2026/2027
NR 601 Primary Care of the
Maturing and Aged Family Midterm
Exam Review Book for Advanced
Practice Nursing Students 2026/2027
Question 1:
A 68-year-old male experienced transient right-sided weakness, slurred speech, and
confusion that resolved within 24 hours. CT scan of the brain is normal. What is the
most appropriate next step in management?
A. Reassure the patient that symptoms will not recur
B. Start aspirin 81 mg immediately
C. Order EEG and administer oxygen therapy
D. Identify and manage modifiable cardiovascular risk factors
Correct Answer: D. Identify and manage modifiable cardiovascular risk factors
Rationale:
The patient most likely experienced a transient ischemic attack (TIA), which is a
warning sign for future stroke risk. The priority is not symptomatic treatment or
reassurance but prevention of future cerebrovascular events. Identifying and
modifying risk factors such as hypertension, diabetes, smoking, and hyperlipidemia
significantly reduces stroke risk. Aspirin may be indicated later, but risk factor
modification is the foundational first step. EEG and oxygen are not indicated because
there is no evidence of seizure or hypoxia.
Question 2:
A 56-year-old man screened for diabetes has a fasting plasma glucose level of 96
mg/dL. What is the most appropriate management plan?
A. Start Metformin 500 mg twice daily
B. Repeat fasting glucose in one year
C. Repeat fasting glucose in three years
D. Refer for ophthalmology screening
Correct Answer: C. Repeat fasting glucose in three years
Rationale:
A fasting glucose of 96 mg/dL is within the normal range (<100 mg/dL). Routine
screening guidelines recommend repeating diabetes screening every three years in
,2026/2027
low-risk individuals. Metformin is not indicated without impaired glucose regulation.
Annual screening is unnecessary unless risk factors increase. Ophthalmology referral
is reserved for confirmed diabetes.
Question 3:
A 57-year-old woman presents with irritability, insomnia, and anxiety due to recent
financial stress. What is the most appropriate first-line pharmacologic treatment?
A. Diazepam
B. Clonazepam
C. Aripiprazole
D. Paroxetine
Correct Answer: D. Paroxetine
Rationale:
Paroxetine, a selective serotonin reuptake inhibitor (SSRI), is a first-line treatment for
generalized anxiety disorder and depressive symptoms. Benzodiazepines such as
diazepam and clonazepam are not first-line due to dependence and sedation risks.
Aripiprazole is an antipsychotic and not indicated for primary anxiety disorders.
Question 4:
The most common sustained arrhythmia characterized by fibrillatory P waves is:
A. AV block
B. Atrial tachycardia
C. Atrial fibrillation
D. Atrial flutter
Correct Answer: C. Atrial fibrillation
Rationale:
Atrial fibrillation is the most common sustained arrhythmia and is characterized by
absent organized P waves and irregularly irregular rhythm due to chaotic atrial
electrical activity. Atrial flutter has sawtooth flutter waves, while AV block involves
conduction delay. Atrial tachycardia has organized rapid atrial activity.
Question 5:
Atrophic vaginitis is clinically significant because it:
A. Creates a more acidic vaginal environment
B. Has identical symptoms in all women
,2026/2027
C. Is a contributing factor for recurrent urinary tract infections
D. Should not be treated with lubricants
Correct Answer: C. Is a contributing factor for recurrent urinary tract
infections
Rationale:
Estrogen deficiency in atrophic vaginitis leads to thinning of vaginal and urethral
mucosa, increasing susceptibility to UTIs. Symptoms vary among women, and
lubricants or estrogen therapy may be used for treatment. The vaginal environment
becomes less acidic, not more.
Question 6:
Which is the most appropriate screening tool for delirium in hospitalized patients?
A. SLUMS exam
B. Montreal Cognitive Assessment
C. Lawton ADL scale
D. Confusion Assessment Method (CAM)
Correct Answer: D. Confusion Assessment Method (CAM)
Rationale:
The CAM is the gold-standard tool for identifying delirium. It assesses acute onset,
inattention, disorganized thinking, and altered consciousness. SLUMS and MoCA are
cognitive screening tools for dementia, while the Lawton scale assesses functional
ability.
Question 7:
A drug that treats both pain and dyspnea in palliative care is:
A. Lorazepam
B. Gabapentin
C. Methadone
D. Morphine
Correct Answer: D. Morphine
Rationale:
Morphine is the cornerstone opioid in palliative care and effectively treats both pain
and dyspnea by reducing respiratory drive and anxiety related to air hunger.
Lorazepam treats anxiety, gabapentin treats neuropathic pain, and methadone is an
opioid but not first-line for dyspnea.
, 2026/2027
Question 8:
Which screening is recommended annually for elderly patients with type 2 diabetes?
A. Colonoscopy
B. Urology evaluation
C. Gastroenterology follow-up
D. Ophthalmology eye exam
Correct Answer: D. Ophthalmology eye exam
Rationale:
Diabetic patients require annual eye examinations to screen for diabetic retinopathy, a
leading cause of preventable blindness. Colonoscopy and urology referrals are not
routine diabetes-specific annual screenings.
Question 9:
Which feature best distinguishes delirium from dementia?
A. Short-term memory impairment
B. Personality changes
C. Acute onset
D. Impaired attention
Correct Answer: C. Acute onset
Rationale:
Delirium is characterized by acute onset and fluctuating course, while dementia is
chronic and progressive. Both may involve memory impairment and personality
changes, but timing differentiates them.
Question 10:
Most patients receiving hospice care die in:
A. Hospital
B. Nursing home
C. Hospice facility
D. Home
Correct Answer: D. Home
Rationale:
Hospice care prioritizes comfort and quality of life, with most patients preferring to
NR 601 Primary Care of the
Maturing and Aged Family Midterm
Exam Review Book for Advanced
Practice Nursing Students 2026/2027
Question 1:
A 68-year-old male experienced transient right-sided weakness, slurred speech, and
confusion that resolved within 24 hours. CT scan of the brain is normal. What is the
most appropriate next step in management?
A. Reassure the patient that symptoms will not recur
B. Start aspirin 81 mg immediately
C. Order EEG and administer oxygen therapy
D. Identify and manage modifiable cardiovascular risk factors
Correct Answer: D. Identify and manage modifiable cardiovascular risk factors
Rationale:
The patient most likely experienced a transient ischemic attack (TIA), which is a
warning sign for future stroke risk. The priority is not symptomatic treatment or
reassurance but prevention of future cerebrovascular events. Identifying and
modifying risk factors such as hypertension, diabetes, smoking, and hyperlipidemia
significantly reduces stroke risk. Aspirin may be indicated later, but risk factor
modification is the foundational first step. EEG and oxygen are not indicated because
there is no evidence of seizure or hypoxia.
Question 2:
A 56-year-old man screened for diabetes has a fasting plasma glucose level of 96
mg/dL. What is the most appropriate management plan?
A. Start Metformin 500 mg twice daily
B. Repeat fasting glucose in one year
C. Repeat fasting glucose in three years
D. Refer for ophthalmology screening
Correct Answer: C. Repeat fasting glucose in three years
Rationale:
A fasting glucose of 96 mg/dL is within the normal range (<100 mg/dL). Routine
screening guidelines recommend repeating diabetes screening every three years in
,2026/2027
low-risk individuals. Metformin is not indicated without impaired glucose regulation.
Annual screening is unnecessary unless risk factors increase. Ophthalmology referral
is reserved for confirmed diabetes.
Question 3:
A 57-year-old woman presents with irritability, insomnia, and anxiety due to recent
financial stress. What is the most appropriate first-line pharmacologic treatment?
A. Diazepam
B. Clonazepam
C. Aripiprazole
D. Paroxetine
Correct Answer: D. Paroxetine
Rationale:
Paroxetine, a selective serotonin reuptake inhibitor (SSRI), is a first-line treatment for
generalized anxiety disorder and depressive symptoms. Benzodiazepines such as
diazepam and clonazepam are not first-line due to dependence and sedation risks.
Aripiprazole is an antipsychotic and not indicated for primary anxiety disorders.
Question 4:
The most common sustained arrhythmia characterized by fibrillatory P waves is:
A. AV block
B. Atrial tachycardia
C. Atrial fibrillation
D. Atrial flutter
Correct Answer: C. Atrial fibrillation
Rationale:
Atrial fibrillation is the most common sustained arrhythmia and is characterized by
absent organized P waves and irregularly irregular rhythm due to chaotic atrial
electrical activity. Atrial flutter has sawtooth flutter waves, while AV block involves
conduction delay. Atrial tachycardia has organized rapid atrial activity.
Question 5:
Atrophic vaginitis is clinically significant because it:
A. Creates a more acidic vaginal environment
B. Has identical symptoms in all women
,2026/2027
C. Is a contributing factor for recurrent urinary tract infections
D. Should not be treated with lubricants
Correct Answer: C. Is a contributing factor for recurrent urinary tract
infections
Rationale:
Estrogen deficiency in atrophic vaginitis leads to thinning of vaginal and urethral
mucosa, increasing susceptibility to UTIs. Symptoms vary among women, and
lubricants or estrogen therapy may be used for treatment. The vaginal environment
becomes less acidic, not more.
Question 6:
Which is the most appropriate screening tool for delirium in hospitalized patients?
A. SLUMS exam
B. Montreal Cognitive Assessment
C. Lawton ADL scale
D. Confusion Assessment Method (CAM)
Correct Answer: D. Confusion Assessment Method (CAM)
Rationale:
The CAM is the gold-standard tool for identifying delirium. It assesses acute onset,
inattention, disorganized thinking, and altered consciousness. SLUMS and MoCA are
cognitive screening tools for dementia, while the Lawton scale assesses functional
ability.
Question 7:
A drug that treats both pain and dyspnea in palliative care is:
A. Lorazepam
B. Gabapentin
C. Methadone
D. Morphine
Correct Answer: D. Morphine
Rationale:
Morphine is the cornerstone opioid in palliative care and effectively treats both pain
and dyspnea by reducing respiratory drive and anxiety related to air hunger.
Lorazepam treats anxiety, gabapentin treats neuropathic pain, and methadone is an
opioid but not first-line for dyspnea.
, 2026/2027
Question 8:
Which screening is recommended annually for elderly patients with type 2 diabetes?
A. Colonoscopy
B. Urology evaluation
C. Gastroenterology follow-up
D. Ophthalmology eye exam
Correct Answer: D. Ophthalmology eye exam
Rationale:
Diabetic patients require annual eye examinations to screen for diabetic retinopathy, a
leading cause of preventable blindness. Colonoscopy and urology referrals are not
routine diabetes-specific annual screenings.
Question 9:
Which feature best distinguishes delirium from dementia?
A. Short-term memory impairment
B. Personality changes
C. Acute onset
D. Impaired attention
Correct Answer: C. Acute onset
Rationale:
Delirium is characterized by acute onset and fluctuating course, while dementia is
chronic and progressive. Both may involve memory impairment and personality
changes, but timing differentiates them.
Question 10:
Most patients receiving hospice care die in:
A. Hospital
B. Nursing home
C. Hospice facility
D. Home
Correct Answer: D. Home
Rationale:
Hospice care prioritizes comfort and quality of life, with most patients preferring to
