NR601 Primary Care of the Maturing & Aged Family | Final Exam Prep
NR601 / NR 601 — PRIMARY CARE OF THE MATURING & AGED
FAMILY
FINAL EXAM GUIDE | 2026/2027 Update | A+ Graded | Chamberlain University
[ GERIATRIC ASSESSMENT ]
1. A 78-year-old woman is brought in by her daughter who reports her mother has been having
increasing difficulty managing her medications, paying bills, and preparing meals over the past year,
although she still dresses and bathes independently. Which functional category is most affected?
A. Basic Activities of Daily Living (BADLs)
B. Instrumental Activities of Daily Living (IADLs)
C. Advanced Activities of Daily Living (AADLs)
D. Physical Performance Status
✔ Correct Answer: B
Rationale: Instrumental Activities of Daily Living (IADLs) include higher-order tasks such as managing medications,
finances, cooking, transportation, and housekeeping — activities that require more complex cognitive and functional
abilities. Basic ADLs (bathing, dressing, grooming, toileting, transferring, feeding) are preserved in this patient. IADL
impairment often signals early cognitive or functional decline requiring further evaluation.
[ GERIATRIC ASSESSMENT ]
2. During a comprehensive geriatric assessment, a 74-year-old man scores 22/30 on the Mini-Mental
State Examination (MMSE). Which interpretation is most accurate?
A. Score is within normal limits; no further workup needed
B. Score suggests mild cognitive impairment; further evaluation with history, neuropsychological
testing, and labs is warranted
C. Score is diagnostic of moderate dementia requiring immediate cholinesterase inhibitor therapy
D. MMSE score alone is sufficient to diagnose Alzheimer's disease
✔ Correct Answer: B
Rationale: MMSE scores of 24–30 are generally considered normal, scores of 18–23 suggest mild cognitive
impairment, and scores below 18 suggest moderate-to-severe impairment. A score of 22 warrants further evaluation
including detailed history, neuropsychological testing, thyroid function, B12, folate, metabolic panel, and neuroimaging
to differentiate reversible from irreversible causes. MMSE alone cannot diagnose a specific dementia subtype.
[ GERIATRIC ASSESSMENT ]
3. An 82-year-old man has lost 12 pounds unintentionally over the past 6 months, reports fatigue, and
walks slowly. His grip strength is reduced. He meets 3 of 5 Fried frailty criteria. Which management
approach is most appropriate?
A. Initiate hospice consultation
B. Implement a multicomponent intervention including exercise, nutritional support, and medication
review
C. Restrict physical activity to prevent falls
D. Prescribe megestrol acetate as first-line therapy for weight restoration
✔ Correct Answer: B
Rationale: Frailty (meeting ≥3 of 5 Fried criteria: unintentional weight loss, exhaustion, weakness, slowness, low
activity) predicts adverse outcomes including falls, hospitalization, and mortality. Evidence supports multicomponent
interventions including resistance exercise, nutritional supplementation, medication deprescribing, and management of
contributing medical conditions. Restricting activity worsens frailty. Megestrol acetate has significant adverse effects
(VTE, adrenal suppression) and is not first-line.
Page 1 of 48
, NR601 Primary Care of the Maturing & Aged Family | Final Exam Prep
[ GERIATRIC ASSESSMENT ]
4. A 70-year-old patient is assessed using the Timed Up and Go (TUG) test. She takes 16 seconds to
complete the task. Which interpretation is correct?
A. Performance is within normal limits for her age
B. A TUG time greater than 12 seconds indicates increased fall risk; further fall risk assessment and
intervention are indicated
C. TUG time is only relevant in patients over 80
D. TUG cannot be used without concurrent MMSE testing
✔ Correct Answer: B
Rationale: The Timed Up and Go test measures functional mobility and fall risk. A TUG time >12 seconds in older
adults is associated with increased fall risk and poorer mobility. This patient's 16-second time indicates impaired mobility
and warrants comprehensive fall risk assessment, medication review, physical therapy referral, vision check, and home
safety evaluation per clinical guidelines.
[ GERIATRIC ASSESSMENT ]
5. Which screening tool is specifically designed to assess for depression in older adults in the primary
care setting?
A. Hamilton Rating Scale for Depression (HAM-D)
B. Patient Health Questionnaire-9 (PHQ-9) or Geriatric Depression Scale (GDS)
C. Columbia Suicide Severity Rating Scale
D. Confusion Assessment Method (CAM)
✔ Correct Answer: B
Rationale: The Geriatric Depression Scale (GDS, 15- or 30-item) is specifically designed for use in older adults and
avoids somatic items that may reflect medical illness rather than depression. The PHQ-9 is also widely used and
validated in older adults. The HAM-D is a clinician-administered tool used primarily in research. The CAM screens for
delirium, not depression.
[ GERIATRIC ASSESSMENT ]
6. A 75-year-old woman with hypertension, osteoarthritis, and type 2 diabetes is taking 11 medications.
Which validated tool is most appropriate to identify potentially inappropriate medications in this patient?
A. Framingham Risk Score
B. STOPP/START Criteria or the Beers Criteria
C. MMSE
D. AUDIT-C
✔ Correct Answer: B
Rationale: Polypharmacy (≥5 medications) is common in older adults and associated with adverse drug reactions, falls,
hospitalizations, and non-adherence. The AGS Beers Criteria and the STOPP/START tool are validated instruments for
identifying potentially inappropriate medications in older adults. A medication reconciliation review using these tools
should be performed at each visit. The other tools assess cardiovascular risk, cognition, and alcohol use.
[ GERIATRIC ASSESSMENT ]
7. An 80-year-old man with mild cognitive impairment is assessed for driving safety. Which statement
best guides the AGPCNP's approach?
A. Patients with any cognitive impairment should immediately surrender their driver's license
B. Driving assessment should include cognitive, physical, and visual evaluation; referral for formal
driving evaluation by an occupational therapist may be appropriate
Page 2 of 48
, NR601 Primary Care of the Maturing & Aged Family | Final Exam Prep
C. Cognitive impairment does not affect driving ability until the moderate stage
D. Only neurologists can assess driving fitness in older adults
✔ Correct Answer: B
Rationale: Driving fitness in older adults with cognitive impairment requires a multidimensional assessment including
cognition, vision, physical function, reaction time, and medication review. An on-road evaluation by a certified driving
rehabilitation specialist (occupational therapist) provides objective data. The AGPCNP must balance patient safety,
autonomy, and state reporting obligations. A mild impairment diagnosis alone does not mandate immediate cessation of
driving.
[ GERIATRIC ASSESSMENT ]
8. A 77-year-old woman is screened for malnutrition. She has had a 7% body weight loss in 3 months,
reduced dietary intake, and BMI of 20.1 kg/m². Which tool and intervention are most appropriate?
A. Use the AUDIT-C and initiate vitamin B12 supplementation
B. Use the Mini Nutritional Assessment (MNA); refer to registered dietitian and consider nutritional
supplementation
C. No intervention needed; BMI over 18.5 is normal
D. Initiate megestrol acetate 800 mg daily immediately
✔ Correct Answer: B
Rationale: The Mini Nutritional Assessment (MNA) is a validated tool for identifying malnutrition and malnutrition risk in
older adults. This patient demonstrates multiple risk factors for malnutrition (weight loss >5% in 3 months, reduced
intake, borderline BMI). Referral to a registered dietitian and oral nutritional supplementation are the evidence-based
first steps. Megestrol acetate carries significant risks including VTE and adrenal suppression and is not a first-line
intervention.
[ GERIATRIC ASSESSMENT ]
9. An 83-year-old man completes the Montreal Cognitive Assessment (MoCA) and scores 21/30. Which
statement is most accurate?
A. MoCA score of 21 is normal for adults over 80
B. A MoCA score below 26 suggests cognitive impairment; comprehensive evaluation for reversible
causes should be completed
C. MoCA is only validated for patients under 75
D. A MoCA score of 21 is diagnostic of Lewy body dementia
✔ Correct Answer: B
Rationale: The MoCA (Montreal Cognitive Assessment) has a maximum score of 30; scores below 26 suggest
cognitive impairment. It is more sensitive than the MMSE for detecting mild cognitive impairment (MCI). A score of 21
warrants a thorough evaluation including labs (TSH, B12, CBC, CMP, RPR), neuroimaging, and possibly
neuropsychological testing to rule out reversible causes before establishing a primary dementia diagnosis.
[ GERIATRIC ASSESSMENT ]
10. A 69-year-old woman reports urinary leakage when coughing, sneezing, or laughing. She denies
urgency. Which type of urinary incontinence is most likely and what is the first-line treatment?
A. Urge incontinence; immediate-release oxybutynin
B. Stress incontinence; pelvic floor muscle training (Kegel exercises)
C. Overflow incontinence; bethanechol
D. Mixed incontinence; immediate surgical referral
✔ Correct Answer: B
Rationale: Leakage associated with increased intra-abdominal pressure (coughing, sneezing, laughing) without
urgency is characteristic of stress urinary incontinence (SUI), caused by urethral sphincter weakness or pelvic floor
dysfunction. First-line treatment for SUI is pelvic floor muscle training (Kegel exercises), which has strong evidence for
Page 3 of 48
, NR601 Primary Care of the Maturing & Aged Family | Final Exam Prep
reducing leakage episodes. Oxybutynin treats urge incontinence. Overflow incontinence presents with frequent
small-volume leakage and elevated post-void residual.
[ GERIATRIC ASSESSMENT ]
11. A 74-year-old woman presents with a sudden onset of severe, sharp low back pain after bending to
lift a grocery bag. Spine X-ray reveals a vertebral compression fracture at T12. She has no neurologic
deficits. Which condition is the most common underlying cause?
A. Multiple myeloma
B. Osteoporosis
C. Spinal metastasis
D. Paget's disease
✔ Correct Answer: B
Rationale: Vertebral compression fractures in postmenopausal women following minimal or low-energy trauma are
most commonly caused by osteoporosis. Osteoporosis causes trabecular bone loss, making vertebrae susceptible to
fracture with minimal mechanical stress. DEXA scan, FRAX score, and evaluation of secondary causes of bone loss are
indicated. While malignancy (myeloma, metastasis) must be considered, osteoporosis is by far the most common
etiology in this clinical context.
[ GERIATRIC ASSESSMENT ]
12. The AGPCNP is planning preventive care for a 72-year-old man. Per USPSTF recommendations,
which cancer screening is recommended for this patient based solely on age and sex?
A. Annual PSA screening for prostate cancer
B. Annual CT colonography for colorectal cancer
C. One-time abdominal aortic aneurysm (AAA) screening with abdominal ultrasound if he has a
smoking history
D. Annual chest X-ray for lung cancer screening
✔ Correct Answer: C
Rationale: The USPSTF recommends one-time abdominal aortic aneurysm screening with abdominal ultrasound in
men aged 65–75 who have ever smoked (≥100 cigarettes lifetime). For colorectal cancer, multiple screening modalities
are recommended through age 75 (colonoscopy, stool tests, CT colonography). Annual low-dose CT lung cancer
screening is recommended for high-risk adults (ages 50–80, ≥20 pack-year history, current smoker or quit within 15
years). PSA screening for prostate cancer is not universally recommended; it requires shared decision-making.
[ CARDIOVASCULAR ]
13. A 74-year-old man with heart failure with reduced ejection fraction (HFrEF, EF 35%) is already on
lisinopril and carvedilol. His most recent BMP shows potassium of 4.2 mEq/L and eGFR of 55 mL/min.
Which medication should be added to reduce mortality?
A. Amlodipine
B. Digoxin
C. Spironolactone (aldosterone antagonist)
D. Hydralazine
✔ Correct Answer: C
Rationale: Per ACC/AHA HFrEF guidelines, aldosterone antagonists (spironolactone or eplerenone) are Class I
recommended additions to ACE inhibitor and beta-blocker therapy in patients with HFrEF (EF ≤35%), NYHA Class II–IV
symptoms, eGFR >30 mL/min, and potassium <5.0 mEq/L. They reduce mortality, hospitalizations, and sudden cardiac
death. Digoxin reduces hospitalizations but does not reduce mortality. Amlodipine and hydralazine have more limited
roles.
Page 4 of 48
NR601 / NR 601 — PRIMARY CARE OF THE MATURING & AGED
FAMILY
FINAL EXAM GUIDE | 2026/2027 Update | A+ Graded | Chamberlain University
[ GERIATRIC ASSESSMENT ]
1. A 78-year-old woman is brought in by her daughter who reports her mother has been having
increasing difficulty managing her medications, paying bills, and preparing meals over the past year,
although she still dresses and bathes independently. Which functional category is most affected?
A. Basic Activities of Daily Living (BADLs)
B. Instrumental Activities of Daily Living (IADLs)
C. Advanced Activities of Daily Living (AADLs)
D. Physical Performance Status
✔ Correct Answer: B
Rationale: Instrumental Activities of Daily Living (IADLs) include higher-order tasks such as managing medications,
finances, cooking, transportation, and housekeeping — activities that require more complex cognitive and functional
abilities. Basic ADLs (bathing, dressing, grooming, toileting, transferring, feeding) are preserved in this patient. IADL
impairment often signals early cognitive or functional decline requiring further evaluation.
[ GERIATRIC ASSESSMENT ]
2. During a comprehensive geriatric assessment, a 74-year-old man scores 22/30 on the Mini-Mental
State Examination (MMSE). Which interpretation is most accurate?
A. Score is within normal limits; no further workup needed
B. Score suggests mild cognitive impairment; further evaluation with history, neuropsychological
testing, and labs is warranted
C. Score is diagnostic of moderate dementia requiring immediate cholinesterase inhibitor therapy
D. MMSE score alone is sufficient to diagnose Alzheimer's disease
✔ Correct Answer: B
Rationale: MMSE scores of 24–30 are generally considered normal, scores of 18–23 suggest mild cognitive
impairment, and scores below 18 suggest moderate-to-severe impairment. A score of 22 warrants further evaluation
including detailed history, neuropsychological testing, thyroid function, B12, folate, metabolic panel, and neuroimaging
to differentiate reversible from irreversible causes. MMSE alone cannot diagnose a specific dementia subtype.
[ GERIATRIC ASSESSMENT ]
3. An 82-year-old man has lost 12 pounds unintentionally over the past 6 months, reports fatigue, and
walks slowly. His grip strength is reduced. He meets 3 of 5 Fried frailty criteria. Which management
approach is most appropriate?
A. Initiate hospice consultation
B. Implement a multicomponent intervention including exercise, nutritional support, and medication
review
C. Restrict physical activity to prevent falls
D. Prescribe megestrol acetate as first-line therapy for weight restoration
✔ Correct Answer: B
Rationale: Frailty (meeting ≥3 of 5 Fried criteria: unintentional weight loss, exhaustion, weakness, slowness, low
activity) predicts adverse outcomes including falls, hospitalization, and mortality. Evidence supports multicomponent
interventions including resistance exercise, nutritional supplementation, medication deprescribing, and management of
contributing medical conditions. Restricting activity worsens frailty. Megestrol acetate has significant adverse effects
(VTE, adrenal suppression) and is not first-line.
Page 1 of 48
, NR601 Primary Care of the Maturing & Aged Family | Final Exam Prep
[ GERIATRIC ASSESSMENT ]
4. A 70-year-old patient is assessed using the Timed Up and Go (TUG) test. She takes 16 seconds to
complete the task. Which interpretation is correct?
A. Performance is within normal limits for her age
B. A TUG time greater than 12 seconds indicates increased fall risk; further fall risk assessment and
intervention are indicated
C. TUG time is only relevant in patients over 80
D. TUG cannot be used without concurrent MMSE testing
✔ Correct Answer: B
Rationale: The Timed Up and Go test measures functional mobility and fall risk. A TUG time >12 seconds in older
adults is associated with increased fall risk and poorer mobility. This patient's 16-second time indicates impaired mobility
and warrants comprehensive fall risk assessment, medication review, physical therapy referral, vision check, and home
safety evaluation per clinical guidelines.
[ GERIATRIC ASSESSMENT ]
5. Which screening tool is specifically designed to assess for depression in older adults in the primary
care setting?
A. Hamilton Rating Scale for Depression (HAM-D)
B. Patient Health Questionnaire-9 (PHQ-9) or Geriatric Depression Scale (GDS)
C. Columbia Suicide Severity Rating Scale
D. Confusion Assessment Method (CAM)
✔ Correct Answer: B
Rationale: The Geriatric Depression Scale (GDS, 15- or 30-item) is specifically designed for use in older adults and
avoids somatic items that may reflect medical illness rather than depression. The PHQ-9 is also widely used and
validated in older adults. The HAM-D is a clinician-administered tool used primarily in research. The CAM screens for
delirium, not depression.
[ GERIATRIC ASSESSMENT ]
6. A 75-year-old woman with hypertension, osteoarthritis, and type 2 diabetes is taking 11 medications.
Which validated tool is most appropriate to identify potentially inappropriate medications in this patient?
A. Framingham Risk Score
B. STOPP/START Criteria or the Beers Criteria
C. MMSE
D. AUDIT-C
✔ Correct Answer: B
Rationale: Polypharmacy (≥5 medications) is common in older adults and associated with adverse drug reactions, falls,
hospitalizations, and non-adherence. The AGS Beers Criteria and the STOPP/START tool are validated instruments for
identifying potentially inappropriate medications in older adults. A medication reconciliation review using these tools
should be performed at each visit. The other tools assess cardiovascular risk, cognition, and alcohol use.
[ GERIATRIC ASSESSMENT ]
7. An 80-year-old man with mild cognitive impairment is assessed for driving safety. Which statement
best guides the AGPCNP's approach?
A. Patients with any cognitive impairment should immediately surrender their driver's license
B. Driving assessment should include cognitive, physical, and visual evaluation; referral for formal
driving evaluation by an occupational therapist may be appropriate
Page 2 of 48
, NR601 Primary Care of the Maturing & Aged Family | Final Exam Prep
C. Cognitive impairment does not affect driving ability until the moderate stage
D. Only neurologists can assess driving fitness in older adults
✔ Correct Answer: B
Rationale: Driving fitness in older adults with cognitive impairment requires a multidimensional assessment including
cognition, vision, physical function, reaction time, and medication review. An on-road evaluation by a certified driving
rehabilitation specialist (occupational therapist) provides objective data. The AGPCNP must balance patient safety,
autonomy, and state reporting obligations. A mild impairment diagnosis alone does not mandate immediate cessation of
driving.
[ GERIATRIC ASSESSMENT ]
8. A 77-year-old woman is screened for malnutrition. She has had a 7% body weight loss in 3 months,
reduced dietary intake, and BMI of 20.1 kg/m². Which tool and intervention are most appropriate?
A. Use the AUDIT-C and initiate vitamin B12 supplementation
B. Use the Mini Nutritional Assessment (MNA); refer to registered dietitian and consider nutritional
supplementation
C. No intervention needed; BMI over 18.5 is normal
D. Initiate megestrol acetate 800 mg daily immediately
✔ Correct Answer: B
Rationale: The Mini Nutritional Assessment (MNA) is a validated tool for identifying malnutrition and malnutrition risk in
older adults. This patient demonstrates multiple risk factors for malnutrition (weight loss >5% in 3 months, reduced
intake, borderline BMI). Referral to a registered dietitian and oral nutritional supplementation are the evidence-based
first steps. Megestrol acetate carries significant risks including VTE and adrenal suppression and is not a first-line
intervention.
[ GERIATRIC ASSESSMENT ]
9. An 83-year-old man completes the Montreal Cognitive Assessment (MoCA) and scores 21/30. Which
statement is most accurate?
A. MoCA score of 21 is normal for adults over 80
B. A MoCA score below 26 suggests cognitive impairment; comprehensive evaluation for reversible
causes should be completed
C. MoCA is only validated for patients under 75
D. A MoCA score of 21 is diagnostic of Lewy body dementia
✔ Correct Answer: B
Rationale: The MoCA (Montreal Cognitive Assessment) has a maximum score of 30; scores below 26 suggest
cognitive impairment. It is more sensitive than the MMSE for detecting mild cognitive impairment (MCI). A score of 21
warrants a thorough evaluation including labs (TSH, B12, CBC, CMP, RPR), neuroimaging, and possibly
neuropsychological testing to rule out reversible causes before establishing a primary dementia diagnosis.
[ GERIATRIC ASSESSMENT ]
10. A 69-year-old woman reports urinary leakage when coughing, sneezing, or laughing. She denies
urgency. Which type of urinary incontinence is most likely and what is the first-line treatment?
A. Urge incontinence; immediate-release oxybutynin
B. Stress incontinence; pelvic floor muscle training (Kegel exercises)
C. Overflow incontinence; bethanechol
D. Mixed incontinence; immediate surgical referral
✔ Correct Answer: B
Rationale: Leakage associated with increased intra-abdominal pressure (coughing, sneezing, laughing) without
urgency is characteristic of stress urinary incontinence (SUI), caused by urethral sphincter weakness or pelvic floor
dysfunction. First-line treatment for SUI is pelvic floor muscle training (Kegel exercises), which has strong evidence for
Page 3 of 48
, NR601 Primary Care of the Maturing & Aged Family | Final Exam Prep
reducing leakage episodes. Oxybutynin treats urge incontinence. Overflow incontinence presents with frequent
small-volume leakage and elevated post-void residual.
[ GERIATRIC ASSESSMENT ]
11. A 74-year-old woman presents with a sudden onset of severe, sharp low back pain after bending to
lift a grocery bag. Spine X-ray reveals a vertebral compression fracture at T12. She has no neurologic
deficits. Which condition is the most common underlying cause?
A. Multiple myeloma
B. Osteoporosis
C. Spinal metastasis
D. Paget's disease
✔ Correct Answer: B
Rationale: Vertebral compression fractures in postmenopausal women following minimal or low-energy trauma are
most commonly caused by osteoporosis. Osteoporosis causes trabecular bone loss, making vertebrae susceptible to
fracture with minimal mechanical stress. DEXA scan, FRAX score, and evaluation of secondary causes of bone loss are
indicated. While malignancy (myeloma, metastasis) must be considered, osteoporosis is by far the most common
etiology in this clinical context.
[ GERIATRIC ASSESSMENT ]
12. The AGPCNP is planning preventive care for a 72-year-old man. Per USPSTF recommendations,
which cancer screening is recommended for this patient based solely on age and sex?
A. Annual PSA screening for prostate cancer
B. Annual CT colonography for colorectal cancer
C. One-time abdominal aortic aneurysm (AAA) screening with abdominal ultrasound if he has a
smoking history
D. Annual chest X-ray for lung cancer screening
✔ Correct Answer: C
Rationale: The USPSTF recommends one-time abdominal aortic aneurysm screening with abdominal ultrasound in
men aged 65–75 who have ever smoked (≥100 cigarettes lifetime). For colorectal cancer, multiple screening modalities
are recommended through age 75 (colonoscopy, stool tests, CT colonography). Annual low-dose CT lung cancer
screening is recommended for high-risk adults (ages 50–80, ≥20 pack-year history, current smoker or quit within 15
years). PSA screening for prostate cancer is not universally recommended; it requires shared decision-making.
[ CARDIOVASCULAR ]
13. A 74-year-old man with heart failure with reduced ejection fraction (HFrEF, EF 35%) is already on
lisinopril and carvedilol. His most recent BMP shows potassium of 4.2 mEq/L and eGFR of 55 mL/min.
Which medication should be added to reduce mortality?
A. Amlodipine
B. Digoxin
C. Spironolactone (aldosterone antagonist)
D. Hydralazine
✔ Correct Answer: C
Rationale: Per ACC/AHA HFrEF guidelines, aldosterone antagonists (spironolactone or eplerenone) are Class I
recommended additions to ACE inhibitor and beta-blocker therapy in patients with HFrEF (EF ≤35%), NYHA Class II–IV
symptoms, eGFR >30 mL/min, and potassium <5.0 mEq/L. They reduce mortality, hospitalizations, and sudden cardiac
death. Digoxin reduces hospitalizations but does not reduce mortality. Amlodipine and hydralazine have more limited
roles.
Page 4 of 48
