1
NR601 / NR 601 Midterm Exam Primary Care of the
Maturing and Aged Family Actual Exam 2026/2027 |
Complete Exam-Style Questions | 100% Verified –
Detailed Rationales – Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Geriatric Assessment and Age-Related Changes | Q1 – Q15
Section 2 | Common Geriatric Syndromes and Chronic Conditions | Q16 – Q30
Section 3 | Pharmacological Management in Older Adults | Q31 – Q45
Section 4 | Preventive Care, Health Promotion, and Functional Status | Q46 – Q60
Section 5 | Ethical, Legal, and End-of-Life Considerations | Q61 – Q75
SECTION 1: GERIATRIC ASSESSMENT AND AGE-RELATED CHANGES
Question 1 of 75
A 78-year-old woman presents for her annual wellness visit. She lives independently, drives
locally, and manages her own finances. Her daughter reports that over the past year, the patient
has had increasing difficulty remembering appointments, managing her medications, and
preparing complex meals. The patient scores 24/30 on the Montreal Cognitive Assessment
(MoCA), missing points on delayed recall, abstraction, and orientation to date. Her PHQ-9 is 4.
She takes lisinopril and atorvastatin. Which screening tool is most appropriate to formally assess
her functional status and determine if she can continue living independently?
A. The Confusion Assessment Method (CAM) to rule out acute delirium
B. The Mini-Mental State Examination (MMSE) to quantify global cognition
C. A comprehensive assessment of both basic activities of daily living (ADLs) and instrumental
activities of daily living (IADLs) ✓ CORRECT
D. The Geriatric Depression Scale (GDS-15) to evaluate for masked depression
Correct Answer: C
Rationale: The AGS recommends evaluating both ADLs and IADLs as the cornerstone of
geriatric functional assessment because IADL impairment often precedes ADL decline and
predicts the need for supportive services. While the MoCA already identified cognitive concerns,
repeating the MMSE would be redundant and less sensitive to mild impairment than the MoCA
already used. A CAM assessment is unnecessary in the absence of acute confusion or fluctuating
,2
course, and while depression can cause functional decline, her PHQ-9 score is below the clinical
threshold, making a functional assessment the priority.
Question 2 of 75
An 82-year-old man with hypertension and benign prostatic hyperplasia reports progressive
difficulty hearing conversations in restaurants and frequently asks his wife to repeat statements.
He denies otalgia, otorrhea, or vertigo. Otoscopic examination reveals normal tympanic
membranes bilaterally. Weber test lateralizes to the right ear, and Rinne test reveals air
conduction greater than bone conduction in both ears. Which age-related change best explains
his presentation?
A. Cerumen impaction causing conductive hearing loss
B. Presbycusis resulting in symmetric high-frequency sensorineural hearing loss ✓ CORRECT
C. Otosclerosis causing asymmetric conductive hearing loss
D. Meniere disease causing episodic low-frequency sensorineural loss
Correct Answer: B
Rationale: Presbycusis is the most common age-related hearing disorder, characterized by
symmetric, bilateral, high-frequency sensorineural loss that manifests as difficulty with speech
discrimination in noisy environments, consistent with his Rinne and Weber findings. Cerumen
impaction would produce conductive loss with abnormal Rinne findings, while otosclerosis
typically presents in younger adults with progressive conductive loss, and Meniere disease
causes episodic vertigo, tinnitus, and fluctuating low-frequency loss rather than this gradual
symmetric pattern.
Question 3 of 75
A 76-year-old woman with type 2 diabetes and chronic kidney disease (eGFR 42
mL/min/1.73m²) is brought to clinic by her son, who is concerned that she appears confused and
lethargic. Over the past three days, she has had poor oral intake due to nausea. Her medications
include metformin 1000 mg twice daily, glipizide 10 mg daily, lisinopril, and atorvastatin. Vital
signs show BP 98/62 mmHg, HR 88 bpm, temperature 36.8°C. Laboratory studies reveal sodium
138 mEq/L, potassium 5.2 mEq/L, BUN 48 mg/dL, creatinine 2.1 mg/dL (baseline 1.4), and
glucose 52 mg/dL. Which age-related pharmacokinetic change most significantly contributed to
this acute decline?
A. Reduced renal clearance prolonging elimination of renally excreted drugs and increasing
hypoglycemic risk ✓ CORRECT
B. Decreased hepatic blood flow impairing first-pass metabolism of glipizide
,3
C. Increased body fat percentage enhancing lipophilic drug distribution volume
D. Decreased gastric acid secretion reducing absorption of oral hypoglycemics
Correct Answer: A
Rationale: Age-related decline in glomerular filtration rate and reduced renal mass significantly
impair elimination of renally cleared drugs such as metformin and active metabolites of
sulfonylureas, which in the setting of acute illness and poor oral intake precipitated severe
hypoglycemia and acute kidney injury. While hepatic blood flow does decrease with age,
glipizide metabolism is more affected by CYP2C9 than first-pass effects, and neither increased
adipose tissue nor hypochlorhydria explains this acute presentation of hypoglycemia
superimposed on dehydration.
Question 4 of 75
During a home visit for a 69-year-old man recently discharged after hip fracture repair, the nurse
practitioner notes that the patient requires assistance with bathing, dressing, and toileting but can
feed himself independently. He manages his own finances and medications with reminder phone
calls from his daughter. Using Katz ADL and Lawton IADL classifications, how should his
functional status be categorized?
A. Dependent in all ADLs and IADLs requiring skilled nursing facility placement
B. Independent in all ADLs and IADLs appropriate for fully independent living
C. Dependent in select ADLs with preserved IADLs amenable to home-based supportive
services ✓ CORRECT
D. Dependent in IADLs only with full ADL preservation indicating mild impairment
Correct Answer: C
Rationale: The patient demonstrates dependence in three basic ADLs (bathing, dressing,
toileting) while maintaining independence in feeding and requiring only minimal assistance with
IADLs, a pattern consistent with moderate functional impairment that typically responds well to
home health aide services and physical therapy rather than institutionalization. Complete
independence is contradicted by his ADL limitations, and stating he is dependent in IADLs only
misrepresents his bathing, dressing, and toileting needs, while full dependence would require
assistance with feeding as well.
Question 5 of 75
A 74-year-old woman presents with a two-year history of dry, itchy eyes and intermittent blurry
vision that improves with blinking. She wears reading glasses and has no history of diabetes or
hypertension. Slit-lamp examination reveals decreased tear meniscus height, punctate epithelial
, 4
erosions, and meibomian gland dysfunction. Which age-related change is the primary etiology of
her ocular symptoms?
A. Decreased lens elasticity causing presbyopia progression
B. Reduced tear production and altered tear film composition due to lacrimal gland atrophy ✓
CORRECT
C. Corneal endothelial cell loss causing corneal edema
D. Increased intraocular pressure from impaired aqueous humor drainage
Correct Answer: B
Rationale: Keratoconjunctivitis sicca in older adults primarily results from age-related lacrimal
gland atrophy, androgen deficiency, and meibomian gland dysfunction leading to evaporative and
aqueous-deficient dry eye, which explains her punctate erosions and symptom pattern.
Presbyopia causes near-vision difficulty without dryness or erosions, corneal endothelial loss
produces corneal edema and bullous changes rather than dry eye symptoms, and elevated
intraocular pressure characterizes glaucoma, which presents with optic nerve changes and visual
field defects rather than surface irritation.
Question 6 of 75
An 84-year-old man with Parkinson disease, hypertension, and osteoarthritis is evaluated after
his third fall in two months. All falls occurred while transferring from bed to chair or during
ambulation indoors. His medications include carbidopa-levodopa, amlodipine, tamsulosin, and
acetaminophen as needed. On examination, his orthostatic vital signs show a 22 mmHg drop in
systolic blood pressure after standing for three minutes. His Timed Up and Go test is 16 seconds.
Which multifactorial fall risk factor should be addressed first?
A. Initiation of vitamin D supplementation to improve bone density
B. Orthostatic hypotension likely exacerbated by antihypertensive and alpha-blocker therapy ✓
CORRECT
C. Environmental hazards in the home requiring occupational therapy evaluation
D. Parkinson-related gait freezing requiring deep brain stimulation referral
Correct Answer: B
Rationale: The AGS/BGS Clinical Practice Guideline for Prevention of Falls identifies
orthostatic hypotension as a modifiable, high-yield intervention target, and this patient's 22
mmHg systolic drop combined with amlodipine and tamsulosin use represents an immediate,
reversible pharmacological risk that should be addressed before environmental or surgical
interventions. While vitamin D and home safety are important, orthostatic hypotension causes
NR601 / NR 601 Midterm Exam Primary Care of the
Maturing and Aged Family Actual Exam 2026/2027 |
Complete Exam-Style Questions | 100% Verified –
Detailed Rationales – Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Geriatric Assessment and Age-Related Changes | Q1 – Q15
Section 2 | Common Geriatric Syndromes and Chronic Conditions | Q16 – Q30
Section 3 | Pharmacological Management in Older Adults | Q31 – Q45
Section 4 | Preventive Care, Health Promotion, and Functional Status | Q46 – Q60
Section 5 | Ethical, Legal, and End-of-Life Considerations | Q61 – Q75
SECTION 1: GERIATRIC ASSESSMENT AND AGE-RELATED CHANGES
Question 1 of 75
A 78-year-old woman presents for her annual wellness visit. She lives independently, drives
locally, and manages her own finances. Her daughter reports that over the past year, the patient
has had increasing difficulty remembering appointments, managing her medications, and
preparing complex meals. The patient scores 24/30 on the Montreal Cognitive Assessment
(MoCA), missing points on delayed recall, abstraction, and orientation to date. Her PHQ-9 is 4.
She takes lisinopril and atorvastatin. Which screening tool is most appropriate to formally assess
her functional status and determine if she can continue living independently?
A. The Confusion Assessment Method (CAM) to rule out acute delirium
B. The Mini-Mental State Examination (MMSE) to quantify global cognition
C. A comprehensive assessment of both basic activities of daily living (ADLs) and instrumental
activities of daily living (IADLs) ✓ CORRECT
D. The Geriatric Depression Scale (GDS-15) to evaluate for masked depression
Correct Answer: C
Rationale: The AGS recommends evaluating both ADLs and IADLs as the cornerstone of
geriatric functional assessment because IADL impairment often precedes ADL decline and
predicts the need for supportive services. While the MoCA already identified cognitive concerns,
repeating the MMSE would be redundant and less sensitive to mild impairment than the MoCA
already used. A CAM assessment is unnecessary in the absence of acute confusion or fluctuating
,2
course, and while depression can cause functional decline, her PHQ-9 score is below the clinical
threshold, making a functional assessment the priority.
Question 2 of 75
An 82-year-old man with hypertension and benign prostatic hyperplasia reports progressive
difficulty hearing conversations in restaurants and frequently asks his wife to repeat statements.
He denies otalgia, otorrhea, or vertigo. Otoscopic examination reveals normal tympanic
membranes bilaterally. Weber test lateralizes to the right ear, and Rinne test reveals air
conduction greater than bone conduction in both ears. Which age-related change best explains
his presentation?
A. Cerumen impaction causing conductive hearing loss
B. Presbycusis resulting in symmetric high-frequency sensorineural hearing loss ✓ CORRECT
C. Otosclerosis causing asymmetric conductive hearing loss
D. Meniere disease causing episodic low-frequency sensorineural loss
Correct Answer: B
Rationale: Presbycusis is the most common age-related hearing disorder, characterized by
symmetric, bilateral, high-frequency sensorineural loss that manifests as difficulty with speech
discrimination in noisy environments, consistent with his Rinne and Weber findings. Cerumen
impaction would produce conductive loss with abnormal Rinne findings, while otosclerosis
typically presents in younger adults with progressive conductive loss, and Meniere disease
causes episodic vertigo, tinnitus, and fluctuating low-frequency loss rather than this gradual
symmetric pattern.
Question 3 of 75
A 76-year-old woman with type 2 diabetes and chronic kidney disease (eGFR 42
mL/min/1.73m²) is brought to clinic by her son, who is concerned that she appears confused and
lethargic. Over the past three days, she has had poor oral intake due to nausea. Her medications
include metformin 1000 mg twice daily, glipizide 10 mg daily, lisinopril, and atorvastatin. Vital
signs show BP 98/62 mmHg, HR 88 bpm, temperature 36.8°C. Laboratory studies reveal sodium
138 mEq/L, potassium 5.2 mEq/L, BUN 48 mg/dL, creatinine 2.1 mg/dL (baseline 1.4), and
glucose 52 mg/dL. Which age-related pharmacokinetic change most significantly contributed to
this acute decline?
A. Reduced renal clearance prolonging elimination of renally excreted drugs and increasing
hypoglycemic risk ✓ CORRECT
B. Decreased hepatic blood flow impairing first-pass metabolism of glipizide
,3
C. Increased body fat percentage enhancing lipophilic drug distribution volume
D. Decreased gastric acid secretion reducing absorption of oral hypoglycemics
Correct Answer: A
Rationale: Age-related decline in glomerular filtration rate and reduced renal mass significantly
impair elimination of renally cleared drugs such as metformin and active metabolites of
sulfonylureas, which in the setting of acute illness and poor oral intake precipitated severe
hypoglycemia and acute kidney injury. While hepatic blood flow does decrease with age,
glipizide metabolism is more affected by CYP2C9 than first-pass effects, and neither increased
adipose tissue nor hypochlorhydria explains this acute presentation of hypoglycemia
superimposed on dehydration.
Question 4 of 75
During a home visit for a 69-year-old man recently discharged after hip fracture repair, the nurse
practitioner notes that the patient requires assistance with bathing, dressing, and toileting but can
feed himself independently. He manages his own finances and medications with reminder phone
calls from his daughter. Using Katz ADL and Lawton IADL classifications, how should his
functional status be categorized?
A. Dependent in all ADLs and IADLs requiring skilled nursing facility placement
B. Independent in all ADLs and IADLs appropriate for fully independent living
C. Dependent in select ADLs with preserved IADLs amenable to home-based supportive
services ✓ CORRECT
D. Dependent in IADLs only with full ADL preservation indicating mild impairment
Correct Answer: C
Rationale: The patient demonstrates dependence in three basic ADLs (bathing, dressing,
toileting) while maintaining independence in feeding and requiring only minimal assistance with
IADLs, a pattern consistent with moderate functional impairment that typically responds well to
home health aide services and physical therapy rather than institutionalization. Complete
independence is contradicted by his ADL limitations, and stating he is dependent in IADLs only
misrepresents his bathing, dressing, and toileting needs, while full dependence would require
assistance with feeding as well.
Question 5 of 75
A 74-year-old woman presents with a two-year history of dry, itchy eyes and intermittent blurry
vision that improves with blinking. She wears reading glasses and has no history of diabetes or
hypertension. Slit-lamp examination reveals decreased tear meniscus height, punctate epithelial
, 4
erosions, and meibomian gland dysfunction. Which age-related change is the primary etiology of
her ocular symptoms?
A. Decreased lens elasticity causing presbyopia progression
B. Reduced tear production and altered tear film composition due to lacrimal gland atrophy ✓
CORRECT
C. Corneal endothelial cell loss causing corneal edema
D. Increased intraocular pressure from impaired aqueous humor drainage
Correct Answer: B
Rationale: Keratoconjunctivitis sicca in older adults primarily results from age-related lacrimal
gland atrophy, androgen deficiency, and meibomian gland dysfunction leading to evaporative and
aqueous-deficient dry eye, which explains her punctate erosions and symptom pattern.
Presbyopia causes near-vision difficulty without dryness or erosions, corneal endothelial loss
produces corneal edema and bullous changes rather than dry eye symptoms, and elevated
intraocular pressure characterizes glaucoma, which presents with optic nerve changes and visual
field defects rather than surface irritation.
Question 6 of 75
An 84-year-old man with Parkinson disease, hypertension, and osteoarthritis is evaluated after
his third fall in two months. All falls occurred while transferring from bed to chair or during
ambulation indoors. His medications include carbidopa-levodopa, amlodipine, tamsulosin, and
acetaminophen as needed. On examination, his orthostatic vital signs show a 22 mmHg drop in
systolic blood pressure after standing for three minutes. His Timed Up and Go test is 16 seconds.
Which multifactorial fall risk factor should be addressed first?
A. Initiation of vitamin D supplementation to improve bone density
B. Orthostatic hypotension likely exacerbated by antihypertensive and alpha-blocker therapy ✓
CORRECT
C. Environmental hazards in the home requiring occupational therapy evaluation
D. Parkinson-related gait freezing requiring deep brain stimulation referral
Correct Answer: B
Rationale: The AGS/BGS Clinical Practice Guideline for Prevention of Falls identifies
orthostatic hypotension as a modifiable, high-yield intervention target, and this patient's 22
mmHg systolic drop combined with amlodipine and tamsulosin use represents an immediate,
reversible pharmacological risk that should be addressed before environmental or surgical
interventions. While vitamin D and home safety are important, orthostatic hypotension causes
