NR601 PRIMARY CARE OF THE MATURING &
AGED FAMILY Midterm Exam Study Guide | Weeks
1–4 | Chamberlain University
1. 200 MCQ Revision Questions with Answers &
Rationales
1. Which of the following BEST defines the "older adult" population according to the
World Health Organization (WHO)?
A. Adults aged 55 years and older B. Adults aged 60 years and older C. Adults aged 65 years and
older D. Adults aged 70 years and older
Correct Answer: C
Rationale: The WHO defines older adults as individuals aged 65 years and older in
developed countries. This threshold is used for clinical, epidemiological, and policy
purposes. The "young-old" are 65–74, "middle-old" are 75–84, and "oldest-old" are 85+.
Understanding these age categories is essential for NR601 as clinical presentations,
pharmacokinetics, and health priorities differ significantly across these subgroups.
2. Which of the following is the MOST accurate description of the functional reserve
decline associated with normal aging?
A. Organ function declines uniformly across all body systems at the same rate B. Organ systems
maintain full functional capacity but lose reserve capacity, making older adults more vulnerable
to stressors C. All physiological changes with aging are pathological and require treatment D.
Functional decline begins abruptly after age 80
Correct Answer: B
Rationale: Normal aging is characterized by a gradual decline in physiological reserve —
the ability of organ systems to respond to stressors — rather than loss of baseline function.
Under normal conditions, older adults may appear to function normally; however, under
physiological stress (illness, surgery, medications), the reduced reserve capacity manifests
as vulnerability. This concept underpins the geriatric principle of "homeostenosis" — the
progressive narrowing of homeostatic reserve with advancing age.
,3. A 70-year-old patient reports taking 12 different prescription medications. This is BEST
described as:
A. Appropriate pharmacotherapy for a complex older adult B. Polypharmacy — a common and
clinically significant problem in older adults associated with adverse drug events, falls, and
increased mortality C. A normal finding in adults over 65 that does not require clinical attention
D. Underprescribing relative to the patient's age-related needs
Correct Answer: B
Rationale: Polypharmacy is generally defined as the concurrent use of 5 or more
medications, though "excessive polypharmacy" refers to 10 or more. It is highly prevalent
in older adults and associated with: adverse drug reactions, drug-drug interactions, falls,
cognitive impairment, non-adherence, and hospitalizations. The Beers Criteria and
STOPP/START tools help identify potentially inappropriate medications. Medication
reconciliation and deprescribing are core competencies in geriatric primary care.
4. According to the Beers Criteria, which of the following medications is considered
POTENTIALLY INAPPROPRIATE in older adults due to risk of falls and cognitive
impairment?
A. Metformin B. Lisinopril C. Diphenhydramine (Benadryl) D. Atorvastatin
Correct Answer: C
Rationale: The American Geriatrics Society Beers Criteria identifies diphenhydramine
(and all first-generation antihistamines) as potentially inappropriate in older adults due to
strong anticholinergic effects causing: sedation, cognitive impairment, delirium, urinary
retention, constipation, and increased fall risk. Anticholinergic burden accumulates when
multiple anticholinergic medications are prescribed together. The Anticholinergic
Cognitive Burden Scale helps quantify this risk. Alternatives for insomnia: low-dose
doxepin, melatonin; for allergies: second-generation antihistamines (cetirizine, loratadine).
5. Which of the following physiological changes is MOST associated with normal aging in
the cardiovascular system?
A. Decreased systolic blood pressure due to vascular relaxation B. Increased arterial stiffness
leading to isolated systolic hypertension and widened pulse pressure C. Increased cardiac output
at rest D. Decreased left ventricular wall thickness
,Correct Answer: B
Rationale: Normal cardiovascular aging includes: arterial stiffening (reduced elastin,
increased collagen in vessel walls), left ventricular hypertrophy (concentric, due to
increased afterload), reduced cardiac reserve, prolonged ventricular relaxation (diastolic
dysfunction), and decreased maximum heart rate response. Arterial stiffness increases
systolic BP while diastolic BP may fall, resulting in isolated systolic hypertension — the
most common hypertension pattern in older adults. Pulse pressure (SBP - DBP) widens and
is an independent cardiovascular risk factor.
6. Which of the following age-related renal changes has the MOST significant impact on
medication dosing in older adults?
A. Decreased bladder capacity B. Progressive decline in glomerular filtration rate (GFR)
beginning around age 40 C. Increased renal tubular secretion after age 65 D. Decreased renal
blood flow with compensatory increase in GFR
Correct Answer: B
Rationale: GFR declines approximately 1 mL/min/year after age 40, resulting in
significantly reduced renal clearance in older adults. By age 80, GFR may be 50% of
young-adult values even with a normal serum creatinine (due to reduced muscle mass and
creatinine production — serum creatinine is an unreliable marker in elderly). Renally-
cleared medications (lithium, metformin, digoxin, aminoglycosides, gabapentin, NSAIDs)
require dose adjustment. The Cockroft-Gault or CKD-EPI equations estimate GFR more
accurately than serum creatinine alone in the elderly.
7. A 78-year-old patient presents with confusion, weight loss, urinary incontinence, and
recurrent falls. These findings are BEST described by which geriatric concept?
A. Normal aging changes B. Geriatric syndromes — complex, multifactorial clinical conditions
common in older adults that do not fit neatly into traditional disease categories C. Dementia with
behavioral symptoms D. Delirium superimposed on depression
Correct Answer: B
Rationale: Geriatric syndromes are clinical conditions that are highly prevalent in older
adults, multifactorial in etiology, and not easily classified into traditional organ-specific
disease categories. The "Giants of Geriatrics" (originally described by Isaacs): immobility,
instability (falls), incontinence, and intellectual impairment (cognitive). Additional
syndromes include: frailty, delirium, malnutrition, pressure ulcers, and polypharmacy.
, Each syndrome typically results from multiple interacting risk factors across several organ
systems, requiring a comprehensive geriatric assessment (CGA) approach.
8. Which of the following screening tools is MOST appropriate for assessing functional
status in older adults during a primary care visit?
A. Mini-Mental State Examination (MMSE) B. Timed Up and Go (TUG) test C. Activities of
Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) assessment D. Geriatric
Depression Scale (GDS)
Correct Answer: C
Rationale: ADLs (basic self-care: bathing, dressing, grooming, toileting, transferring,
eating) and IADLs (more complex tasks: managing finances, medications, transportation,
cooking, housekeeping, shopping, telephone use) are the gold standard for assessing
functional status in older adults. ADL/IADL impairment predicts adverse outcomes
including institutionalization, caregiver burden, and mortality. Functional assessment is a
core component of the comprehensive geriatric assessment (CGA). The TUG assesses
mobility/fall risk; MMSE assesses cognition; GDS screens for depression.
9. The "comprehensive geriatric assessment" (CGA) is BEST described as:
A. A brief physical examination focused on acute illness B. A multidimensional,
multidisciplinary assessment evaluating medical, functional, cognitive, psychological, social, and
environmental domains to develop a coordinated care plan C. A standardized laboratory panel
for all patients over 65 D. An annual wellness visit focusing only on preventive screenings
Correct Answer: B
Rationale: The CGA is the cornerstone of geriatric care, involving systematic evaluation of:
(1) Medical problems and comorbidities; (2) Functional status (ADL/IADL); (3) Cognitive
function (MMSE/MoCA); (4) Psychological health (depression, anxiety); (5) Social support
and living situation; (6) Nutritional status; (7) Medications (polypharmacy); (8) Sensory
deficits (vision, hearing); (9) Fall risk; (10) Environmental safety. CGA is associated with
improved outcomes: reduced hospitalization, improved functional status, and reduced
mortality compared to standard care.
10. Which of the following BEST describes the pharmacokinetic change in drug
distribution in older adults?
AGED FAMILY Midterm Exam Study Guide | Weeks
1–4 | Chamberlain University
1. 200 MCQ Revision Questions with Answers &
Rationales
1. Which of the following BEST defines the "older adult" population according to the
World Health Organization (WHO)?
A. Adults aged 55 years and older B. Adults aged 60 years and older C. Adults aged 65 years and
older D. Adults aged 70 years and older
Correct Answer: C
Rationale: The WHO defines older adults as individuals aged 65 years and older in
developed countries. This threshold is used for clinical, epidemiological, and policy
purposes. The "young-old" are 65–74, "middle-old" are 75–84, and "oldest-old" are 85+.
Understanding these age categories is essential for NR601 as clinical presentations,
pharmacokinetics, and health priorities differ significantly across these subgroups.
2. Which of the following is the MOST accurate description of the functional reserve
decline associated with normal aging?
A. Organ function declines uniformly across all body systems at the same rate B. Organ systems
maintain full functional capacity but lose reserve capacity, making older adults more vulnerable
to stressors C. All physiological changes with aging are pathological and require treatment D.
Functional decline begins abruptly after age 80
Correct Answer: B
Rationale: Normal aging is characterized by a gradual decline in physiological reserve —
the ability of organ systems to respond to stressors — rather than loss of baseline function.
Under normal conditions, older adults may appear to function normally; however, under
physiological stress (illness, surgery, medications), the reduced reserve capacity manifests
as vulnerability. This concept underpins the geriatric principle of "homeostenosis" — the
progressive narrowing of homeostatic reserve with advancing age.
,3. A 70-year-old patient reports taking 12 different prescription medications. This is BEST
described as:
A. Appropriate pharmacotherapy for a complex older adult B. Polypharmacy — a common and
clinically significant problem in older adults associated with adverse drug events, falls, and
increased mortality C. A normal finding in adults over 65 that does not require clinical attention
D. Underprescribing relative to the patient's age-related needs
Correct Answer: B
Rationale: Polypharmacy is generally defined as the concurrent use of 5 or more
medications, though "excessive polypharmacy" refers to 10 or more. It is highly prevalent
in older adults and associated with: adverse drug reactions, drug-drug interactions, falls,
cognitive impairment, non-adherence, and hospitalizations. The Beers Criteria and
STOPP/START tools help identify potentially inappropriate medications. Medication
reconciliation and deprescribing are core competencies in geriatric primary care.
4. According to the Beers Criteria, which of the following medications is considered
POTENTIALLY INAPPROPRIATE in older adults due to risk of falls and cognitive
impairment?
A. Metformin B. Lisinopril C. Diphenhydramine (Benadryl) D. Atorvastatin
Correct Answer: C
Rationale: The American Geriatrics Society Beers Criteria identifies diphenhydramine
(and all first-generation antihistamines) as potentially inappropriate in older adults due to
strong anticholinergic effects causing: sedation, cognitive impairment, delirium, urinary
retention, constipation, and increased fall risk. Anticholinergic burden accumulates when
multiple anticholinergic medications are prescribed together. The Anticholinergic
Cognitive Burden Scale helps quantify this risk. Alternatives for insomnia: low-dose
doxepin, melatonin; for allergies: second-generation antihistamines (cetirizine, loratadine).
5. Which of the following physiological changes is MOST associated with normal aging in
the cardiovascular system?
A. Decreased systolic blood pressure due to vascular relaxation B. Increased arterial stiffness
leading to isolated systolic hypertension and widened pulse pressure C. Increased cardiac output
at rest D. Decreased left ventricular wall thickness
,Correct Answer: B
Rationale: Normal cardiovascular aging includes: arterial stiffening (reduced elastin,
increased collagen in vessel walls), left ventricular hypertrophy (concentric, due to
increased afterload), reduced cardiac reserve, prolonged ventricular relaxation (diastolic
dysfunction), and decreased maximum heart rate response. Arterial stiffness increases
systolic BP while diastolic BP may fall, resulting in isolated systolic hypertension — the
most common hypertension pattern in older adults. Pulse pressure (SBP - DBP) widens and
is an independent cardiovascular risk factor.
6. Which of the following age-related renal changes has the MOST significant impact on
medication dosing in older adults?
A. Decreased bladder capacity B. Progressive decline in glomerular filtration rate (GFR)
beginning around age 40 C. Increased renal tubular secretion after age 65 D. Decreased renal
blood flow with compensatory increase in GFR
Correct Answer: B
Rationale: GFR declines approximately 1 mL/min/year after age 40, resulting in
significantly reduced renal clearance in older adults. By age 80, GFR may be 50% of
young-adult values even with a normal serum creatinine (due to reduced muscle mass and
creatinine production — serum creatinine is an unreliable marker in elderly). Renally-
cleared medications (lithium, metformin, digoxin, aminoglycosides, gabapentin, NSAIDs)
require dose adjustment. The Cockroft-Gault or CKD-EPI equations estimate GFR more
accurately than serum creatinine alone in the elderly.
7. A 78-year-old patient presents with confusion, weight loss, urinary incontinence, and
recurrent falls. These findings are BEST described by which geriatric concept?
A. Normal aging changes B. Geriatric syndromes — complex, multifactorial clinical conditions
common in older adults that do not fit neatly into traditional disease categories C. Dementia with
behavioral symptoms D. Delirium superimposed on depression
Correct Answer: B
Rationale: Geriatric syndromes are clinical conditions that are highly prevalent in older
adults, multifactorial in etiology, and not easily classified into traditional organ-specific
disease categories. The "Giants of Geriatrics" (originally described by Isaacs): immobility,
instability (falls), incontinence, and intellectual impairment (cognitive). Additional
syndromes include: frailty, delirium, malnutrition, pressure ulcers, and polypharmacy.
, Each syndrome typically results from multiple interacting risk factors across several organ
systems, requiring a comprehensive geriatric assessment (CGA) approach.
8. Which of the following screening tools is MOST appropriate for assessing functional
status in older adults during a primary care visit?
A. Mini-Mental State Examination (MMSE) B. Timed Up and Go (TUG) test C. Activities of
Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) assessment D. Geriatric
Depression Scale (GDS)
Correct Answer: C
Rationale: ADLs (basic self-care: bathing, dressing, grooming, toileting, transferring,
eating) and IADLs (more complex tasks: managing finances, medications, transportation,
cooking, housekeeping, shopping, telephone use) are the gold standard for assessing
functional status in older adults. ADL/IADL impairment predicts adverse outcomes
including institutionalization, caregiver burden, and mortality. Functional assessment is a
core component of the comprehensive geriatric assessment (CGA). The TUG assesses
mobility/fall risk; MMSE assesses cognition; GDS screens for depression.
9. The "comprehensive geriatric assessment" (CGA) is BEST described as:
A. A brief physical examination focused on acute illness B. A multidimensional,
multidisciplinary assessment evaluating medical, functional, cognitive, psychological, social, and
environmental domains to develop a coordinated care plan C. A standardized laboratory panel
for all patients over 65 D. An annual wellness visit focusing only on preventive screenings
Correct Answer: B
Rationale: The CGA is the cornerstone of geriatric care, involving systematic evaluation of:
(1) Medical problems and comorbidities; (2) Functional status (ADL/IADL); (3) Cognitive
function (MMSE/MoCA); (4) Psychological health (depression, anxiety); (5) Social support
and living situation; (6) Nutritional status; (7) Medications (polypharmacy); (8) Sensory
deficits (vision, hearing); (9) Fall risk; (10) Environmental safety. CGA is associated with
improved outcomes: reduced hospitalization, improved functional status, and reduced
mortality compared to standard care.
10. Which of the following BEST describes the pharmacokinetic change in drug
distribution in older adults?
