NR 601 Midterm Exam Practice Questions Primary
Care of the Maturing and Aged Family – 2026 Edition
Questions with Answers & Rationales
SECTION 1: GERIATRIC ASSESSMENT & AGING PHYSIOLOGY
(Questions 1–20)
1. A 72-year-old patient presents for a routine annual examination. Which of
the following is the most common chief complaint reported by older adults in
primary care settings?
A) Dizziness
B) Fatigue
C) Pain
D) Shortness of breath
Answer: C) Pain
Rationale: Pain is the most common chief complaint in older adults presenting to
primary care. It is frequently underrecognized and undertreated in this population.
A comprehensive pain assessment should include location, intensity, quality, onset,
and functional impact.
2. An 80-year-old patient reports increased difficulty hearing conversations,
particularly in crowded environments. Which of the following age-related
changes is the most common cause of this presentation?
A) Cerumen impaction
B) Presbycusis
C) Otosclerosis
D) Meniere's disease
Answer: B) Presbycusis
Rationale: Presbycusis is the age-related, progressive, bilateral sensorineural
hearing loss that affects high-frequency sounds first. It is the most common cause
of hearing loss in older adults. Patients often report difficulty hearing in noisy
,environments. Cerumen impaction is a common reversible cause but is not an age-
related change.
3. A 75-year-old patient is noted to have a 20 mmHg drop in systolic blood
pressure upon standing from a seated position. Which of the following is the
most appropriate initial recommendation?
A) Increase dietary salt intake
B) Discontinue all antihypertensive medications
C) Increase fluid intake and rise slowly from seated positions
D) Start midodrine immediately
Answer: C) Increase fluid intake and rise slowly from seated positions
Rationale: Orthostatic hypotension is defined as a drop of ≥20 mmHg systolic or
≥10 mmHg diastolic within 3 minutes of standing. Initial management includes
non-pharmacologic measures: increasing fluid intake, avoiding sudden changes in
position, and wearing compression stockings. Medications should be reviewed and
adjusted before considering pharmacologic therapy.
4. A 68-year-old patient with a history of hypertension and type 2 diabetes is
due for a comprehensive geriatric assessment. Which of the following
screening tools is most appropriate for assessing cognitive function in this
patient?
A) Mini-Mental State Examination (MMSE)
B) Montreal Cognitive Assessment (MoCA)
C) Mini-Cog
D) Clock Drawing Test
Answer: C) Mini-Cog
Rationale: The Mini-Cog is a brief, validated screening tool for cognitive
impairment in older adults. It combines a three-item recall test with a clock-
drawing test and takes only 3–5 minutes to administer. It is less affected by
education and language than the MMSE or MoCA, making it practical for primary
care settings.
,5. A 78-year-old female reports leaking urine when she coughs or sneezes. She
is otherwise healthy and active. Which of the following is the most appropriate
first-line management?
A) Referral for urodynamic testing
B) Pelvic floor muscle training (Kegel exercises)
C) Initiation of an anticholinergic medication
D) Surgical consultation for sling procedure
Answer: B) Pelvic floor muscle training (Kegel exercises)
Rationale: Stress urinary incontinence is common in older women and is
characterized by involuntary leakage with increased intra-abdominal pressure
(coughing, sneezing, laughing). Pelvic floor muscle training is the first-line, non-
invasive treatment with strong evidence of efficacy. Anticholinergics are used for
urge incontinence, not stress incontinence.
6. A 72-year-old patient with a history of osteoarthritis reports taking
ibuprofen 800 mg three times daily for joint pain. Which of the following is
the most significant concern regarding this medication regimen?
A) Risk of gastrointestinal bleeding
B) Risk of hepatotoxicity
C) Risk of nephrotoxicity
D) Both A and C
Answer: D) Both A and C
Rationale: Chronic high-dose NSAID use in older adults carries significant risks
of gastrointestinal bleeding and acute kidney injury. NSAIDs can reduce renal
blood flow by inhibiting prostaglandin-mediated vasodilation. The Beers Criteria
list NSAIDs as potentially inappropriate for older adults due to these risks.
7. A 65-year-old patient reports feeling sad and losing interest in activities she
once enjoyed over the past several months. She denies suicidal ideation.
Which of the following is the most appropriate screening tool for depression
in older adults?
, A) Geriatric Depression Scale (GDS)
B) PHQ-2
C) PHQ-9
D) Both B and C
Answer: D) Both B and C
Rationale: The PHQ-2 is a brief, two-item screening tool for depression that asks
about anhedonia and depressed mood. A positive PHQ-2 should be followed by the
PHQ-9 for further assessment. The Geriatric Depression Scale is also validated for
older adults but is longer. Both the PHQ-2 and PHQ-9 are appropriate in primary
care.
8. An 82-year-old patient has a new diagnosis of hypertension. According to
the 2017 ACC/AHA guidelines, what is the target blood pressure for this
patient?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Answer: B) <130/80 mmHg
Rationale: The 2017 ACC/AHA hypertension guidelines recommend a target
blood pressure of <130/80 mmHg for all adults, including older adults. The
SPRINT trial demonstrated cardiovascular benefit with intensive blood pressure
control in older adults. However, individualization based on frailty, comorbidities,
and risk of adverse effects is essential.
9. A 70-year-old patient presents with progressive shortness of breath on
exertion and a dry cough. On examination, you note fine inspiratory crackles
at the lung bases and digital clubbing. Chest X-ray shows bilateral reticular
opacities with honeycombing. What is the most likely diagnosis?
A) Chronic obstructive pulmonary disease (COPD)
B) Congestive heart failure
Care of the Maturing and Aged Family – 2026 Edition
Questions with Answers & Rationales
SECTION 1: GERIATRIC ASSESSMENT & AGING PHYSIOLOGY
(Questions 1–20)
1. A 72-year-old patient presents for a routine annual examination. Which of
the following is the most common chief complaint reported by older adults in
primary care settings?
A) Dizziness
B) Fatigue
C) Pain
D) Shortness of breath
Answer: C) Pain
Rationale: Pain is the most common chief complaint in older adults presenting to
primary care. It is frequently underrecognized and undertreated in this population.
A comprehensive pain assessment should include location, intensity, quality, onset,
and functional impact.
2. An 80-year-old patient reports increased difficulty hearing conversations,
particularly in crowded environments. Which of the following age-related
changes is the most common cause of this presentation?
A) Cerumen impaction
B) Presbycusis
C) Otosclerosis
D) Meniere's disease
Answer: B) Presbycusis
Rationale: Presbycusis is the age-related, progressive, bilateral sensorineural
hearing loss that affects high-frequency sounds first. It is the most common cause
of hearing loss in older adults. Patients often report difficulty hearing in noisy
,environments. Cerumen impaction is a common reversible cause but is not an age-
related change.
3. A 75-year-old patient is noted to have a 20 mmHg drop in systolic blood
pressure upon standing from a seated position. Which of the following is the
most appropriate initial recommendation?
A) Increase dietary salt intake
B) Discontinue all antihypertensive medications
C) Increase fluid intake and rise slowly from seated positions
D) Start midodrine immediately
Answer: C) Increase fluid intake and rise slowly from seated positions
Rationale: Orthostatic hypotension is defined as a drop of ≥20 mmHg systolic or
≥10 mmHg diastolic within 3 minutes of standing. Initial management includes
non-pharmacologic measures: increasing fluid intake, avoiding sudden changes in
position, and wearing compression stockings. Medications should be reviewed and
adjusted before considering pharmacologic therapy.
4. A 68-year-old patient with a history of hypertension and type 2 diabetes is
due for a comprehensive geriatric assessment. Which of the following
screening tools is most appropriate for assessing cognitive function in this
patient?
A) Mini-Mental State Examination (MMSE)
B) Montreal Cognitive Assessment (MoCA)
C) Mini-Cog
D) Clock Drawing Test
Answer: C) Mini-Cog
Rationale: The Mini-Cog is a brief, validated screening tool for cognitive
impairment in older adults. It combines a three-item recall test with a clock-
drawing test and takes only 3–5 minutes to administer. It is less affected by
education and language than the MMSE or MoCA, making it practical for primary
care settings.
,5. A 78-year-old female reports leaking urine when she coughs or sneezes. She
is otherwise healthy and active. Which of the following is the most appropriate
first-line management?
A) Referral for urodynamic testing
B) Pelvic floor muscle training (Kegel exercises)
C) Initiation of an anticholinergic medication
D) Surgical consultation for sling procedure
Answer: B) Pelvic floor muscle training (Kegel exercises)
Rationale: Stress urinary incontinence is common in older women and is
characterized by involuntary leakage with increased intra-abdominal pressure
(coughing, sneezing, laughing). Pelvic floor muscle training is the first-line, non-
invasive treatment with strong evidence of efficacy. Anticholinergics are used for
urge incontinence, not stress incontinence.
6. A 72-year-old patient with a history of osteoarthritis reports taking
ibuprofen 800 mg three times daily for joint pain. Which of the following is
the most significant concern regarding this medication regimen?
A) Risk of gastrointestinal bleeding
B) Risk of hepatotoxicity
C) Risk of nephrotoxicity
D) Both A and C
Answer: D) Both A and C
Rationale: Chronic high-dose NSAID use in older adults carries significant risks
of gastrointestinal bleeding and acute kidney injury. NSAIDs can reduce renal
blood flow by inhibiting prostaglandin-mediated vasodilation. The Beers Criteria
list NSAIDs as potentially inappropriate for older adults due to these risks.
7. A 65-year-old patient reports feeling sad and losing interest in activities she
once enjoyed over the past several months. She denies suicidal ideation.
Which of the following is the most appropriate screening tool for depression
in older adults?
, A) Geriatric Depression Scale (GDS)
B) PHQ-2
C) PHQ-9
D) Both B and C
Answer: D) Both B and C
Rationale: The PHQ-2 is a brief, two-item screening tool for depression that asks
about anhedonia and depressed mood. A positive PHQ-2 should be followed by the
PHQ-9 for further assessment. The Geriatric Depression Scale is also validated for
older adults but is longer. Both the PHQ-2 and PHQ-9 are appropriate in primary
care.
8. An 82-year-old patient has a new diagnosis of hypertension. According to
the 2017 ACC/AHA guidelines, what is the target blood pressure for this
patient?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Answer: B) <130/80 mmHg
Rationale: The 2017 ACC/AHA hypertension guidelines recommend a target
blood pressure of <130/80 mmHg for all adults, including older adults. The
SPRINT trial demonstrated cardiovascular benefit with intensive blood pressure
control in older adults. However, individualization based on frailty, comorbidities,
and risk of adverse effects is essential.
9. A 70-year-old patient presents with progressive shortness of breath on
exertion and a dry cough. On examination, you note fine inspiratory crackles
at the lung bases and digital clubbing. Chest X-ray shows bilateral reticular
opacities with honeycombing. What is the most likely diagnosis?
A) Chronic obstructive pulmonary disease (COPD)
B) Congestive heart failure
