NR 601
MIDTERM EXAM
Verified Questions & Answers With Rationales
(Primary Care of the Maturing and
Aged Family Practicum)
Chamberlain
CONSISTS OF 100+ QUESTIONS
WEEKS 1 – 4 COVERED
,1. The NP is analyzing a patient’s symptoms for a possible asthma diagnosis. The
patient describes nocturnal symptoms alone. Before confirming an asthma
diagnosis, what other diagnoses should the NP consider based on the patient’s
nocturnal symptoms alone:
A. Postnasal drip and gastroesophageal reflux disease (GERD)
B. Pulmonary embolism and lung cancer
C. Pneumothorax and tuberculosis
D. Acute bronchitis and pneumonia
Correct Answer:
A. Postnasal drip and gastroesophageal reflux disease (GERD)
Rationale:
Nocturnal cough or breathing symptoms may occur with asthma, but postnasal
drip and GERD are common alternative causes that should be considered before
confirming asthma.
2. Which of the following tools is MOST effective in uncovering geriatric
syndromes that may go unrecognized:
A. Chest x-ray
B. Structured geriatric review of systems
C. Lipid panel only
D. Spirometry only
Correct Answer:
B. Structured geriatric review of systems
Rationale:
A structured geriatric review of systems helps identify falls, frailty, cognitive
changes, incontinence, polypharmacy, functional decline, and other syndromes
that may not be volunteered by older adults.
3. A patient describes chest discomfort that occurs with activity and resolves
with rest. What is the PRIORITY differential diagnosis based on this
presentation:
A. Stable angina
B. Costochondritis
C. GERD only
D. Panic disorder
,Correct Answer:
A. Stable angina
Rationale:
Chest discomfort triggered by exertion and relieved by rest is classic for stable
angina caused by myocardial oxygen demand exceeding supply.
4. A 78-year-old man with a history of hypertension is found to have left
ventricular hypertrophy on echocardiogram. Why is this finding clinically
significant:
A. It increases the risk of stroke, heart failure, and sudden death
B. It confirms pneumonia
C. It rules out cardiovascular disease
D. It is always a benign aging change
Correct Answer:
A. It increases the risk of stroke, heart failure, and sudden death
Rationale:
Long-standing hypertension can cause left ventricular hypertrophy, which
increases myocardial workload and is associated with higher cardiovascular
morbidity and mortality.
5. During a physical exam, the NP suspects right-sided heart failure in a 78-year-
old patient with fatigue and bilateral lower extremity swelling. Which of the
following findings MOST strongly supports this suspicion:
A. Elevated jugular venous pressure
B. Dry mucous membranes
C. Hyperactive bowel sounds
D. Unilateral wheezing
Correct Answer:
A. Elevated jugular venous pressure
Rationale:
Right-sided heart failure causes systemic venous congestion, commonly
presenting with elevated JVP, peripheral edema, hepatomegaly, and ascites.
6. The NP is examining an older adult patient with suspected mitral stenosis
(MS). Which of the following is the MOST common cause of MS:
, A. Rheumatic fever
B. Viral pneumonia
C. Hyperthyroidism
D. Acute kidney injury
Correct Answer:
A. Rheumatic fever
Rationale:
Rheumatic heart disease remains the most common cause of mitral stenosis
because chronic valvular scarring narrows the mitral valve orifice.
7. A 65-year-old patient with stable COPD presents for a follow-up visit. The
patient has a CAT score of 18 and an mMRC score of 2. Based on these scores,
which INITIAL pharmacological therapy should the NP prescribe:
A. Long-acting bronchodilator
B. Short course of antibiotics only
C. Immediate oral corticosteroids for life
D. No inhaled therapy
Correct Answer:
A. Long-acting bronchodilator
Rationale:
A CAT score ≥10 and mMRC ≥2 indicate significant COPD symptoms. Long-acting
bronchodilator therapy improves dyspnea, exercise tolerance, and daily
symptoms.
8. The NP is evaluating several patients for resistant hypertension. Which
patient is MOST likely to have resistant hypertension:
A. A 65-year-old patient with a blood pressure of 145/90 mmHg, taking three
antihypertensive agents, including a diuretic, with no identifiable causes of
hypertension
B. A patient with one elevated reading during stress
C. A patient controlled on one medication
D. A patient with white-coat hypertension only
Correct Answer:
A. A 65-year-old patient with a blood pressure of 145/90 mmHg, taking three
antihypertensive agents, including a diuretic, with no identifiable causes of
MIDTERM EXAM
Verified Questions & Answers With Rationales
(Primary Care of the Maturing and
Aged Family Practicum)
Chamberlain
CONSISTS OF 100+ QUESTIONS
WEEKS 1 – 4 COVERED
,1. The NP is analyzing a patient’s symptoms for a possible asthma diagnosis. The
patient describes nocturnal symptoms alone. Before confirming an asthma
diagnosis, what other diagnoses should the NP consider based on the patient’s
nocturnal symptoms alone:
A. Postnasal drip and gastroesophageal reflux disease (GERD)
B. Pulmonary embolism and lung cancer
C. Pneumothorax and tuberculosis
D. Acute bronchitis and pneumonia
Correct Answer:
A. Postnasal drip and gastroesophageal reflux disease (GERD)
Rationale:
Nocturnal cough or breathing symptoms may occur with asthma, but postnasal
drip and GERD are common alternative causes that should be considered before
confirming asthma.
2. Which of the following tools is MOST effective in uncovering geriatric
syndromes that may go unrecognized:
A. Chest x-ray
B. Structured geriatric review of systems
C. Lipid panel only
D. Spirometry only
Correct Answer:
B. Structured geriatric review of systems
Rationale:
A structured geriatric review of systems helps identify falls, frailty, cognitive
changes, incontinence, polypharmacy, functional decline, and other syndromes
that may not be volunteered by older adults.
3. A patient describes chest discomfort that occurs with activity and resolves
with rest. What is the PRIORITY differential diagnosis based on this
presentation:
A. Stable angina
B. Costochondritis
C. GERD only
D. Panic disorder
,Correct Answer:
A. Stable angina
Rationale:
Chest discomfort triggered by exertion and relieved by rest is classic for stable
angina caused by myocardial oxygen demand exceeding supply.
4. A 78-year-old man with a history of hypertension is found to have left
ventricular hypertrophy on echocardiogram. Why is this finding clinically
significant:
A. It increases the risk of stroke, heart failure, and sudden death
B. It confirms pneumonia
C. It rules out cardiovascular disease
D. It is always a benign aging change
Correct Answer:
A. It increases the risk of stroke, heart failure, and sudden death
Rationale:
Long-standing hypertension can cause left ventricular hypertrophy, which
increases myocardial workload and is associated with higher cardiovascular
morbidity and mortality.
5. During a physical exam, the NP suspects right-sided heart failure in a 78-year-
old patient with fatigue and bilateral lower extremity swelling. Which of the
following findings MOST strongly supports this suspicion:
A. Elevated jugular venous pressure
B. Dry mucous membranes
C. Hyperactive bowel sounds
D. Unilateral wheezing
Correct Answer:
A. Elevated jugular venous pressure
Rationale:
Right-sided heart failure causes systemic venous congestion, commonly
presenting with elevated JVP, peripheral edema, hepatomegaly, and ascites.
6. The NP is examining an older adult patient with suspected mitral stenosis
(MS). Which of the following is the MOST common cause of MS:
, A. Rheumatic fever
B. Viral pneumonia
C. Hyperthyroidism
D. Acute kidney injury
Correct Answer:
A. Rheumatic fever
Rationale:
Rheumatic heart disease remains the most common cause of mitral stenosis
because chronic valvular scarring narrows the mitral valve orifice.
7. A 65-year-old patient with stable COPD presents for a follow-up visit. The
patient has a CAT score of 18 and an mMRC score of 2. Based on these scores,
which INITIAL pharmacological therapy should the NP prescribe:
A. Long-acting bronchodilator
B. Short course of antibiotics only
C. Immediate oral corticosteroids for life
D. No inhaled therapy
Correct Answer:
A. Long-acting bronchodilator
Rationale:
A CAT score ≥10 and mMRC ≥2 indicate significant COPD symptoms. Long-acting
bronchodilator therapy improves dyspnea, exercise tolerance, and daily
symptoms.
8. The NP is evaluating several patients for resistant hypertension. Which
patient is MOST likely to have resistant hypertension:
A. A 65-year-old patient with a blood pressure of 145/90 mmHg, taking three
antihypertensive agents, including a diuretic, with no identifiable causes of
hypertension
B. A patient with one elevated reading during stress
C. A patient controlled on one medication
D. A patient with white-coat hypertension only
Correct Answer:
A. A 65-year-old patient with a blood pressure of 145/90 mmHg, taking three
antihypertensive agents, including a diuretic, with no identifiable causes of
