NR601 / NR 601 PRIMARY CARE OF
THE MATURING & AGED FAMILY
PRACTICUM MIDTERM EXAM STUDY
GUIDE WITH ACCURATE ANSWERS
2026 COMPLETE REVIEW PACKAGE
◉ . An 81-year-old transgender female with history of depression and
hyperlipidemia presents to your clinic for routine care. She endorses a
history of smoking, currently smoking 1 pack per day, and occasionally
drinks a glass of wine, although she denies illicit drug use. She reports
she takes atorvastatin 20 mg and subcutaneous estrogen therapy.
Answer: Counseling on smoking cessation
◉ An 84-year-old male with history of stroke without residual deficit,
systolic heart failure, and type 2 diabetes presents to clinic for follow-up.
He is independently living in a retirement community and still works
part time on a golf course. He currently takes aspirin 81 mg, metoprolol
tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril
10 mg daily. He reports his last colonoscopy was 8 years ago, with no
abnormality. He reports he is sexually active with men and women,
engaging in receptive oral, receptive anal, and penetrative sex. He states
he has had over three sexual partners in the last year with intermittent
condom use. What sexually transmitted infection testing should be
offered?
Answer: Urine testing, blood testing, anal swab, and oropharyngeal
swab
◉ Which of the following is true about tolterodine?
,Answer: It has greater risk of adverse effects with its twice-daily
formulation.
◉ An 82-year-old man, Mr. A, complains of worsening nocturia,
occurring four times per night. His other lower urinary tract symptoms
are slow stream, occasional urgency, and urgency-related leakage once
weekly. Medical problems include poorly controlled hypertension,
diastolic heart failure, hyperlipidemia, osteoarthritis, and prediabetes.
His medications include lisinopril 20 mg daily, metoprolol succinate 75
mg daily, atorvastatin 10 mg daily, metformin 500 mg twice daily,
hydrocodone-acetaminophen as needed, and aspirin 81 mg daily.
Amlodipine 5 mg daily was recently added by his cardiologist. On
review of systems, Mr. A complains that nocturia is causing daytime
fatigue, and he is more constipated. Physical examination is notable for
blood pressure 162/83 mmHg, heart rate 60 beats per minute, clear
lungs, soft abdomen, enlarged prostate, and 21 pretibial edema. Your
next step in management should be:
Answer: Stop amlodipine and increase lisinopril.
◉ The daughter of a 79-year-old woman notes that her mother, who has
dementia and lives with her, is wetting herself when she attends her new
day program. Program staff have requested that "something be done" as
she is requiring a clothes change nearly every time she is there. She
cannot describe the circumstances of leakage, saying "it just comes."
Leakage is uncommon at home. Her medications include donepezil and
acetaminophen. Physical examination is normal. Initial treatment
approach will require intervention by which of the following?
Answer: Day program staff
, ◉ . Ms. J, who is 82 years old, complains of urine leakage while playing
golf. This has gotten worse over the past year, and she rarely makes it
through nine holes without feeling like she needs to "run into the bushes
and go." Leakage is usually small volume, but causes her extreme
embarrassment because she is afraid she will smell of urine. She has
tried limiting caffeine in the morning before she golfs and avoiding
drinking water while playing, to no effect. She also tried "those Kegler"
exercises in the past without success. Which of the following is the most
appropriate recommendation for Ms. J?
Answer: Bladder training
◉ What is the most common cause of erectile dysfunction in older men?
Answer: Atherosclerosis
◉ Which is the most reasonable first step in the treatment of older men
with erectile dysfunction?
Answer: Sildenafil
◉ A 72-year-old woman reports vaginal dryness that interferes with
coitus. Her medical history includes type 2 diabetes, hypertension, and
osteoarthritis. Medications are glyburide, chlorthalidone, and
acetaminophen. What would be your first step in therapy?
Answer: Stop chlorthalidone
◉ A 70-year-old woman reports sexual pain with deep penetration only.
What is the most likely cause of her problem?
Answer: High-tone pelvic floor dysfunction
THE MATURING & AGED FAMILY
PRACTICUM MIDTERM EXAM STUDY
GUIDE WITH ACCURATE ANSWERS
2026 COMPLETE REVIEW PACKAGE
◉ . An 81-year-old transgender female with history of depression and
hyperlipidemia presents to your clinic for routine care. She endorses a
history of smoking, currently smoking 1 pack per day, and occasionally
drinks a glass of wine, although she denies illicit drug use. She reports
she takes atorvastatin 20 mg and subcutaneous estrogen therapy.
Answer: Counseling on smoking cessation
◉ An 84-year-old male with history of stroke without residual deficit,
systolic heart failure, and type 2 diabetes presents to clinic for follow-up.
He is independently living in a retirement community and still works
part time on a golf course. He currently takes aspirin 81 mg, metoprolol
tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril
10 mg daily. He reports his last colonoscopy was 8 years ago, with no
abnormality. He reports he is sexually active with men and women,
engaging in receptive oral, receptive anal, and penetrative sex. He states
he has had over three sexual partners in the last year with intermittent
condom use. What sexually transmitted infection testing should be
offered?
Answer: Urine testing, blood testing, anal swab, and oropharyngeal
swab
◉ Which of the following is true about tolterodine?
,Answer: It has greater risk of adverse effects with its twice-daily
formulation.
◉ An 82-year-old man, Mr. A, complains of worsening nocturia,
occurring four times per night. His other lower urinary tract symptoms
are slow stream, occasional urgency, and urgency-related leakage once
weekly. Medical problems include poorly controlled hypertension,
diastolic heart failure, hyperlipidemia, osteoarthritis, and prediabetes.
His medications include lisinopril 20 mg daily, metoprolol succinate 75
mg daily, atorvastatin 10 mg daily, metformin 500 mg twice daily,
hydrocodone-acetaminophen as needed, and aspirin 81 mg daily.
Amlodipine 5 mg daily was recently added by his cardiologist. On
review of systems, Mr. A complains that nocturia is causing daytime
fatigue, and he is more constipated. Physical examination is notable for
blood pressure 162/83 mmHg, heart rate 60 beats per minute, clear
lungs, soft abdomen, enlarged prostate, and 21 pretibial edema. Your
next step in management should be:
Answer: Stop amlodipine and increase lisinopril.
◉ The daughter of a 79-year-old woman notes that her mother, who has
dementia and lives with her, is wetting herself when she attends her new
day program. Program staff have requested that "something be done" as
she is requiring a clothes change nearly every time she is there. She
cannot describe the circumstances of leakage, saying "it just comes."
Leakage is uncommon at home. Her medications include donepezil and
acetaminophen. Physical examination is normal. Initial treatment
approach will require intervention by which of the following?
Answer: Day program staff
, ◉ . Ms. J, who is 82 years old, complains of urine leakage while playing
golf. This has gotten worse over the past year, and she rarely makes it
through nine holes without feeling like she needs to "run into the bushes
and go." Leakage is usually small volume, but causes her extreme
embarrassment because she is afraid she will smell of urine. She has
tried limiting caffeine in the morning before she golfs and avoiding
drinking water while playing, to no effect. She also tried "those Kegler"
exercises in the past without success. Which of the following is the most
appropriate recommendation for Ms. J?
Answer: Bladder training
◉ What is the most common cause of erectile dysfunction in older men?
Answer: Atherosclerosis
◉ Which is the most reasonable first step in the treatment of older men
with erectile dysfunction?
Answer: Sildenafil
◉ A 72-year-old woman reports vaginal dryness that interferes with
coitus. Her medical history includes type 2 diabetes, hypertension, and
osteoarthritis. Medications are glyburide, chlorthalidone, and
acetaminophen. What would be your first step in therapy?
Answer: Stop chlorthalidone
◉ A 70-year-old woman reports sexual pain with deep penetration only.
What is the most likely cause of her problem?
Answer: High-tone pelvic floor dysfunction
