NR 601 PRACTICE EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A 68-year-old established female patient presents for an annual wellness visit. She
reports occasional mild forgetfulness, such as misplacing her keys, but manages all
instrumental activities of daily living independently. Her score on the Mini-Cog test is 4/5.
Which of the following is the most appropriate next clinical step?
A. Prescribe donepezil immediately to halt cognitive decline
B. Document normal age-related cognitive changes and reassure the patient and her family
C. Order a comprehensive neuropsychological evaluation and screen for reversible causes of
cognitive impairment
D. Refer the patient directly to a memory care facility for placement evaluation
A Mini-Cog score of 4/5 indicates a borderline screen where further evaluation is warranted
to differentiate normal aging from mild cognitive impairment (MCI) or early dementia.
Screening for reversible causes (such as vitamin B12 deficiency, hypothyroidism, depression,
or medication side effects) and ordering formal neuropsychological testing are critical initial
steps before initiating pharmacotherapy or making definitive diagnostic leaps. Donepezil is not
indicated for isolated mild forgetfulness without a formal dementia diagnosis.
2. A 72-year-old male with a history of heart failure and hypertension presents to the
primary care clinic complaining of severe morning stiffness in his shoulders and hips
lasting over an hour, along with low-grade fever and unintended weight loss. Laboratory
findings reveal an erythrocyte sedimentation rate (ESR) of 85 mm/hr and a C-reactive
protein (CRP) of 4.2 mg/dL. Which of the following is the most likely diagnosis?
A. Rheumatoid arthritis
B. Polymyalgia rheumatica
C. Fibromyalgia
D. Osteoarthritis of the spine
Polymyalgia rheumatica (PMR) characteristically presents in older adults with bilateral
shoulder and hip girdle aching and morning stiffness lasting longer than 45 minutes,
accompanied by marked inflammatory markers (elevated ESR and CRP) and systemic
symptoms like weight loss and low-grade fever. Rheumatoid arthritis typically involves
peripheral small joints rather than proximal girdles. Fibromyalgia lacks elevated
,inflammatory markers. Osteoarthritis is non-inflammatory and does not cause systemic
symptoms or markedly elevated ESR.
3. An 80-year-old nursing home resident is brought to the clinic for evaluation of sudden-
onset confusion, agitation, and visual hallucinations over the past 24 hours. Vital signs
show a temperature of 38.4°C, heart rate of 105 bpm, blood pressure of 110/70 mmHg, and
oxygen saturation of 94% on room air. Urinalysis reveals cloudy urine with positive
leukocyte esterase and numerous bacteria. Which of the following is the most appropriate
initial management?
A. Initiate oral haloperidol for acute agitation control and reassess in one week
B. Begin empiric broad-spectrum antibiotic therapy after obtaining urine and blood cultures, and
investigate for an acute delirium trigger
C. Restrain the patient physically to prevent elopement and monitor closely
D. Order an urgent magnetic resonance imaging (MRI) of the brain to rule out acute ischemic stroke
This patient is presenting with acute delirium secondary to a urinary tract infection
(urosepsis/UTI), evidenced by acute altered mental status, fever, tachycardia, and abnormal
urinalysis. The priority is treating the underlying medical trigger with appropriate cultures
and targeted or empiric antibiotics, while avoiding physical restraints and utilizing non-
pharmacological behavioral interventions. Haloperidol addresses only the symptom, not the
underlying life-threatening cause, and should be used cautiously.
4. A 65-year-old female with a 40-pack-year smoking history presents for a routine physical
examination. She currently smokes one pack per day and states she is not ready to quit
smoking completely, though she acknowledges it is bad for her health. Which of the
following motivational interviewing strategies should the nurse practitioner employ?
A. Confront her firmly about the severe risks of continued smoking and demand she set a quit date today
B. Express empathy, explore the discrepancy between her health goals and her smoking habit, and
roll with resistance without lecturing
C. Ignore the smoking habit entirely since she is not ready to change
D. Tell her that if she does not quit, you will refuse to refill her blood pressure medications
In the contemplation stage of change, confrontational or authoritarian approaches increase
patient defensiveness. Motivational interviewing relies on expressing empathy, developing
discrepancy, rolling with resistance, and supporting self-efficacy. This patient acknowledges
the negative impact of smoking, which provides an opening to explore her ambivalence gently
without coercion.
5. A 79-year-old male presents with progressive, painless blurring of vision in his right eye
over the past year. He reports difficulty reading and seeing street signs, and notes that
, headlights glare significantly when driving at night. Examination reveals absent red reflex
and a visibly cloudy lens. Which of the following is the most definitive treatment for this
condition?
A. Prescription of stronger reading glasses
B. Intravitreal vascular endothelial growth factor (VEGF) inhibitor injections
C. Surgical removal of the crystalline lens with intraocular lens implantation
D. Laser trabeculoplasty
The clinical presentation is classic for cataracts, characterized by progressive painless vision
loss, glare, and a cloudy lens with an absent red reflex. The definitive treatment is surgical
extraction of the opacified lens coupled with intraocular lens placement. Glasses only provide
temporary, partial visual correction. VEGF injections treat macular degeneration or diabetic
retinopathy, while laser trabeculoplasty is used for glaucoma.
6. A 70-year-old female comes to the clinic accompanied by her daughter, who reports that
her mother has been increasingly forgetful, paying bills twice, and getting lost while driving
in her familiar neighborhood over the past two years. The patient scores 21/30 on the
Montreal Cognitive Assessment (MoCA). Her laboratory workup, including thyroid-
stimulating hormone (TSH) and vitamin B12 levels, is completely normal. Which of the
following is the most likely diagnosis?
A. Normal pressure hydrocephalus
B. Major neurocognitive disorder due to Alzheimer disease (Alzheimer dementia)
C. Delirium secondary to metabolic encephalopathy
D. Age-associated memory impairment
The gradual, progressive decline in multiple cognitive domains (memory, executive function,
visuospatial skills) affecting instrumental activities of daily living (managing finances,
navigating) with a normal metabolic and vitamin workup points strongly toward Alzheimer
disease. Delirium is acute and fluctuating. Normal pressure hydrocephalus classically
presents with the triad of gait disturbance, urinary incontinence, and dementia. Age-
associated memory impairment involves minor, non-disabling memory lapses.
7. A nurse practitioner is performing a comprehensive geriatric assessment on a frail 86-
year-old male. Which of the following screening tools is specifically designed to assess basic
activities of daily living (ADLs)?
A. Lawton Instrumental Activities of Daily Living Scale
B. Katz Index of Independence in Activities of Daily Living
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A 68-year-old established female patient presents for an annual wellness visit. She
reports occasional mild forgetfulness, such as misplacing her keys, but manages all
instrumental activities of daily living independently. Her score on the Mini-Cog test is 4/5.
Which of the following is the most appropriate next clinical step?
A. Prescribe donepezil immediately to halt cognitive decline
B. Document normal age-related cognitive changes and reassure the patient and her family
C. Order a comprehensive neuropsychological evaluation and screen for reversible causes of
cognitive impairment
D. Refer the patient directly to a memory care facility for placement evaluation
A Mini-Cog score of 4/5 indicates a borderline screen where further evaluation is warranted
to differentiate normal aging from mild cognitive impairment (MCI) or early dementia.
Screening for reversible causes (such as vitamin B12 deficiency, hypothyroidism, depression,
or medication side effects) and ordering formal neuropsychological testing are critical initial
steps before initiating pharmacotherapy or making definitive diagnostic leaps. Donepezil is not
indicated for isolated mild forgetfulness without a formal dementia diagnosis.
2. A 72-year-old male with a history of heart failure and hypertension presents to the
primary care clinic complaining of severe morning stiffness in his shoulders and hips
lasting over an hour, along with low-grade fever and unintended weight loss. Laboratory
findings reveal an erythrocyte sedimentation rate (ESR) of 85 mm/hr and a C-reactive
protein (CRP) of 4.2 mg/dL. Which of the following is the most likely diagnosis?
A. Rheumatoid arthritis
B. Polymyalgia rheumatica
C. Fibromyalgia
D. Osteoarthritis of the spine
Polymyalgia rheumatica (PMR) characteristically presents in older adults with bilateral
shoulder and hip girdle aching and morning stiffness lasting longer than 45 minutes,
accompanied by marked inflammatory markers (elevated ESR and CRP) and systemic
symptoms like weight loss and low-grade fever. Rheumatoid arthritis typically involves
peripheral small joints rather than proximal girdles. Fibromyalgia lacks elevated
,inflammatory markers. Osteoarthritis is non-inflammatory and does not cause systemic
symptoms or markedly elevated ESR.
3. An 80-year-old nursing home resident is brought to the clinic for evaluation of sudden-
onset confusion, agitation, and visual hallucinations over the past 24 hours. Vital signs
show a temperature of 38.4°C, heart rate of 105 bpm, blood pressure of 110/70 mmHg, and
oxygen saturation of 94% on room air. Urinalysis reveals cloudy urine with positive
leukocyte esterase and numerous bacteria. Which of the following is the most appropriate
initial management?
A. Initiate oral haloperidol for acute agitation control and reassess in one week
B. Begin empiric broad-spectrum antibiotic therapy after obtaining urine and blood cultures, and
investigate for an acute delirium trigger
C. Restrain the patient physically to prevent elopement and monitor closely
D. Order an urgent magnetic resonance imaging (MRI) of the brain to rule out acute ischemic stroke
This patient is presenting with acute delirium secondary to a urinary tract infection
(urosepsis/UTI), evidenced by acute altered mental status, fever, tachycardia, and abnormal
urinalysis. The priority is treating the underlying medical trigger with appropriate cultures
and targeted or empiric antibiotics, while avoiding physical restraints and utilizing non-
pharmacological behavioral interventions. Haloperidol addresses only the symptom, not the
underlying life-threatening cause, and should be used cautiously.
4. A 65-year-old female with a 40-pack-year smoking history presents for a routine physical
examination. She currently smokes one pack per day and states she is not ready to quit
smoking completely, though she acknowledges it is bad for her health. Which of the
following motivational interviewing strategies should the nurse practitioner employ?
A. Confront her firmly about the severe risks of continued smoking and demand she set a quit date today
B. Express empathy, explore the discrepancy between her health goals and her smoking habit, and
roll with resistance without lecturing
C. Ignore the smoking habit entirely since she is not ready to change
D. Tell her that if she does not quit, you will refuse to refill her blood pressure medications
In the contemplation stage of change, confrontational or authoritarian approaches increase
patient defensiveness. Motivational interviewing relies on expressing empathy, developing
discrepancy, rolling with resistance, and supporting self-efficacy. This patient acknowledges
the negative impact of smoking, which provides an opening to explore her ambivalence gently
without coercion.
5. A 79-year-old male presents with progressive, painless blurring of vision in his right eye
over the past year. He reports difficulty reading and seeing street signs, and notes that
, headlights glare significantly when driving at night. Examination reveals absent red reflex
and a visibly cloudy lens. Which of the following is the most definitive treatment for this
condition?
A. Prescription of stronger reading glasses
B. Intravitreal vascular endothelial growth factor (VEGF) inhibitor injections
C. Surgical removal of the crystalline lens with intraocular lens implantation
D. Laser trabeculoplasty
The clinical presentation is classic for cataracts, characterized by progressive painless vision
loss, glare, and a cloudy lens with an absent red reflex. The definitive treatment is surgical
extraction of the opacified lens coupled with intraocular lens placement. Glasses only provide
temporary, partial visual correction. VEGF injections treat macular degeneration or diabetic
retinopathy, while laser trabeculoplasty is used for glaucoma.
6. A 70-year-old female comes to the clinic accompanied by her daughter, who reports that
her mother has been increasingly forgetful, paying bills twice, and getting lost while driving
in her familiar neighborhood over the past two years. The patient scores 21/30 on the
Montreal Cognitive Assessment (MoCA). Her laboratory workup, including thyroid-
stimulating hormone (TSH) and vitamin B12 levels, is completely normal. Which of the
following is the most likely diagnosis?
A. Normal pressure hydrocephalus
B. Major neurocognitive disorder due to Alzheimer disease (Alzheimer dementia)
C. Delirium secondary to metabolic encephalopathy
D. Age-associated memory impairment
The gradual, progressive decline in multiple cognitive domains (memory, executive function,
visuospatial skills) affecting instrumental activities of daily living (managing finances,
navigating) with a normal metabolic and vitamin workup points strongly toward Alzheimer
disease. Delirium is acute and fluctuating. Normal pressure hydrocephalus classically
presents with the triad of gait disturbance, urinary incontinence, and dementia. Age-
associated memory impairment involves minor, non-disabling memory lapses.
7. A nurse practitioner is performing a comprehensive geriatric assessment on a frail 86-
year-old male. Which of the following screening tools is specifically designed to assess basic
activities of daily living (ADLs)?
A. Lawton Instrumental Activities of Daily Living Scale
B. Katz Index of Independence in Activities of Daily Living
