Page |1
NU 671 – Primary Care of the Maturing and Aged Family Final Exam
Practice Review –Questions with Rationales
Institution: Purdue University Global
Format: Multiple Choice
Content Areas: Cardiovascular, Respiratory, Endocrine,
Neurology, Musculoskeletal, GI, GU/Renal,
Hematology/Oncology, Mental Health, Infectious Disease,
Geriatric Syndromes, Pharmacology, and Preventive Care
SECTION 1: CARDIOVASCULAR (Questions 1–15)
Question 1
A 72-year-old man with a history of hypertension, diabetes, and
hyperlipidemia presents for follow-up. Current BP is 142/86
mmHg. According to ACC/AHA guidelines, what is the
recommended BP goal for most older adults if tolerated?
A. <150/90 mmHg
B. <140/90 mmHg
C. <130/80 mmHg
D. <120/80 mmHg
E. No treatment needed
, Page |2
Answer: C
Rationale: The ACC/AHA recommends a target of <130/80
mmHg for most adults, including older adults, if tolerated.
Lifestyle modification should be encouraged, and
pharmacologic therapy may be intensified.
Question 2
A 65-year-old Black man with primary hypertension and no
compelling indications should be started on which of the
following first-line medications?
A. Lisinopril
B. Amlodipine or a thiazide diuretic
C. Metoprolol
D. Clonidine
E. Hydralazine
Answer: B
Rationale: For Black patients without chronic kidney disease or
heart failure, thiazide diuretics or calcium channel blockers are
preferred first-line agents. ACE inhibitors may be less effective
as monotherapy in this population.
Question 3
, Page |3
A 78-year-old woman with atrial fibrillation, hypertension, and
diabetes has a CHA₂DS₂-VASc score of 5. Which of the following
is the most appropriate stroke prevention strategy?
A. Aspirin alone
B. No anticoagulation
C. Warfarin or a direct oral anticoagulant (DOAC)
D. Clopidogrel alone
E. Only rate control
Answer: C
Rationale: A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women
indicates a clear benefit from oral anticoagulation. DOACs are
generally preferred over warfarin for nonvalvular atrial
fibrillation.
Question 4
A 70-year-old man with heart failure with reduced ejection
fraction (HFrEF) presents with dyspnea, orthopnea, and an S3
gallop. Which medication class has the strongest mortality
benefit?
A. Digoxin
B. Loop diuretics
C. ACE inhibitors or angiotensin receptor-neprilysin inhibitor
(ARNI)
, Page |4
D. Calcium channel blockers
E. Aspirin
Answer: C
Rationale: ACE inhibitors, ARBs, or ARNI reduce mortality in
HFrEF. Beta-blockers and mineralocorticoid receptor antagonists
also reduce mortality. Digoxin and diuretics improve symptoms
but do not reduce mortality.
Question 5
A 66-year-old man with a 40-pack-year smoking history
presents with leg pain that occurs with walking and is relieved
by rest. Physical exam reveals cool, pale lower extremities and
diminished pedal pulses. What is the most likely diagnosis?
A. Venous insufficiency
B. Peripheral arterial disease
C. Lymphedema
D. Deep vein thrombosis
E. Diabetic neuropathy
Answer: B
Rationale: Intermittent claudication, cool pale skin, and
diminished pulses are classic features of peripheral arterial
disease. Venous insufficiency typically causes edema, brown
discoloration, and stasis ulcers.
NU 671 – Primary Care of the Maturing and Aged Family Final Exam
Practice Review –Questions with Rationales
Institution: Purdue University Global
Format: Multiple Choice
Content Areas: Cardiovascular, Respiratory, Endocrine,
Neurology, Musculoskeletal, GI, GU/Renal,
Hematology/Oncology, Mental Health, Infectious Disease,
Geriatric Syndromes, Pharmacology, and Preventive Care
SECTION 1: CARDIOVASCULAR (Questions 1–15)
Question 1
A 72-year-old man with a history of hypertension, diabetes, and
hyperlipidemia presents for follow-up. Current BP is 142/86
mmHg. According to ACC/AHA guidelines, what is the
recommended BP goal for most older adults if tolerated?
A. <150/90 mmHg
B. <140/90 mmHg
C. <130/80 mmHg
D. <120/80 mmHg
E. No treatment needed
, Page |2
Answer: C
Rationale: The ACC/AHA recommends a target of <130/80
mmHg for most adults, including older adults, if tolerated.
Lifestyle modification should be encouraged, and
pharmacologic therapy may be intensified.
Question 2
A 65-year-old Black man with primary hypertension and no
compelling indications should be started on which of the
following first-line medications?
A. Lisinopril
B. Amlodipine or a thiazide diuretic
C. Metoprolol
D. Clonidine
E. Hydralazine
Answer: B
Rationale: For Black patients without chronic kidney disease or
heart failure, thiazide diuretics or calcium channel blockers are
preferred first-line agents. ACE inhibitors may be less effective
as monotherapy in this population.
Question 3
, Page |3
A 78-year-old woman with atrial fibrillation, hypertension, and
diabetes has a CHA₂DS₂-VASc score of 5. Which of the following
is the most appropriate stroke prevention strategy?
A. Aspirin alone
B. No anticoagulation
C. Warfarin or a direct oral anticoagulant (DOAC)
D. Clopidogrel alone
E. Only rate control
Answer: C
Rationale: A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women
indicates a clear benefit from oral anticoagulation. DOACs are
generally preferred over warfarin for nonvalvular atrial
fibrillation.
Question 4
A 70-year-old man with heart failure with reduced ejection
fraction (HFrEF) presents with dyspnea, orthopnea, and an S3
gallop. Which medication class has the strongest mortality
benefit?
A. Digoxin
B. Loop diuretics
C. ACE inhibitors or angiotensin receptor-neprilysin inhibitor
(ARNI)
, Page |4
D. Calcium channel blockers
E. Aspirin
Answer: C
Rationale: ACE inhibitors, ARBs, or ARNI reduce mortality in
HFrEF. Beta-blockers and mineralocorticoid receptor antagonists
also reduce mortality. Digoxin and diuretics improve symptoms
but do not reduce mortality.
Question 5
A 66-year-old man with a 40-pack-year smoking history
presents with leg pain that occurs with walking and is relieved
by rest. Physical exam reveals cool, pale lower extremities and
diminished pedal pulses. What is the most likely diagnosis?
A. Venous insufficiency
B. Peripheral arterial disease
C. Lymphedema
D. Deep vein thrombosis
E. Diabetic neuropathy
Answer: B
Rationale: Intermittent claudication, cool pale skin, and
diminished pulses are classic features of peripheral arterial
disease. Venous insufficiency typically causes edema, brown
discoloration, and stasis ulcers.
