NR 601 – Primary Care of Adults & Older Adults Final | 2025/2026 Verified NP Questions

NR 601 – Primary Care of Adults &
Older Adults Final | 2025/2026
Verified NP Questions

Question 1: Chronic Disease Management

A 62-year-old male with T2DM (A1c 8.2%) and CKD stage 3 (eGFR 48 mL/min) is on metformin 1000
mg BID. Recent ASCVD event. Optimize management per 2025 ADA guidelines?

A. Add sulfonylurea
B. Increase metformin to 2000 mg
C. Add GLP-1 RA like semaglutide

D. Switch to insulin

Rationale: In T2DM with CKD/ASCVD, GLP-1 receptor agonists provide CV/renal protection (RRR
14% MACE, 20% CKD progression) via weight loss, anti-inflammation, and albuminuria reduction
(ADA 2025). Sulfonylurea (A) risks hypo; metformin max in CKD (B); insulin (D) if A1c >9%. NP
implication: Titrate semaglutide 0.25 mg weekly, monitor GI side effects (15%).




Question 2: Chronic Disease Management

A 70-year-old female with HFpEF (EF 55%), BP 145/85 mmHg, on lisinopril 20 mg. NYHA II
symptoms. Next step per 2025 AHA?

A. Add beta-blocker
B. Increase lisinopril to 40 mg
C. Add SGLT2i like dapagliflozin 10 mg

D. Diuretic escalation

Rationale: SGLT2i reduce HF hospitalizations 21% in HFpEF by natriuresis, reduced preload, and
cardiac energetics (DELIVER trial, AHA 2025). Beta-blocker (A) less evidence; ACEi max (B) risks
AKI. NP implication: Check eGFR baseline, educate on dehydration risk.

,Question 3: Chronic Disease Management

A 58-year-old male with COPD GOLD B (FEV1 68%), 1 exacerbation/year, on LABA/ICS. Recent quit
attempt. Adjust per 2025 GOLD?

A. Add LAMA
B. Switch to LAMA monotherapy
C. Continue dual therapy + smoking cessation support

D. Add roflumilast

Rationale: LABA/ICS sufficient for GOLD B; focus on smoking cessation (reduces decline 30%) with
varenicline counseling (GOLD 2025). LAMA add (A) for C/D; roflumilast (D) for chronic bronchitis. NP
implication: Offer NRT, follow-up spirometry q1y.




Question 4: Chronic Disease Management

A 65-year-old female with RA (DAS28 4.5), on methotrexate 15 mg weekly. Joint swelling persists.
Escalate per 2025 ACR?

A. Add NSAID
B. Increase MTX to 25 mg
C. Add TNF inhibitor like etanercept

D. Switch to leflunomide

Rationale: Biologic DMARDs achieve low disease activity in 60% moderate RA via cytokine blockade
(ACR 2025). NSAID (A) symptomatic; MTX max (B) hepatotoxic. NP implication: TB screen, monitor
LFTs q1-3m.




Question 5: Chronic Disease Management

A 72-year-old male with osteoporosis (T-score -2.8), on bisphosphonate 5 years. FRAX 25% major
fracture risk. Next?

A. Continue alendronate
B. Add teriparatide
C. Switch to denosumab 60 mg SQ q6m

D. Calcium only

, Rationale: Denosumab reduces vertebral fractures 68% in high-risk via RANKL inhibition, suitable
post-bisphosphonate holiday (NOF 2025). Teriparatide (B) anabolic first-line. NP implication: DEXA
q2y, hypocalcemia risk.




Question 6: Chronic Disease Management

A 55-year-old obese female (BMI 35) with NAFLD, ALT 65 U/L. Lifestyle changes failed. Per 2025
AASLD?

A. Ursodeoxycholic acid
B. Vitamin E 800 IU
C. Pioglitazone 30 mg daily

D. Statin only

Rationale: Pioglitazone improves steatosis 40% via PPARγ activation in NASH without diabetes
(AASLD 2025). Vit E (B) for non-diabetics. NP implication: HF contraindication, LFTs q3m.




Question 7: Chronic Disease Management

A 68-year-old with Parkinson's (UPDRS 35), on levodopa 600 mg/day, wearing off. Add per 2025 AAN?

A. Amantadine
B. Selegiline
C. Entacapone

D. Deep brain stimulation

Rationale: COMT inhibitor extends levodopa duration 1-2h by reducing metabolism (AAN 2025). DBS
(D) for advanced. NP implication: Diarrhea monitor (10%).




Question 8: Chronic Disease Management

A 60-year-old with CKD stage 4 (eGFR 28), anemia Hb 9.5 g/dL. EPO therapy target?

A. Hb 12 g/dL
B. Hb 11 g/dL
C. Hb 10-11 g/dL

D. Transfusion