NR 601/NR 601 MIDTERM EXAM PRIMARY CARE OF THE
MATURING AND AGED FAMILY ACTUAL EXAM NEWEST
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
MOST RECENT EXAM VERSION A NEW UPDATED
VERSION LATEST 2026-2027 (VERIFIED ANSWERS) FULLY
REVISED EXAM ALREADY A+
A 68-year-old male with hypertension presents with blood pressure readings of
150/92 mm Hg on three separate occasions. He has no history of diabetes or
chronic kidney disease. According to the ACC/AHA 2017 guideline, what is
his target blood pressure goal?
A) <150/90 mm Hg
B) <140/90 mm Hg
C) <130/80 mm Hg
D) <120/80 mm Hg
Answer: C) <130/80 mm Hg
Rationale: The 2017 ACC/AHA guideline recommends a blood pressure
target of less than 130/80 mm Hg for all adults with hypertension, regardless
of age or comorbidities such as diabetes or chronic kidney disease. This is a
shift from previous guidelines that had higher targets for older adults.
An 82-year-old female with heart failure with preserved ejection fraction
(HFpEF) reports worsening dyspnea on exertion and has 3+ pitting edema in
her lower extremities. Her jugular venous pressure is elevated at 12 cm H2O.
,Which medication has been shown to most likely improve her symptoms and
reduce hospitalizations?
A) Digoxin
B) Spironolactone
C) Metoprolol succinate
D) Hydralazine
Answer: B) Spironolactone
Rationale: The TOPCAT trial demonstrated that spironolactone can reduce
hospitalizations in patients with HFpEF. Digoxin and beta-blockers like
metoprolol are primarily indicated for heart failure with reduced ejection
fraction (HFrEF). Hydralazine is not a standard first-line treatment for
HFpEF.
A 75-year-old male on warfarin for atrial fibrillation has a subtherapeutic INR
of 1.2. He admits to missing several doses of his medication over the past
week. What is the most appropriate next step in management?
A) Increase the warfarin dose by 50%
B) Administer oral vitamin K 10 mg
C) Resume warfarin at his current dose and recheck INR in one week
D) Immediately switch to apixaban
Answer: C) Resume warfarin at his current dose and recheck INR in one week
Rationale: For a subtherapeutic INR due to missed doses, the safest and most
appropriate action is to resume the patient's usual dose and recheck the INR in
about a week to ensure it returns to the therapeutic range. Vitamin K is
indicated for significant bleeding or a critically high INR. Switching
anticoagulants without a bridging plan or further workup is not the first step.
,A 79-year-old male is newly diagnosed with non-valvular atrial fibrillation. His
CHA₂DS₂-VASc score is 4. Which anticoagulant is preferred for stroke
prevention in this patient?
A) Aspirin 81 mg daily
B) Warfarin
C) Apixaban
D) No anticoagulation
Answer: C) Apixaban
Rationale: For patients with a CHA₂DS₂-VASc score of ≥2 in men (or ≥3 in
women), oral anticoagulation is strongly recommended. Direct oral
anticoagulants (DOACs) like apixaban are generally preferred over warfarin
for non-valvular atrial fibrillation due to their favorable efficacy and safety
profiles, including lower risk of intracranial hemorrhage. Aspirin alone is
insufficient for high-risk patients.
A 74-year-old female with HFrEF has an ejection fraction of 35% despite being
on optimal medical therapy. Which additional medication class has been
shown to reduce mortality in HFrEF regardless of diabetes status?
A) SGLT2 inhibitors (e.g., dapagliflozin)
B) Glipizide
C) Pioglitazone
D) Metformin
Answer: A) SGLT2 inhibitors (e.g., dapagliflozin)
Rationale: SGLT2 inhibitors, such as dapagliflozin and empagliflozin, have
been proven in large clinical trials to reduce hospitalizations for heart failure
and cardiovascular death in patients with HFrEF, irrespective of whether they
have type 2 diabetes. This is a major advancement in HFrEF treatment.
, An 81-year-old male on aspirin 81 mg daily for secondary prevention of
cardiovascular disease asks if he should stop it before a scheduled dental
extraction. What is the appropriate recommendation?
A) Stop aspirin 7 days before the procedure
B) Continue aspirin as the bleeding risk is low
C) Double the dose of aspirin before the procedure
D) Switch to clopidogrel for 2 weeks
Answer: B) Continue aspirin as the bleeding risk is low
Rationale: For most routine dental procedures, the risk of a thrombotic event
from discontinuing aspirin outweighs the minimal risk of increased bleeding. It
is generally recommended to continue aspirin for secondary prevention in
these situations.
A 76-year-old female with hypertension is started on lisinopril. One week later,
she calls the clinic complaining of a dry, hacking cough that started shortly
after beginning the medication. What is the most appropriate next step?
A) Reassure her that the cough will resolve on its own
B) Add a beta-agonist inhaler to manage the cough
C) Discontinue lisinopril and start losartan
D) Increase the lisinopril dose to 20 mg daily
Answer: C) Discontinue lisinopril and start losartan
Rationale: A dry cough is a common side effect of ACE inhibitors, mediated
by bradykinin accumulation. The cough is often reversible upon
discontinuation. An ARB like losartan is an excellent alternative with a much
lower incidence of cough (<1%).
MATURING AND AGED FAMILY ACTUAL EXAM NEWEST
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
MOST RECENT EXAM VERSION A NEW UPDATED
VERSION LATEST 2026-2027 (VERIFIED ANSWERS) FULLY
REVISED EXAM ALREADY A+
A 68-year-old male with hypertension presents with blood pressure readings of
150/92 mm Hg on three separate occasions. He has no history of diabetes or
chronic kidney disease. According to the ACC/AHA 2017 guideline, what is
his target blood pressure goal?
A) <150/90 mm Hg
B) <140/90 mm Hg
C) <130/80 mm Hg
D) <120/80 mm Hg
Answer: C) <130/80 mm Hg
Rationale: The 2017 ACC/AHA guideline recommends a blood pressure
target of less than 130/80 mm Hg for all adults with hypertension, regardless
of age or comorbidities such as diabetes or chronic kidney disease. This is a
shift from previous guidelines that had higher targets for older adults.
An 82-year-old female with heart failure with preserved ejection fraction
(HFpEF) reports worsening dyspnea on exertion and has 3+ pitting edema in
her lower extremities. Her jugular venous pressure is elevated at 12 cm H2O.
,Which medication has been shown to most likely improve her symptoms and
reduce hospitalizations?
A) Digoxin
B) Spironolactone
C) Metoprolol succinate
D) Hydralazine
Answer: B) Spironolactone
Rationale: The TOPCAT trial demonstrated that spironolactone can reduce
hospitalizations in patients with HFpEF. Digoxin and beta-blockers like
metoprolol are primarily indicated for heart failure with reduced ejection
fraction (HFrEF). Hydralazine is not a standard first-line treatment for
HFpEF.
A 75-year-old male on warfarin for atrial fibrillation has a subtherapeutic INR
of 1.2. He admits to missing several doses of his medication over the past
week. What is the most appropriate next step in management?
A) Increase the warfarin dose by 50%
B) Administer oral vitamin K 10 mg
C) Resume warfarin at his current dose and recheck INR in one week
D) Immediately switch to apixaban
Answer: C) Resume warfarin at his current dose and recheck INR in one week
Rationale: For a subtherapeutic INR due to missed doses, the safest and most
appropriate action is to resume the patient's usual dose and recheck the INR in
about a week to ensure it returns to the therapeutic range. Vitamin K is
indicated for significant bleeding or a critically high INR. Switching
anticoagulants without a bridging plan or further workup is not the first step.
,A 79-year-old male is newly diagnosed with non-valvular atrial fibrillation. His
CHA₂DS₂-VASc score is 4. Which anticoagulant is preferred for stroke
prevention in this patient?
A) Aspirin 81 mg daily
B) Warfarin
C) Apixaban
D) No anticoagulation
Answer: C) Apixaban
Rationale: For patients with a CHA₂DS₂-VASc score of ≥2 in men (or ≥3 in
women), oral anticoagulation is strongly recommended. Direct oral
anticoagulants (DOACs) like apixaban are generally preferred over warfarin
for non-valvular atrial fibrillation due to their favorable efficacy and safety
profiles, including lower risk of intracranial hemorrhage. Aspirin alone is
insufficient for high-risk patients.
A 74-year-old female with HFrEF has an ejection fraction of 35% despite being
on optimal medical therapy. Which additional medication class has been
shown to reduce mortality in HFrEF regardless of diabetes status?
A) SGLT2 inhibitors (e.g., dapagliflozin)
B) Glipizide
C) Pioglitazone
D) Metformin
Answer: A) SGLT2 inhibitors (e.g., dapagliflozin)
Rationale: SGLT2 inhibitors, such as dapagliflozin and empagliflozin, have
been proven in large clinical trials to reduce hospitalizations for heart failure
and cardiovascular death in patients with HFrEF, irrespective of whether they
have type 2 diabetes. This is a major advancement in HFrEF treatment.
, An 81-year-old male on aspirin 81 mg daily for secondary prevention of
cardiovascular disease asks if he should stop it before a scheduled dental
extraction. What is the appropriate recommendation?
A) Stop aspirin 7 days before the procedure
B) Continue aspirin as the bleeding risk is low
C) Double the dose of aspirin before the procedure
D) Switch to clopidogrel for 2 weeks
Answer: B) Continue aspirin as the bleeding risk is low
Rationale: For most routine dental procedures, the risk of a thrombotic event
from discontinuing aspirin outweighs the minimal risk of increased bleeding. It
is generally recommended to continue aspirin for secondary prevention in
these situations.
A 76-year-old female with hypertension is started on lisinopril. One week later,
she calls the clinic complaining of a dry, hacking cough that started shortly
after beginning the medication. What is the most appropriate next step?
A) Reassure her that the cough will resolve on its own
B) Add a beta-agonist inhaler to manage the cough
C) Discontinue lisinopril and start losartan
D) Increase the lisinopril dose to 20 mg daily
Answer: C) Discontinue lisinopril and start losartan
Rationale: A dry cough is a common side effect of ACE inhibitors, mediated
by bradykinin accumulation. The cough is often reversible upon
discontinuation. An ARB like losartan is an excellent alternative with a much
lower incidence of cough (<1%).
