NR 601 Final Exam: Primary Care Aging - Chamberlain
University Updated and Latest Questions and Correct
Answers with Rationale
1. Which assessment tool is most appropriate for a primary care provider to use when screening an 82-year-
old patient for cognitive impairment during a busy clinic visit?
A. MMSE (Mini-Mental State Examination)
B. MoCA (Montreal Cognitive Assessment)
C. Mini-Cog
D. Geriatric Depression Scale
Correct Answer: C
Rationale: The Mini-Cog is a highly efficient screening tool that takes only 3 minutes to administer. It
consists of a three-item recall and a clock-drawing test which assesses multiple cognitive domains. While
the MMSE and MoCA are more comprehensive, they require significantly more time and often involve
licensing fees or specialized training. The Geriatric Depression Scale is specifically for mood assessment
and not cognitive screening. Using the Mini-Cog allows for rapid identification of patients needing further
evaluation in a primary care setting.
2. An 85-year-old patient presents with insomnia. According to the Beers Criteria, which medication should
the nurse practitioner avoid prescribing?
A. Melatonin
B. Trazodone
C. Diphenhydramine
D. Zolpidem
,Correct Answer: C
Rationale: Diphenhydramine is a first-generation antihistamine listed in the Beers Criteria as potentially
inappropriate for older adults. It carries a high risk of anticholinergic effects including confusion, dry
mouth, and urinary retention. Furthermore, it significantly increases the risk of falls and delirium in the
geriatric population. While Zolpidem also carries risks, Diphenhydramine is specifically highlighted for
its potent anticholinergic profile. Providers should prioritize non-pharmacological interventions or safer
alternatives for sleep management.
3. When managing hypertension in a ‘healthy’ 70-year-old patient, what is the target blood pressure goal
according to JNC 8 guidelines?
A. < 120/80 mmHg
B. < 130/80 mmHg
C. < 150/90 mmHg
D. < 140/90 mmHg
Correct Answer: C
Rationale: JNC 8 guidelines recommend a target blood pressure of less than 150/90 mmHg for adults
aged 60 years or older. This recommendation aims to balance the benefits of stroke prevention with the
risks of orthostatic hypotension and falls. Lower targets like 130/80 are often reserved for patients with
comorbidities such as diabetes or chronic kidney disease. Overtreatment in the elderly can lead to
adverse events like syncope and renal failure. The provider must assess the patient’s overall frailty when
deciding on specific treatment thresholds.
4. A 78-year-old male reports difficulty starting his urinary stream and frequent nighttime urination. Which
initial medication class is first-line for managing these symptoms of BPH?
A. 5-alpha-reductase inhibitors
,B. Alpha-1 blockers
C. Anticholinergics
D. Phosphodiesterase-5 inhibitors
Correct Answer: B
Rationale: Alpha-1 blockers, such as Tamsulosin, are considered first-line therapy for symptomatic
Benign Prostatic Hyperplasia (BPH). They work by relaxing the smooth muscle in the bladder neck and
prostate to improve urine flow quickly. 5-alpha-reductase inhibitors like Finasteride are effective but
usually take several months to reduce prostate volume. Anticholinergics are generally avoided as initial
monotherapy because they can increase the risk of urinary retention. Clinicians should monitor for side
effects like orthostatic hypotension when starting alpha-blockers in older men.
5. An elderly patient presents with acute onset of confusion, fluctuating levels of consciousness, and
inattention. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Depression
D. Delirium
Correct Answer: D
Rationale: Delirium is characterized by an acute change in mental status with a fluctuating course and
inattention. Unlike dementia, which is a slow, progressive decline, delirium is often reversible and
triggered by an underlying medical condition. Common causes include infections, medications, or
metabolic disturbances in the elderly. Alzheimer’s and Vascular dementia typically present with more
, gradual onset and stable levels of consciousness. Prompt identification of the underlying cause is critical
to prevent morbidity and long-term cognitive decline.
6. Which of the following is a component of the Fried Frailty Phenotype?
A. Cognitive decline
B. Recent hospitalization
C. Presence of three or more chronic diseases
D. Low physical activity
Correct Answer: D
Rationale: The Fried Frailty Phenotype identifies frailty based on five specific criteria: unintentional
weight loss, exhaustion, low physical activity, slow walking speed, and weak grip strength. A patient
meeting three or more of these criteria is classified as frail. Low physical activity is a core measure
because it reflects reduced physiological reserve and energy expenditure. Cognitive decline and
comorbidity count are important but are not part of this specific clinical definition. Assessing these
components helps clinicians predict the risk of falls, disability, and mortality.
7. A 75-year-old female with Type 2 Diabetes has a history of multiple falls and a life expectancy of 5 years.
What is the most appropriate A1C goal for her?
A. < 6.5%
B. < 7.0%
C. < 7.5%
D. < 8.0% - 8.5%
Correct Answer: D
University Updated and Latest Questions and Correct
Answers with Rationale
1. Which assessment tool is most appropriate for a primary care provider to use when screening an 82-year-
old patient for cognitive impairment during a busy clinic visit?
A. MMSE (Mini-Mental State Examination)
B. MoCA (Montreal Cognitive Assessment)
C. Mini-Cog
D. Geriatric Depression Scale
Correct Answer: C
Rationale: The Mini-Cog is a highly efficient screening tool that takes only 3 minutes to administer. It
consists of a three-item recall and a clock-drawing test which assesses multiple cognitive domains. While
the MMSE and MoCA are more comprehensive, they require significantly more time and often involve
licensing fees or specialized training. The Geriatric Depression Scale is specifically for mood assessment
and not cognitive screening. Using the Mini-Cog allows for rapid identification of patients needing further
evaluation in a primary care setting.
2. An 85-year-old patient presents with insomnia. According to the Beers Criteria, which medication should
the nurse practitioner avoid prescribing?
A. Melatonin
B. Trazodone
C. Diphenhydramine
D. Zolpidem
,Correct Answer: C
Rationale: Diphenhydramine is a first-generation antihistamine listed in the Beers Criteria as potentially
inappropriate for older adults. It carries a high risk of anticholinergic effects including confusion, dry
mouth, and urinary retention. Furthermore, it significantly increases the risk of falls and delirium in the
geriatric population. While Zolpidem also carries risks, Diphenhydramine is specifically highlighted for
its potent anticholinergic profile. Providers should prioritize non-pharmacological interventions or safer
alternatives for sleep management.
3. When managing hypertension in a ‘healthy’ 70-year-old patient, what is the target blood pressure goal
according to JNC 8 guidelines?
A. < 120/80 mmHg
B. < 130/80 mmHg
C. < 150/90 mmHg
D. < 140/90 mmHg
Correct Answer: C
Rationale: JNC 8 guidelines recommend a target blood pressure of less than 150/90 mmHg for adults
aged 60 years or older. This recommendation aims to balance the benefits of stroke prevention with the
risks of orthostatic hypotension and falls. Lower targets like 130/80 are often reserved for patients with
comorbidities such as diabetes or chronic kidney disease. Overtreatment in the elderly can lead to
adverse events like syncope and renal failure. The provider must assess the patient’s overall frailty when
deciding on specific treatment thresholds.
4. A 78-year-old male reports difficulty starting his urinary stream and frequent nighttime urination. Which
initial medication class is first-line for managing these symptoms of BPH?
A. 5-alpha-reductase inhibitors
,B. Alpha-1 blockers
C. Anticholinergics
D. Phosphodiesterase-5 inhibitors
Correct Answer: B
Rationale: Alpha-1 blockers, such as Tamsulosin, are considered first-line therapy for symptomatic
Benign Prostatic Hyperplasia (BPH). They work by relaxing the smooth muscle in the bladder neck and
prostate to improve urine flow quickly. 5-alpha-reductase inhibitors like Finasteride are effective but
usually take several months to reduce prostate volume. Anticholinergics are generally avoided as initial
monotherapy because they can increase the risk of urinary retention. Clinicians should monitor for side
effects like orthostatic hypotension when starting alpha-blockers in older men.
5. An elderly patient presents with acute onset of confusion, fluctuating levels of consciousness, and
inattention. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Depression
D. Delirium
Correct Answer: D
Rationale: Delirium is characterized by an acute change in mental status with a fluctuating course and
inattention. Unlike dementia, which is a slow, progressive decline, delirium is often reversible and
triggered by an underlying medical condition. Common causes include infections, medications, or
metabolic disturbances in the elderly. Alzheimer’s and Vascular dementia typically present with more
, gradual onset and stable levels of consciousness. Prompt identification of the underlying cause is critical
to prevent morbidity and long-term cognitive decline.
6. Which of the following is a component of the Fried Frailty Phenotype?
A. Cognitive decline
B. Recent hospitalization
C. Presence of three or more chronic diseases
D. Low physical activity
Correct Answer: D
Rationale: The Fried Frailty Phenotype identifies frailty based on five specific criteria: unintentional
weight loss, exhaustion, low physical activity, slow walking speed, and weak grip strength. A patient
meeting three or more of these criteria is classified as frail. Low physical activity is a core measure
because it reflects reduced physiological reserve and energy expenditure. Cognitive decline and
comorbidity count are important but are not part of this specific clinical definition. Assessing these
components helps clinicians predict the risk of falls, disability, and mortality.
7. A 75-year-old female with Type 2 Diabetes has a history of multiple falls and a life expectancy of 5 years.
What is the most appropriate A1C goal for her?
A. < 6.5%
B. < 7.0%
C. < 7.5%
D. < 8.0% - 8.5%
Correct Answer: D
