NR 601 Exam 2: Primary Care Aging - Chamberlain
University Updated and Latest Questions and Correct
Answers with Rationale
1. An 82-year-old patient with type 2 diabetes has a history of heart failure and cognitive decline. What is
the recommended HbA1c target for this individual according to the ADA guidelines?
A. Less than 7.0%
B. Less than 7.5%
C. Less than 8.0-8.5%
D. Less than 6.5%
Correct Answer: C
Rationale: For older adults with complex or poor health, a less stringent HbA1c target of less than 8.0-
8.5% is appropriate. This group often has limited life expectancy and a higher risk of hypoglycemia-
related complications. Over-treatment in the elderly can lead to falls and cognitive worsening due to low
blood glucose levels. The primary goal of management for this demographic is the avoidance of
symptomatic hyperglycemia and hypoglycemia. Clinicians must balance the benefits of glycemic control
against the significant risks of intensive therapy.
2. Which of the following is the first-line antihypertensive medication for an African American patient over
age 65 without chronic kidney disease?
A. Amlodipine
B. Lisinopril
C. Metoprolol
D. Losartan
,Correct Answer: A
Rationale: The JNC 8 and ACC/AHA guidelines suggest that African Americans respond better to calcium
channel blockers or thiazide diuretics as initial therapy. Amlodipine is a dihydropyridine calcium channel
blocker that effectively lowers blood pressure in this population. ACE inhibitors like Lisinopril are often
less effective as monotherapy for African American patients compared to other classes. Starting with the
correct class improves blood pressure control and reduces the risk of stroke. It is important to monitor
for peripheral edema, a common side effect of calcium channel blockers in older adults.
3. A 70-year-old patient presents with chronic cough and dyspnea. Spirometry reveals a post-bronchodilator
FEV1/FVC ratio of 0.62. What is the most likely diagnosis?
A. Asthma
B. Congestive Heart Failure
C. Chronic Obstructive Pulmonary Disease (COPD)
D. Restrictive Lung Disease
Correct Answer: C
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the diagnostic hallmark of COPD.
This ratio indicates persistent airflow limitation that is not fully reversible with medication. Asthma
usually demonstrates significant reversibility, which is not seen in the fixed obstruction of COPD.
Spirometry is the gold standard for making an accurate diagnosis of chronic respiratory conditions in the
elderly. Proper interpretation of these values allows for correct staging and management according to
GOLD guidelines.
4. When managing a patient with symptomatic knee osteoarthritis, what is the first-line pharmacological
treatment recommended to minimize systemic side effects?
A. Topical Diclofenac
, B. Oral Ibuprofen
C. Oral Prednisone
D. Intra-articular Corticosteroids
Correct Answer: A
Rationale: Topical NSAIDs are recommended as first-line therapy for knee osteoarthritis in older adults
because they have low systemic absorption. This reduces the risk of gastrointestinal bleeding, renal
impairment, and cardiovascular events associated with oral NSAIDs. Oral Ibuprofen should be used with
caution in the elderly according to the Beers Criteria. Topical agents provide effective localized pain relief
directly at the site of inflammation. Clinicians should always prioritize non-pharmacological and topical
treatments before moving to systemic options.
5. An older adult with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently on a beta-blocker
and an ACE inhibitor. Which medication class is now recommended as part of the ‘four pillars’ of therapy?
A. SGLT2 Inhibitors
B. Loop Diuretics
C. Calcium Channel Blockers
D. Nitrates
Correct Answer: A
Rationale: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are now considered standard therapy for
HFrEF regardless of diabetes status. These medications reduce the risk of heart failure hospitalization
and cardiovascular mortality. Along with ACE inhibitors (or ARNIs), beta-blockers, and mineralocorticoid
receptor antagonists, they form the foundation of management. It is important to monitor renal function
University Updated and Latest Questions and Correct
Answers with Rationale
1. An 82-year-old patient with type 2 diabetes has a history of heart failure and cognitive decline. What is
the recommended HbA1c target for this individual according to the ADA guidelines?
A. Less than 7.0%
B. Less than 7.5%
C. Less than 8.0-8.5%
D. Less than 6.5%
Correct Answer: C
Rationale: For older adults with complex or poor health, a less stringent HbA1c target of less than 8.0-
8.5% is appropriate. This group often has limited life expectancy and a higher risk of hypoglycemia-
related complications. Over-treatment in the elderly can lead to falls and cognitive worsening due to low
blood glucose levels. The primary goal of management for this demographic is the avoidance of
symptomatic hyperglycemia and hypoglycemia. Clinicians must balance the benefits of glycemic control
against the significant risks of intensive therapy.
2. Which of the following is the first-line antihypertensive medication for an African American patient over
age 65 without chronic kidney disease?
A. Amlodipine
B. Lisinopril
C. Metoprolol
D. Losartan
,Correct Answer: A
Rationale: The JNC 8 and ACC/AHA guidelines suggest that African Americans respond better to calcium
channel blockers or thiazide diuretics as initial therapy. Amlodipine is a dihydropyridine calcium channel
blocker that effectively lowers blood pressure in this population. ACE inhibitors like Lisinopril are often
less effective as monotherapy for African American patients compared to other classes. Starting with the
correct class improves blood pressure control and reduces the risk of stroke. It is important to monitor
for peripheral edema, a common side effect of calcium channel blockers in older adults.
3. A 70-year-old patient presents with chronic cough and dyspnea. Spirometry reveals a post-bronchodilator
FEV1/FVC ratio of 0.62. What is the most likely diagnosis?
A. Asthma
B. Congestive Heart Failure
C. Chronic Obstructive Pulmonary Disease (COPD)
D. Restrictive Lung Disease
Correct Answer: C
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the diagnostic hallmark of COPD.
This ratio indicates persistent airflow limitation that is not fully reversible with medication. Asthma
usually demonstrates significant reversibility, which is not seen in the fixed obstruction of COPD.
Spirometry is the gold standard for making an accurate diagnosis of chronic respiratory conditions in the
elderly. Proper interpretation of these values allows for correct staging and management according to
GOLD guidelines.
4. When managing a patient with symptomatic knee osteoarthritis, what is the first-line pharmacological
treatment recommended to minimize systemic side effects?
A. Topical Diclofenac
, B. Oral Ibuprofen
C. Oral Prednisone
D. Intra-articular Corticosteroids
Correct Answer: A
Rationale: Topical NSAIDs are recommended as first-line therapy for knee osteoarthritis in older adults
because they have low systemic absorption. This reduces the risk of gastrointestinal bleeding, renal
impairment, and cardiovascular events associated with oral NSAIDs. Oral Ibuprofen should be used with
caution in the elderly according to the Beers Criteria. Topical agents provide effective localized pain relief
directly at the site of inflammation. Clinicians should always prioritize non-pharmacological and topical
treatments before moving to systemic options.
5. An older adult with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently on a beta-blocker
and an ACE inhibitor. Which medication class is now recommended as part of the ‘four pillars’ of therapy?
A. SGLT2 Inhibitors
B. Loop Diuretics
C. Calcium Channel Blockers
D. Nitrates
Correct Answer: A
Rationale: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are now considered standard therapy for
HFrEF regardless of diabetes status. These medications reduce the risk of heart failure hospitalization
and cardiovascular mortality. Along with ACE inhibitors (or ARNIs), beta-blockers, and mineralocorticoid
receptor antagonists, they form the foundation of management. It is important to monitor renal function
