NR 601 Primary Care of Aging Adult Midterm Exam: (Latest
2026/2027 Update) Comprehensive Q&A with Rationales |
Grade A | 100% Correct Verified Answers
Subject: Primary Care of Aging Adult – Functional Assessment (Katz ADL, Lawton IADL); Pulmonary
Function Testing (FEV1); Atypical Presentations in Geriatrics (Acute Abdomen, Depression,
Hyperthyroidism, MI, Infectious Disease, Pneumonia, UTI); Geriatric Syndromes; Exercise Guidelines
for Older Adults; Comprehensive Geriatric Assessment (5 Domains); Screening Tools (Nutrition – MNA;
Socioenvironmental – Lubben Scale; QOL – SF-36); Polypharmacy (BEERS Criteria, STOPP/START,
MAI); Colorectal Cancer Screening (Age 50-75); Pneumococcal Vaccination (PCV13, PPSV23).
Source: NR 601 Midterm Exam 2026, AGS Beers Criteria, USPSTF, CDC Immunization Schedules,
American Geriatrics Society.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
What are two established tools to evaluate functional health?
Correct Answer: Katz Activities of Daily Living Scale and Lawton and Brody Scale for Instrumental
Activities of Daily Living.
1. Katz ADL measures basic self-care: bathing, dressing, toileting, transferring, continence, feeding.
Dependence indicates need for personal care assistance.
2. Lawton IADL measures higher-level function: phone use, shopping, meal preparation, housekeeping,
laundry, transportation, medication management, finances. Impairment predicts need for community-
based supports.
3. Both are standard components of the Comprehensive Geriatric Assessment (CGA).
What is FEV1?
Correct Answer: Forced expiratory volume in 1 second – the volume of air a person can forcefully
exhale in the first second of a forced vital capacity (FVC) maneuver.
1. FEV1 is a key spirometry parameter. Normal aging: FEV1 declines ~30 mL/year; FEV1/FVC ratio
declines by 0.2% per year.
2. Obstructive lung disease (COPD, asthma): FEV1/FVC <0.70. Restrictive lung disease: FEV1 and FVC
both reduced, ratio normal or high.
3. FEV1 <50% predicted correlates with increased surgical risk (lung resection, major abdominal
surgery).
True or False: abnormal lab results are part of the aging process
Correct Answer: False
1. Age-related changes occur, but abnormal laboratory values should not be dismissed as "normal for
age."
2. Physiologic changes: GFR declines (~1 mL/min/year after 40), but eGFR <60 indicates CKD, not
"normal aging."
3. Anemia (Hgb <12 g/dL in women, <13 g/dL in men) requires evaluation; not benign.
, Atypical presentations in acute abdominal illness in older adults?
Correct Answer: Vague symptoms, acute confusion, constipation, mild discomfort, tachypnea,
altered mental status, absence of fever.
1. Older adults have blunted immune/inflammatory response: may not develop fever or leukocytosis.
Pain perception decreased.
2. Common presenting sign: unexplained functional decline (falls, inability to perform ADLs).
3. High index of suspicion needed; delayed diagnosis increases morbidity and mortality.
Atypical presentation in depression in older adults
Correct Answer: Anorexia, vague abdominal cramps, new constipation, agitation, insomnia, lack of
sadness (depression without sadness).
1. Somatic complaints common: insomnia, fatigue, anorexia, weight loss, constipation, abdominal pain
(may mimic GI disease).
2. Cognitive complaints: memory problems (pseudodementia), slowed processing, difficulty
concentrating.
3. Screen with PHQ-2 then PHQ-9; treat with SSRIs (sertraline, escitalopram) and/or CBT.
Atypical presentation of hyperthyroidism in older adults
Correct Answer: Apathetic thyrotoxicosis – fatigue, weakness, weight loss, palpitations,
tachycardia, new-onset atrial fibrillation, heart failure if undiagnosed.
1. Classic signs absent: no heat intolerance, hyperactivity, tremor, or goiter (may be absent).
2. Symptoms: depression (apathetic), proximal muscle weakness, falls, weight loss despite anorexia,
new atrial fibrillation.
3. Diagnosis: suppressed TSH; elevated free T4/T3. Treat with methimazole, radioactive iodine, or beta-
blockers for symptom control.
Atypical presentation of myocardial infarction (MI) in older adults
Correct Answer: No chest pain; fatigue, nausea, decreased function and cognition. Classic:
dyspnea, epigastric pain, weakness, nausea/vomiting, history of cardiac failure. Higher in females:
non-Q wave MI.
1. Silent MI (no chest pain) more common in elderly and diabetics. Present with dyspnea (48%), fatigue
(37%), syncope (25%).
2. Obtain ECG and troponin in any older adult with unexplained dyspnea, epigastric pain, new confusion,
or functional decline.
3. Treatment: aspirin, oxygen, nitroglycerin (if not hypotensive), morphine, revascularization.
Atypical presentation in infectious disease in older adults
Correct Answer: Low-grade fever or no fever; malaise; sepsis without leukocytosis or fever; falls,
new confusion, or altered mental status; decreased function; anorexia.
1. Fever may be absent (only 50% of elderly with serious infection have fever). Hypothermia is ominous.
2. Sepsis may present with hypotension, tachycardia, tachypnea, altered mental status (delirium).
3. Common occult infections: UTI (without dysuria), pneumonia (no cough/fever), endocarditis
(nonspecific symptoms).
2026/2027 Update) Comprehensive Q&A with Rationales |
Grade A | 100% Correct Verified Answers
Subject: Primary Care of Aging Adult – Functional Assessment (Katz ADL, Lawton IADL); Pulmonary
Function Testing (FEV1); Atypical Presentations in Geriatrics (Acute Abdomen, Depression,
Hyperthyroidism, MI, Infectious Disease, Pneumonia, UTI); Geriatric Syndromes; Exercise Guidelines
for Older Adults; Comprehensive Geriatric Assessment (5 Domains); Screening Tools (Nutrition – MNA;
Socioenvironmental – Lubben Scale; QOL – SF-36); Polypharmacy (BEERS Criteria, STOPP/START,
MAI); Colorectal Cancer Screening (Age 50-75); Pneumococcal Vaccination (PCV13, PPSV23).
Source: NR 601 Midterm Exam 2026, AGS Beers Criteria, USPSTF, CDC Immunization Schedules,
American Geriatrics Society.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
What are two established tools to evaluate functional health?
Correct Answer: Katz Activities of Daily Living Scale and Lawton and Brody Scale for Instrumental
Activities of Daily Living.
1. Katz ADL measures basic self-care: bathing, dressing, toileting, transferring, continence, feeding.
Dependence indicates need for personal care assistance.
2. Lawton IADL measures higher-level function: phone use, shopping, meal preparation, housekeeping,
laundry, transportation, medication management, finances. Impairment predicts need for community-
based supports.
3. Both are standard components of the Comprehensive Geriatric Assessment (CGA).
What is FEV1?
Correct Answer: Forced expiratory volume in 1 second – the volume of air a person can forcefully
exhale in the first second of a forced vital capacity (FVC) maneuver.
1. FEV1 is a key spirometry parameter. Normal aging: FEV1 declines ~30 mL/year; FEV1/FVC ratio
declines by 0.2% per year.
2. Obstructive lung disease (COPD, asthma): FEV1/FVC <0.70. Restrictive lung disease: FEV1 and FVC
both reduced, ratio normal or high.
3. FEV1 <50% predicted correlates with increased surgical risk (lung resection, major abdominal
surgery).
True or False: abnormal lab results are part of the aging process
Correct Answer: False
1. Age-related changes occur, but abnormal laboratory values should not be dismissed as "normal for
age."
2. Physiologic changes: GFR declines (~1 mL/min/year after 40), but eGFR <60 indicates CKD, not
"normal aging."
3. Anemia (Hgb <12 g/dL in women, <13 g/dL in men) requires evaluation; not benign.
, Atypical presentations in acute abdominal illness in older adults?
Correct Answer: Vague symptoms, acute confusion, constipation, mild discomfort, tachypnea,
altered mental status, absence of fever.
1. Older adults have blunted immune/inflammatory response: may not develop fever or leukocytosis.
Pain perception decreased.
2. Common presenting sign: unexplained functional decline (falls, inability to perform ADLs).
3. High index of suspicion needed; delayed diagnosis increases morbidity and mortality.
Atypical presentation in depression in older adults
Correct Answer: Anorexia, vague abdominal cramps, new constipation, agitation, insomnia, lack of
sadness (depression without sadness).
1. Somatic complaints common: insomnia, fatigue, anorexia, weight loss, constipation, abdominal pain
(may mimic GI disease).
2. Cognitive complaints: memory problems (pseudodementia), slowed processing, difficulty
concentrating.
3. Screen with PHQ-2 then PHQ-9; treat with SSRIs (sertraline, escitalopram) and/or CBT.
Atypical presentation of hyperthyroidism in older adults
Correct Answer: Apathetic thyrotoxicosis – fatigue, weakness, weight loss, palpitations,
tachycardia, new-onset atrial fibrillation, heart failure if undiagnosed.
1. Classic signs absent: no heat intolerance, hyperactivity, tremor, or goiter (may be absent).
2. Symptoms: depression (apathetic), proximal muscle weakness, falls, weight loss despite anorexia,
new atrial fibrillation.
3. Diagnosis: suppressed TSH; elevated free T4/T3. Treat with methimazole, radioactive iodine, or beta-
blockers for symptom control.
Atypical presentation of myocardial infarction (MI) in older adults
Correct Answer: No chest pain; fatigue, nausea, decreased function and cognition. Classic:
dyspnea, epigastric pain, weakness, nausea/vomiting, history of cardiac failure. Higher in females:
non-Q wave MI.
1. Silent MI (no chest pain) more common in elderly and diabetics. Present with dyspnea (48%), fatigue
(37%), syncope (25%).
2. Obtain ECG and troponin in any older adult with unexplained dyspnea, epigastric pain, new confusion,
or functional decline.
3. Treatment: aspirin, oxygen, nitroglycerin (if not hypotensive), morphine, revascularization.
Atypical presentation in infectious disease in older adults
Correct Answer: Low-grade fever or no fever; malaise; sepsis without leukocytosis or fever; falls,
new confusion, or altered mental status; decreased function; anorexia.
1. Fever may be absent (only 50% of elderly with serious infection have fever). Hypothermia is ominous.
2. Sepsis may present with hypotension, tachycardia, tachypnea, altered mental status (delirium).
3. Common occult infections: UTI (without dysuria), pneumonia (no cough/fever), endocarditis
(nonspecific symptoms).
