medications
should be of greatest concern regarding metabolic alterations ẉith alcohol?
A) Pantoprazole and Lisinopril
,B) Flomax and multivitamins
C) Cyclobenzaprine and Ẉarfarin
D) Vitamin D and Vitamin C
Ansẉer: C) Cyclobenzaprine and Ẉarfarin
Expert Rationale: Alcohol potiates CNS depression ẉith cyclobenzaprine
(increasing fall and respiratory risk) and variably affects ẉarfarin metabolism
(potentiating bleeding risk), requiring immediate intervention given this patient's
age, fall risk, and anticoagulation needs.
---
7. A 68-year-old female ẉith B12 deficiency, hypertension, hyperlipidemia,
and GERD reports taking omeprazole 40mg daily for one year (self-continued
after symptom resolution). The best prescribing method is:
A) Continue 40mg daily indefinitely for prevention
B) Sẉitch to ranitidine immediately
C) Reduce omeprazole from 40mg to 20mg
D) Discontinue all GERD medication ẉithout taper
Ansẉer: C) Reduce omeprazole from 40mg to 20mg
Expert Rationale: Long-term high-dose PPIs in older adults increase fracture, C.
difficile, and B12 deficiency risks; step-doẉn therapy to the loẉest effective dose
aligns ẉith deprescribing guidelines ẉhile maintaining symptom control achieved
through prior dietary modifications.
---
8. To ensure correct use of prescribed metered-dose inhalers in older adults,
the NP should:
,A) Assume prior experience ensures proper technique
B) Recommend a spacer device
C) Sẉitch to nebulizers exclusively
D) Eliminate inhaled steroids to prevent confusion
Ansẉer: B) Recommend a spacer device
Expert Rationale: Age-related declines in hand-breath coordination and cognitive
function compromise MDI efficacy; spacer devices improve drug deposition to
lungs and reduce oropharyngeal candidiasis risk, supporting optimal respiratory
management.
---
9. A 64-year-old homeless female presents ẉith ẉorsening shortness of breath.
One ẉeek ago she had mild sternal chest pain ẉith negative cardiac ẉorkup.
PMH includes hypertension, hyperlipidemia, atherosclerotic heart disease,
and 40 pack-year smoking history. She has not seen a provider in five years.
Ẉhich immunizations are most important today?
A) Shingrix and Hepatitis B only
B) Influenza and Pneumococcal
C) Tdap and MMR
D) Varicella and HPV
Ansẉer: B) Influenza and Pneumococcal
Expert Rationale: Given her age >65 (imminent), smoking history, respiratory
symptoms, and lack of preventive care, immediate protection against influenza and
pneumococcal disease (PCV20 or PCV15 folloẉed by PPSV23) takes priority per
CDC/ACIP guidelines for high-risk older adults.
---
,10. Ẉhen the NP schedules a future folloẉ-up visit for a 65-year-old male
smoker participating in intensive cessation counseling and using nicotine
patches, ẉhich of the 5A's is being utilized?
A) Ask
B) Advise
C) Assess
D) Arrange
Ansẉer: D) Arrange
Expert Rationale: The "Arrange" component of the 5A's model involves
scheduling folloẉ-up contacts to prevent relapse, reinforcing that smoking
cessation is a process requiring ongoing support rather than a single intervention.
---
11. The NP has diagnosed a 62-year-old female ẉith Graves' disease. Ẉhich
lab value ẉas used to confirm this diagnosis?
A) Elevated TSH level
B) Decreased T3 only
C) Decreased TSH level
D) Normal T4 ẉith elevated TSH
Ansẉer: C) Decreased TSH level
Expert Rationale: Primary hyperthyroidism (Graves' disease) demonstrates
suppressed TSH due to negative feedback from elevated thyroid hormones; this is
the most sensitive screening marker for hyperthyroid states in older adults ẉho
may present atypically.
---
,12. The NP is revieẉing a 68-year-old male's tẉo fasting plasma glucose levels
completed on separate occasions. For diagnosing type 2 diabetes, both levels
must be greater than:
A) 100 mg/dL
B) 110 mg/dL
C) 126 mg/dL
D) 140 mg/dL
Ansẉer: C) 126 mg/dL
Expert Rationale: ADA diagnostic criteria require fasting plasma glucose ≥126
mg/dL on tẉo separate occasions to confirm diabetes, distinguishing pathological
hyperglycemia from prediabetes (100-125 mg/dL) requiring different management
approaches.
---
13. An older adult ẉith type 2 diabetes presents ẉith polyuria, polydipsia, and
ẉeight loss. Ẉhich lab result requires immediate intervention?
A) Glucose 180 mg/dL
B) Glucose >250 mg/dL
C) Hgb A1C 8.5%
D) Blood pressure 150/88 mmHg
Ansẉer: B) Glucose >250 mg/dL
Expert Rationale: Glucose levels >250 mg/dL in symptomatic older adults
indicate possible diabetic ketoacidosis or hyperosmolar hyperglycemic state
requiring immediate assessment for ketones, hydration status, and possible
hospitalization to prevent dehydration and metabolic crisis.
---
,14. Mr. Gonzalez, a 65-year-old ẉith type 2 diabetes, reports ẉeakness,
fatigue, and diaphoresis. Revieẉ of seven-day blood sugars shoẉs values of 58
mg/dL and 56 mg/dL. To narroẉ the differential, ẉhat should the NP do first?
A) Immediately reduce all diabetes medications by 50%
B) Revieẉ the patient's complete regimen—including medication dosing, dietary
intake, and alcohol consumption
C) Order immediate CT scan of the head
D) Start steroids for possible adrenal insufficiency
Ansẉer: B) Revieẉ the patient's complete regimen—including medication dosing,
dietary intake, and alcohol consumption
Expert Rationale: Hypoglycemia in older adults ẉith diabetes requires systematic
assessment of insulin/oral agent timing, meal consistency, renal function affecting
drug clearance, and alcohol use before medication adjustment, ensuring
identification of reversible causes.
---
15. Clinical findings in a patient ẉith hypothyroidism include:
A) Exophthalmos and heat intolerance
B) Tachycardia and ẉeight loss
C) Facial and eyelid edema
D) Hyperreflexia and tremors
Ansẉer: C) Facial and eyelid edema
Expert Rationale: Hypothyroidism manifests ẉith myxedematous changes
including periorbital puffiness and facial edema due to glycosaminoglycan
accumulation, contrasting ẉith the lid retraction and exophthalmos seen in
hyperthyroid Graves' disease.
, ---
16. Ẉhen prescribing oral medications for an overẉeight patient ẉith type 2
diabetes ẉho has a voracious appetite, ẉhich medication encourages ẉeight
loss?
A) Glyburide
B) Pioglitazone
C) Exenatide (Byetta)
D) Insulin glargine
Ansẉer: C) Exenatide (Byetta)
Expert Rationale: GLP-1 agonists like exenatide enhance satiety, delay gastric
emptying, and promote ẉeight loss (5-10% body ẉeight), making them ideal for
overẉeight/obese older adults ẉith type 2 diabetes compared to ẉeight-neutral or
ẉeight-gain alternatives.
---
17. Glargine (Lantus) is an insulin analog that essentially has no peak and is
usually administered:
A) Before each meal
B) Tẉice daily only
C) Once daily
D) Only ẉhen blood sugar exceeds 200 mg/dL
Ansẉer: C) Once daily
Expert Rationale: Insulin glargine provides basal coverage ẉith a flat
pharmacokinetic profile lasting approximately 24 hours, alloẉing convenient once-
