NR 601 Final Exam Guide 2026 Primary Care of
the Maturing and Aged Family Questions with
Answers and Rationales
1. An 86-year-old female presents for a wellness visit with her partner of 35
years. They are not married. She asks what documentation is needed to
ensure her partner can make medical decisions for her if she becomes unable
to do so. What is the most appropriate recommendation?
A. Advise them to complete a living will only
B. Advise them to complete an advance directive including a healthcare proxy
C. Advise them that marriage is required for medical decision-making
D. Advise them to complete a financial power of attorney
Rationale: An advance directive with a healthcare proxy (durable power of
attorney for healthcare) is the appropriate recommendation. This allows her partner
to make medical decisions even though they are not married. A living will
addresses end-of-life preferences but does not designate a decision-maker.
2. According to the "5 Ms" framework of geriatric care, which of the
following is NOT one of the 5 Ms?
A. Mind
B. Mobility
C. Medications
D. Metabolism
Rationale: The 5 Ms of geriatric care are Mind, Mobility, Medications,
Multicomplexity, and Matters Most. "Metabolism" is not one of the 5 Ms. This
framework provides a patient-centered approach to caring for older adults.
3. Which assessment tool is best for evaluating fall risk related to gait and
balance in an older adult?
,A. Katz Index of Independence in Activities of Daily Living
B. Lawton Instrumental Activities of Daily Living Scale
C. Timed Up and Go (TUG) test
D. Mini-Cog
Rationale: The Timed Up and Go (TUG) test assesses gait and balance. A TUG
time > 12 seconds indicates increased fall risk. The Katz ADL assesses basic self-
care, the Lawton IADL assesses more complex daily activities, and the Mini-Cog
assesses cognitive function.
4. A 79-year-old male scores 6/30 on the PHQ-9 and 22/30 on the MoCA. He
reports fatigue and poor appetite for 2 months with no acute confusion. What
is the most likely diagnosis?
A. Delirium
B. Major depressive disorder
C. Mild cognitive impairment (MCI)
D. Normal aging
Rationale: A MoCA score of 18–25 suggests mild cognitive impairment (MCI)
with objective cognitive deficit without significant functional loss. A PHQ-9 score
of 6 indicates mild depressive symptoms, not major depressive disorder. Delirium
is characterized by acute onset and fluctuating course.
5. Which of the following is a primary physiological change associated with
aging?
A. Increased physiological reserve of most body systems
B. Enhanced homeostatic mechanisms
C. Reduced physiological reserve and impaired immunological function
D. Increased immunological function
Rationale: The three primary physiological changes of aging are: (1) reduced
physiological reserve of most body systems (cardiac, respiratory, renal); (2)
reduced homeostatic mechanisms (temperature control, fluid/electrolyte balance);
and (3) impaired immunological function (increased infection risk, more prevalent
autoimmune diseases).
,6. A comprehensive geriatric assessment (CGA) includes evaluation of which
of the following domains?
A. Physical health only
B. Cognitive function only
C. Physical, cognitive, functional, social, and environmental domains
D. Financial status only
Rationale: A comprehensive geriatric assessment is a multidimensional process
designed to assess functional ability, physical health, cognitive and mental health,
social support, financial status, and environmental factors.
7. Which screening tool is most appropriate for detecting cognitive
impairment in a busy primary care setting?
A. Montreal Cognitive Assessment (MoCA)
B. Saint Louis University Mental Status Exam (SLUMS)
C. Mini-Cog
D. Clock Drawing Test only
Rationale: The Mini-Cog is a rapid screening tool (3-minute administration) that
combines a three-item recall with a clock drawing test. It is practical for busy
primary care settings and has good sensitivity for detecting cognitive impairment.
8. An 82-year-old patient reports urinary leakage with coughing, sneezing,
and laughing. This is best described as:
A. Urge incontinence
B. Stress incontinence
C. Overflow incontinence
D. Functional incontinence
Rationale: Stress incontinence is characterized by leakage with activities that
increase intra-abdominal pressure (coughing, sneezing, laughing, exercise). Urge
incontinence involves leakage with a sudden, strong urge to void. Overflow
incontinence results from urinary retention.
, 9. Which of the following is the first-line behavioral treatment for urge
incontinence?
A. Timed voiding every 2 hours
B. Kegel exercises 3 times daily
C. Bladder training with scheduled voiding
D. Decrease fluid intake after 6 PM
Rationale: Bladder training with scheduled voiding, combined with pelvic floor
muscle exercises (Kegel exercises), is first-line behavioral treatment for urge
incontinence. Fluid restriction may worsen dehydration and is not recommended as
a primary intervention.
10. An 84-year-old male with a history of stroke, systolic heart failure, and
type 2 diabetes is sexually active with men and women, engaging in receptive
oral, receptive anal, and penetrative sex with multiple partners and
intermittent condom use. What sexually transmitted infection testing should
be offered?
A. Urine testing, blood testing, anal swab, and oropharyngeal swab
B. Urine testing only
C. Blood testing only
D. No testing is indicated at this age
Rationale: This patient has multiple risk factors for STIs including multiple
partners, inconsistent condom use, and engagement in receptive anal and oral sex.
Comprehensive STI screening should include urine testing (for
chlamydia/gonorrhea), blood testing (syphilis, HIV), anal swab, and oropharyngeal
swab.
11. Which of the following is the most appropriate screening recommendation
for colorectal cancer in a 75-year-old patient with no prior screening?
A. No screening is recommended after age 75
B. Individualized decision based on life expectancy and health status
the Maturing and Aged Family Questions with
Answers and Rationales
1. An 86-year-old female presents for a wellness visit with her partner of 35
years. They are not married. She asks what documentation is needed to
ensure her partner can make medical decisions for her if she becomes unable
to do so. What is the most appropriate recommendation?
A. Advise them to complete a living will only
B. Advise them to complete an advance directive including a healthcare proxy
C. Advise them that marriage is required for medical decision-making
D. Advise them to complete a financial power of attorney
Rationale: An advance directive with a healthcare proxy (durable power of
attorney for healthcare) is the appropriate recommendation. This allows her partner
to make medical decisions even though they are not married. A living will
addresses end-of-life preferences but does not designate a decision-maker.
2. According to the "5 Ms" framework of geriatric care, which of the
following is NOT one of the 5 Ms?
A. Mind
B. Mobility
C. Medications
D. Metabolism
Rationale: The 5 Ms of geriatric care are Mind, Mobility, Medications,
Multicomplexity, and Matters Most. "Metabolism" is not one of the 5 Ms. This
framework provides a patient-centered approach to caring for older adults.
3. Which assessment tool is best for evaluating fall risk related to gait and
balance in an older adult?
,A. Katz Index of Independence in Activities of Daily Living
B. Lawton Instrumental Activities of Daily Living Scale
C. Timed Up and Go (TUG) test
D. Mini-Cog
Rationale: The Timed Up and Go (TUG) test assesses gait and balance. A TUG
time > 12 seconds indicates increased fall risk. The Katz ADL assesses basic self-
care, the Lawton IADL assesses more complex daily activities, and the Mini-Cog
assesses cognitive function.
4. A 79-year-old male scores 6/30 on the PHQ-9 and 22/30 on the MoCA. He
reports fatigue and poor appetite for 2 months with no acute confusion. What
is the most likely diagnosis?
A. Delirium
B. Major depressive disorder
C. Mild cognitive impairment (MCI)
D. Normal aging
Rationale: A MoCA score of 18–25 suggests mild cognitive impairment (MCI)
with objective cognitive deficit without significant functional loss. A PHQ-9 score
of 6 indicates mild depressive symptoms, not major depressive disorder. Delirium
is characterized by acute onset and fluctuating course.
5. Which of the following is a primary physiological change associated with
aging?
A. Increased physiological reserve of most body systems
B. Enhanced homeostatic mechanisms
C. Reduced physiological reserve and impaired immunological function
D. Increased immunological function
Rationale: The three primary physiological changes of aging are: (1) reduced
physiological reserve of most body systems (cardiac, respiratory, renal); (2)
reduced homeostatic mechanisms (temperature control, fluid/electrolyte balance);
and (3) impaired immunological function (increased infection risk, more prevalent
autoimmune diseases).
,6. A comprehensive geriatric assessment (CGA) includes evaluation of which
of the following domains?
A. Physical health only
B. Cognitive function only
C. Physical, cognitive, functional, social, and environmental domains
D. Financial status only
Rationale: A comprehensive geriatric assessment is a multidimensional process
designed to assess functional ability, physical health, cognitive and mental health,
social support, financial status, and environmental factors.
7. Which screening tool is most appropriate for detecting cognitive
impairment in a busy primary care setting?
A. Montreal Cognitive Assessment (MoCA)
B. Saint Louis University Mental Status Exam (SLUMS)
C. Mini-Cog
D. Clock Drawing Test only
Rationale: The Mini-Cog is a rapid screening tool (3-minute administration) that
combines a three-item recall with a clock drawing test. It is practical for busy
primary care settings and has good sensitivity for detecting cognitive impairment.
8. An 82-year-old patient reports urinary leakage with coughing, sneezing,
and laughing. This is best described as:
A. Urge incontinence
B. Stress incontinence
C. Overflow incontinence
D. Functional incontinence
Rationale: Stress incontinence is characterized by leakage with activities that
increase intra-abdominal pressure (coughing, sneezing, laughing, exercise). Urge
incontinence involves leakage with a sudden, strong urge to void. Overflow
incontinence results from urinary retention.
, 9. Which of the following is the first-line behavioral treatment for urge
incontinence?
A. Timed voiding every 2 hours
B. Kegel exercises 3 times daily
C. Bladder training with scheduled voiding
D. Decrease fluid intake after 6 PM
Rationale: Bladder training with scheduled voiding, combined with pelvic floor
muscle exercises (Kegel exercises), is first-line behavioral treatment for urge
incontinence. Fluid restriction may worsen dehydration and is not recommended as
a primary intervention.
10. An 84-year-old male with a history of stroke, systolic heart failure, and
type 2 diabetes is sexually active with men and women, engaging in receptive
oral, receptive anal, and penetrative sex with multiple partners and
intermittent condom use. What sexually transmitted infection testing should
be offered?
A. Urine testing, blood testing, anal swab, and oropharyngeal swab
B. Urine testing only
C. Blood testing only
D. No testing is indicated at this age
Rationale: This patient has multiple risk factors for STIs including multiple
partners, inconsistent condom use, and engagement in receptive anal and oral sex.
Comprehensive STI screening should include urine testing (for
chlamydia/gonorrhea), blood testing (syphilis, HIV), anal swab, and oropharyngeal
swab.
11. Which of the following is the most appropriate screening recommendation
for colorectal cancer in a 75-year-old patient with no prior screening?
A. No screening is recommended after age 75
B. Individualized decision based on life expectancy and health status
