NR 601 FINAL EXAM 2026/2027 | Primary Care of Maturing &
Aged Family Practicum | Questions & Answers Verified |
Chamberlain | Pass Guaranteed - A+ Graded
Q1: A 78-year-old woman presents for her annual wellness visit. She lives independently,
manages her own medications, and reports no falls in the past year. Her blood pressure
is 142/88 mmHg, heart rate 72 bpm. She takes amlodipine 5 mg daily. According to the
2023 AGS/AAFP guidelines, what is the most appropriate next step in management?
A. Increase amlodipine to 10 mg daily
B. Add lisinopril 10 mg daily
C. Continue current regimen; BP goal <150/90 for most adults ≥65 [CORRECT]
D. Add hydrochlorothiazide 25 mg daily
Correct Answer: C
Rationale: The 2023 AGS/AAFP guidelines recommend a systolic BP target of <150
mmHg for most adults aged 65 and older, recognizing that tighter control (<140/90)
may be appropriate for healthy, robust older adults but increases risks of hypotension,
falls, and kidney injury in frail patients. This patient is independent and functional, but
her BP of 142/88 is close to target. Aggressive intensification (A, B, D) risks orthostatic
hypotension and falls without clear benefit. The best approach is continued monitoring
with current regimen, lifestyle counseling, and reassessment. If SBP consistently >150
or she has high cardiovascular risk, intensification could be considered with careful
monitoring for orthostatic changes.
Q2: An 82-year-old man with type 2 diabetes, CKD stage 3a, and mild cognitive
impairment presents for follow-up. His HbA1c is 7.8%, eGFR 42 mL/min/1.73m², and he
,reports one hypoglycemic episode last month. He takes metformin 1000 mg BID and
glipizide 10 mg daily. According to ADA and AGS guidelines, what is the most
appropriate medication adjustment?
A. Increase glipizide to achieve HbA1c <7%
B. Discontinue glipizide; consider DPP-4 inhibitor or GLP-1 RA with low hypoglycemia
risk [CORRECT]
C. Add insulin for better glycemic control
D. Continue current regimen; HbA1c target is appropriate
Correct Answer: B
Rationale: This patient has multiple factors indicating need for de-intensification:
advanced age, CKD, hypoglycemia history, and cognitive impairment. The AGS and ADA
recommend relaxed HbA1c targets (7.5-8.0% or even higher) for older adults with
complex health status to avoid hypoglycemia, which causes falls, cognitive decline,
cardiovascular events, and death. Sulfonylureas like glipizide are high-risk medications
per Beers Criteria due to hypoglycemia risk, especially with CKD (reduced renal
clearance). The best approach is discontinuing glipizide and switching to a safer agent:
DPP-4 inhibitors (sitagliptin, linagliptin—dose-adjusted for renal function) or GLP-1 RAs
(dulaglutide, liraglutide—cardiovascular benefits but GI side effects) have low
hypoglycemia risk. Insulin (C) increases hypoglycemia risk further. Continuing glipizide
(D) risks recurrent hypoglycemia.
Q3: A 75-year-old woman is brought to clinic by her daughter due to confusion over the
past 3 days. She was hospitalized for pneumonia 1 week ago and discharged on
levofloxacin 3 days ago. On exam, she is alert but disoriented to time and place, has
fluctuating attention, and is picking at invisible objects. Her temperature is 99.1°F, HR
92, BP 138/82. What is the most likely diagnosis?
A. Alzheimer's disease progression
,B. Delirium due to multifactorial causes including infection and medication [CORRECT]
C. Depression with psychotic features
D. Normal pressure hydrocephalus
Correct Answer: B
Rationale: This presentation is classic delirium: acute onset (hours to days), fluctuating
course, inattention, disorientation, and perceptual disturbances (picking at objects =
visual hallucinations/illusions). The temporal relationship to hospitalization, infection
(pneumonia), and levofloxacin (fluoroquinolone associated with delirium, especially in
elderly) supports multifactorial delirium. Alzheimer's (A) has insidious onset over years,
not days. Depression (C) features mood disturbance, not acute confusion. NPH (D)
presents with chronic gait disturbance, urinary incontinence, and cognitive decline, not
acute delirium. Immediate workup includes infection evaluation, medication review,
metabolic panel, and delirium precautions.
Q4: A 68-year-old man with osteoarthritis takes ibuprofen 800 mg TID for knee pain. He
has hypertension controlled with lisinopril and reports occasional heartburn. His
creatinine has risen from 1.1 to 1.6 mg/dL over 6 months. According to the Beers
Criteria, what is the priority intervention?
A. Add omeprazole for gastroprotection
B. Switch ibuprofen to naproxen 500 mg BID
C. Discontinue NSAID; trial acetaminophen or topical NSAIDs; consider
non-pharmacologic therapies [CORRECT]
D. Add misoprostol and continue ibuprofen
Correct Answer: C
Rationale: NSAIDs are potentially inappropriate in older adults per Beers Criteria due to
risks of: GI bleeding, renal impairment, cardiovascular events, and exacerbation of heart
failure. This patient shows declining renal function (creatinine rise, eGFR drop) likely due
, to NSAID-induced hemodynamically-mediated kidney injury. Adding PPIs (A) or
misoprostol (D) addresses GI risk but not renal or cardiovascular risks. Switching to
another NSAID (B) doesn't reduce risks. The appropriate approach is NSAID
discontinuation, trial of safer alternatives (acetaminophen up to 3g/day, topical NSAIDs
with minimal systemic absorption), and non-pharmacologic therapies (exercise, weight
loss, physical therapy, intra-articular injections). If NSAIDs are essential, use lowest
effective dose, shortest duration, with PPI protection and renal monitoring.
Q5: An 84-year-old woman with advanced dementia resides in a nursing facility. She has
lost 8 pounds over 3 months, refuses most meals, and chokes on thin liquids. Her
advance directive states "no artificial nutrition or hydration." Her daughter requests
placement of a PEG tube. What is the most appropriate response?
A. Honor the daughter's request as surrogate decision-maker
B. Explain that evidence shows PEG tubes do not improve survival, aspiration risk, or
quality of life in advanced dementia; recommend comfort-focused feeding strategies
[CORRECT]
C. Refuse all discussion of feeding with the family
D. Request a court order to override the advance directive
Correct Answer: B
Rationale: Strong evidence (including AGS and AMDA guidelines) demonstrates that
PEG tubes in advanced dementia do not improve survival, reduce aspiration pneumonia
risk, prevent pressure ulcers, or enhance quality of life compared to careful
hand-feeding. They increase risks of infection, restraints, and discomfort. The patient's
documented wishes (no artificial nutrition/hydration) should guide care. The daughter's
request likely stems from fear of starvation and desire to help. The clinician should:
empathize with concerns, explain evidence and prognosis, offer comfort-focused
alternatives (hand-feeding preferred foods, texture modifications, feeding assistance,
Aged Family Practicum | Questions & Answers Verified |
Chamberlain | Pass Guaranteed - A+ Graded
Q1: A 78-year-old woman presents for her annual wellness visit. She lives independently,
manages her own medications, and reports no falls in the past year. Her blood pressure
is 142/88 mmHg, heart rate 72 bpm. She takes amlodipine 5 mg daily. According to the
2023 AGS/AAFP guidelines, what is the most appropriate next step in management?
A. Increase amlodipine to 10 mg daily
B. Add lisinopril 10 mg daily
C. Continue current regimen; BP goal <150/90 for most adults ≥65 [CORRECT]
D. Add hydrochlorothiazide 25 mg daily
Correct Answer: C
Rationale: The 2023 AGS/AAFP guidelines recommend a systolic BP target of <150
mmHg for most adults aged 65 and older, recognizing that tighter control (<140/90)
may be appropriate for healthy, robust older adults but increases risks of hypotension,
falls, and kidney injury in frail patients. This patient is independent and functional, but
her BP of 142/88 is close to target. Aggressive intensification (A, B, D) risks orthostatic
hypotension and falls without clear benefit. The best approach is continued monitoring
with current regimen, lifestyle counseling, and reassessment. If SBP consistently >150
or she has high cardiovascular risk, intensification could be considered with careful
monitoring for orthostatic changes.
Q2: An 82-year-old man with type 2 diabetes, CKD stage 3a, and mild cognitive
impairment presents for follow-up. His HbA1c is 7.8%, eGFR 42 mL/min/1.73m², and he
,reports one hypoglycemic episode last month. He takes metformin 1000 mg BID and
glipizide 10 mg daily. According to ADA and AGS guidelines, what is the most
appropriate medication adjustment?
A. Increase glipizide to achieve HbA1c <7%
B. Discontinue glipizide; consider DPP-4 inhibitor or GLP-1 RA with low hypoglycemia
risk [CORRECT]
C. Add insulin for better glycemic control
D. Continue current regimen; HbA1c target is appropriate
Correct Answer: B
Rationale: This patient has multiple factors indicating need for de-intensification:
advanced age, CKD, hypoglycemia history, and cognitive impairment. The AGS and ADA
recommend relaxed HbA1c targets (7.5-8.0% or even higher) for older adults with
complex health status to avoid hypoglycemia, which causes falls, cognitive decline,
cardiovascular events, and death. Sulfonylureas like glipizide are high-risk medications
per Beers Criteria due to hypoglycemia risk, especially with CKD (reduced renal
clearance). The best approach is discontinuing glipizide and switching to a safer agent:
DPP-4 inhibitors (sitagliptin, linagliptin—dose-adjusted for renal function) or GLP-1 RAs
(dulaglutide, liraglutide—cardiovascular benefits but GI side effects) have low
hypoglycemia risk. Insulin (C) increases hypoglycemia risk further. Continuing glipizide
(D) risks recurrent hypoglycemia.
Q3: A 75-year-old woman is brought to clinic by her daughter due to confusion over the
past 3 days. She was hospitalized for pneumonia 1 week ago and discharged on
levofloxacin 3 days ago. On exam, she is alert but disoriented to time and place, has
fluctuating attention, and is picking at invisible objects. Her temperature is 99.1°F, HR
92, BP 138/82. What is the most likely diagnosis?
A. Alzheimer's disease progression
,B. Delirium due to multifactorial causes including infection and medication [CORRECT]
C. Depression with psychotic features
D. Normal pressure hydrocephalus
Correct Answer: B
Rationale: This presentation is classic delirium: acute onset (hours to days), fluctuating
course, inattention, disorientation, and perceptual disturbances (picking at objects =
visual hallucinations/illusions). The temporal relationship to hospitalization, infection
(pneumonia), and levofloxacin (fluoroquinolone associated with delirium, especially in
elderly) supports multifactorial delirium. Alzheimer's (A) has insidious onset over years,
not days. Depression (C) features mood disturbance, not acute confusion. NPH (D)
presents with chronic gait disturbance, urinary incontinence, and cognitive decline, not
acute delirium. Immediate workup includes infection evaluation, medication review,
metabolic panel, and delirium precautions.
Q4: A 68-year-old man with osteoarthritis takes ibuprofen 800 mg TID for knee pain. He
has hypertension controlled with lisinopril and reports occasional heartburn. His
creatinine has risen from 1.1 to 1.6 mg/dL over 6 months. According to the Beers
Criteria, what is the priority intervention?
A. Add omeprazole for gastroprotection
B. Switch ibuprofen to naproxen 500 mg BID
C. Discontinue NSAID; trial acetaminophen or topical NSAIDs; consider
non-pharmacologic therapies [CORRECT]
D. Add misoprostol and continue ibuprofen
Correct Answer: C
Rationale: NSAIDs are potentially inappropriate in older adults per Beers Criteria due to
risks of: GI bleeding, renal impairment, cardiovascular events, and exacerbation of heart
failure. This patient shows declining renal function (creatinine rise, eGFR drop) likely due
, to NSAID-induced hemodynamically-mediated kidney injury. Adding PPIs (A) or
misoprostol (D) addresses GI risk but not renal or cardiovascular risks. Switching to
another NSAID (B) doesn't reduce risks. The appropriate approach is NSAID
discontinuation, trial of safer alternatives (acetaminophen up to 3g/day, topical NSAIDs
with minimal systemic absorption), and non-pharmacologic therapies (exercise, weight
loss, physical therapy, intra-articular injections). If NSAIDs are essential, use lowest
effective dose, shortest duration, with PPI protection and renal monitoring.
Q5: An 84-year-old woman with advanced dementia resides in a nursing facility. She has
lost 8 pounds over 3 months, refuses most meals, and chokes on thin liquids. Her
advance directive states "no artificial nutrition or hydration." Her daughter requests
placement of a PEG tube. What is the most appropriate response?
A. Honor the daughter's request as surrogate decision-maker
B. Explain that evidence shows PEG tubes do not improve survival, aspiration risk, or
quality of life in advanced dementia; recommend comfort-focused feeding strategies
[CORRECT]
C. Refuse all discussion of feeding with the family
D. Request a court order to override the advance directive
Correct Answer: B
Rationale: Strong evidence (including AGS and AMDA guidelines) demonstrates that
PEG tubes in advanced dementia do not improve survival, reduce aspiration pneumonia
risk, prevent pressure ulcers, or enhance quality of life compared to careful
hand-feeding. They increase risks of infection, restraints, and discomfort. The patient's
documented wishes (no artificial nutrition/hydration) should guide care. The daughter's
request likely stems from fear of starvation and desire to help. The clinician should:
empathize with concerns, explain evidence and prognosis, offer comfort-focused
alternatives (hand-feeding preferred foods, texture modifications, feeding assistance,
