NR 601 FINAL EXAM 2026: ADULT AND
GERIATRIC PRIMARY CARE COMPREHENSIVE
ASSESSMENT
CORE DOMAINS
• Health Promotion and Disease Prevention
• Assessment and Diagnostic Reasoning
• Management of Acute and Chronic Conditions
• Geriatric Syndromes and Palliative Care
• Pharmacotherapeutics and Polypharmacy
• Regulatory, Legal, and Ethical Practice
• Behavioral Health and Cognitive Disorders
• Cultural Competence and Patient Education
INTRODUCTION
This comprehensive examination is designed to assess the advanced clinical
knowledge, diagnostic reasoning, and management skills essential for adult and
geriatric primary care nurse practitioners. The assessment evaluates competency
across foundational theory, applied professional knowledge, regulatory and legal
compliance, ethics and professional standards, and real-world clinical scenarios.
Through multiple-choice and scenario-based questions, candidates must
demonstrate critical thinking and decision-making abilities required for safe,
effective, and evidence-based practice in diverse healthcare settings. Emphasis is
placed on practical application of knowledge to optimize patient outcomes in
adult and geriatric populations.
,SECTION ONE: QUESTIONS 1–350
Question 1
A 72-year-old male presents to the clinic for a routine annual wellness visit. He
reports no acute complaints but mentions he has been experiencing increased
urinary frequency and nocturia over the past three months. His medical history
includes hypertension, type 2 diabetes mellitus, and benign prostatic hyperplasia.
Current medications include lisinopril 20 mg daily, metformin 1000 mg twice
daily, and tamsulosin 0.4 mg daily. Vital signs are stable, and his physical
examination is unremarkable except for a mildly enlarged prostate on digital
rectal examination. Which of the following is the most appropriate next step in
management?
A. Initiate finasteride 5 mg daily to reduce prostate size
B. Obtain a prostate-specific antigen level and urinalysis
C. Refer to urology for possible transurethral resection of the prostate
D. Reassure the patient that nocturia is a normal part of aging
B. Obtain a prostate-specific antigen level and urinalysis
RATIONALE: The most appropriate next step is to obtain a prostate-specific
antigen level and urinalysis. While tamsulosin is already being used to manage
BPH symptoms, the new onset of increased urinary frequency and nocturia
warrants further evaluation to rule out malignancy or infection. PSA helps screen
for prostate cancer, and urinalysis can identify urinary tract infection or
hematuria. Initiating finasteride would be premature without ruling out other
causes. Referral to urology for surgical intervention is not indicated at this stage.
Reassuring the patient without evaluation would be inappropriate given the
change in symptoms.
Question 2
A 68-year-old female with a history of osteoporosis and vitamin D deficiency
presents for follow-up. She has been taking calcium carbonate 1200 mg daily and
vitamin D3 800 IU daily. Her most recent DEXA scan shows a T-score of -2.8 at the
,femoral neck. She has no history of fractures. Which of the following is the most
appropriate pharmacological intervention?
A. Continue current regimen and repeat DEXA in two years
B. Initiate alendronate 70 mg weekly
C. Initiate raloxifene 60 mg daily
D. Initiate teriparatide 20 mcg subcutaneous daily
B. Initiate alendronate 70 mg weekly
RATIONALE: The patient has osteoporosis with a T-score of -2.8, which is
below -2.5, indicating pharmacological treatment is warranted. Alendronate, a
bisphosphonate, is first-line therapy for postmenopausal osteoporosis. Continuing
calcium and vitamin D alone is insufficient for treating established osteoporosis.
Raloxifene is typically reserved for patients who cannot tolerate bisphosphonates
or have specific risk factors. Teriparatide is an anabolic agent reserved for severe
cases or those who have failed other therapies.
Question 3
A 78-year-old male is brought to the clinic by his daughter who reports he has
become increasingly forgetful over the past year. He frequently repeats questions
and has difficulty managing his finances. The daughter also notes he has started
wandering at night. The patient denies any memory problems and states he feels
fine. A mini-mental state examination reveals a score of 21/30. Which of the
following is the most appropriate initial diagnostic approach?
A. Initiate donepezil 5 mg daily for suspected Alzheimer's disease
B. Order laboratory tests and brain imaging to rule out reversible causes
C. Reassure the family that memory loss is normal in aging
D. Refer immediately to psychiatry for definitive diagnosis
B. Order laboratory tests and brain imaging to rule out reversible causes
RATIONALE: Before diagnosing dementia, reversible causes of cognitive
impairment must be ruled out. Laboratory tests should include thyroid function,
vitamin B12, folate, electrolytes, and glucose. Brain imaging helps rule out
, structural lesions, subdural hematomas, or normal pressure hydrocephalus.
Initiating donepezil without a confirmed diagnosis is premature. Reassuring the
family would be inappropriate given significant functional impairment. Psychiatric
referral may be considered later, but medical workup must come first.
Question 4
A 65-year-old female with a history of chronic obstructive pulmonary disease
presents with increased dyspnea and productive cough over the past three days.
She reports increased sputum production and change in sputum color to green.
She has been using her rescue inhaler more frequently. Vital signs show
respiratory rate of 24, oxygen saturation of 88% on room air, and heart rate of 96.
Lung auscultation reveals bilateral wheezing and coarse crackles at the bases.
Which of the following is the most appropriate management?
A. Prescribe a course of oral azithromycin
B. Initiate supplemental oxygen and systemic corticosteroids
C. Admit to hospital for intravenous antibiotics
D. Increase use of rescue inhaler and monitor at home
B. Initiate supplemental oxygen and systemic corticosteroids
RATIONALE: The patient is experiencing an acute exacerbation of COPD with
hypoxemia (oxygen saturation 88%) and increased symptoms. Supplemental
oxygen should be initiated to maintain oxygen saturation between 88-92%.
Systemic corticosteroids are recommended for moderate to severe exacerbations
to reduce inflammation and prevent further deterioration. While antibiotics may
be indicated for infectious exacerbations, the initial priority is oxygenation and
corticosteroid therapy. Hospital admission may be necessary if she does not
improve, but outpatient management with close follow-up can be attempted
initially. Simply increasing rescue inhaler use without addressing hypoxemia is
insufficient.
Question 5
GERIATRIC PRIMARY CARE COMPREHENSIVE
ASSESSMENT
CORE DOMAINS
• Health Promotion and Disease Prevention
• Assessment and Diagnostic Reasoning
• Management of Acute and Chronic Conditions
• Geriatric Syndromes and Palliative Care
• Pharmacotherapeutics and Polypharmacy
• Regulatory, Legal, and Ethical Practice
• Behavioral Health and Cognitive Disorders
• Cultural Competence and Patient Education
INTRODUCTION
This comprehensive examination is designed to assess the advanced clinical
knowledge, diagnostic reasoning, and management skills essential for adult and
geriatric primary care nurse practitioners. The assessment evaluates competency
across foundational theory, applied professional knowledge, regulatory and legal
compliance, ethics and professional standards, and real-world clinical scenarios.
Through multiple-choice and scenario-based questions, candidates must
demonstrate critical thinking and decision-making abilities required for safe,
effective, and evidence-based practice in diverse healthcare settings. Emphasis is
placed on practical application of knowledge to optimize patient outcomes in
adult and geriatric populations.
,SECTION ONE: QUESTIONS 1–350
Question 1
A 72-year-old male presents to the clinic for a routine annual wellness visit. He
reports no acute complaints but mentions he has been experiencing increased
urinary frequency and nocturia over the past three months. His medical history
includes hypertension, type 2 diabetes mellitus, and benign prostatic hyperplasia.
Current medications include lisinopril 20 mg daily, metformin 1000 mg twice
daily, and tamsulosin 0.4 mg daily. Vital signs are stable, and his physical
examination is unremarkable except for a mildly enlarged prostate on digital
rectal examination. Which of the following is the most appropriate next step in
management?
A. Initiate finasteride 5 mg daily to reduce prostate size
B. Obtain a prostate-specific antigen level and urinalysis
C. Refer to urology for possible transurethral resection of the prostate
D. Reassure the patient that nocturia is a normal part of aging
B. Obtain a prostate-specific antigen level and urinalysis
RATIONALE: The most appropriate next step is to obtain a prostate-specific
antigen level and urinalysis. While tamsulosin is already being used to manage
BPH symptoms, the new onset of increased urinary frequency and nocturia
warrants further evaluation to rule out malignancy or infection. PSA helps screen
for prostate cancer, and urinalysis can identify urinary tract infection or
hematuria. Initiating finasteride would be premature without ruling out other
causes. Referral to urology for surgical intervention is not indicated at this stage.
Reassuring the patient without evaluation would be inappropriate given the
change in symptoms.
Question 2
A 68-year-old female with a history of osteoporosis and vitamin D deficiency
presents for follow-up. She has been taking calcium carbonate 1200 mg daily and
vitamin D3 800 IU daily. Her most recent DEXA scan shows a T-score of -2.8 at the
,femoral neck. She has no history of fractures. Which of the following is the most
appropriate pharmacological intervention?
A. Continue current regimen and repeat DEXA in two years
B. Initiate alendronate 70 mg weekly
C. Initiate raloxifene 60 mg daily
D. Initiate teriparatide 20 mcg subcutaneous daily
B. Initiate alendronate 70 mg weekly
RATIONALE: The patient has osteoporosis with a T-score of -2.8, which is
below -2.5, indicating pharmacological treatment is warranted. Alendronate, a
bisphosphonate, is first-line therapy for postmenopausal osteoporosis. Continuing
calcium and vitamin D alone is insufficient for treating established osteoporosis.
Raloxifene is typically reserved for patients who cannot tolerate bisphosphonates
or have specific risk factors. Teriparatide is an anabolic agent reserved for severe
cases or those who have failed other therapies.
Question 3
A 78-year-old male is brought to the clinic by his daughter who reports he has
become increasingly forgetful over the past year. He frequently repeats questions
and has difficulty managing his finances. The daughter also notes he has started
wandering at night. The patient denies any memory problems and states he feels
fine. A mini-mental state examination reveals a score of 21/30. Which of the
following is the most appropriate initial diagnostic approach?
A. Initiate donepezil 5 mg daily for suspected Alzheimer's disease
B. Order laboratory tests and brain imaging to rule out reversible causes
C. Reassure the family that memory loss is normal in aging
D. Refer immediately to psychiatry for definitive diagnosis
B. Order laboratory tests and brain imaging to rule out reversible causes
RATIONALE: Before diagnosing dementia, reversible causes of cognitive
impairment must be ruled out. Laboratory tests should include thyroid function,
vitamin B12, folate, electrolytes, and glucose. Brain imaging helps rule out
, structural lesions, subdural hematomas, or normal pressure hydrocephalus.
Initiating donepezil without a confirmed diagnosis is premature. Reassuring the
family would be inappropriate given significant functional impairment. Psychiatric
referral may be considered later, but medical workup must come first.
Question 4
A 65-year-old female with a history of chronic obstructive pulmonary disease
presents with increased dyspnea and productive cough over the past three days.
She reports increased sputum production and change in sputum color to green.
She has been using her rescue inhaler more frequently. Vital signs show
respiratory rate of 24, oxygen saturation of 88% on room air, and heart rate of 96.
Lung auscultation reveals bilateral wheezing and coarse crackles at the bases.
Which of the following is the most appropriate management?
A. Prescribe a course of oral azithromycin
B. Initiate supplemental oxygen and systemic corticosteroids
C. Admit to hospital for intravenous antibiotics
D. Increase use of rescue inhaler and monitor at home
B. Initiate supplemental oxygen and systemic corticosteroids
RATIONALE: The patient is experiencing an acute exacerbation of COPD with
hypoxemia (oxygen saturation 88%) and increased symptoms. Supplemental
oxygen should be initiated to maintain oxygen saturation between 88-92%.
Systemic corticosteroids are recommended for moderate to severe exacerbations
to reduce inflammation and prevent further deterioration. While antibiotics may
be indicated for infectious exacerbations, the initial priority is oxygenation and
corticosteroid therapy. Hospital admission may be necessary if she does not
improve, but outpatient management with close follow-up can be attempted
initially. Simply increasing rescue inhaler use without addressing hypoxemia is
insufficient.
Question 5
