NR601 Final Exam 2026/2027 – Primary
Care of the Maturing & Aged Family
Practicum Complete Q&A Study Guide with
Detailed Rationales
1. Geriatric assessments encompass four main domains. Which of the
following is NOT one of these domains?
• A) Mental
• B) Physical
• C) Financial
• D) Spiritual
Rationale: The four main domains of geriatric assessment are mental, physical,
functional, and social/economic. Spiritual assessment, while important, is not
considered one of the four core domains of the standard geriatric assessment.
2. When should a comprehensive geriatric assessment be performed?
• A) Only when a patient is acutely ill
• B) When a patient is stable and at the time of the initial visit when
establishing care
• C) Only when the patient requests it
• D) Annually after age 75
Rationale: A geriatric assessment should be done when a patient is stable and at
the time of the initial visit when the patient is establishing care. This provides a
baseline for future comparisons and allows for early identification of issues.
3. An 82-year-old man with heart failure and stage 3 CKD is taking
furosemide 80 mg BID. His BP is 98/58 mmHg, and his creatinine has risen.
What is the most appropriate adjustment?
, • A) Increase lisinopril
• B) Reduce furosemide to 40 mg BID
• C) Start spironolactone
• D) Add hydrochlorothiazide
Rationale: The hypotension and rising creatinine suggest over-diuresis (prerenal
azotemia). Reducing the diuretic dose is the appropriate first step to improve renal
perfusion while maintaining some diuresis.
4. A 79-year-old man with COPD (GOLD B) has an FEV₁ of 55% predicted
and two exacerbations per year. His inhaler technique is correct. Which
regimen is best?
• A) LABA alone
• B) LAMA alone
• C) LABA + LAMA
• D) LABA + ICS
Rationale: For GOLD B COPD with FEV₁ < 60% and multiple exacerbations,
LABA + LAMA is the preferred regimen. This combination provides optimal
bronchodilation without the added risks of ICS.
5. The most common sleep disturbance of older adults is:
• A) Insomnia
• B) Obstructive sleep apnea
• C) Restless leg syndrome
• D) Circadian rhythm disorder
Rationale: Obstructive sleep apnea is the most common sleep disturbance in older
adults. It is characterized by recurrent episodes of upper airway collapse during
sleep, leading to apnea and hypopnea.
,6. How is obstructive sleep apnea diagnosed?
• A) Overnight oximetry
• B) Home sleep test
• C) Polysomnography
• D) Clinical symptoms alone
Rationale: Obstructive sleep apnea is confirmed by polysomnography.
Polysomnography measures the sum of apneas and hypopneas to determine the
apnea-hypopnea index (AHI).
7. Which of the following is the most appropriate screening tool for delirium?
• A) St. Louis University Mental Status Exam (SLUMS)
• B) Montreal Cognitive Assessment (MoCA)
• C) Confusion Assessment Method (CAM)
• D) Mini-Mental State Examination (MMSE)
Rationale: The Confusion Assessment Method (CAM) is the most appropriate
screening tool for delirium. It is specifically designed to detect delirium and has
high sensitivity and specificity.
8. Which of the following signs or symptoms is NOT characteristic of
delirium?
• A) Patient is coherent
• B) Short duration
• C) Sudden onset
• D) Symptoms are worse in the evenings
Rationale: Delirium is characterized by incoherence, not coherence. Other features
include short duration, sudden onset, and symptoms that fluctuate and are often
worse in the evening (sundowning).
, 9. Risk factors for delirium in older adults include all of the following
EXCEPT:
• A) Multiple medical problems
• B) Multisensory deficits
• C) Polypharmacy
• D) Good social support
Rationale: Risk factors for delirium include multiple medical problems,
multisensory deficits, and polypharmacy. Good social support is protective and not
a risk factor for delirium.
10. A 68-year-old woman presents with urine leakage whenever she sneezes,
laughs, or strains. She denies dysuria, frequency, and nocturia. Urine dipstick
is negative. What is the diagnosis?
• A) Stress incontinence
• B) Urinary incontinence
• C) Urge incontinence
• D) Overflow incontinence
Rationale: Stress incontinence is characterized by urine leakage with coughing,
sneezing, laughing, or straining. The negative urine dipstick and absence of
dysuria, frequency, and nocturia help differentiate it from other types of
incontinence.
11. Age-related changes in the bladder, urethra, and ureters include all of the
following in older women EXCEPT:
• A) Decline in ureteral resistance pressure
• B) Increased estrogen production's influence on the bladder and ureter
• C) Laxity of the pelvic muscle
• D) Decline in bladder outlet function
Care of the Maturing & Aged Family
Practicum Complete Q&A Study Guide with
Detailed Rationales
1. Geriatric assessments encompass four main domains. Which of the
following is NOT one of these domains?
• A) Mental
• B) Physical
• C) Financial
• D) Spiritual
Rationale: The four main domains of geriatric assessment are mental, physical,
functional, and social/economic. Spiritual assessment, while important, is not
considered one of the four core domains of the standard geriatric assessment.
2. When should a comprehensive geriatric assessment be performed?
• A) Only when a patient is acutely ill
• B) When a patient is stable and at the time of the initial visit when
establishing care
• C) Only when the patient requests it
• D) Annually after age 75
Rationale: A geriatric assessment should be done when a patient is stable and at
the time of the initial visit when the patient is establishing care. This provides a
baseline for future comparisons and allows for early identification of issues.
3. An 82-year-old man with heart failure and stage 3 CKD is taking
furosemide 80 mg BID. His BP is 98/58 mmHg, and his creatinine has risen.
What is the most appropriate adjustment?
, • A) Increase lisinopril
• B) Reduce furosemide to 40 mg BID
• C) Start spironolactone
• D) Add hydrochlorothiazide
Rationale: The hypotension and rising creatinine suggest over-diuresis (prerenal
azotemia). Reducing the diuretic dose is the appropriate first step to improve renal
perfusion while maintaining some diuresis.
4. A 79-year-old man with COPD (GOLD B) has an FEV₁ of 55% predicted
and two exacerbations per year. His inhaler technique is correct. Which
regimen is best?
• A) LABA alone
• B) LAMA alone
• C) LABA + LAMA
• D) LABA + ICS
Rationale: For GOLD B COPD with FEV₁ < 60% and multiple exacerbations,
LABA + LAMA is the preferred regimen. This combination provides optimal
bronchodilation without the added risks of ICS.
5. The most common sleep disturbance of older adults is:
• A) Insomnia
• B) Obstructive sleep apnea
• C) Restless leg syndrome
• D) Circadian rhythm disorder
Rationale: Obstructive sleep apnea is the most common sleep disturbance in older
adults. It is characterized by recurrent episodes of upper airway collapse during
sleep, leading to apnea and hypopnea.
,6. How is obstructive sleep apnea diagnosed?
• A) Overnight oximetry
• B) Home sleep test
• C) Polysomnography
• D) Clinical symptoms alone
Rationale: Obstructive sleep apnea is confirmed by polysomnography.
Polysomnography measures the sum of apneas and hypopneas to determine the
apnea-hypopnea index (AHI).
7. Which of the following is the most appropriate screening tool for delirium?
• A) St. Louis University Mental Status Exam (SLUMS)
• B) Montreal Cognitive Assessment (MoCA)
• C) Confusion Assessment Method (CAM)
• D) Mini-Mental State Examination (MMSE)
Rationale: The Confusion Assessment Method (CAM) is the most appropriate
screening tool for delirium. It is specifically designed to detect delirium and has
high sensitivity and specificity.
8. Which of the following signs or symptoms is NOT characteristic of
delirium?
• A) Patient is coherent
• B) Short duration
• C) Sudden onset
• D) Symptoms are worse in the evenings
Rationale: Delirium is characterized by incoherence, not coherence. Other features
include short duration, sudden onset, and symptoms that fluctuate and are often
worse in the evening (sundowning).
, 9. Risk factors for delirium in older adults include all of the following
EXCEPT:
• A) Multiple medical problems
• B) Multisensory deficits
• C) Polypharmacy
• D) Good social support
Rationale: Risk factors for delirium include multiple medical problems,
multisensory deficits, and polypharmacy. Good social support is protective and not
a risk factor for delirium.
10. A 68-year-old woman presents with urine leakage whenever she sneezes,
laughs, or strains. She denies dysuria, frequency, and nocturia. Urine dipstick
is negative. What is the diagnosis?
• A) Stress incontinence
• B) Urinary incontinence
• C) Urge incontinence
• D) Overflow incontinence
Rationale: Stress incontinence is characterized by urine leakage with coughing,
sneezing, laughing, or straining. The negative urine dipstick and absence of
dysuria, frequency, and nocturia help differentiate it from other types of
incontinence.
11. Age-related changes in the bladder, urethra, and ureters include all of the
following in older women EXCEPT:
• A) Decline in ureteral resistance pressure
• B) Increased estrogen production's influence on the bladder and ureter
• C) Laxity of the pelvic muscle
• D) Decline in bladder outlet function
