1|Page
NR 601 PRIMARY CARE OF THE MATURING &
AGED FAMILY – 102 CASE STUDY QUESTIONS
WITH RATIONALES | CHAMBERLAIN COLLEGE
OF NURSING | A+ GUARANTEED
# Table of Contents
| Section | Topic Area | Cases | Questions |
| 1 | Hypertension & Cardiovascular Disease | 1–12 | 1–14 |
| 2 | Diabetes Mellitus & Metabolic Syndrome | 13–20 | 15–22 |
| 3 | Chronic Kidney Disease & Electrolytes | 21–26 | 23–28 |
| 4 | Thyroid & Endocrine Disorders | 27–32 | 29–34 |
| 5 | Osteoarthritis, Osteoporosis & Falls | 33–42 | 35–44 |
| 6 | Dementia, Delirium & Cognitive Impairment | 43–52 | 45–56 |
| 7 | Depression, Anxiety & Behavioral Health | 53–60 | 57–64 |
| 8 | Polypharmacy & Beers Criteria | 61–68 | 65–72 |
| 9 | Urinary Incontinence & Prostate Disorders | 69–74 | 73–78 |
| 10 | Geriatric Syndromes: Frailty, Falls, Pressure Injuries | 75–82 | 79–
86 |
| 11 | Palliative Care, Advanced Directives & Ethics | 83–88 | 87–92 |
| 12 | Health Maintenance & Screening | 89–96 | 93–100 |
| 13 | Complex Case Review & Exam Prep | 97–100 | 101–108 |
**Format:** Case → Question → Answer → Rationale
,2|Page
# Section 1: Hypertension & Cardiovascular Disease in Older Adults
(Cases 1–12)
---
## Case 1
An 82-year-old female with hypertension, DM type 2, and CKD stage 3a
presents for follow-up. BP today is 148/86 mmHg. Home meds:
lisinopril 20 mg daily, amlodipine 5 mg daily. She reports occasional
dizziness when standing up quickly.
**Question 1:** What is the most appropriate next step in managing her
hypertension?
A) Add a thiazide diuretic
B) Increase lisinopril to 40 mg daily
C) Review standing/sitting BP to rule out orthostatic hypotension before
intensifying therapy
D) Stop amlodipine immediately
**Answer:** C
**Rationale:** Older adults are at risk for orthostatic hypotension.
Check orthostatic vitals. Target BP for adults >65 with CKD is <130/80
but individualize; avoid overtreatment causing falls.
,3|Page
---
## Case 2
A 76-year-old man with a history of HFpEF (heart failure with preserved
ejection fraction) presents with dyspnea on exertion and bilateral lower
extremity edema. BP 142/88, HR 78. Medications: lisinopril 10 mg
daily, metoprolol succinate 50 mg daily.
**Question 2:** Which medication adjustment is most appropriate?
A) Add a loop diuretic (furosemide) for volume overload
B) Increase metoprolol to 100 mg
C) Switch lisinopril to amlodipine
D) Add digoxin 0.125 mg daily
**Answer:** A
**Rationale:** Diuretics are first-line for volume management in
HFpEF. ACE inhibitors are used but do not acutely relieve edema.
---
## Case 3
, 4|Page
An 80-year-old female with atrial fibrillation (paroxysmal) has a
CHA₂DS₂-VASc score of 5. She is on warfarin with INR 2.0-2.5. She
now falls frequently due to neuropathy.
**Question 3:** What should the provider consider regarding
anticoagulation?
A) Stop warfarin immediately due to fall risk
B) Continue warfarin; benefit of stroke prevention outweighs risk of
bleeding if fall risk is moderate (less than 300 falls/year)
C) Switch to aspirin 325 mg daily
D) No anticoagulation needed for paroxysmal AF
**Answer:** B
**Rationale:** The risk of hemorrhagic stroke from stopping
anticoagulation exceeds fall-related bleeding risk unless patient has
>300 falls/year or severe bleeding diathesis.
---
## Case 4
A 79-year-old male with hypertension and BPH is on lisinopril 20 mg
and tamsulosin 0.4 mg. BP today 118/70. He reports feeling lightheaded
when standing.
NR 601 PRIMARY CARE OF THE MATURING &
AGED FAMILY – 102 CASE STUDY QUESTIONS
WITH RATIONALES | CHAMBERLAIN COLLEGE
OF NURSING | A+ GUARANTEED
# Table of Contents
| Section | Topic Area | Cases | Questions |
| 1 | Hypertension & Cardiovascular Disease | 1–12 | 1–14 |
| 2 | Diabetes Mellitus & Metabolic Syndrome | 13–20 | 15–22 |
| 3 | Chronic Kidney Disease & Electrolytes | 21–26 | 23–28 |
| 4 | Thyroid & Endocrine Disorders | 27–32 | 29–34 |
| 5 | Osteoarthritis, Osteoporosis & Falls | 33–42 | 35–44 |
| 6 | Dementia, Delirium & Cognitive Impairment | 43–52 | 45–56 |
| 7 | Depression, Anxiety & Behavioral Health | 53–60 | 57–64 |
| 8 | Polypharmacy & Beers Criteria | 61–68 | 65–72 |
| 9 | Urinary Incontinence & Prostate Disorders | 69–74 | 73–78 |
| 10 | Geriatric Syndromes: Frailty, Falls, Pressure Injuries | 75–82 | 79–
86 |
| 11 | Palliative Care, Advanced Directives & Ethics | 83–88 | 87–92 |
| 12 | Health Maintenance & Screening | 89–96 | 93–100 |
| 13 | Complex Case Review & Exam Prep | 97–100 | 101–108 |
**Format:** Case → Question → Answer → Rationale
,2|Page
# Section 1: Hypertension & Cardiovascular Disease in Older Adults
(Cases 1–12)
---
## Case 1
An 82-year-old female with hypertension, DM type 2, and CKD stage 3a
presents for follow-up. BP today is 148/86 mmHg. Home meds:
lisinopril 20 mg daily, amlodipine 5 mg daily. She reports occasional
dizziness when standing up quickly.
**Question 1:** What is the most appropriate next step in managing her
hypertension?
A) Add a thiazide diuretic
B) Increase lisinopril to 40 mg daily
C) Review standing/sitting BP to rule out orthostatic hypotension before
intensifying therapy
D) Stop amlodipine immediately
**Answer:** C
**Rationale:** Older adults are at risk for orthostatic hypotension.
Check orthostatic vitals. Target BP for adults >65 with CKD is <130/80
but individualize; avoid overtreatment causing falls.
,3|Page
---
## Case 2
A 76-year-old man with a history of HFpEF (heart failure with preserved
ejection fraction) presents with dyspnea on exertion and bilateral lower
extremity edema. BP 142/88, HR 78. Medications: lisinopril 10 mg
daily, metoprolol succinate 50 mg daily.
**Question 2:** Which medication adjustment is most appropriate?
A) Add a loop diuretic (furosemide) for volume overload
B) Increase metoprolol to 100 mg
C) Switch lisinopril to amlodipine
D) Add digoxin 0.125 mg daily
**Answer:** A
**Rationale:** Diuretics are first-line for volume management in
HFpEF. ACE inhibitors are used but do not acutely relieve edema.
---
## Case 3
, 4|Page
An 80-year-old female with atrial fibrillation (paroxysmal) has a
CHA₂DS₂-VASc score of 5. She is on warfarin with INR 2.0-2.5. She
now falls frequently due to neuropathy.
**Question 3:** What should the provider consider regarding
anticoagulation?
A) Stop warfarin immediately due to fall risk
B) Continue warfarin; benefit of stroke prevention outweighs risk of
bleeding if fall risk is moderate (less than 300 falls/year)
C) Switch to aspirin 325 mg daily
D) No anticoagulation needed for paroxysmal AF
**Answer:** B
**Rationale:** The risk of hemorrhagic stroke from stopping
anticoagulation exceeds fall-related bleeding risk unless patient has
>300 falls/year or severe bleeding diathesis.
---
## Case 4
A 79-year-old male with hypertension and BPH is on lisinopril 20 mg
and tamsulosin 0.4 mg. BP today 118/70. He reports feeling lightheaded
when standing.
