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NR601 MIDTERM EXAM (CHAMBERLAIN UNIVERSITY) EXAM
QUESTIONS AND CORRECT VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR – JUST RELEASED
EXAM COVERAGE — NR601 MIDTERM EXAM (CHAMBERLAIN UNIVERSITY)
The NR601 Midterm Exam is the first major assessment for Chamberlain University’s NR601
Primary Care of the Maturing and Aged Family course. This exam focuses on
the comprehensive primary care management of older adults (ages 65 and older) . It tests the
student's ability to integrate clinical reasoning, differential diagnosis, and evidence-based
management for the geriatric population.
Key content areas include:
Physiologic Changes of Aging — Normal age-related changes across all body systems
(cardiovascular, pulmonary, renal, neurologic, endocrine, musculoskeletal,
gastrointestinal, integumentary, sensory) and their clinical implications.
Comprehensive Geriatric Assessment (CGA) — Functional assessment (ADLs, IADLs),
cognitive screening (MoCA, Mini-Cog, SLUMS), fall risk assessment (Timed Up and Go,
Get Up and Go), medication review (Beers Criteria, STOPP/START), nutritional screening
(MNA, unintentional weight loss), social assessment (support system, elder abuse risk,
driving safety), advanced care planning (advance directives, POLST, healthcare proxy).
Common Geriatric Syndromes — Frailty, sarcopenia, falls, dizziness, syncope, delirium
(hyperactive, hypoactive, mixed), dementia (Alzheimer's disease, vascular dementia,
Lewy body dementia, frontotemporal dementia), urinary incontinence (stress, urge,
overflow, functional, mixed), fecal incontinence, pressure ulcers, sleep disorders
(insomnia, sleep apnea), polypharmacy, and medication adherence.
Common Chronic Conditions in Older Adults — Hypertension (targets, fall risk with
overtreatment, JNC 8/ACC/AHA guidelines), diabetes mellitus type 2 (A1C goals relaxed
7.5-8.5% in frail elderly, hypoglycemia risk, medication choices), heart failure (HFpEF vs.
HFrEF, diuretics, monitoring, SGLT2 inhibitors), coronary artery disease, atrial fibrillation
(anticoagulation decisions, DOACs vs. warfarin, bleeding risk), chronic kidney disease
(stage-based management, medication adjustments, dialysis decisions), COPD,
osteoarthritis, osteoporosis (screening DEXA, bisphosphonates, denosumab), depression
(PHQ-9, GDS, SSRIs with caution), anxiety, and Parkinson’s disease.
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Pharmacology in Aging — Pharmacokinetic changes (reduced renal clearance,
decreased hepatic metabolism, increased volume of distribution for lipophilic drugs),
pharmacodynamic changes (increased sensitivity to CNS depressants, anticoagulants,
antihypertensives). High-risk medications (Beers Criteria List): benzodiazepines,
anticholinergics (diphenhydramine, tricyclic antidepressants, oxybutynin), NSAIDs,
muscle relaxants, sulfonylureas (glipizide), sliding scale insulin, meperidine, barbiturates,
antipsychotics for dementia-related behaviors (black box warning).
Health Promotion & Disease Prevention in Older Adults — Vaccines (influenza,
pneumococcal PCV13/PPSV23, shingles RZV, Tdap/Td, RSV), cancer screening
(mammogram, colonoscopy, PSA – shared decision-making, stopping ages), falls
prevention (home safety, vitamin D, balance exercises), bone density screening (DXA
starting at age 65), advance care planning discussions, cognitive screening, and driving
safety assessment.
Ethical & Legal Issues — Capacity vs. competency, surrogate decision-making,
guardianship, elder abuse reporting (mandatory in many states), driving cessation
counseling, end-of-life care (palliative vs. hospice, goals of care conversations).
NR601 MIDTERM EXAM — 200 RANDOMIZED SCENARIO-BASED MCQS
1. An 82-year-old male with hypertension and diabetes presents for annual exam. He reports no
new concerns. Which screening test is no longer routinely recommended by USPSTF for this
patient based on age alone?
A) Colorectal cancer screening
B) Blood pressure measurement
C) Diabetes screening
D) Osteoporosis screening
Answer: A
*RATIONALE: USPSTF recommends stopping colorectal cancer screening after age 75 in average-
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risk patients, though individual factors may be considered up to age 85. Blood pressure and
diabetes screening have no upper age limit; osteoporosis screening continues at age 65+.*
2. A 78-year-old female with stage 3 CKD (eGFR 35) and type 2 diabetes has an A1C of 7.2%. She
is on metformin and glipizide. Which medication change is most appropriate to reduce
hypoglycemia risk?
A) Increase metformin
B) Add insulin glargine
C) Discontinue glipizide
D) Add SGLT2 inhibitor
Answer: C
*RATIONALE: Sulfonylureas (glipizide) increase hypoglycemia risk in older adults with CKD; de-
prescribing is recommended per Beers Criteria, especially when A1C is controlled.*
3. A 74-year-old male with hypertension on lisinopril and HCTZ reports dizziness when standing.
BP seated is 130/80, standing 100/60. What is the most appropriate next step?
A) Add midodrine
B) Discontinue lisinopril
C) Decrease HCTZ dose
D) Increase fluid intake only
Answer: B
RATIONALE: Orthostatic hypotension from ACE inhibitor; discontinue the most likely culprit
(lisinopril) first, monitor BP, then adjust diuretic if needed.
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4. An 80-year-old female with Alzheimer's dementia is started on donepezil. Her daughter
reports the patient had a bowel movement yesterday after 5 days of nothing. What is the most
likely cause?
A) Donepezil side effect
B) Normal aging change
C) Dehydration
D) Opioid use
Answer: A
RATIONALE: Cholinesterase inhibitors (donepezil) increase GI motility and can cause diarrhea but
also constipation due to decreased fluid intake; however, increased cholinergic tone can cause
both; here, likely donepezil-related GI effects.
5. A 76-year-old male with heart failure with preserved ejection fraction (HFpEF) presents with
worsening dyspnea and 4-lb weight gain in 3 days. He is on furosemide 40 mg daily. What is the
most appropriate next step?
A) Increase furosemide to 40 mg BID
B) Add metolazone
C) Admit to hospital
D) Double beta-blocker dose
Answer: C
RATIONALE: Rapid weight gain and worsening dyspnea in HF indicate acute decompensation
requiring hospital admission for IV diuretics and monitoring.
NR601 MIDTERM EXAM (CHAMBERLAIN UNIVERSITY) EXAM
QUESTIONS AND CORRECT VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR – JUST RELEASED
EXAM COVERAGE — NR601 MIDTERM EXAM (CHAMBERLAIN UNIVERSITY)
The NR601 Midterm Exam is the first major assessment for Chamberlain University’s NR601
Primary Care of the Maturing and Aged Family course. This exam focuses on
the comprehensive primary care management of older adults (ages 65 and older) . It tests the
student's ability to integrate clinical reasoning, differential diagnosis, and evidence-based
management for the geriatric population.
Key content areas include:
Physiologic Changes of Aging — Normal age-related changes across all body systems
(cardiovascular, pulmonary, renal, neurologic, endocrine, musculoskeletal,
gastrointestinal, integumentary, sensory) and their clinical implications.
Comprehensive Geriatric Assessment (CGA) — Functional assessment (ADLs, IADLs),
cognitive screening (MoCA, Mini-Cog, SLUMS), fall risk assessment (Timed Up and Go,
Get Up and Go), medication review (Beers Criteria, STOPP/START), nutritional screening
(MNA, unintentional weight loss), social assessment (support system, elder abuse risk,
driving safety), advanced care planning (advance directives, POLST, healthcare proxy).
Common Geriatric Syndromes — Frailty, sarcopenia, falls, dizziness, syncope, delirium
(hyperactive, hypoactive, mixed), dementia (Alzheimer's disease, vascular dementia,
Lewy body dementia, frontotemporal dementia), urinary incontinence (stress, urge,
overflow, functional, mixed), fecal incontinence, pressure ulcers, sleep disorders
(insomnia, sleep apnea), polypharmacy, and medication adherence.
Common Chronic Conditions in Older Adults — Hypertension (targets, fall risk with
overtreatment, JNC 8/ACC/AHA guidelines), diabetes mellitus type 2 (A1C goals relaxed
7.5-8.5% in frail elderly, hypoglycemia risk, medication choices), heart failure (HFpEF vs.
HFrEF, diuretics, monitoring, SGLT2 inhibitors), coronary artery disease, atrial fibrillation
(anticoagulation decisions, DOACs vs. warfarin, bleeding risk), chronic kidney disease
(stage-based management, medication adjustments, dialysis decisions), COPD,
osteoarthritis, osteoporosis (screening DEXA, bisphosphonates, denosumab), depression
(PHQ-9, GDS, SSRIs with caution), anxiety, and Parkinson’s disease.
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Pharmacology in Aging — Pharmacokinetic changes (reduced renal clearance,
decreased hepatic metabolism, increased volume of distribution for lipophilic drugs),
pharmacodynamic changes (increased sensitivity to CNS depressants, anticoagulants,
antihypertensives). High-risk medications (Beers Criteria List): benzodiazepines,
anticholinergics (diphenhydramine, tricyclic antidepressants, oxybutynin), NSAIDs,
muscle relaxants, sulfonylureas (glipizide), sliding scale insulin, meperidine, barbiturates,
antipsychotics for dementia-related behaviors (black box warning).
Health Promotion & Disease Prevention in Older Adults — Vaccines (influenza,
pneumococcal PCV13/PPSV23, shingles RZV, Tdap/Td, RSV), cancer screening
(mammogram, colonoscopy, PSA – shared decision-making, stopping ages), falls
prevention (home safety, vitamin D, balance exercises), bone density screening (DXA
starting at age 65), advance care planning discussions, cognitive screening, and driving
safety assessment.
Ethical & Legal Issues — Capacity vs. competency, surrogate decision-making,
guardianship, elder abuse reporting (mandatory in many states), driving cessation
counseling, end-of-life care (palliative vs. hospice, goals of care conversations).
NR601 MIDTERM EXAM — 200 RANDOMIZED SCENARIO-BASED MCQS
1. An 82-year-old male with hypertension and diabetes presents for annual exam. He reports no
new concerns. Which screening test is no longer routinely recommended by USPSTF for this
patient based on age alone?
A) Colorectal cancer screening
B) Blood pressure measurement
C) Diabetes screening
D) Osteoporosis screening
Answer: A
*RATIONALE: USPSTF recommends stopping colorectal cancer screening after age 75 in average-
, Page 3 of 93
risk patients, though individual factors may be considered up to age 85. Blood pressure and
diabetes screening have no upper age limit; osteoporosis screening continues at age 65+.*
2. A 78-year-old female with stage 3 CKD (eGFR 35) and type 2 diabetes has an A1C of 7.2%. She
is on metformin and glipizide. Which medication change is most appropriate to reduce
hypoglycemia risk?
A) Increase metformin
B) Add insulin glargine
C) Discontinue glipizide
D) Add SGLT2 inhibitor
Answer: C
*RATIONALE: Sulfonylureas (glipizide) increase hypoglycemia risk in older adults with CKD; de-
prescribing is recommended per Beers Criteria, especially when A1C is controlled.*
3. A 74-year-old male with hypertension on lisinopril and HCTZ reports dizziness when standing.
BP seated is 130/80, standing 100/60. What is the most appropriate next step?
A) Add midodrine
B) Discontinue lisinopril
C) Decrease HCTZ dose
D) Increase fluid intake only
Answer: B
RATIONALE: Orthostatic hypotension from ACE inhibitor; discontinue the most likely culprit
(lisinopril) first, monitor BP, then adjust diuretic if needed.
, Page 4 of 93
4. An 80-year-old female with Alzheimer's dementia is started on donepezil. Her daughter
reports the patient had a bowel movement yesterday after 5 days of nothing. What is the most
likely cause?
A) Donepezil side effect
B) Normal aging change
C) Dehydration
D) Opioid use
Answer: A
RATIONALE: Cholinesterase inhibitors (donepezil) increase GI motility and can cause diarrhea but
also constipation due to decreased fluid intake; however, increased cholinergic tone can cause
both; here, likely donepezil-related GI effects.
5. A 76-year-old male with heart failure with preserved ejection fraction (HFpEF) presents with
worsening dyspnea and 4-lb weight gain in 3 days. He is on furosemide 40 mg daily. What is the
most appropriate next step?
A) Increase furosemide to 40 mg BID
B) Add metolazone
C) Admit to hospital
D) Double beta-blocker dose
Answer: C
RATIONALE: Rapid weight gain and worsening dyspnea in HF indicate acute decompensation
requiring hospital admission for IV diuretics and monitoring.
