NR-601: CARE OF THE AGED FAMILY
PRACTICUM FINAL COMPREHENSIVE EXAM
GUIDE, PRACTICE EXAM ( VERIFIED
QUESTIONS & ANSWERS) WITH RATIONALES,
A+ GRADED ALREADY PASSED
Question 1:
A 78-year-old female presents with gradual memory loss over 2 years.
She forgets recent conversations, misplaces items, and has difficulty
managing finances. She remains socially engaged and independent with
ADLs. Mini-Cog: 3-item recall 1/3, abnormal clock drawing. What is the
most likely diagnosis?
A. Normal aging
B. Mild cognitive impairment (MCI)
C. Alzheimer's disease (mild stage)
D. Depression with cognitive impairment
Rationale: Correct answer: C. Alzheimer's disease (mild stage) presents
with progressive memory loss (episodic memory) affecting daily
function (finances). Mini-Cog positive for dementia. MCI (B) does not
impair instrumental ADLs. Normal aging (A) does not cause memory
loss affecting function. Depression-related cognitive impairment (D)
would have mood symptoms.
,
---
Question 2:
An 82-year-old male with hypertension on lisinopril 20mg daily reports
dizziness upon standing. BP supine 135/80, standing 100/65. What is the
most appropriate next step?
A. Increase lisinopril dose
B. Add midodrine
C. Reduce lisinopril dose
D. Add fludrocortisone
Rationale: Correct answer: C. Orthostatic hypotension (drop >20 mmHg
systolic) from antihypertensive requires dose reduction. Do not add
pressor agents (B, D). Increase lisinopril (A) worsens hypotension.
---
Question 3:
An 85-year-old with dementia is started on donepezil 5mg at bedtime.
She reports vivid nightmares. What is the most appropriate next step?
A. Discontinue donepezil immediately
B. Switch donepezil to morning dosing
C. Add prazosin for nightmares
D. Increase donepezil to 10mg
,
Rationale: Correct answer: B. Donepezil causes vivid dreams/nightmares
(cholinergic). Switching to morning dosing often resolves. Discontinuing
(A) loses cognitive benefit. Prazosin (C) not indicated. Increasing (D)
may worsen.
---
Question 4:
A 75-year-old with type 2 diabetes has A1c 8.2% on metformin 1000mg
BID. She lives independently, no CVD. She reports falling 2 times in
past year. What is the most appropriate A1c target?
A. <6.5%
B. 7.0-7.5%
C. 7.5-8.0%
D. <8.5%
Rationale: Correct answer: C. 7.5-8.0% is appropriate for older adults
with moderate comorbidity and fall risk (hypoglycemia avoidance).
Tight control (A, B) increases fall risk from hypoglycemia. D is for
frail/limited life expectancy.
---
Question 5:
,
An 80-year-old with HFpEF (EF 60%) presents with worsening dyspnea,
JVD, and 3+ edema on furosemide 40mg daily. What is the most
appropriate next step?
A. Increase furosemide to 80mg BID
B. Add metolazone
C. Switch to torsemide
D. Add spironolactone
Rationale: Correct answer: A. Increase loop diuretic dose first in
diuretic-resistant volume overload. Add metolazone (B) if high-dose
loop diuretic fails (sequential nephron blockade). Torsemide (C) has
better bioavailability but not first change.
---
Question 6:
An 88-year-old male with BPH on tamsulosin reports dizziness and a
fall. BP supine 140/80, standing 100/65. What medication change is most
appropriate?
A. Continue tamsulosin – symptoms will improve
B. Switch to doxazosin
C. Reduce tamsulosin dose
D. Add midodrine
Rationale: Correct answer: C. Tamsulosin (alpha-1 blocker) can cause
orthostatic hypotension. Reduce dose (0.4mg to 0.4mg every other day
PRACTICUM FINAL COMPREHENSIVE EXAM
GUIDE, PRACTICE EXAM ( VERIFIED
QUESTIONS & ANSWERS) WITH RATIONALES,
A+ GRADED ALREADY PASSED
Question 1:
A 78-year-old female presents with gradual memory loss over 2 years.
She forgets recent conversations, misplaces items, and has difficulty
managing finances. She remains socially engaged and independent with
ADLs. Mini-Cog: 3-item recall 1/3, abnormal clock drawing. What is the
most likely diagnosis?
A. Normal aging
B. Mild cognitive impairment (MCI)
C. Alzheimer's disease (mild stage)
D. Depression with cognitive impairment
Rationale: Correct answer: C. Alzheimer's disease (mild stage) presents
with progressive memory loss (episodic memory) affecting daily
function (finances). Mini-Cog positive for dementia. MCI (B) does not
impair instrumental ADLs. Normal aging (A) does not cause memory
loss affecting function. Depression-related cognitive impairment (D)
would have mood symptoms.
,
---
Question 2:
An 82-year-old male with hypertension on lisinopril 20mg daily reports
dizziness upon standing. BP supine 135/80, standing 100/65. What is the
most appropriate next step?
A. Increase lisinopril dose
B. Add midodrine
C. Reduce lisinopril dose
D. Add fludrocortisone
Rationale: Correct answer: C. Orthostatic hypotension (drop >20 mmHg
systolic) from antihypertensive requires dose reduction. Do not add
pressor agents (B, D). Increase lisinopril (A) worsens hypotension.
---
Question 3:
An 85-year-old with dementia is started on donepezil 5mg at bedtime.
She reports vivid nightmares. What is the most appropriate next step?
A. Discontinue donepezil immediately
B. Switch donepezil to morning dosing
C. Add prazosin for nightmares
D. Increase donepezil to 10mg
,
Rationale: Correct answer: B. Donepezil causes vivid dreams/nightmares
(cholinergic). Switching to morning dosing often resolves. Discontinuing
(A) loses cognitive benefit. Prazosin (C) not indicated. Increasing (D)
may worsen.
---
Question 4:
A 75-year-old with type 2 diabetes has A1c 8.2% on metformin 1000mg
BID. She lives independently, no CVD. She reports falling 2 times in
past year. What is the most appropriate A1c target?
A. <6.5%
B. 7.0-7.5%
C. 7.5-8.0%
D. <8.5%
Rationale: Correct answer: C. 7.5-8.0% is appropriate for older adults
with moderate comorbidity and fall risk (hypoglycemia avoidance).
Tight control (A, B) increases fall risk from hypoglycemia. D is for
frail/limited life expectancy.
---
Question 5:
,
An 80-year-old with HFpEF (EF 60%) presents with worsening dyspnea,
JVD, and 3+ edema on furosemide 40mg daily. What is the most
appropriate next step?
A. Increase furosemide to 80mg BID
B. Add metolazone
C. Switch to torsemide
D. Add spironolactone
Rationale: Correct answer: A. Increase loop diuretic dose first in
diuretic-resistant volume overload. Add metolazone (B) if high-dose
loop diuretic fails (sequential nephron blockade). Torsemide (C) has
better bioavailability but not first change.
---
Question 6:
An 88-year-old male with BPH on tamsulosin reports dizziness and a
fall. BP supine 140/80, standing 100/65. What medication change is most
appropriate?
A. Continue tamsulosin – symptoms will improve
B. Switch to doxazosin
C. Reduce tamsulosin dose
D. Add midodrine
Rationale: Correct answer: C. Tamsulosin (alpha-1 blocker) can cause
orthostatic hypotension. Reduce dose (0.4mg to 0.4mg every other day
