NR 601 – FINAL EXAM (2026/2027) | QUESTIONS AND A+ GRADED ANSWERS
NR 601: Primary Care of the Maturing and Aged Family - Final Examination | Core Domains: Geriatric
Assessment & Comprehensive Evaluation, Management of Common Geriatric Syndromes (Falls,
Dementia, Polypharmacy, Incontinence), Chronic Disease Management in Older Adults, Palliative &
End-of-Life Care, Pharmacotherapy & Prescribing for Older Adults, Ethical & Legal Issues in Geriatric
Care, Interprofessional Collaboration in Aging Populations, and Health Promotion & Functional
Optimization in Aging | Adult-Gerontology Primary Care Nurse Practitioner Focus | Comprehensive
Geriatric Final Exam Format
Exam Structure
The NR 601 Final Exam for the 2026/2027 academic cycle is a 125-question, multiple-choice question
(MCQ) examination.
Introduction
This NR 601 Final Exam guide for the 2026/2027 cycle prepares AGPCNP students for the comprehensive
assessment of primary care for older adults. The content integrates principles of geriatric assessment,
complex chronic disease management, pharmacology considering age-related changes, and holistic,
patient-centered approaches to care for the maturing and aged population within the primary care setting.
Answer Format
All correct answers and geriatric management strategies must be presented in bold and green, followed
by detailed rationales that apply geriatric assessment tools (e.g., SPICES, MMSE, Beers Criteria), justify
pharmacologic adjustments for renal/hepatic function, develop care plans for geriatric syndromes,
integrate palliative care principles, and adhere to ethical standards in caring for older adults.
Questions (125 Total)
1. An 82-year-old male presents with new-onset confusion, urinary incontinence, and falls. Urinalysis
shows leukocytes and nitrites. What condition should the nurse practitioner suspect?
A. Alzheimer’s dementia
B. Delirium secondary to urinary tract infection
C. Parkinson’s disease
D. Normal pressure hydrocephalus
Rationale: Delirium is an acute, fluctuating change in cognition often triggered by infection,
medications, or metabolic disturbances. UTI is a common cause in older adults, presenting atypically
with confusion, incontinence, or falls rather than dysuria or fever. Dementia is chronic and progressive;
NPH includes gait apraxia and urinary urgency but not acute confusion.
,2. Which medication on the Beers Criteria list should be avoided in older adults due to high
anticholinergic burden?
A. Lisinopril
B. Diphenhydramine
C. Metformin
D. Atorvastatin
Rationale: Diphenhydramine is listed in the AGS Beers Criteria as potentially inappropriate in older
adults due to strong anticholinergic effects, which increase risks of cognitive impairment, constipation,
urinary retention, and falls. Non-sedating antihistamines (e.g., loratadine) are safer alternatives.
3. A 78-year-old female reports falling twice in the past month. She takes amlodipine, sertraline, and
hydrochlorothiazide. What is the priority intervention?
A. Prescribe a walker
B. Perform a comprehensive fall risk assessment including medication review and gait
evaluation
C. Order brain MRI
D. Increase fluid intake
Rationale: Falls in older adults are multifactorial. A comprehensive assessment per CDC STEADI
guidelines includes medication review (diuretics and SSRIs increase fall risk), gait/balance testing (e.g.,
Timed Up and Go), vision check, and home safety evaluation. Polypharmacy is a major modifiable risk
factor.
4. An 85-year-old with advanced dementia and recurrent aspiration pneumonia has a family requesting
“everything done.” What is the most appropriate response?
A. Proceed with intubation and ICU admission
B. Facilitate goals-of-care discussion focusing on quality of life and prognosis
C. Ignore the request due to futility
D. Transfer to hospice without consent
Rationale: In advanced dementia, aggressive interventions like intubation do not improve survival
and often reduce quality of life. The NP should lead a compassionate conversation about disease
trajectory, align treatment with patient values, and discuss comfort-focused options like hospice. Shared
decision-making respects autonomy while providing guidance.
,5. Which screening tool is most appropriate for assessing cognitive impairment in a primary care setting?
A. PHQ-9
B. Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA)
C. GAD-7
D. SPICES
Rationale: MMSE and MoCA are validated tools for cognitive screening. MoCA is more sensitive for
mild cognitive impairment. PHQ-9 and GAD-7 assess depression and anxiety; SPICES is a geriatric
syndrome screen (Sleep, Problems with eating, Incontinence, Confusion, Evidence of falls, Skin
breakdown).
6. A 75-year-old male with CKD stage 3 (eGFR 42 mL/min) requires pain management after knee
replacement. Which medication is safest?
A. Naproxen
B. Acetaminophen
C. Ibuprofen
D. Celecoxib
Rationale: NSAIDs (naproxen, ibuprofen, celecoxib) can worsen renal function and cause fluid
retention in CKD. Acetaminophen is the preferred analgesic for mild-moderate pain in older adults with
kidney disease. Opioids may be used cautiously if needed, but acetaminophen is first-line.
7. An 80-year-old female with heart failure (EF 30%) has a serum potassium of 3.0 mEq/L and is on
furosemide. What is the priority action?
A. Administer spironolactone 25 mg PO
B. Prescribe potassium chloride 20 mEq daily and monitor ECG
C. Increase furosemide dose
D. Discontinue all diuretics
Rationale: Hypokalemia increases the risk of digoxin toxicity and lethal arrhythmias, especially in
patients with HFrEF. Potassium replacement is urgent. Spironolactone (a potassium-sparing diuretic)
may be added later per guideline-directed medical therapy (GDMT), but immediate K⁺ repletion is
critical.
8. Which statement best reflects the principle of “start low, go slow” in geriatric prescribing?
, A. Begin with adult doses and adjust downward if side effects occur
B. Initiate medications at ½ to ⅓ the adult dose and titrate slowly based on response and
tolerance
C. Avoid all new medications in patients over 80
D. Use only once-daily dosing regardless of drug half-life
Rationale: Age-related declines in renal/hepatic clearance, increased body fat, and reduced lean mass
alter pharmacokinetics. Starting low and going slow minimizes adverse drug reactions—the leading
cause of hospitalization in older adults.
9. A 77-year-old male with type 2 diabetes has an HbA1c of 8.2%. He has CKD stage 3 and heart failure.
What is the next best step per ADA 2026 guidelines?
A. Add glyburide
B. Add SGLT2 inhibitor (e.g., empagliflozin)
C. Increase metformin to maximum dose
D. Start insulin glargine
Rationale: ADA 2026 recommends SGLT2 inhibitors or GLP-1 RAs with proven cardiovascular and
renal benefits for patients with T2DM and ASCVD, HF, or CKD—regardless of HbA1c. Empagliflozin
reduces HF hospitalizations and slows CKD progression. Glyburide is on Beers Criteria due to
hypoglycemia risk.
10. An 88-year-old female lives alone and has unintentional weight loss of 10 pounds in 3 months. What
is the most likely cause?
A. Normal aging
B. Underlying malignancy, depression, or occult infection
C. Increased physical activity
D. High-fiber diet
Rationale: Unintentional weight loss in older adults is never normal and warrants investigation.
Common causes include cancer, depression, GI disorders, hyperthyroidism, and infections (e.g., TB). A
thorough history, physical, and basic labs (CBC, TSH, LFTs) are indicated.
11. The primary goal of palliative care is to:
A. Cure the underlying disease
NR 601: Primary Care of the Maturing and Aged Family - Final Examination | Core Domains: Geriatric
Assessment & Comprehensive Evaluation, Management of Common Geriatric Syndromes (Falls,
Dementia, Polypharmacy, Incontinence), Chronic Disease Management in Older Adults, Palliative &
End-of-Life Care, Pharmacotherapy & Prescribing for Older Adults, Ethical & Legal Issues in Geriatric
Care, Interprofessional Collaboration in Aging Populations, and Health Promotion & Functional
Optimization in Aging | Adult-Gerontology Primary Care Nurse Practitioner Focus | Comprehensive
Geriatric Final Exam Format
Exam Structure
The NR 601 Final Exam for the 2026/2027 academic cycle is a 125-question, multiple-choice question
(MCQ) examination.
Introduction
This NR 601 Final Exam guide for the 2026/2027 cycle prepares AGPCNP students for the comprehensive
assessment of primary care for older adults. The content integrates principles of geriatric assessment,
complex chronic disease management, pharmacology considering age-related changes, and holistic,
patient-centered approaches to care for the maturing and aged population within the primary care setting.
Answer Format
All correct answers and geriatric management strategies must be presented in bold and green, followed
by detailed rationales that apply geriatric assessment tools (e.g., SPICES, MMSE, Beers Criteria), justify
pharmacologic adjustments for renal/hepatic function, develop care plans for geriatric syndromes,
integrate palliative care principles, and adhere to ethical standards in caring for older adults.
Questions (125 Total)
1. An 82-year-old male presents with new-onset confusion, urinary incontinence, and falls. Urinalysis
shows leukocytes and nitrites. What condition should the nurse practitioner suspect?
A. Alzheimer’s dementia
B. Delirium secondary to urinary tract infection
C. Parkinson’s disease
D. Normal pressure hydrocephalus
Rationale: Delirium is an acute, fluctuating change in cognition often triggered by infection,
medications, or metabolic disturbances. UTI is a common cause in older adults, presenting atypically
with confusion, incontinence, or falls rather than dysuria or fever. Dementia is chronic and progressive;
NPH includes gait apraxia and urinary urgency but not acute confusion.
,2. Which medication on the Beers Criteria list should be avoided in older adults due to high
anticholinergic burden?
A. Lisinopril
B. Diphenhydramine
C. Metformin
D. Atorvastatin
Rationale: Diphenhydramine is listed in the AGS Beers Criteria as potentially inappropriate in older
adults due to strong anticholinergic effects, which increase risks of cognitive impairment, constipation,
urinary retention, and falls. Non-sedating antihistamines (e.g., loratadine) are safer alternatives.
3. A 78-year-old female reports falling twice in the past month. She takes amlodipine, sertraline, and
hydrochlorothiazide. What is the priority intervention?
A. Prescribe a walker
B. Perform a comprehensive fall risk assessment including medication review and gait
evaluation
C. Order brain MRI
D. Increase fluid intake
Rationale: Falls in older adults are multifactorial. A comprehensive assessment per CDC STEADI
guidelines includes medication review (diuretics and SSRIs increase fall risk), gait/balance testing (e.g.,
Timed Up and Go), vision check, and home safety evaluation. Polypharmacy is a major modifiable risk
factor.
4. An 85-year-old with advanced dementia and recurrent aspiration pneumonia has a family requesting
“everything done.” What is the most appropriate response?
A. Proceed with intubation and ICU admission
B. Facilitate goals-of-care discussion focusing on quality of life and prognosis
C. Ignore the request due to futility
D. Transfer to hospice without consent
Rationale: In advanced dementia, aggressive interventions like intubation do not improve survival
and often reduce quality of life. The NP should lead a compassionate conversation about disease
trajectory, align treatment with patient values, and discuss comfort-focused options like hospice. Shared
decision-making respects autonomy while providing guidance.
,5. Which screening tool is most appropriate for assessing cognitive impairment in a primary care setting?
A. PHQ-9
B. Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA)
C. GAD-7
D. SPICES
Rationale: MMSE and MoCA are validated tools for cognitive screening. MoCA is more sensitive for
mild cognitive impairment. PHQ-9 and GAD-7 assess depression and anxiety; SPICES is a geriatric
syndrome screen (Sleep, Problems with eating, Incontinence, Confusion, Evidence of falls, Skin
breakdown).
6. A 75-year-old male with CKD stage 3 (eGFR 42 mL/min) requires pain management after knee
replacement. Which medication is safest?
A. Naproxen
B. Acetaminophen
C. Ibuprofen
D. Celecoxib
Rationale: NSAIDs (naproxen, ibuprofen, celecoxib) can worsen renal function and cause fluid
retention in CKD. Acetaminophen is the preferred analgesic for mild-moderate pain in older adults with
kidney disease. Opioids may be used cautiously if needed, but acetaminophen is first-line.
7. An 80-year-old female with heart failure (EF 30%) has a serum potassium of 3.0 mEq/L and is on
furosemide. What is the priority action?
A. Administer spironolactone 25 mg PO
B. Prescribe potassium chloride 20 mEq daily and monitor ECG
C. Increase furosemide dose
D. Discontinue all diuretics
Rationale: Hypokalemia increases the risk of digoxin toxicity and lethal arrhythmias, especially in
patients with HFrEF. Potassium replacement is urgent. Spironolactone (a potassium-sparing diuretic)
may be added later per guideline-directed medical therapy (GDMT), but immediate K⁺ repletion is
critical.
8. Which statement best reflects the principle of “start low, go slow” in geriatric prescribing?
, A. Begin with adult doses and adjust downward if side effects occur
B. Initiate medications at ½ to ⅓ the adult dose and titrate slowly based on response and
tolerance
C. Avoid all new medications in patients over 80
D. Use only once-daily dosing regardless of drug half-life
Rationale: Age-related declines in renal/hepatic clearance, increased body fat, and reduced lean mass
alter pharmacokinetics. Starting low and going slow minimizes adverse drug reactions—the leading
cause of hospitalization in older adults.
9. A 77-year-old male with type 2 diabetes has an HbA1c of 8.2%. He has CKD stage 3 and heart failure.
What is the next best step per ADA 2026 guidelines?
A. Add glyburide
B. Add SGLT2 inhibitor (e.g., empagliflozin)
C. Increase metformin to maximum dose
D. Start insulin glargine
Rationale: ADA 2026 recommends SGLT2 inhibitors or GLP-1 RAs with proven cardiovascular and
renal benefits for patients with T2DM and ASCVD, HF, or CKD—regardless of HbA1c. Empagliflozin
reduces HF hospitalizations and slows CKD progression. Glyburide is on Beers Criteria due to
hypoglycemia risk.
10. An 88-year-old female lives alone and has unintentional weight loss of 10 pounds in 3 months. What
is the most likely cause?
A. Normal aging
B. Underlying malignancy, depression, or occult infection
C. Increased physical activity
D. High-fiber diet
Rationale: Unintentional weight loss in older adults is never normal and warrants investigation.
Common causes include cancer, depression, GI disorders, hyperthyroidism, and infections (e.g., TB). A
thorough history, physical, and basic labs (CBC, TSH, LFTs) are indicated.
11. The primary goal of palliative care is to:
A. Cure the underlying disease
