NR601 Week 1 Questions With Answers and Explanations
Primary Care of the Maturing and Aged Family | 600-Question Comprehensive Mock Exam
Question 1. Which framework organizes geriatric care around Mind, Mobility, Medications, Multicomplexity, and
Matters Most?
A. The APGAR score
B. The 5Ms framework
C. The Wells criteria
D. The Glasgow Coma Scale
Correct Answer: B. The 5Ms framework
Explanation: The Geriatric 5Ms provide a practical framework for comprehensive care of older adults. The domains are Mind,
Mobility, Medications, Multicomplexity, and Matters Most. The framework encourages clinicians to look beyond isolated diseases
and consider function, goals, and treatment burden. It is particularly useful when planning patient-centered primary care.
Question 2. What is the main purpose of a comprehensive geriatric assessment?
A. To identify medical, functional, psychological, and social needs and develop an integrated plan
B. To determine chronological age
C. To perform only a medication review
D. To replace the physical examination
Correct Answer: A. To identify medical, functional, psychological, and social needs and develop an integrated plan
Explanation: Comprehensive geriatric assessment is multidimensional and commonly interdisciplinary. It evaluates medical
conditions together with function, cognition, mood, mobility, medications, nutrition, social circumstances, and environmental
concerns. The findings are used to create an integrated care plan. This approach is especially useful when an older adult has
multiple interacting problems.
Question 3. Which task is an activity of daily living (ADL)?
A. Managing medications
B. Shopping for groceries
C. Managing finances
D. Bathing
Correct Answer: D. Bathing
Explanation: Basic activities of daily living describe fundamental self-care functions such as bathing, dressing, toileting,
transferring, continence, and feeding. Managing finances, shopping, and medications are instrumental activities of daily living. ADL
impairment generally indicates a greater level of functional dependence. Functional status can be more informative than age alone
when planning care.
Question 4. Which task is an instrumental activity of daily living (IADL)?
A. Eating independently
B. Using the toilet
C. Managing medications
D. Transferring from bed to chair
Correct Answer: C. Managing medications
Explanation: IADLs are more complex activities required for independent community living. Examples include managing
medications and finances, shopping, cooking, transportation, and communication. Eating, transferring, and toileting are basic ADLs.
Decline in IADLs may appear before loss of basic self-care abilities.
Question 5. An older adult reports two falls in the past year. What is the best next step?
Page 1
,A. Explain that falls are inevitable with aging
B. Stop all medications immediately
C. Perform a multifactorial fall-risk assessment
D. Recommend permanent bed rest
Correct Answer: C. Perform a multifactorial fall-risk assessment
Explanation: Recurrent falls warrant assessment of potentially modifiable contributors. Evaluation can include gait and balance,
orthostatic blood pressure, vision, footwear, medications, cognition, environmental hazards, and relevant medical conditions. Falls
should not be dismissed as a normal consequence of aging. Interventions are individualized to identified risk factors.
Question 6. What does the Timed Up and Go test primarily assess?
A. Nutritional intake
B. Functional mobility and fall risk
C. Hearing acuity
D. Long-term memory
Correct Answer: B. Functional mobility and fall risk
Explanation: The Timed Up and Go test observes a person rising from a chair, walking a short distance, turning, returning, and
sitting. It provides a quick view of functional mobility and can contribute to fall-risk assessment. Performance should be interpreted
in clinical context rather than as a stand-alone diagnosis. Abnormal findings may prompt more detailed gait and balance evaluation.
Question 7. An older adult becomes dizzy when standing. Which assessment is particularly important?
A. Orthostatic blood pressure and pulse
B. Visual acuity only
C. Skinfold thickness
D. Abdominal circumference only
Correct Answer: A. Orthostatic blood pressure and pulse
Explanation: Postural dizziness can reflect orthostatic hypotension, medication effects, dehydration, autonomic dysfunction, or
other conditions. Measuring blood pressure and pulse after appropriate position changes helps evaluate this possibility. Medication
review and assessment of hydration and fall risk are also important. Symptoms should not automatically be attributed to normal
aging.
Question 8. Which medication-related issue is especially important in older adults?
A. Automatic need for higher doses
B. Uniform renal clearance across all ages
C. Absence of drug interactions
D. Polypharmacy and potentially inappropriate medication use
Correct Answer: D. Polypharmacy and potentially inappropriate medication use
Explanation: Older adults often take multiple prescription and nonprescription products, increasing the chance of interactions and
adverse effects. Age-related changes in renal function, body composition, and pharmacodynamics can further alter medication
response. Medication reconciliation should include over-the-counter drugs and supplements. Treatment should be periodically
reviewed for indication, benefit, risk, and opportunities to simplify.
Question 9. Which principle is most appropriate when prescribing a new medication to a frail older adult?
A. Ignore kidney function if creatinine is normal
B. Add medication before reviewing the current list
C. Start every medication at the maximum dose
D. Use the lowest effective dose and titrate thoughtfully while monitoring response
Correct Answer: D. Use the lowest effective dose and titrate thoughtfully while monitoring response
Page 2
,Explanation: Older adults may have increased sensitivity to medications and reduced physiologic reserve. A cautious starting dose
and careful titration can reduce adverse effects, although the exact approach depends on the drug and clinical situation. Renal and
hepatic function, interactions, goals, and treatment burden should be considered. Medication review should precede unnecessary
prescribing cascades.
Question 10. Why can a normal serum creatinine be misleading in some older adults?
A. Serum creatinine directly measures liver function
B. Creatinine is unrelated to kidney function
C. Reduced muscle mass can mask impaired renal filtration
D. Older adults always have increased muscle mass
Correct Answer: C. Reduced muscle mass can mask impaired renal filtration
Explanation: Creatinine production is influenced by muscle mass, which often decreases with aging and frailty. Consequently, a
seemingly normal serum creatinine can coexist with reduced glomerular filtration. Renally cleared medications should be
considered in the context of estimated kidney function and the individual patient. This helps reduce dose-related toxicity.
Question 11. Which finding suggests delirium rather than a chronic neurocognitive disorder?
A. Stable memory impairment without fluctuation
B. Acute onset with fluctuating attention
C. Longstanding difficulty managing finances
D. Gradual decline over years
Correct Answer: B. Acute onset with fluctuating attention
Explanation: Delirium typically develops acutely and features disturbed attention and awareness with a fluctuating course. Major
neurocognitive disorders usually develop more gradually. Delirium often signals an underlying medical illness, medication effect,
intoxication, withdrawal, or metabolic disturbance. An acute change from cognitive baseline requires prompt evaluation.
Question 12. An older adult has sudden confusion during a urinary infection. What is the priority clinical
interpretation?
A. Consider delirium caused by an acute medical condition
B. Delay evaluation for several months
C. Consider confusion a normal aging change
D. Assume irreversible dementia
Correct Answer: A. Consider delirium caused by an acute medical condition
Explanation: Acute confusion in the setting of illness is concerning for delirium. The priority is to identify and treat the precipitating
cause while supporting safety, hydration, orientation, and other needs. Delirium can occur in a person with or without preexisting
dementia. Acute cognitive change should never simply be labeled normal aging.
Question 13. Which question best addresses the 'Matters Most' domain of the 5Ms?
A. What health outcomes and daily activities are most important to you?
B. Which pharmacy is closest to the clinic?
C. How many diagnoses are in your chart?
D. What is your chronological age?
Correct Answer: A. What health outcomes and daily activities are most important to you?
Explanation: Matters Most centers care on the older adult's goals, values, preferences, and desired health outcomes. This
information helps clinicians judge whether proposed tests and treatments align with what the patient considers meaningful. It is
especially important when multiple reasonable treatment options exist. Shared decision-making becomes more useful when goals
are explicit.
Question 14. Which approach best reflects patient-centered care in an older adult with multiple chronic illnesses?
A. Treat every disease target independently without considering burden
Page 3
, B. Assume longevity is every patient's only goal
C. Exclude the patient from treatment decisions
D. Prioritize treatments according to benefits, burdens, prognosis, function, and the patient's goals
Correct Answer: D. Prioritize treatments according to benefits, burdens, prognosis, function, and the patient's goals
Explanation: Multimorbidity creates competing priorities, treatment burden, and sometimes conflicting recommendations.
Patient-centered care integrates evidence with prognosis, function, quality of life, and individual preferences. The best plan may
differ from disease-specific targets used in younger or healthier populations. Shared decision-making helps align care with the
patient's priorities.
Question 15. Which finding most strongly indicates frailty?
A. Chronological age of 70 years alone
B. Gray hair
C. Reduced physiologic reserve with increased vulnerability to stressors
D. Retirement from employment
Correct Answer: C. Reduced physiologic reserve with increased vulnerability to stressors
Explanation: Frailty describes decreased physiologic reserve and increased vulnerability to relatively minor stressors. It is not
synonymous with chronological age, disability, or any single disease. Features may include weakness, slowed mobility, low activity,
weight loss, or broader deficit accumulation depending on the model used. Identifying frailty can inform risk assessment and care
planning.
Question 16. An older adult unintentionally lost 10 lb in 3 months. What should the clinician do?
A. Wait until the patient loses substantially more weight
B. Evaluate nutritional status and potential medical, dental, medication, mood, and social causes
C. Assume weight loss is normal aging
D. Recommend fasting
Correct Answer: B. Evaluate nutritional status and potential medical, dental, medication, mood, and social causes
Explanation: Unintentional weight loss in an older adult warrants evaluation because it can reflect malnutrition, disease,
depression, medication effects, oral problems, food insecurity, or functional limitations. Nutritional assessment is an important
component of geriatric care. Early identification may reveal reversible contributors. Weight loss should not be dismissed as an
expected aging change.
Question 17. Which sensory problem can contribute to apparent cognitive impairment or social withdrawal?
A. Gray hair
B. Untreated hearing loss
C. Reduced skin elasticity
D. Normal presbyopia corrected with glasses
Correct Answer: B. Untreated hearing loss
Explanation: Hearing impairment can interfere with communication, cognitive testing, social engagement, and adherence to care
plans. A patient who cannot hear questions clearly may appear confused or uncooperative. Sensory function should therefore be
assessed before interpreting cognitive performance. Appropriate hearing support can improve communication and quality of life.
Question 18. Which communication technique is best for an older adult with hearing impairment?
A. Face the patient, reduce background noise, and speak clearly at a moderate pace
B. Speak rapidly while looking at the computer
C. Use only written communication without asking preference
D. Shout from behind the patient
Correct Answer: A. Face the patient, reduce background noise, and speak clearly at a moderate pace
Page 4
Primary Care of the Maturing and Aged Family | 600-Question Comprehensive Mock Exam
Question 1. Which framework organizes geriatric care around Mind, Mobility, Medications, Multicomplexity, and
Matters Most?
A. The APGAR score
B. The 5Ms framework
C. The Wells criteria
D. The Glasgow Coma Scale
Correct Answer: B. The 5Ms framework
Explanation: The Geriatric 5Ms provide a practical framework for comprehensive care of older adults. The domains are Mind,
Mobility, Medications, Multicomplexity, and Matters Most. The framework encourages clinicians to look beyond isolated diseases
and consider function, goals, and treatment burden. It is particularly useful when planning patient-centered primary care.
Question 2. What is the main purpose of a comprehensive geriatric assessment?
A. To identify medical, functional, psychological, and social needs and develop an integrated plan
B. To determine chronological age
C. To perform only a medication review
D. To replace the physical examination
Correct Answer: A. To identify medical, functional, psychological, and social needs and develop an integrated plan
Explanation: Comprehensive geriatric assessment is multidimensional and commonly interdisciplinary. It evaluates medical
conditions together with function, cognition, mood, mobility, medications, nutrition, social circumstances, and environmental
concerns. The findings are used to create an integrated care plan. This approach is especially useful when an older adult has
multiple interacting problems.
Question 3. Which task is an activity of daily living (ADL)?
A. Managing medications
B. Shopping for groceries
C. Managing finances
D. Bathing
Correct Answer: D. Bathing
Explanation: Basic activities of daily living describe fundamental self-care functions such as bathing, dressing, toileting,
transferring, continence, and feeding. Managing finances, shopping, and medications are instrumental activities of daily living. ADL
impairment generally indicates a greater level of functional dependence. Functional status can be more informative than age alone
when planning care.
Question 4. Which task is an instrumental activity of daily living (IADL)?
A. Eating independently
B. Using the toilet
C. Managing medications
D. Transferring from bed to chair
Correct Answer: C. Managing medications
Explanation: IADLs are more complex activities required for independent community living. Examples include managing
medications and finances, shopping, cooking, transportation, and communication. Eating, transferring, and toileting are basic ADLs.
Decline in IADLs may appear before loss of basic self-care abilities.
Question 5. An older adult reports two falls in the past year. What is the best next step?
Page 1
,A. Explain that falls are inevitable with aging
B. Stop all medications immediately
C. Perform a multifactorial fall-risk assessment
D. Recommend permanent bed rest
Correct Answer: C. Perform a multifactorial fall-risk assessment
Explanation: Recurrent falls warrant assessment of potentially modifiable contributors. Evaluation can include gait and balance,
orthostatic blood pressure, vision, footwear, medications, cognition, environmental hazards, and relevant medical conditions. Falls
should not be dismissed as a normal consequence of aging. Interventions are individualized to identified risk factors.
Question 6. What does the Timed Up and Go test primarily assess?
A. Nutritional intake
B. Functional mobility and fall risk
C. Hearing acuity
D. Long-term memory
Correct Answer: B. Functional mobility and fall risk
Explanation: The Timed Up and Go test observes a person rising from a chair, walking a short distance, turning, returning, and
sitting. It provides a quick view of functional mobility and can contribute to fall-risk assessment. Performance should be interpreted
in clinical context rather than as a stand-alone diagnosis. Abnormal findings may prompt more detailed gait and balance evaluation.
Question 7. An older adult becomes dizzy when standing. Which assessment is particularly important?
A. Orthostatic blood pressure and pulse
B. Visual acuity only
C. Skinfold thickness
D. Abdominal circumference only
Correct Answer: A. Orthostatic blood pressure and pulse
Explanation: Postural dizziness can reflect orthostatic hypotension, medication effects, dehydration, autonomic dysfunction, or
other conditions. Measuring blood pressure and pulse after appropriate position changes helps evaluate this possibility. Medication
review and assessment of hydration and fall risk are also important. Symptoms should not automatically be attributed to normal
aging.
Question 8. Which medication-related issue is especially important in older adults?
A. Automatic need for higher doses
B. Uniform renal clearance across all ages
C. Absence of drug interactions
D. Polypharmacy and potentially inappropriate medication use
Correct Answer: D. Polypharmacy and potentially inappropriate medication use
Explanation: Older adults often take multiple prescription and nonprescription products, increasing the chance of interactions and
adverse effects. Age-related changes in renal function, body composition, and pharmacodynamics can further alter medication
response. Medication reconciliation should include over-the-counter drugs and supplements. Treatment should be periodically
reviewed for indication, benefit, risk, and opportunities to simplify.
Question 9. Which principle is most appropriate when prescribing a new medication to a frail older adult?
A. Ignore kidney function if creatinine is normal
B. Add medication before reviewing the current list
C. Start every medication at the maximum dose
D. Use the lowest effective dose and titrate thoughtfully while monitoring response
Correct Answer: D. Use the lowest effective dose and titrate thoughtfully while monitoring response
Page 2
,Explanation: Older adults may have increased sensitivity to medications and reduced physiologic reserve. A cautious starting dose
and careful titration can reduce adverse effects, although the exact approach depends on the drug and clinical situation. Renal and
hepatic function, interactions, goals, and treatment burden should be considered. Medication review should precede unnecessary
prescribing cascades.
Question 10. Why can a normal serum creatinine be misleading in some older adults?
A. Serum creatinine directly measures liver function
B. Creatinine is unrelated to kidney function
C. Reduced muscle mass can mask impaired renal filtration
D. Older adults always have increased muscle mass
Correct Answer: C. Reduced muscle mass can mask impaired renal filtration
Explanation: Creatinine production is influenced by muscle mass, which often decreases with aging and frailty. Consequently, a
seemingly normal serum creatinine can coexist with reduced glomerular filtration. Renally cleared medications should be
considered in the context of estimated kidney function and the individual patient. This helps reduce dose-related toxicity.
Question 11. Which finding suggests delirium rather than a chronic neurocognitive disorder?
A. Stable memory impairment without fluctuation
B. Acute onset with fluctuating attention
C. Longstanding difficulty managing finances
D. Gradual decline over years
Correct Answer: B. Acute onset with fluctuating attention
Explanation: Delirium typically develops acutely and features disturbed attention and awareness with a fluctuating course. Major
neurocognitive disorders usually develop more gradually. Delirium often signals an underlying medical illness, medication effect,
intoxication, withdrawal, or metabolic disturbance. An acute change from cognitive baseline requires prompt evaluation.
Question 12. An older adult has sudden confusion during a urinary infection. What is the priority clinical
interpretation?
A. Consider delirium caused by an acute medical condition
B. Delay evaluation for several months
C. Consider confusion a normal aging change
D. Assume irreversible dementia
Correct Answer: A. Consider delirium caused by an acute medical condition
Explanation: Acute confusion in the setting of illness is concerning for delirium. The priority is to identify and treat the precipitating
cause while supporting safety, hydration, orientation, and other needs. Delirium can occur in a person with or without preexisting
dementia. Acute cognitive change should never simply be labeled normal aging.
Question 13. Which question best addresses the 'Matters Most' domain of the 5Ms?
A. What health outcomes and daily activities are most important to you?
B. Which pharmacy is closest to the clinic?
C. How many diagnoses are in your chart?
D. What is your chronological age?
Correct Answer: A. What health outcomes and daily activities are most important to you?
Explanation: Matters Most centers care on the older adult's goals, values, preferences, and desired health outcomes. This
information helps clinicians judge whether proposed tests and treatments align with what the patient considers meaningful. It is
especially important when multiple reasonable treatment options exist. Shared decision-making becomes more useful when goals
are explicit.
Question 14. Which approach best reflects patient-centered care in an older adult with multiple chronic illnesses?
A. Treat every disease target independently without considering burden
Page 3
, B. Assume longevity is every patient's only goal
C. Exclude the patient from treatment decisions
D. Prioritize treatments according to benefits, burdens, prognosis, function, and the patient's goals
Correct Answer: D. Prioritize treatments according to benefits, burdens, prognosis, function, and the patient's goals
Explanation: Multimorbidity creates competing priorities, treatment burden, and sometimes conflicting recommendations.
Patient-centered care integrates evidence with prognosis, function, quality of life, and individual preferences. The best plan may
differ from disease-specific targets used in younger or healthier populations. Shared decision-making helps align care with the
patient's priorities.
Question 15. Which finding most strongly indicates frailty?
A. Chronological age of 70 years alone
B. Gray hair
C. Reduced physiologic reserve with increased vulnerability to stressors
D. Retirement from employment
Correct Answer: C. Reduced physiologic reserve with increased vulnerability to stressors
Explanation: Frailty describes decreased physiologic reserve and increased vulnerability to relatively minor stressors. It is not
synonymous with chronological age, disability, or any single disease. Features may include weakness, slowed mobility, low activity,
weight loss, or broader deficit accumulation depending on the model used. Identifying frailty can inform risk assessment and care
planning.
Question 16. An older adult unintentionally lost 10 lb in 3 months. What should the clinician do?
A. Wait until the patient loses substantially more weight
B. Evaluate nutritional status and potential medical, dental, medication, mood, and social causes
C. Assume weight loss is normal aging
D. Recommend fasting
Correct Answer: B. Evaluate nutritional status and potential medical, dental, medication, mood, and social causes
Explanation: Unintentional weight loss in an older adult warrants evaluation because it can reflect malnutrition, disease,
depression, medication effects, oral problems, food insecurity, or functional limitations. Nutritional assessment is an important
component of geriatric care. Early identification may reveal reversible contributors. Weight loss should not be dismissed as an
expected aging change.
Question 17. Which sensory problem can contribute to apparent cognitive impairment or social withdrawal?
A. Gray hair
B. Untreated hearing loss
C. Reduced skin elasticity
D. Normal presbyopia corrected with glasses
Correct Answer: B. Untreated hearing loss
Explanation: Hearing impairment can interfere with communication, cognitive testing, social engagement, and adherence to care
plans. A patient who cannot hear questions clearly may appear confused or uncooperative. Sensory function should therefore be
assessed before interpreting cognitive performance. Appropriate hearing support can improve communication and quality of life.
Question 18. Which communication technique is best for an older adult with hearing impairment?
A. Face the patient, reduce background noise, and speak clearly at a moderate pace
B. Speak rapidly while looking at the computer
C. Use only written communication without asking preference
D. Shout from behind the patient
Correct Answer: A. Face the patient, reduce background noise, and speak clearly at a moderate pace
Page 4
