NR 601 / NR 602 Midterm Exam ALL NEW 2025/ 2026 VERSIONS EXAM QUESTIONS WITH VERIFIED ANSWERS (100% CORRECT) LATEST VERSIONS EXAM 2025/ 2026 UPDATE RATED A+.

NR 601 / NR 602 Midterm Exam ALL NEW 2025/ 2026 VERSIONS EXAM A 10-year-old presents to the office with his mother with complaints of itchy and red eyes for 1 day. He reports watery drainage in both eyes associated with constant itching. He has no fever or constitutional symptoms. The patient has a sibling that just started day care recently. Upon examination, vision is 20/20 OU with glasses. He has mild to moderate conjunctival hyperemia with bilateral preauricular lymph nodes that are inflamed. What is the most likely diagnosis? Viral conjunctivitis A 64-year-old has had a corneal infection for several weeks. He asks why the infection is still present. How do you respond? Because the cornea doesn't have a blood supply, an infection can be fought off as usual A 47-year-old presents to the clinic with a red eye. How would the NP differentiate between iritis and conjunctivitis? Ciliary flush pg. 2 A 54-year-old presents to the office with a painful red eye without discharge. What is the most likely initial diagnosis? Iritis An 82-year-old presents with several eye complaints. She states that her eyes are always dry and look sunken in. What is the most likely cause? Normal age-related changes A 46-year-old is diagnosed with viral conjunctivitis. What treatment should be included? Supportive measures and lubricant eye drops A 25-year-old presents with bleeding in my eye for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient's sclera of the right eye only and takes up less than 50% of the eye. The patient's remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment? Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks. pg. 3 A patient comes into the clinic complaining of pain in her right eye. On examination, the nurse practitioner (NP) sees a pustule at the lid margin that is painful to touch, red, and swollen. What is the most likely diagnosis? Hordeolum (stye) A patient has been treated for glaucoma for five (5) years. Which of the following will provide an indication of the level of progression during the funduscopic examination for this patient? Estimating cup-to-disk ratio The NP should instruct a patient diagnosed with glaucoma that the purpose of medication is to: Lower the intraocular pressure pg. 4 NR 601 Midterm Exam Chapter 1: Principles of Primary Care of Older Adults Which one of the following is most true about aging changes? Stage 3 and 4 sleep decreases. An old woman who is cared for by attentive, cautious, concerned family is particularly likely to suffer from which one of the following complications after an episode of gastroenteritis? Immobility related to overconcern Which one of the following is most true about psychological aging? Ageism can lead to isolation and depression. Of the following conditions, which one is most common and most often preventable? Iatrogenic disease pg. 5 Based on current demographic data, which statement identifies a predictive trend regarding the health care needs of society? More nursing services will be required to serve the needs of the population 85 years of age and older An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that aging may cause this change due to the: Slower ability of the pupil to adjust to changes in lighting Which one of the following is most true about the rule of fourths? What used to be called normal aging can be largely explained by processes that are not normal. Chapter 3: Geriatric Assessment An 86-year-old male who lives in an assisted living facility is at the clinic. He has a history of hypertension and manages his own medications. He admits he takes them sometimes. After speaking to him, you find it unclear if he understands the questions and discussions. Which of the following evidences that the patient has adequate health literacy? pg. 6 He knows the names and doses of his medications and can explain why he takes them. You are performing a geriatric assessment on an 82-year-old female. At the end of the visit, which of the following would require top priority over the others? The death of the patient's caregiver Ms. M's family has noticed memory loss for the past 6 months. She continues to drive but recently had a fender bender and was caught speeding on a 35-mph road. She insists that she is safe and needs to drive to church and for shopping. What is the best next step? Get a driving evaluation. The following are true statements about bipolar disorders in older adults except Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults. Chapter 5: Wellness and Prevention pg. 7 The US Advisory Committee on Immunization Practices and the Centers for Disease Control currently recommend which one of the following? a. All older adults be immunized against influenza annually and that they receive at least one pneumococcal vaccination. b. All high-risk older adults should receive an additional pneumococcal vaccination 5 years or more after their first immunization. c. Older adults should receive a one-time revaccination for pneumonia if they were initially vaccinated more than 5 years previously and were less than 65 years of age at the time of the initial vaccination. d. All of these are recommended. Healthcare providers should recommend that older adults engage in which one of the following? 150 minutes of moderate intensity physical activity weekly Guidelines for the primary prevention of stroke recommend that aspirin be used in which one of the following? Individuals whose risk is high enough for the benefits to outweigh the risks pg. 8 Even though older adults are less likely to get counseled for smoking cessation, they have which one of the following? The same quit rates as younger individuals When educating the older adult population about the risks to physical health that chronic alcohol abuse presents, the nurse practitioner is especially careful to include the: Identification of the signs and symptoms of gastrointestinal bleeding An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging? Assessing the client for both depression and anxiety The nurse practitioner shows an understanding of appropriate influenza vaccination guidelines for a client over the age of 65 when stating: Regardless of your physical health you really should get a yearly flu shot pg. 9 Chapter 6: Cultural Competency and Cultural Humility in Caring for Older Adults Which of the following is true about cultural humility? It places emphasis on power imbalances and promotes interpersonal sensitivity through partnerships with and learning from patients. Racial disparities have been a part of US healthcare for many decades. How might this impact the expectations of older Black Americans? a. Reluctance to participate in medical research because of unethical studies in the past b. Underrepresentation of Black physicians in the geriatric workforce c. Cumulative effects of differences in access to healthcare providers d. All of these Dementia is a relatively common condition in the geriatric population. It becomes more common as people age. Which is the most appropriate description of "personhood" as it relates to people with dementia? pg. 10 The ability to relate to others as people, rather than preserving cognitive independence, is an important aspect of "personhood." Immigrant families bring cultural traditions into healthcare decisions. With regard to older adults, which of the following is true? End-of-life care is particularly sensitive to cultural beliefs and should be explored carefully with the patient and family, as appropriate. It has been projected that the cultural group presenting the greatest growth rate among the older adult population will be the: Hispanic Ethnocentrism is defined as: a belief that one's ethnic group is superior to that of another true Which of the following culturally diverse male clients will most benefit from educational material related to "Staying Healthy into your 80s" Japanese pg. 11 Chapter 7: Appropriate Prescribing Patient GG is an 82-year-old woman with complaints of dysuria and polyuria. A urinalysis is positive for a urinary tract infection. She is 55 kg, her serum creatinine is 1.5 mg/dL, and she has no known drug allergies. Which of the following is the most appropriate antibiotic regimen? Sulfamethoxazole/trimethoprim 400/80 mg BID for 3 days An older woman with a history of mild Alzheimer disease was recently started on oxybutynin 10 mg orally twice daily for urinary incontinence. Her family reports that she has been increasingly disoriented over the past month and she notes some constipation on the review of systems during her office visit. What management is best regarding her urinary incontinence? Change oxybutynin to mirabegron 25 mg orally daily. Patient SL is a 68-year-old man you are seeing for follow-up of uncontrolled hypertension. He is currently prescribed amlodipine 10 mg daily, azilsartan 40 mg daily, metoprolol tartrate 50 mg BID (twice daily), and hydrochlorothiazide (HCTZ) 25 mg daily, and his blood pressure is consistently above target. Secondary causes of hypertension have been ruled out. You ask him about missing doses and he tells you that it is difficult to take so many tablets and the brand-name medication is very expensive. Select the best way to improve this patient's adherence. You decide to discontinue brand name azilsartan and: Initiate losartan/HCTZ 50/25 mg once daily; HCTZ is stopped. pg. 12 Chapter 24: Constipation and Fecal Incontinence Constipation in older adults may result from many factors. Which of the following is not considered a common contributing factor to constipation in older adults? Obesity Risk factors associated with constipation in older women are: a. High number of medications b. Multiple comorbidities c. Female sex d. Black American race/ethnicity e. All of these The first step in developing a treatment strategy for a physically active patient with constipation symptoms that are not caused by other potential causes is to: pg. 13 Recommend higher fiber and water intake Over-the-counter Milk of Magnesia and polyethylene glycol improve constipation by: Promoting secretion of water into the intestinal lumen Supplemental fiber treatment can improve symptoms related to constipation and FI. True or False True Which of the following drugs does not typically cause constipation Magnesium-containing antacid Which of the following is not a common cause of constipation? hypercalcemia pg. 14 Chapter 28: Malnutrition and Feeding Problems Mr. Lee is an 80-year-old man who lives alone who comes to the office for a routine visit. He lost 10 lb in the last 3 months and complains of fatigue, poor appetite, and trouble sleeping. Which of the following is least useful during his initial assessment? Vaccination history During the physical assessment, you notice Mr. Lee has temporal wasting, loss of subcutaneous fat, and decreased handgrip strength. He also complains of dry mouth. His C-reactive protein is within normal limits. What additional lab test(s) are most useful for evaluating his nutritional status? Serum albumin While discussing Mr. Lee's diet, he states that his wife did all the cooking and since she passed away 5 months ago, he eats mostly soups and sandwiches. He does not drive, and he does not like to ask his son to take him to the store because he does not want to be a burden. What nutrition intervention would you recommend? Consult dietician to determine nutritional needs pg. 15 Mrs. Miller is a 78-year-old female admitted to the hospital with pneumonia. She is on oxygen and is fatigued. The nurses notice her coughing when she drinks regular liquids. She states this happens at home as well. Her appetite has been poor in the hospital and she is only eating 50% of her meals. What is your first nutrition intervention? Consult speech therapy for a swallowing evaluation Mrs. Green is an 88-year-old female discharging home from the hospital after sustaining a right hip fracture from a fall. She required surgery to fix the fracture and is now ambulating using a walker. Her Mini-Nutritional Assessment in the hospital was positive for malnutrition risk. She lives alone and only has one family member who lives nearby. What nutrition interventions is least helpful once she discharges home? Recommend she move into a retirement community Which assessment data would not be of particular concern when attempting to manage an older adult's risk for dehydration? Chronic constipation Chapter 30: Pressure Injuries pg. 16 You provide chronic disease management for a 94-year-old male with advanced Alzheimer's dementia. He also goes to an adult day center 5 days per week. You had recently ordered a lift to help him transfer from bed to wheelchair, where he spends most of his day. The wheelchair was assessed by physical therapy and he has a pressure-redistributing cushion. When in bed, he tends to sleep on his back all night unless repositioned by family. He is incontinent of bowel and bladder. At the last visit 3 months ago, the daughter noticed that he had started to pocket his food intermittently. Speech consultation provided education to the family on how to cue the patient for safe swallowing. He has maintained his current weight. Presently he has no pressure injuries. Which care plan will minimize this patient's chances of developing a pressure injury? While in bed, reposition every 2 to 4 hours, order specialized foam overlay, apply barrier cream every shift to protect skin from moisture-associated skin damage, and continue one-to-one feeding. An 84-year-old woman has been readmitted to a long-term care facility after a fall and C6 fracture. Initially, she developed neurogenic shock, resulting in hypotension, bradycardia, and flaccid paralysis. She has a percutaneous endoscopic gastrostomy tube. She spends most of her time in bed, requiring full assistance with turning and repositioning. She has a Foley catheter for urinary retention. She develops copious diarrhea of unclear etiology. C. diff and others were negative. In the past, a rectal tube caused severe gastrointestinal bleeding requiring a blood transfusion; this device was not reconsidered for stool management. Turning her for hygiene care has been a challenge because she will often yell out in pain. She has developed a wound on her right buttock area. The discharge paperwork from the long-term care facility indicates that this started as a purplish discoloration 5 days ago. What is the diagnosis? Unstageable pressure injury pg. 17 A 65-year-old male with Parkinson disease comes to your clinic after a 6-week hospitalization for aspiration pneumonia. He has had worsening mobility in the past year and uses a wheelchair. He developed a stage 3 heel pressure injury. Vascular was consulted and determined that he had adequate arterial flow for wound healing. They recommended wet to dry dressings TID. The wife has been providing his rehabilitative care at home. She notes that the wet to dry dressings are painful to the patient. She gives him oxycodone before dressing changes. The wound has moderate foul-smelling drainage, wet necrotic slough that does not obscure the wound base, and mild erythema. The wife notes that her husband has increasing pain over the past few days and bleeds easily with dressing changes. He has had no fever, chills, or other systemic symptoms. Which of the following signs or symptoms would suggest that a wound is infected? a. Increasing pain b. Foul-smelling drainage c. Necrotic tissue d. Erythema e. All of the above For the patient in question 3, in addition to floating the heels and other pressure reduction techniques, which is the preferred local wound care management plan? Silver-impregnated hydrofiber three times per week and as-needed cleansing pg. 18 Chapter 36: Hypertension An 80-year-old Black woman has a blood pressure (BP) of 168/102 mmHg and is started on amlodipine 5 mg daily. The JNC 8 panel recommends treating this patient to a goal blood pressure of less than 150 mmHg systolic and 90 mmHg diastolic A 54-year-old Hispanic woman has home BP of 155/95 mmHg, confirmed by multiple similar readings and office BP of 154/94 mmHg. She exercises, follows a low-salt diet, and rarely drinks alcohol. Which one of the following medications would be most appropriate for this patient? Chlorthalidone A 72-year-old man with a history of hypertension recently had acute coronary syndrome for which he was hospitalized and treated with a stent to one of his coronary arteries. In addition to antiplatelet therapy, what antihypertensives are recommended to treat his BP and improve outcomes regarding his ischemic heart disease? Lisinopril and metoprolol Chapter 37: Coronary Artery Disease and Atrial Fibrillation pg. 19 The pathophysiology that underlies the formation of atherosclerotic plaque in coronary arteries is primarily associated with which of the following mechanisms? Inflammation An 80-year-old woman is evaluated in your clinic for muscle aches. Her daughter, who is a nurse, states that her symptoms worsened after recently starting atorvastatin 80 mg daily. This medication and dose was selected based on the patient wanting to reduce her chance of a heart attack or stroke. She has a known history of stable coronary artery disease (CAD), without prior coronary revascularization. She takes low dose aspirin and her blood pressure is well controlled on lisinopril 20 mg once daily. You recognize that myalgias and myopathic symptoms are dose related and more common in older adults prescribed statins. Which of the following recommendations would be appropriate at this time? Discontinue atorvastatin until the myopathy has resolved, then consider restarting atorvastatin at a low dose, such as 10 mg once daily or an alternative statin A 75-year-old man with stable ischemic heart disease (SIHD) and moderate angina returns for follow-up. Prior stress testing has documented myocardial ischemia. A coronary angiogram performed 6 months ago showed that he has few options for revascularization and should be managed medically, although high-risk percutaneous coronary intervention (PCI) can be performed for lifestyle limiting symptoms. Reviewing his medications, it appears that he has been taking pg. 20 amlodipine 10 mg daily, in addition to statin, aspirin, and as needed sublingual nitroglycerin. What would be the most appropriate next step in his management? His antianginal regimen should be improved to include the addition of a beta blocker and/or a long acting nitrate. An 88-year-old female patient with Parkinson disease presents to clinic for hospital follow-up for atrial fibrillation (AF) with rapid ventricular response (RVR). Home heart rate monitoring shows good rate control of her AF ventricular rates. She has a history of falls and labile international normalized ratio (INR) with irregular adherence with blood draws. Her current medications include carbidopa-levodopa, metoprolol, and warfarin and she has a robust drug plan that allows for a variety of medication choices. What changes would you recommend to her medication regimen? Convert warfarin to a direct oral anticoagulant Chapter 38: Heart Failure In patients with heart failure, the most useful initial imaging modality is: Transthoracic echocardiogram Compared with angiotensin-converting enzyme (ACE) inhibitors, angiotensinreceptor blocker are less likely to be associated with: pg. 21 Angioedema Which class of drug has not been shown to provide a mortality benefit in heart failure patients with reduced ejection fraction? Diuretics Which of the following would be consistent with the new onset of heart failure in an older patient? a. Dyspnea b. Worsening ability to self-care c. Anorexia d. Confusion e. All of the above Which of the following drugs do not trigger or aggravate a cough? Hydrochlorothiazide pg. 22 Chapter 41: Diabetes Mellitus You are seeing an 85-year-old gentleman with a 15-year history of diabetes mellitus, coronary artery disease and coronary artery bypass grafting 7 years ago, and mild chronic obstructive pulmonary disease. He lives in a senior living community in an independent apartment and gets help from family with shopping and medication management. He feels generally well, but complains of occasional episodes of weakness and nausea in the morning and before lunch. What is the most appropriate advice for this gentleman with respect to treatment goals for his diabetes? Check blood glucose each morning before breakfast and adjust medications to keep HbA1C 8%. Which of the following management strategies would have the lowest risk of hypoglycemia in an older adult with type 2 diabetes mellitus? Metformin You are seeing an 80-year-old woman who recently moved to the area to live closer to her daughter. She reports a 10-year history of diabetes mellitus, which she has managed with metformin and glimeperide. She feels well but admits to having been very busy in the recent past. In fact, she has not seen a doctor in nearly a year. pg. 23 Which of the following health assessment measures would be appropriate in this patient? Brief cognitive testing and examination of gait and balance A client is newly diagnosed with type 2 diabetes mellitus. Which diagnostic test will best evaluate the management plan prescribed for this client? Quarterly hemoglobin A1C Chapter 42: Thyroid Disorders The most common presenting feature of hyperthyroidism in older adults is: Atrial fibrillation. Hyperthyroidism is diagnosed with which of the following: A decreased serum level of thyroid-stimulating hormone (TSH) and an elevated serum level of unbound thyroxine (free T4). pg. 24 Which one of the following is correct about subclinical hypothyroidism? Treatment is controversial. Which of the following is correct about thyroid disease in older adults? Hypothyroidism is associated with weight loss in older adults. Which of the following statements about thyroid cancer are true? Papillary thyroid cancer is more common in older adults. If untreated, subclinical hyperthyroidism: May cause cardiac failure. Which diagnostic laboratory test would the nurse practitioner typically not order for the purpose of evaluating an individual's acute, unexplained weight loss pg. 25 Serum Potassium Weight loss is frequently caused by ingestion of one or more of the following drugs. Antibiotics Digoxin Nonsteroidal anti-inflammatory drugs (NSAIDs) Theophylline Chapter 43: Osteoporosis A 70-year-old postmenopausal female presents to your clinic to discuss treatment options for her low bone density. She has no prior history of hip or vertebral fractures. She has type 2 diabetes mellitus and associated chronic kidney disease (baseline creatinine clearance 29 mL/min). Body mass index (BMI) is 30 kg/m2. She had a myocardial infarction 1 year ago. She was diagnosed with breast cancer 10 years ago, for which she underwent a mastectomy, chemotherapy, external beam radiation, and a course of tamoxifen. She takes a daily calcium and vitamin D supplement. Serum calcium and 25-hydroxyvitamin D levels are normal. She has a family history of maternal hip fracture Current DXA L-spine Total hip Femoral neck T-score −2.4 −2.1 −2.3 pg. 26 FRAX 10-year fracture risk score: Major osteoporotic fracture = 12%, hip fracture = 5% Which of the following is the best treatment option for this pati Denosumab A 71-year-old male with a past medical history of hypertension presents for follow-up of his osteoporosis. He was diagnosed with osteoporosis by DXA scan 5 years ago after an ankle fracture and has been on weekly alendronate 70 mg since that time. He has no prior history of hip or vertebral fractures. He is active and performs aerobic and strength-training exercises four times per week. No kyphosis is noted on examination. BMI is 23 kg/m2. No loss of height while on alendronate. He takes a daily calcium and vitamin D supplement. He does not smoke or consume alcohol. His repeat DXA scan demonstrates a significant increase in his spine bone mass density (BMD) of 5%. Pretreatment DXA L-spine Total hip Femoral neck T-score −2.7 −2.2 −2.5 Current DXA L-spine Total hip Femoral neck T-score −2.0 −2.1 −2.3 Which of the following is the most appropriate trea Discuss initiation of drug holiday pg. 27 A 73-year-old postmenopausal female presents for follow-up of her osteoporosis. Because of gastrointestinal (GI) intolerance to alendronate, she has received 3 years of intravenous zoledronic acid. She has a history significant for type 2 diabetes mellitus with associated peripheral neuropathy and chronic obstructive pulmonary disease treated frequently with glucocorticoids. She has a prior history of a nontraumatic vertebral fracture at T12. She falls frequently. She continues to smoke cigarettes daily. She does not consume alcohol. Her BMI is 25 kg/m2. Since initiating zoledronic acid, she has had stable height and no new vertebral fractures. Current DXA results L-spine Total hip Femoral neck T-score −2.8 −2.5 −2.4 The BMD has remained stable compared with prior DXA measures after 3 years of zoledronic acid. Which of the following is the most appropriate treatment opti