NR601 Week 8 Final Exam/NR 601 Primary Care of the
Maturing and Aged Family Practicum NR 601 Midterm and
Finals Examplify Online Proctored Exam Newest 2025/2026
Complete - 150 Questions
Section 1: Health Promotion and Disease Prevention in Older Adults (Questions 1-15)
1 A 78-year-old community-dwelling individual with hypertension and type 2 diabetes presents for an annual
wellness visit. Current blood pressure is 128/76 mmHg on lisinopril 10 mg daily. Hemoglobin A1c is 7.0% on
metformin. The patient has no history of falls, cognitive impairment, or cardiovascular disease. According to the
2023 USPSTF recommendation on statin use for primary prevention of CVD, which of the following is the most
appropriate next step?
A) Initiate high-intensity statin therapy (atorvastatin 40-80 mg) without further risk calculation.
B) Calculate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score using the pooled cohort
equations; if 7.5%, discuss adding a moderate-intensity statin.
C) Defer statin therapy because the patient is over 75 and evidence for benefit is insufficient.
D) Order a coronary artery calcium (CAC) score to guide decision-making before considering statin.
Answer: B
Rationale: The 2022/2023 USPSTF recommendation for adults aged 40-75 with no prior CVD and with one or more
risk factors (hypertension, diabetes) recommends a moderate-intensity statin if the 10-year ASCVD risk is 7.5%.
For adults >75, the evidence is limited but still recommends shared decision-making based on risk estimation.
Option A is too aggressive without risk calculation; Option C ignores that age alone does not preclude benefit;
Option D may be considered but is not the first step as per USPSTF.
2 A 72-year-old patient with a history of chronic kidney disease stage 3 (eGFR 45 mL/min/1.73 m²) and
well-controlled hypertension asks about colorectal cancer screening. The patient had a colonoscopy 8 years ago
that was normal. Which of the following best reflects current guidelines for continued screening in this
population?
A) Repeat colonoscopy in 10 years because the prior exam was normal and age-adjusted life expectancy is >10
years.
B) Discontinue screening because the patient is over 70 and has CKD, which increases procedural risk.
C) Switch to annual fecal immunochemical testing (FIT) because colonoscopy carries higher risk in CKD.
D) Offer a one-time CT colonography to avoid sedation risks, then stop screening.
Answer: A
Rationale: The US Multi-Society Task Force recommends that average-risk individuals with a normal colonoscopy
should repeat in 10 years. Age alone is not a reason to stop if life expectancy exceeds the screening interval. CKD
stage 3 does not contraindicate colonoscopy if managed appropriately. Option B incorrectly assumes age and CKD
warrant cessation; Option C is not indicated for average-risk with prior normal colonoscopy; Option D is not
standard and CT colonography still requires bowel preparation.
3 Which of the following immunizations is specifically recommended by the CDC's Advisory Committee on
Immunization Practices (ACIP) for all adults aged 65 years, regardless of underlying conditions, and is
administered as a single dose?
A) Respiratory syncytial virus (RSV) vaccine (Arexvy or Abrysvo)
,B) Recombinant zoster vaccine (RZV, Shingrix)
C) 20-valent pneumococcal conjugate vaccine (PCV20)
D) High-dose quadrivalent influenza vaccine (Fluzone High-Dose)
Answer: B
Rationale: ACIP recommends RZV for immunocompetent adults aged "e50 years, but for those "e65, it is a routine
single-dose (actually 2-dose series) vaccine. However, among the options, RZV is the only one universally
recommended for all adults 65 without risk-based conditions. PCV20 is recommended for those with risk factors or
as shared decision-making for 65+. RSV vaccine is recommended for adults 60 with shared decision-making, not
universal. High-dose influenza vaccine is recommended for 65 but is not a single-dose (annual).
4 A 76-year-old patient with mild cognitive impairment (MCI) and a history of peptic ulcer disease asks about
daily aspirin for heart attack prevention. The patient has no prior cardiovascular events. Which of the following
is the most appropriate approach?
A) Start low-dose aspirin (81 mg) daily because the benefit of preventing myocardial infarction outweighs the
risk of gastrointestinal bleeding.
B) Recommend against initiating aspirin due to increased bleeding risk and uncertain net benefit in older adults
without CVD.
C) Order a fecal occult blood test before starting aspirin to rule out occult bleeding.
D) Prescribe enteric-coated aspirin to reduce gastrointestinal risk and monitor renal function.
Answer: B
Rationale: The 2022 USPSTF recommendation advises against initiating low-dose aspirin for primary prevention of
CVD in adults aged 60 years due to a net zero or harmful benefit (increased bleeding risk). This patient also has
peptic ulcer disease history, further elevating bleeding risk. Option A ignores the age threshold and risk factors;
Option C is not recommended as a screening tool; Option D does not sufficiently mitigate risk and enteric coating
does not eliminate GI bleeding.
5 Which of the following screening tests is recommended by the USPSTF for all adults aged 65 and older,
regardless of risk factors, and is performed at least once?
A) Abdominal aortic aneurysm (AAA) screening with ultrasound
B) Bone mineral density (BMD) screening for osteoporosis
C) Hepatitis C virus (HCV) screening with anti-HCV antibody
D) Tuberculosis screening with IGRA or PPD
Answer: C
Rationale: The USPSTF recommends one-time HCV screening for all adults aged 18-79 years (expanded to include
65+). For those >79, shared decision-making applies, but for 65+, it is recommended at least once. AAA screening
is only for men aged 65-75 who have ever smoked; BMD screening is for women 65, but not all (risk assessment);
TB screening is not universal.
6 A 74-year-old patient with a 30-pack-year smoking history, currently smoking, has no symptoms of lung cancer.
The patient has a life expectancy of at least 10 years based on functional status. According to the USPSTF,
which of the following is the most appropriate lung cancer screening recommendation?
A) No screening because the patient is over 70 and screening is not recommended beyond age 74.
B) Annual low-dose computed tomography (LDCT) until age 80, with shared decision-making.
C) Chest X-ray annually for 3 years, then discontinue.
D) LDCT every 3 years because the patient has a significant smoking history.
Answer: B
Rationale: The 2021 USPSTF recommends annual LDCT for adults aged 50-80 with a 20 pack-year smoking
,history and currently smoke or quit within 15 years. Screening should stop when the patient has not smoked for 15
years or develops a condition limiting life expectancy. Option A incorrectly states age 70; Option C is not
recommended; Option D interval is incorrect.
7 A 68-year-old patient with a history of osteoarthritis and hypertension asks about fall prevention strategies. The
patient reports one fall in the past year without injury. Which of the following interventions has the strongest
evidence for reducing fall risk in community-dwelling older adults?
A) Prescribing vitamin D 800 IU daily and calcium 1200 mg daily
B) Multifactorial risk assessment followed by tailored interventions (e.g., medication review, vision assessment,
home safety evaluation)
C) Referral for a single vision correction (e.g., new glasses) if visual acuity is impaired
D) Encouraging the patient to use a cane or walker for ambulation
Answer: B
Rationale: The USPSTF recommends that clinicians exercise to prevent falls in community-dwelling adults "e65 at
increased risk, but multifactorial assessment and tailored interventions have strong evidence for reducing fall rates.
Option A has limited evidence for fall prevention; Option C alone is insufficient; Option D may reduce mobility
and increase fall risk if not properly fitted.
8 A 70-year-old patient with a body mass index of 27 kg/m² and no history of diabetes undergoes screening for
prediabetes. Fasting plasma glucose is 108 mg/dL, and hemoglobin A1c is 5.9%. According to the American
Diabetes Association (ADA) guidelines, which of the following is the most appropriate next step?
A) Diagnose prediabetes and recommend lifestyle modification including weight loss and increased physical
activity.
B) Start metformin 500 mg daily due to age and elevated A1c.
C) Repeat fasting glucose and A1c in 3 months because results are borderline.
D) No intervention because A1c <6.0% is considered normal.
Answer: A
Rationale: ADA criteria for prediabetes include fasting glucose 100-125 mg/dL or A1c 5.7-6.4%. This patient meets
both criteria. Lifestyle modification is first-line. Metformin is considered for those with BMI 35, age <60, or
women with GDM, but this patient does not meet those criteria. Option C is not necessary for diagnosis; Option D
is incorrect.
9 Which of the following is a recommended strategy for promoting physical activity in older adults according to
the American College of Sports Medicine (ACSM) and CDC?
A) Engage in at least 150 minutes of moderate-intensity aerobic activity per week and two days of
muscle-strengthening activities.
B) Avoid any high-impact activity to prevent joint injury and focus solely on flexibility exercises.
C) Accumulate 30 minutes of vigorous-intensity aerobic activity on 5 days per week, with no specific strength
training.
D) Perform balance exercises three times per week, but only if there is a history of falls.
Answer: A
Rationale: The ACSM and CDC recommend that older adults should aim for at least 150 minutes of
moderate-intensity aerobic activity per week (e.g., brisk walking) and muscle-strengthening activities on 2 or more
days per week. Option B is overly restrictive; Option C recommends vigorous activity which may not be
appropriate for all; Option D is insufficient for overall health.
, 10 A 72-year-old patient with a history of atrial fibrillation (on warfarin) and hypertension asks about the
COVID-19 vaccine booster. The patient received the primary series of mRNA vaccine (Pfizer-BioNTech) 6
months ago. Which of the following is the most appropriate recommendation according to the CDC?
A) Administer a booster dose of the same mRNA vaccine (Pfizer) at least 2 months after the primary series.
B) Administer a booster dose of any COVID-19 vaccine (mRNA or viral vector) at least 5 months after the
primary series.
C) No booster is needed because the patient is on anticoagulation and risk of injection-site bleeding outweighs
benefit.
D) Administer a second booster dose (fourth dose) because the patient is immunocompromised due to atrial
fibrillation.
Answer: B
Rationale: As of 2025, CDC recommends that adults aged "e65 receive a booster dose of the updated (2024-2025)
COVID-19 vaccine at least 2 months after the last dose. Option A is outdated (2 months interval for some, but
generally 5 months for initial booster); Option C is incorrect because anticoagulation is not a contraindication;
Option D is incorrect because atrial fibrillation is not immunocompromising.
11 A primary care clinic is implementing a comprehensive health promotion program for community-dwelling
older adults. Based on current guidelines from the U.S. Preventive Services Task Force (USPSTF) and the
Centers for Disease Control and Prevention (CDC), which combination of preventive interventions is most
strongly recommended for all adults aged 65 years and older, regardless of individual risk factors?
A) Annual lung cancer screening with low-dose CT, colorectal cancer screening until age 75, and one-time
hepatitis C screening
B) Annual influenza vaccination, pneumococcal vaccination with PCV20 or PCV15 followed by PPSV23, and
zoster vaccine recombinant (RZV) two-dose series
C) Daily low-dose aspirin for primary prevention of cardiovascular disease, biennial mammography up to age 74,
and bone mineral density testing every two years
D) Screening for cognitive impairment annually, screening for fall risk with multifactorial assessment, and
referral to physical therapy for gait training
Answer: B
Rationale: The USPSTF and CDC strongly recommend annual influenza vaccination, pneumococcal vaccination
(PCV20 alone or PCV15 followed by PPSV23), and the two-dose RZV series for all immunocompetent adults aged
65. Option A is incorrect because lung cancer screening is only for high-risk individuals (heavy smokers), and
hepatitis C screening is one-time but not for all ages. Option C is incorrect because aspirin is no longer
recommended for primary prevention in older adults due to bleeding risks, and mammography and bone density
screening have age limits and are not universally recommended annually. Option D is incorrect because cognitive
screening is not universally recommended by USPSTF (insufficient evidence), and fall risk screening is
recommended but not as strongly as immunizations.
12 In the context of health promotion for older adults, which of the following statements best reflects the current
evidence regarding the use of the 'Annual Wellness Visit' (AWV) and its impact on health outcomes?
A) The AWV has been shown to significantly reduce mortality and hospitalizations in all older adults when
combined with personalized prevention plans.
B) The AWV is primarily a billing mechanism without proven benefit, but it allows for opportunistic screening
and vaccination updates.
C) The AWV improves delivery of preventive services such as cancer screenings and vaccinations, but evidence
for reducing morbidity or mortality is limited.
Maturing and Aged Family Practicum NR 601 Midterm and
Finals Examplify Online Proctored Exam Newest 2025/2026
Complete - 150 Questions
Section 1: Health Promotion and Disease Prevention in Older Adults (Questions 1-15)
1 A 78-year-old community-dwelling individual with hypertension and type 2 diabetes presents for an annual
wellness visit. Current blood pressure is 128/76 mmHg on lisinopril 10 mg daily. Hemoglobin A1c is 7.0% on
metformin. The patient has no history of falls, cognitive impairment, or cardiovascular disease. According to the
2023 USPSTF recommendation on statin use for primary prevention of CVD, which of the following is the most
appropriate next step?
A) Initiate high-intensity statin therapy (atorvastatin 40-80 mg) without further risk calculation.
B) Calculate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score using the pooled cohort
equations; if 7.5%, discuss adding a moderate-intensity statin.
C) Defer statin therapy because the patient is over 75 and evidence for benefit is insufficient.
D) Order a coronary artery calcium (CAC) score to guide decision-making before considering statin.
Answer: B
Rationale: The 2022/2023 USPSTF recommendation for adults aged 40-75 with no prior CVD and with one or more
risk factors (hypertension, diabetes) recommends a moderate-intensity statin if the 10-year ASCVD risk is 7.5%.
For adults >75, the evidence is limited but still recommends shared decision-making based on risk estimation.
Option A is too aggressive without risk calculation; Option C ignores that age alone does not preclude benefit;
Option D may be considered but is not the first step as per USPSTF.
2 A 72-year-old patient with a history of chronic kidney disease stage 3 (eGFR 45 mL/min/1.73 m²) and
well-controlled hypertension asks about colorectal cancer screening. The patient had a colonoscopy 8 years ago
that was normal. Which of the following best reflects current guidelines for continued screening in this
population?
A) Repeat colonoscopy in 10 years because the prior exam was normal and age-adjusted life expectancy is >10
years.
B) Discontinue screening because the patient is over 70 and has CKD, which increases procedural risk.
C) Switch to annual fecal immunochemical testing (FIT) because colonoscopy carries higher risk in CKD.
D) Offer a one-time CT colonography to avoid sedation risks, then stop screening.
Answer: A
Rationale: The US Multi-Society Task Force recommends that average-risk individuals with a normal colonoscopy
should repeat in 10 years. Age alone is not a reason to stop if life expectancy exceeds the screening interval. CKD
stage 3 does not contraindicate colonoscopy if managed appropriately. Option B incorrectly assumes age and CKD
warrant cessation; Option C is not indicated for average-risk with prior normal colonoscopy; Option D is not
standard and CT colonography still requires bowel preparation.
3 Which of the following immunizations is specifically recommended by the CDC's Advisory Committee on
Immunization Practices (ACIP) for all adults aged 65 years, regardless of underlying conditions, and is
administered as a single dose?
A) Respiratory syncytial virus (RSV) vaccine (Arexvy or Abrysvo)
,B) Recombinant zoster vaccine (RZV, Shingrix)
C) 20-valent pneumococcal conjugate vaccine (PCV20)
D) High-dose quadrivalent influenza vaccine (Fluzone High-Dose)
Answer: B
Rationale: ACIP recommends RZV for immunocompetent adults aged "e50 years, but for those "e65, it is a routine
single-dose (actually 2-dose series) vaccine. However, among the options, RZV is the only one universally
recommended for all adults 65 without risk-based conditions. PCV20 is recommended for those with risk factors or
as shared decision-making for 65+. RSV vaccine is recommended for adults 60 with shared decision-making, not
universal. High-dose influenza vaccine is recommended for 65 but is not a single-dose (annual).
4 A 76-year-old patient with mild cognitive impairment (MCI) and a history of peptic ulcer disease asks about
daily aspirin for heart attack prevention. The patient has no prior cardiovascular events. Which of the following
is the most appropriate approach?
A) Start low-dose aspirin (81 mg) daily because the benefit of preventing myocardial infarction outweighs the
risk of gastrointestinal bleeding.
B) Recommend against initiating aspirin due to increased bleeding risk and uncertain net benefit in older adults
without CVD.
C) Order a fecal occult blood test before starting aspirin to rule out occult bleeding.
D) Prescribe enteric-coated aspirin to reduce gastrointestinal risk and monitor renal function.
Answer: B
Rationale: The 2022 USPSTF recommendation advises against initiating low-dose aspirin for primary prevention of
CVD in adults aged 60 years due to a net zero or harmful benefit (increased bleeding risk). This patient also has
peptic ulcer disease history, further elevating bleeding risk. Option A ignores the age threshold and risk factors;
Option C is not recommended as a screening tool; Option D does not sufficiently mitigate risk and enteric coating
does not eliminate GI bleeding.
5 Which of the following screening tests is recommended by the USPSTF for all adults aged 65 and older,
regardless of risk factors, and is performed at least once?
A) Abdominal aortic aneurysm (AAA) screening with ultrasound
B) Bone mineral density (BMD) screening for osteoporosis
C) Hepatitis C virus (HCV) screening with anti-HCV antibody
D) Tuberculosis screening with IGRA or PPD
Answer: C
Rationale: The USPSTF recommends one-time HCV screening for all adults aged 18-79 years (expanded to include
65+). For those >79, shared decision-making applies, but for 65+, it is recommended at least once. AAA screening
is only for men aged 65-75 who have ever smoked; BMD screening is for women 65, but not all (risk assessment);
TB screening is not universal.
6 A 74-year-old patient with a 30-pack-year smoking history, currently smoking, has no symptoms of lung cancer.
The patient has a life expectancy of at least 10 years based on functional status. According to the USPSTF,
which of the following is the most appropriate lung cancer screening recommendation?
A) No screening because the patient is over 70 and screening is not recommended beyond age 74.
B) Annual low-dose computed tomography (LDCT) until age 80, with shared decision-making.
C) Chest X-ray annually for 3 years, then discontinue.
D) LDCT every 3 years because the patient has a significant smoking history.
Answer: B
Rationale: The 2021 USPSTF recommends annual LDCT for adults aged 50-80 with a 20 pack-year smoking
,history and currently smoke or quit within 15 years. Screening should stop when the patient has not smoked for 15
years or develops a condition limiting life expectancy. Option A incorrectly states age 70; Option C is not
recommended; Option D interval is incorrect.
7 A 68-year-old patient with a history of osteoarthritis and hypertension asks about fall prevention strategies. The
patient reports one fall in the past year without injury. Which of the following interventions has the strongest
evidence for reducing fall risk in community-dwelling older adults?
A) Prescribing vitamin D 800 IU daily and calcium 1200 mg daily
B) Multifactorial risk assessment followed by tailored interventions (e.g., medication review, vision assessment,
home safety evaluation)
C) Referral for a single vision correction (e.g., new glasses) if visual acuity is impaired
D) Encouraging the patient to use a cane or walker for ambulation
Answer: B
Rationale: The USPSTF recommends that clinicians exercise to prevent falls in community-dwelling adults "e65 at
increased risk, but multifactorial assessment and tailored interventions have strong evidence for reducing fall rates.
Option A has limited evidence for fall prevention; Option C alone is insufficient; Option D may reduce mobility
and increase fall risk if not properly fitted.
8 A 70-year-old patient with a body mass index of 27 kg/m² and no history of diabetes undergoes screening for
prediabetes. Fasting plasma glucose is 108 mg/dL, and hemoglobin A1c is 5.9%. According to the American
Diabetes Association (ADA) guidelines, which of the following is the most appropriate next step?
A) Diagnose prediabetes and recommend lifestyle modification including weight loss and increased physical
activity.
B) Start metformin 500 mg daily due to age and elevated A1c.
C) Repeat fasting glucose and A1c in 3 months because results are borderline.
D) No intervention because A1c <6.0% is considered normal.
Answer: A
Rationale: ADA criteria for prediabetes include fasting glucose 100-125 mg/dL or A1c 5.7-6.4%. This patient meets
both criteria. Lifestyle modification is first-line. Metformin is considered for those with BMI 35, age <60, or
women with GDM, but this patient does not meet those criteria. Option C is not necessary for diagnosis; Option D
is incorrect.
9 Which of the following is a recommended strategy for promoting physical activity in older adults according to
the American College of Sports Medicine (ACSM) and CDC?
A) Engage in at least 150 minutes of moderate-intensity aerobic activity per week and two days of
muscle-strengthening activities.
B) Avoid any high-impact activity to prevent joint injury and focus solely on flexibility exercises.
C) Accumulate 30 minutes of vigorous-intensity aerobic activity on 5 days per week, with no specific strength
training.
D) Perform balance exercises three times per week, but only if there is a history of falls.
Answer: A
Rationale: The ACSM and CDC recommend that older adults should aim for at least 150 minutes of
moderate-intensity aerobic activity per week (e.g., brisk walking) and muscle-strengthening activities on 2 or more
days per week. Option B is overly restrictive; Option C recommends vigorous activity which may not be
appropriate for all; Option D is insufficient for overall health.
, 10 A 72-year-old patient with a history of atrial fibrillation (on warfarin) and hypertension asks about the
COVID-19 vaccine booster. The patient received the primary series of mRNA vaccine (Pfizer-BioNTech) 6
months ago. Which of the following is the most appropriate recommendation according to the CDC?
A) Administer a booster dose of the same mRNA vaccine (Pfizer) at least 2 months after the primary series.
B) Administer a booster dose of any COVID-19 vaccine (mRNA or viral vector) at least 5 months after the
primary series.
C) No booster is needed because the patient is on anticoagulation and risk of injection-site bleeding outweighs
benefit.
D) Administer a second booster dose (fourth dose) because the patient is immunocompromised due to atrial
fibrillation.
Answer: B
Rationale: As of 2025, CDC recommends that adults aged "e65 receive a booster dose of the updated (2024-2025)
COVID-19 vaccine at least 2 months after the last dose. Option A is outdated (2 months interval for some, but
generally 5 months for initial booster); Option C is incorrect because anticoagulation is not a contraindication;
Option D is incorrect because atrial fibrillation is not immunocompromising.
11 A primary care clinic is implementing a comprehensive health promotion program for community-dwelling
older adults. Based on current guidelines from the U.S. Preventive Services Task Force (USPSTF) and the
Centers for Disease Control and Prevention (CDC), which combination of preventive interventions is most
strongly recommended for all adults aged 65 years and older, regardless of individual risk factors?
A) Annual lung cancer screening with low-dose CT, colorectal cancer screening until age 75, and one-time
hepatitis C screening
B) Annual influenza vaccination, pneumococcal vaccination with PCV20 or PCV15 followed by PPSV23, and
zoster vaccine recombinant (RZV) two-dose series
C) Daily low-dose aspirin for primary prevention of cardiovascular disease, biennial mammography up to age 74,
and bone mineral density testing every two years
D) Screening for cognitive impairment annually, screening for fall risk with multifactorial assessment, and
referral to physical therapy for gait training
Answer: B
Rationale: The USPSTF and CDC strongly recommend annual influenza vaccination, pneumococcal vaccination
(PCV20 alone or PCV15 followed by PPSV23), and the two-dose RZV series for all immunocompetent adults aged
65. Option A is incorrect because lung cancer screening is only for high-risk individuals (heavy smokers), and
hepatitis C screening is one-time but not for all ages. Option C is incorrect because aspirin is no longer
recommended for primary prevention in older adults due to bleeding risks, and mammography and bone density
screening have age limits and are not universally recommended annually. Option D is incorrect because cognitive
screening is not universally recommended by USPSTF (insufficient evidence), and fall risk screening is
recommended but not as strongly as immunizations.
12 In the context of health promotion for older adults, which of the following statements best reflects the current
evidence regarding the use of the 'Annual Wellness Visit' (AWV) and its impact on health outcomes?
A) The AWV has been shown to significantly reduce mortality and hospitalizations in all older adults when
combined with personalized prevention plans.
B) The AWV is primarily a billing mechanism without proven benefit, but it allows for opportunistic screening
and vaccination updates.
C) The AWV improves delivery of preventive services such as cancer screenings and vaccinations, but evidence
for reducing morbidity or mortality is limited.
