1
NR 602 Midterm Exam Chamberlain Primary
Care Actual Exam 2026/2027 – Complete Exam-
Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Primary Care Across the Lifespan — Questions 1-25]
Q1: A 72-year-old male presents for an annual wellness visit. His daughter notes that he has
become more forgetful over the past six months, frequently repeats questions, and misplaced his
checkbook twice last week. According to the USPSTF, which screening tool is most appropriate
to assess for cognitive impairment in this patient?
A. Montreal Cognitive Assessment (MoCA)
B. Mini-Cog
C. Saint Louis University Mental Status (SLUMS) exam
D. Clock Drawing Test alone
Correct Answer: B
Rationale: The USPSTF recommends assessing older adults for cognitive impairment when there
is an observed impairment or a reported concern from a patient/family member. The Mini-Cog is
a brief, validated tool that takes approximately 3 minutes to administer and is highly sensitive for
dementia screening, making it ideal for primary care settings. The MoCA and SLUMS are more
sensitive for mild cognitive impairment but take longer to administer. The Clock Drawing Test
alone lacks sensitivity when used without the three-item recall component found in the Mini-
Cog.
Q2: During a 4-month-old well-child visit, the parent asks what they can do to prevent sudden
infant death syndrome (SIDS). You advise that the most effective intervention is:
A. Placing the infant on a firm mattress with a fitted sheet
B. Room-sharing without bed-sharing
C. Offering a pacifier at nap time and bedtime
D. Immunizing the infant according to the recommended schedule
,2
Correct Answer: B
Rationale: While all options are safe sleep recommendations, room-sharing without bed-sharing
is the most significant intervention associated with a reduced risk of SIDS, allowing parents to
monitor the infant easily while avoiding the hazards of the sleep environment. Placing the infant
on a firm mattress is standard, but the proximity of the caregiver in a separate sleep surface is
paramount. Pacifiers are protective but secondary to the sleeping location. Immunizations are not
a direct SIDS prevention method.
Q3: A 55-year-old female patient presents with complaints of dry eyes and dry mouth. She notes
difficulty swallowing dry foods and has used artificial tears daily for months. An autoimmune
workup is positive for anti-SSA (Ro) and anti-SSB (La) antibodies. Which of the following
systemic complications is she most at risk for developing?
A. Renal failure
B. Pulmonary hypertension
C. Non-Hodgkin lymphoma
D. Acute pancreatitis
Correct Answer: C
Rationale: Sjögren's syndrome, an autoimmune disorder affecting exocrine glands, carries a
significantly increased risk (up to 44 times higher than the general population) of developing
non-Hodgkin lymphoma, particularly mucosa-associated lymphoid tissue (MALT) lymphoma.
While renal involvement (tubulointerstitial nephritis) can occur, renal failure is less common
than lymphoma. Pulmonary hypertension and acute pancreatitis are not primary systemic
associations with Sjögren's.
Q4: You are counseling a 65-year-old patient regarding polypharmacy. Which medication class is
explicitly listed on the AGS Beers Criteria as potentially inappropriate in older adults due to an
increased risk of falls and fractures?
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Beta-blockers
C. Proton pump inhibitors (PPIs)
,3
D. Topical antifungals
Correct Answer: A
Rationale: The AGS Beers Criteria identifies SSRIs as potentially inappropriate in older adults
because they can cause hyponatremia and contribute to orthostatic hypotension and falls,
increasing fracture risk. Beta-blockers are generally safe though caution is advised with
bradycardia; PPIs have risks like C. diff and bone loss but are not primarily flagged for
immediate fall risk like sedatives or SSRIs. Topical antifungals have minimal systemic
absorption and are generally safe.
Q5: A 6-month-old infant presents with a diffuse, erythematous, scaly rash on the scalp, cheeks,
and extensor surfaces of the extremities. The parent reports the baby is very itchy. What is the
first-line treatment recommendation for this condition?
A. Oral antihistamines (diphenhydramine)
B. Low-potency topical corticosteroids (hydrocortisone 1%)
C. Medium-potency topical corticosteroids (triamcinolone 0.1%)
D. Calcineurin inhibitors (tacrolimus)
Correct Answer: B
Rationale: This presentation is consistent with atopic dermatitis (eczema). First-line treatment for
infants involves liberal emollients and low-potency topical corticosteroids like hydrocortisone
1% to treat inflammation in sensitive areas (face, diaper area) to avoid skin atrophy. Medium-
potency steroids are generally avoided on the face and in infants due to systemic absorption
risks. Calcineurin inhibitors are second-line (steroid-sparing) agents. Oral antihistamines do not
treat the dermatitis itself but may help with sleep if pruritus is severe.
Q6: An 82-year-old female is evaluated for frailty. She is able to bathe and dress independently
but requires assistance with cooking and managing her finances. This loss of function affects
which category of activities?
A. Basic Activities of Daily Living (BADLs)
B. Instrumental Activities of Daily Living (IADLs)
C. Advanced Activities of Daily Living (AADLs)
, 4
D. Functional Capacity Measures
Correct Answer: B
Rationale: Instrumental Activities of Daily Living (IADLs) are complex skills required for
independent living in the community, such as managing finances, cooking, shopping, and using
the telephone. Bathing and dressing are Basic Activities of Daily Living (BADLs), which are
fundamental self-care tasks. Loss of IADLs often precedes loss of BADLs in the progression of
disability and frailty.
Q7: When using the CAGE-AID questionnaire to screen for substance use in a primary care
setting, a positive response to which specific question correlates most strongly with a diagnosis
of alcohol dependence?
A. "Have people annoyed you by criticizing your drinking?"
B. "Have you felt you ought to Cut down on your drinking?"
C. "Have you ever felt Guilty about your drinking?"
D. "Have you ever had a drink first thing in the morning to steady your nerves or get rid of a
hangover (Eye-opener)?"
Correct Answer: D
Rationale: While any positive response on CAGE-AID warrants further investigation, the "Eye-
opener" question is the strongest single predictor of alcohol dependence. It indicates
physiological dependence and the need for alcohol to prevent withdrawal symptoms or function
in the morning. "Cutting down" is a common sentiment among many users, but the morning use
is a hallmark of severe dependence.
Q8: A 14-year-old male presents for a sports physical. His blood pressure is 134/84 mm Hg on
two separate occasions. He is obese (BMI >95th percentile). According to the AAP guidelines,
how should this hypertension be initially staged and managed?
A. White coat hypertension; monitor BP at home
B. Stage 1 hypertension; initiate lifestyle modifications
C. Stage 2 hypertension; initiate pharmacologic therapy
NR 602 Midterm Exam Chamberlain Primary
Care Actual Exam 2026/2027 – Complete Exam-
Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Primary Care Across the Lifespan — Questions 1-25]
Q1: A 72-year-old male presents for an annual wellness visit. His daughter notes that he has
become more forgetful over the past six months, frequently repeats questions, and misplaced his
checkbook twice last week. According to the USPSTF, which screening tool is most appropriate
to assess for cognitive impairment in this patient?
A. Montreal Cognitive Assessment (MoCA)
B. Mini-Cog
C. Saint Louis University Mental Status (SLUMS) exam
D. Clock Drawing Test alone
Correct Answer: B
Rationale: The USPSTF recommends assessing older adults for cognitive impairment when there
is an observed impairment or a reported concern from a patient/family member. The Mini-Cog is
a brief, validated tool that takes approximately 3 minutes to administer and is highly sensitive for
dementia screening, making it ideal for primary care settings. The MoCA and SLUMS are more
sensitive for mild cognitive impairment but take longer to administer. The Clock Drawing Test
alone lacks sensitivity when used without the three-item recall component found in the Mini-
Cog.
Q2: During a 4-month-old well-child visit, the parent asks what they can do to prevent sudden
infant death syndrome (SIDS). You advise that the most effective intervention is:
A. Placing the infant on a firm mattress with a fitted sheet
B. Room-sharing without bed-sharing
C. Offering a pacifier at nap time and bedtime
D. Immunizing the infant according to the recommended schedule
,2
Correct Answer: B
Rationale: While all options are safe sleep recommendations, room-sharing without bed-sharing
is the most significant intervention associated with a reduced risk of SIDS, allowing parents to
monitor the infant easily while avoiding the hazards of the sleep environment. Placing the infant
on a firm mattress is standard, but the proximity of the caregiver in a separate sleep surface is
paramount. Pacifiers are protective but secondary to the sleeping location. Immunizations are not
a direct SIDS prevention method.
Q3: A 55-year-old female patient presents with complaints of dry eyes and dry mouth. She notes
difficulty swallowing dry foods and has used artificial tears daily for months. An autoimmune
workup is positive for anti-SSA (Ro) and anti-SSB (La) antibodies. Which of the following
systemic complications is she most at risk for developing?
A. Renal failure
B. Pulmonary hypertension
C. Non-Hodgkin lymphoma
D. Acute pancreatitis
Correct Answer: C
Rationale: Sjögren's syndrome, an autoimmune disorder affecting exocrine glands, carries a
significantly increased risk (up to 44 times higher than the general population) of developing
non-Hodgkin lymphoma, particularly mucosa-associated lymphoid tissue (MALT) lymphoma.
While renal involvement (tubulointerstitial nephritis) can occur, renal failure is less common
than lymphoma. Pulmonary hypertension and acute pancreatitis are not primary systemic
associations with Sjögren's.
Q4: You are counseling a 65-year-old patient regarding polypharmacy. Which medication class is
explicitly listed on the AGS Beers Criteria as potentially inappropriate in older adults due to an
increased risk of falls and fractures?
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Beta-blockers
C. Proton pump inhibitors (PPIs)
,3
D. Topical antifungals
Correct Answer: A
Rationale: The AGS Beers Criteria identifies SSRIs as potentially inappropriate in older adults
because they can cause hyponatremia and contribute to orthostatic hypotension and falls,
increasing fracture risk. Beta-blockers are generally safe though caution is advised with
bradycardia; PPIs have risks like C. diff and bone loss but are not primarily flagged for
immediate fall risk like sedatives or SSRIs. Topical antifungals have minimal systemic
absorption and are generally safe.
Q5: A 6-month-old infant presents with a diffuse, erythematous, scaly rash on the scalp, cheeks,
and extensor surfaces of the extremities. The parent reports the baby is very itchy. What is the
first-line treatment recommendation for this condition?
A. Oral antihistamines (diphenhydramine)
B. Low-potency topical corticosteroids (hydrocortisone 1%)
C. Medium-potency topical corticosteroids (triamcinolone 0.1%)
D. Calcineurin inhibitors (tacrolimus)
Correct Answer: B
Rationale: This presentation is consistent with atopic dermatitis (eczema). First-line treatment for
infants involves liberal emollients and low-potency topical corticosteroids like hydrocortisone
1% to treat inflammation in sensitive areas (face, diaper area) to avoid skin atrophy. Medium-
potency steroids are generally avoided on the face and in infants due to systemic absorption
risks. Calcineurin inhibitors are second-line (steroid-sparing) agents. Oral antihistamines do not
treat the dermatitis itself but may help with sleep if pruritus is severe.
Q6: An 82-year-old female is evaluated for frailty. She is able to bathe and dress independently
but requires assistance with cooking and managing her finances. This loss of function affects
which category of activities?
A. Basic Activities of Daily Living (BADLs)
B. Instrumental Activities of Daily Living (IADLs)
C. Advanced Activities of Daily Living (AADLs)
, 4
D. Functional Capacity Measures
Correct Answer: B
Rationale: Instrumental Activities of Daily Living (IADLs) are complex skills required for
independent living in the community, such as managing finances, cooking, shopping, and using
the telephone. Bathing and dressing are Basic Activities of Daily Living (BADLs), which are
fundamental self-care tasks. Loss of IADLs often precedes loss of BADLs in the progression of
disability and frailty.
Q7: When using the CAGE-AID questionnaire to screen for substance use in a primary care
setting, a positive response to which specific question correlates most strongly with a diagnosis
of alcohol dependence?
A. "Have people annoyed you by criticizing your drinking?"
B. "Have you felt you ought to Cut down on your drinking?"
C. "Have you ever felt Guilty about your drinking?"
D. "Have you ever had a drink first thing in the morning to steady your nerves or get rid of a
hangover (Eye-opener)?"
Correct Answer: D
Rationale: While any positive response on CAGE-AID warrants further investigation, the "Eye-
opener" question is the strongest single predictor of alcohol dependence. It indicates
physiological dependence and the need for alcohol to prevent withdrawal symptoms or function
in the morning. "Cutting down" is a common sentiment among many users, but the morning use
is a hallmark of severe dependence.
Q8: A 14-year-old male presents for a sports physical. His blood pressure is 134/84 mm Hg on
two separate occasions. He is obese (BMI >95th percentile). According to the AAP guidelines,
how should this hypertension be initially staged and managed?
A. White coat hypertension; monitor BP at home
B. Stage 1 hypertension; initiate lifestyle modifications
C. Stage 2 hypertension; initiate pharmacologic therapy
