NR 601
FINAL EXAM
Verified Questions & Answers With Rationales
(Primary Care of the Maturing and
Aged Family Practicum)
Chamberlain
CONSISTS OF 100 QUESTIONS
WEEKS 5 – 8 COVERED
,1. A 58-year-old patient with long-standing type 2 diabetes presents with complaints
of dizziness when standing, bloating after meals, and occasional episodes of urinary
incontinence. He also reports mild numbness in both feet. Which of the following
complications of diabetes is the MOST likely explanation for his symptoms:
A. Diabetic autonomic neuropathy affecting multiple organ systems
B. Diabetic ketoacidosis
C. Peripheral arterial disease
D. Acute hypoglycemia
Correct Answer:
A. Diabetic autonomic neuropathy affecting multiple organ systems
Rationale:
Orthostatic dizziness, gastroparesis-like bloating, urinary incontinence, and peripheral
numbness suggest diabetic neuropathy involving autonomic and peripheral nerves.
2. An 82-year-old patient presents with fatigue, dry skin, and constipation. Lab tests
reveal elevated TSH and low free T4. Which of the following is the MOST common
cause of hypothyroidism in iodine-sufficient regions:
A. Pituitary tumor
B. Autoimmune thyroiditis
C. Iodine deficiency
D. Thyroid storm
Correct Answer:
B. Autoimmune thyroiditis
Rationale:
In iodine-sufficient areas, Hashimoto autoimmune thyroiditis is the most common cause
of primary hypothyroidism and presents with elevated TSH and low free T4.
3. A 35-year-old patient presents with low mood, loss of interest in previously
enjoyable activities, fatigue, and poor concentration. Which of the following
additional findings would MOST support a diagnosis of major depressive disorder
(MDD):
A. Persistent insomnia or hypersomnia
B. Brief sadness lasting one day
C. Increased energy and decreased need for sleep
D. Isolated irritability without functional impairment
Correct Answer:
A. Persistent insomnia or hypersomnia
,Rationale:
MDD requires persistent symptoms such as depressed mood or anhedonia plus
associated symptoms including sleep disturbance, fatigue, guilt, appetite change, poor
concentration, or suicidal thoughts.
4. A 76-year-old patient presents with atrial fibrillation and newly diagnosed
hyperthyroidism. Which of the following treatments should be considered FIRST to
control cardiovascular symptoms:
A. Levothyroxine
B. Propranolol (Inderal)
C. Metformin
D. Donepezil
Correct Answer:
B. Propranolol (Inderal)
Rationale:
Beta blockers rapidly control adrenergic symptoms of hyperthyroidism such as
tachycardia, tremor, palpitations, and atrial fibrillation while definitive thyroid
treatment is planned.
5. Which of the following screening tools is MOST used in primary care to assess for
major depressive disorder (MDD):
A. GAD-7
B. Mini-Cog
C. PHQ-9 (Patient Health Questionnaire-9)
D. MMSE
Correct Answer:
C. PHQ-9 (Patient Health Questionnaire-9)
Rationale:
The PHQ-9 is widely used in primary care to screen for depression, assess symptom
severity, and monitor treatment response.
6. A 45-year-old man presents with fever, dysuria, and perineal discomfort. On exam,
he is febrile and has a tender prostate. Urine and blood cultures are obtained. What is
the MOST appropriate INITIAL management strategy:
A. Delay antibiotics until culture results return
B. Start empirical antimicrobial therapy with a fluoroquinolone while awaiting culture
results
, C. Perform immediate prostate massage
D. Treat with topical antifungal therapy
Correct Answer:
B. Start empirical antimicrobial therapy with a fluoroquinolone while awaiting culture
results
Rationale:
Fever, dysuria, perineal pain, and tender prostate suggest acute bacterial prostatitis.
Empiric antibiotics should be started after cultures are collected.
7. Which of the following medications is MOST likely to interfere with thyroid
hormone metabolism and increase the risk of hypothyroidism in older adults:
A. Amiodarone (Pacerone)
B. Acetaminophen
C. Omeprazole
D. Lisinopril
Correct Answer:
A. Amiodarone (Pacerone)
Rationale:
Amiodarone contains iodine and can disrupt thyroid hormone synthesis and
metabolism, causing either hypothyroidism or hyperthyroidism.
8. Which of the following symptoms is MOST commonly seen in older adults with
generalized anxiety disorder (GAD), making diagnosis more difficult:
A. Somatic complaints such as gastrointestinal distress or muscle tension
B. Sudden unilateral weakness
C. Productive cough with fever
D. Painless jaundice
Correct Answer:
A. Somatic complaints such as gastrointestinal distress or muscle tension
Rationale:
Older adults with anxiety may report physical symptoms such as muscle tension, GI
upset, fatigue, sleep disturbance, or restlessness rather than emotional worry alone.
9. A 58-year-old woman who has been postmenopausal for 8 years is interested in
starting hormone therapy to help prevent cardiovascular disease. She has no
vasomotor symptoms and no history of osteoporosis. What is the BEST response:
A. Hormone therapy should be started to prevent cardiovascular disease
FINAL EXAM
Verified Questions & Answers With Rationales
(Primary Care of the Maturing and
Aged Family Practicum)
Chamberlain
CONSISTS OF 100 QUESTIONS
WEEKS 5 – 8 COVERED
,1. A 58-year-old patient with long-standing type 2 diabetes presents with complaints
of dizziness when standing, bloating after meals, and occasional episodes of urinary
incontinence. He also reports mild numbness in both feet. Which of the following
complications of diabetes is the MOST likely explanation for his symptoms:
A. Diabetic autonomic neuropathy affecting multiple organ systems
B. Diabetic ketoacidosis
C. Peripheral arterial disease
D. Acute hypoglycemia
Correct Answer:
A. Diabetic autonomic neuropathy affecting multiple organ systems
Rationale:
Orthostatic dizziness, gastroparesis-like bloating, urinary incontinence, and peripheral
numbness suggest diabetic neuropathy involving autonomic and peripheral nerves.
2. An 82-year-old patient presents with fatigue, dry skin, and constipation. Lab tests
reveal elevated TSH and low free T4. Which of the following is the MOST common
cause of hypothyroidism in iodine-sufficient regions:
A. Pituitary tumor
B. Autoimmune thyroiditis
C. Iodine deficiency
D. Thyroid storm
Correct Answer:
B. Autoimmune thyroiditis
Rationale:
In iodine-sufficient areas, Hashimoto autoimmune thyroiditis is the most common cause
of primary hypothyroidism and presents with elevated TSH and low free T4.
3. A 35-year-old patient presents with low mood, loss of interest in previously
enjoyable activities, fatigue, and poor concentration. Which of the following
additional findings would MOST support a diagnosis of major depressive disorder
(MDD):
A. Persistent insomnia or hypersomnia
B. Brief sadness lasting one day
C. Increased energy and decreased need for sleep
D. Isolated irritability without functional impairment
Correct Answer:
A. Persistent insomnia or hypersomnia
,Rationale:
MDD requires persistent symptoms such as depressed mood or anhedonia plus
associated symptoms including sleep disturbance, fatigue, guilt, appetite change, poor
concentration, or suicidal thoughts.
4. A 76-year-old patient presents with atrial fibrillation and newly diagnosed
hyperthyroidism. Which of the following treatments should be considered FIRST to
control cardiovascular symptoms:
A. Levothyroxine
B. Propranolol (Inderal)
C. Metformin
D. Donepezil
Correct Answer:
B. Propranolol (Inderal)
Rationale:
Beta blockers rapidly control adrenergic symptoms of hyperthyroidism such as
tachycardia, tremor, palpitations, and atrial fibrillation while definitive thyroid
treatment is planned.
5. Which of the following screening tools is MOST used in primary care to assess for
major depressive disorder (MDD):
A. GAD-7
B. Mini-Cog
C. PHQ-9 (Patient Health Questionnaire-9)
D. MMSE
Correct Answer:
C. PHQ-9 (Patient Health Questionnaire-9)
Rationale:
The PHQ-9 is widely used in primary care to screen for depression, assess symptom
severity, and monitor treatment response.
6. A 45-year-old man presents with fever, dysuria, and perineal discomfort. On exam,
he is febrile and has a tender prostate. Urine and blood cultures are obtained. What is
the MOST appropriate INITIAL management strategy:
A. Delay antibiotics until culture results return
B. Start empirical antimicrobial therapy with a fluoroquinolone while awaiting culture
results
, C. Perform immediate prostate massage
D. Treat with topical antifungal therapy
Correct Answer:
B. Start empirical antimicrobial therapy with a fluoroquinolone while awaiting culture
results
Rationale:
Fever, dysuria, perineal pain, and tender prostate suggest acute bacterial prostatitis.
Empiric antibiotics should be started after cultures are collected.
7. Which of the following medications is MOST likely to interfere with thyroid
hormone metabolism and increase the risk of hypothyroidism in older adults:
A. Amiodarone (Pacerone)
B. Acetaminophen
C. Omeprazole
D. Lisinopril
Correct Answer:
A. Amiodarone (Pacerone)
Rationale:
Amiodarone contains iodine and can disrupt thyroid hormone synthesis and
metabolism, causing either hypothyroidism or hyperthyroidism.
8. Which of the following symptoms is MOST commonly seen in older adults with
generalized anxiety disorder (GAD), making diagnosis more difficult:
A. Somatic complaints such as gastrointestinal distress or muscle tension
B. Sudden unilateral weakness
C. Productive cough with fever
D. Painless jaundice
Correct Answer:
A. Somatic complaints such as gastrointestinal distress or muscle tension
Rationale:
Older adults with anxiety may report physical symptoms such as muscle tension, GI
upset, fatigue, sleep disturbance, or restlessness rather than emotional worry alone.
9. A 58-year-old woman who has been postmenopausal for 8 years is interested in
starting hormone therapy to help prevent cardiovascular disease. She has no
vasomotor symptoms and no history of osteoporosis. What is the BEST response:
A. Hormone therapy should be started to prevent cardiovascular disease
