NR601 Midterm Exam Primary Care of the Maturing
and Aged Family Practicum Actual Exam |
Chamberlain University 75 Questions – Pass
Guaranteed - A+ Graded
Section 1: Geriatric Assessment & Age-Related Physiology
Q1: A healthy 75-year-old patient asks why their serum creatinine is slightly elevated at
1.2 mg/dL despite feeling well. The NP explains that this most likely reflects which
expected age-related physiologic change?
A. Pathologic tubular necrosis requiring nephrology referral
B. A 50% increase in renal blood flow due to cardiac compensation
C. A gradual decline in glomerular filtration rate beginning around age 40 [CORRECT]
D. Acute kidney injury from unrecognized dehydration
Correct Answer: C
Rationale: The best answer is C. After age 40, GFR naturally declines by roughly 1
mL/min per year in healthy adults, so a modest creatinine rise in an otherwise
asymptomatic older patient often reflects normal aging rather than disease. What we
want to remember clinically is that we use eGFR and clinical context rather than
creatinine alone when assessing renal function in this population.
Q2: During a wellness visit, a 68-year-old patient wonders why their blood pressure
seems to fluctuate more than it used to. The NP explains that normal cardiovascular
aging includes which of the following changes?
A. Increased systolic blood pressure, decreased diastolic pressure, and widened pulse
pressure [CORRECT]
B. Decreased arterial stiffness and improved baroreceptor sensitivity
C. Increased compliance of the left ventricle and decreased afterload
D. Enhanced parasympathetic tone leading to bradycardia at rest
Correct Answer: A
,Rationale: The best answer is A. As adults age, collagen cross-linking makes arteries
stiffer, which raises systolic pressure while diastolic pressure often falls after the sixth
decade, producing the wide pulse pressure we commonly see in older patients. This
matches the expected hemodynamic pattern of vascular aging.
Q3: According to current CDC recommendations, which pneumococcal vaccine option is
acceptable for a healthy 65-year-old patient who has never received any pneumococcal
vaccine?
A. PPSV23 only, repeated every 5 years
B. PCV13 followed by PPSV23 in 8 weeks
C. No pneumococcal vaccine is needed until age 75
D. A single dose of PCV20 or PCV21 [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Current CDC guidance recommends routine
pneumococcal vaccination for all adults 50 and older, and for those 65 and up who are
vaccine-naïve, a single dose of PCV20 or PCV21 provides complete coverage without
needing a follow-up polysaccharide vaccine. That simplifies the schedule and improves
completion rates in primary care.
Q4: The NP is evaluating a 79-year-old patient’s ability to live independently. Which
assessment tool best measures higher-level functioning such as managing
medications, finances, and transportation?
A. The Katz Index of Activities of Daily Living
B. The Mini-Mental State Examination
C. The Morse Fall Scale
D. The Lawton Instrumental Activities of Daily Living Scale [CORRECT]
Correct Answer: D
Rationale: The best answer is D. The Lawton IADL scale specifically evaluates the more
complex skills—like shopping, housekeeping, managing money, and taking
medications—that determine whether an older adult can remain independent in the
community. The Katz ADL scale, by contrast, focuses on basic self-care tasks like
bathing and dressing.
,Q5: A 76-year-old patient on lisinopril and hydrochlorothiazide reports feeling
lightheaded when standing. Vital signs show BP 142/78 supine and 118/64 after
standing for 3 minutes, with mild dizziness. What is the NP's first action?
A. Reduce or hold the diuretic, review timing of antihypertensives, and reassess
[CORRECT]
B. Order an echocardiogram to rule out aortic stenosis
C. Add fludrocortisone to support blood pressure
D. Increase salt intake and add midodrine without changing current medications
Correct Answer: A
Rationale: The best answer is A. A drop of more than 20 mmHg systolic or 10 mmHg
diastolic with symptoms meets the criteria for orthostatic hypotension, and in this case
the diuretic and ACE inhibitor are the most likely culprits. What we want to remember
clinically is that medication adjustment—often reducing or timing the diuretic
differently—should come before adding new drugs or ordering expensive workups.
Q6: An 81-year-old patient takes 12 seconds to complete the Timed Up and Go test and
reports one fall in the past year. Based on this information, what is the NP's next best
step?
A. Reassure the patient that this is normal and schedule routine follow-up in one year
B. Recommend strict bed rest to prevent future injury
C. Initiate a multifactorial fall risk assessment and targeted interventions [CORRECT]
D. Prescribe meclizine for dizziness prevention
Correct Answer: C
Rationale: The best answer is C. A Timed Up and Go greater than 12 seconds indicates
increased fall risk, and any reported fall in the past year warrants a full evaluation
looking at gait, balance, medications, vision, and home safety. This choice is correct
because in older adults, falls are rarely due to a single cause, so a multifactorial
approach is the standard of care.
Q7: A 74-year-old patient with 8th-grade education scores 24/30 on the MMSE. The NP
suspects mild cognitive impairment but wants a more sensitive screening tool for
executive function. Which tool is most appropriate?
A. The Geriatric Depression Scale
B. The Clock-Drawing Test alone
C. The Confusion Assessment Method
, D. The Montreal Cognitive Assessment (MoCA) [CORRECT]
Correct Answer: D
Rationale: The best answer is D. The MoCA is more sensitive than the MMSE for
detecting mild cognitive impairment and executive dysfunction, especially in patients
with lower educational attainment where MMSE scores can be misleadingly low. What
we want to remember clinically is that screening tool selection matters when we are
trying to catch early changes before they progress.
Q8: Mrs. Henderson, an 82-year-old widow, comes in with her daughter because of
increasing forgetfulness. She takes amlodipine, metformin, omeprazole, oxybutynin, and
diphenhydramine for sleep. She fell last week getting up at night. Her physical exam is
otherwise unremarkable. What is the NP's first priority?
A. Order a brain MRI to rule out normal pressure hydrocephalus
B. Start donepezil for probable Alzheimer's disease
C. Discontinue the diphenhydramine and oxybutynin, and review fall safety [CORRECT]
D. Refer immediately to neurology for lumbar puncture
Correct Answer: C
Rationale: The best answer is C. Both diphenhydramine and oxybutynin carry significant
anticholinergic burden that can worsen cognition and increase fall risk in older adults,
and stopping potentially inappropriate medications should always come before ordering
advanced imaging or starting dementia medications. This choice is correct because in
geriatric primary care, we look for reversible causes first, and medication effects are
among the most common.
Q9: A 69-year-old patient in good health asks about advance directives during their
annual wellness visit. What is the NP's most appropriate initial response?
A. "We only discuss that when someone is seriously ill."
B. "You should hire an attorney before we talk about this."
C. "I will fill out a POLST form for you today."
D. "Let's start by exploring what matters most to you and who you would want to speak
for you if you couldn't." [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Advance care planning is a process, not a form, and the
best place to start is understanding the patient's values, goals, and preferred surrogate
and Aged Family Practicum Actual Exam |
Chamberlain University 75 Questions – Pass
Guaranteed - A+ Graded
Section 1: Geriatric Assessment & Age-Related Physiology
Q1: A healthy 75-year-old patient asks why their serum creatinine is slightly elevated at
1.2 mg/dL despite feeling well. The NP explains that this most likely reflects which
expected age-related physiologic change?
A. Pathologic tubular necrosis requiring nephrology referral
B. A 50% increase in renal blood flow due to cardiac compensation
C. A gradual decline in glomerular filtration rate beginning around age 40 [CORRECT]
D. Acute kidney injury from unrecognized dehydration
Correct Answer: C
Rationale: The best answer is C. After age 40, GFR naturally declines by roughly 1
mL/min per year in healthy adults, so a modest creatinine rise in an otherwise
asymptomatic older patient often reflects normal aging rather than disease. What we
want to remember clinically is that we use eGFR and clinical context rather than
creatinine alone when assessing renal function in this population.
Q2: During a wellness visit, a 68-year-old patient wonders why their blood pressure
seems to fluctuate more than it used to. The NP explains that normal cardiovascular
aging includes which of the following changes?
A. Increased systolic blood pressure, decreased diastolic pressure, and widened pulse
pressure [CORRECT]
B. Decreased arterial stiffness and improved baroreceptor sensitivity
C. Increased compliance of the left ventricle and decreased afterload
D. Enhanced parasympathetic tone leading to bradycardia at rest
Correct Answer: A
,Rationale: The best answer is A. As adults age, collagen cross-linking makes arteries
stiffer, which raises systolic pressure while diastolic pressure often falls after the sixth
decade, producing the wide pulse pressure we commonly see in older patients. This
matches the expected hemodynamic pattern of vascular aging.
Q3: According to current CDC recommendations, which pneumococcal vaccine option is
acceptable for a healthy 65-year-old patient who has never received any pneumococcal
vaccine?
A. PPSV23 only, repeated every 5 years
B. PCV13 followed by PPSV23 in 8 weeks
C. No pneumococcal vaccine is needed until age 75
D. A single dose of PCV20 or PCV21 [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Current CDC guidance recommends routine
pneumococcal vaccination for all adults 50 and older, and for those 65 and up who are
vaccine-naïve, a single dose of PCV20 or PCV21 provides complete coverage without
needing a follow-up polysaccharide vaccine. That simplifies the schedule and improves
completion rates in primary care.
Q4: The NP is evaluating a 79-year-old patient’s ability to live independently. Which
assessment tool best measures higher-level functioning such as managing
medications, finances, and transportation?
A. The Katz Index of Activities of Daily Living
B. The Mini-Mental State Examination
C. The Morse Fall Scale
D. The Lawton Instrumental Activities of Daily Living Scale [CORRECT]
Correct Answer: D
Rationale: The best answer is D. The Lawton IADL scale specifically evaluates the more
complex skills—like shopping, housekeeping, managing money, and taking
medications—that determine whether an older adult can remain independent in the
community. The Katz ADL scale, by contrast, focuses on basic self-care tasks like
bathing and dressing.
,Q5: A 76-year-old patient on lisinopril and hydrochlorothiazide reports feeling
lightheaded when standing. Vital signs show BP 142/78 supine and 118/64 after
standing for 3 minutes, with mild dizziness. What is the NP's first action?
A. Reduce or hold the diuretic, review timing of antihypertensives, and reassess
[CORRECT]
B. Order an echocardiogram to rule out aortic stenosis
C. Add fludrocortisone to support blood pressure
D. Increase salt intake and add midodrine without changing current medications
Correct Answer: A
Rationale: The best answer is A. A drop of more than 20 mmHg systolic or 10 mmHg
diastolic with symptoms meets the criteria for orthostatic hypotension, and in this case
the diuretic and ACE inhibitor are the most likely culprits. What we want to remember
clinically is that medication adjustment—often reducing or timing the diuretic
differently—should come before adding new drugs or ordering expensive workups.
Q6: An 81-year-old patient takes 12 seconds to complete the Timed Up and Go test and
reports one fall in the past year. Based on this information, what is the NP's next best
step?
A. Reassure the patient that this is normal and schedule routine follow-up in one year
B. Recommend strict bed rest to prevent future injury
C. Initiate a multifactorial fall risk assessment and targeted interventions [CORRECT]
D. Prescribe meclizine for dizziness prevention
Correct Answer: C
Rationale: The best answer is C. A Timed Up and Go greater than 12 seconds indicates
increased fall risk, and any reported fall in the past year warrants a full evaluation
looking at gait, balance, medications, vision, and home safety. This choice is correct
because in older adults, falls are rarely due to a single cause, so a multifactorial
approach is the standard of care.
Q7: A 74-year-old patient with 8th-grade education scores 24/30 on the MMSE. The NP
suspects mild cognitive impairment but wants a more sensitive screening tool for
executive function. Which tool is most appropriate?
A. The Geriatric Depression Scale
B. The Clock-Drawing Test alone
C. The Confusion Assessment Method
, D. The Montreal Cognitive Assessment (MoCA) [CORRECT]
Correct Answer: D
Rationale: The best answer is D. The MoCA is more sensitive than the MMSE for
detecting mild cognitive impairment and executive dysfunction, especially in patients
with lower educational attainment where MMSE scores can be misleadingly low. What
we want to remember clinically is that screening tool selection matters when we are
trying to catch early changes before they progress.
Q8: Mrs. Henderson, an 82-year-old widow, comes in with her daughter because of
increasing forgetfulness. She takes amlodipine, metformin, omeprazole, oxybutynin, and
diphenhydramine for sleep. She fell last week getting up at night. Her physical exam is
otherwise unremarkable. What is the NP's first priority?
A. Order a brain MRI to rule out normal pressure hydrocephalus
B. Start donepezil for probable Alzheimer's disease
C. Discontinue the diphenhydramine and oxybutynin, and review fall safety [CORRECT]
D. Refer immediately to neurology for lumbar puncture
Correct Answer: C
Rationale: The best answer is C. Both diphenhydramine and oxybutynin carry significant
anticholinergic burden that can worsen cognition and increase fall risk in older adults,
and stopping potentially inappropriate medications should always come before ordering
advanced imaging or starting dementia medications. This choice is correct because in
geriatric primary care, we look for reversible causes first, and medication effects are
among the most common.
Q9: A 69-year-old patient in good health asks about advance directives during their
annual wellness visit. What is the NP's most appropriate initial response?
A. "We only discuss that when someone is seriously ill."
B. "You should hire an attorney before we talk about this."
C. "I will fill out a POLST form for you today."
D. "Let's start by exploring what matters most to you and who you would want to speak
for you if you couldn't." [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Advance care planning is a process, not a form, and the
best place to start is understanding the patient's values, goals, and preferred surrogate
