NR 601 MIDTERM EXAM COMPREHENSIVE QUESTION BANK:
PRIMARY CARE OF THE MATURING AND AGED FAMILY
PRACTICUM
200 BOARD-STYLE PRACTICE QUESTIONS WITH ANSWERS AND
RATIONALES COVERING PMR, GOUT, OA, RA, HEART FAILURE,
GERIATRIC PHARMACOLOGY, AND AGING-RELATED
CONDITIONS
1. A 78-year-old patient with suspected polymyalgia rheumatica
(PMR) presents with bilateral shoulder pain and morning stiffness
lasting over 45 minutes. Which laboratory finding is most consistent
with an active PMR diagnosis?
A) Normal complete blood count
B) Erythrocyte sedimentation rate (ESR) of 15 mm/hr
C) C-reactive protein (CRP) < 1.0 mg/dL
D) Erythrocyte sedimentation rate (ESR) of 65 mm/hr
Correct Answer: D. PMR is a chronic inflammatory disease, and an
elevated acute phase response (ESR > 50 mm/hr) is a hallmark feature,
though not specific for diagnosis .
2. A 72-year-old male presents with a painful, swollen right first
metatarsophalangeal joint. To confirm the diagnosis of gout, which
diagnostic test is considered the gold standard?
A) Serum uric acid level
B) X-ray of the foot
C) Joint aspiration with polarized light microscopy
,D) Bone scan
Correct Answer: C. The definitive diagnosis of gout is made by
identifying monosodium urate crystals in synovial fluid using polarized
light microscopy .
3. Which medication is most commonly associated with triggering or
worsening gout in older adult patients, particularly those with
hypertension?
A) Lisinopril
B) Metformin
C) Thiazide diuretics
D) Atorvastatin
Correct Answer: C. Thiazide diuretics are well-known for increasing
serum uric acid levels and are a common contributing factor to gout in
older adults .
4. According to the American College of Cardiology/American Heart
Association (ACC/AHA) staging system for heart failure, a patient who
has structural heart disease but has never exhibited signs or
symptoms of heart failure is classified as:
A) Stage A
B) Stage B
C) Stage C
D) Stage D
Correct Answer: B. Stage B (Pre-HF) is defined by the presence of
structural heart disease (e.g., left ventricular hypertrophy, valvular
disease) without current or past symptoms of heart failure .
5. A patient taking a new medication for hypertension reports a
persistent, dry cough. Which antihypertensive is most likely
,responsible for this side effect?
A) Amlodipine
B) Metoprolol
C) Hydrochlorothiazide
D) Lisinopril
Correct Answer: D. ACE inhibitors like lisinopril are notorious for
causing a dry, non-productive cough due to the accumulation of
bradykinin.
6. Which of the following describes a normal physiological change that
occurs in the heart with aging?
A) Increased elasticity of the heart valves
B) Thickening and stiffening of heart valves due to fibrosis and sclerosis
C) Decreased size of the left atrium
D) Increased cardiac output at rest
Correct Answer: B. Valvular thickening and stiffening due to fibrosis and
sclerosis are age-related changes that can lead to murmurs and
decreased cardiac efficiency.
7. What is the recommended initial imaging modality for diagnosing
and evaluating structural heart disease and dysfunction noninvasively
in an older adult?
A) Chest X-ray
B) Electrocardiogram (ECG)
C) Echocardiogram
D) Cardiac MRI
Correct Answer: C. An echocardiogram is the best noninvasive tool to
assess cardiac structure, function, valve morphology, and ejection
fraction.
, 8. The American Geriatrics Society Beers Criteria is primarily a tool for
evaluating medication safety in which population?
A) All adults with polypharmacy
B) Patients over the age of 50
C) Adults over the age of 65
D) Patients in hospice care only
Correct Answer: C. The Beers Criteria is specifically designed for use in
adults aged 65 and older to identify potentially inappropriate
medications .
9. What is the prevalence of depression in nursing home residents
compared to community-dwelling older adults?
A) It is roughly the same
B) 2-3 times greater
C) 3-4 times greater
D) 5-6 times greater
Correct Answer: C. The prevalence of depression is significantly higher
in nursing home residents, approximately 3-4 times greater than in
community-living older adults.
10. A 65-year-old patient presents with a sharp-angled curvature of
the spine on examination. This finding is most accurately referred to
as:
A) Kyphosis
B) Scoliosis
C) Gibbus
D) Lordosis
Correct Answer: C. A gibbus is a sharp, angular kyphotic deformity,
often associated with conditions like osteoporosis (vertebral collapse)
or tuberculosis.
PRIMARY CARE OF THE MATURING AND AGED FAMILY
PRACTICUM
200 BOARD-STYLE PRACTICE QUESTIONS WITH ANSWERS AND
RATIONALES COVERING PMR, GOUT, OA, RA, HEART FAILURE,
GERIATRIC PHARMACOLOGY, AND AGING-RELATED
CONDITIONS
1. A 78-year-old patient with suspected polymyalgia rheumatica
(PMR) presents with bilateral shoulder pain and morning stiffness
lasting over 45 minutes. Which laboratory finding is most consistent
with an active PMR diagnosis?
A) Normal complete blood count
B) Erythrocyte sedimentation rate (ESR) of 15 mm/hr
C) C-reactive protein (CRP) < 1.0 mg/dL
D) Erythrocyte sedimentation rate (ESR) of 65 mm/hr
Correct Answer: D. PMR is a chronic inflammatory disease, and an
elevated acute phase response (ESR > 50 mm/hr) is a hallmark feature,
though not specific for diagnosis .
2. A 72-year-old male presents with a painful, swollen right first
metatarsophalangeal joint. To confirm the diagnosis of gout, which
diagnostic test is considered the gold standard?
A) Serum uric acid level
B) X-ray of the foot
C) Joint aspiration with polarized light microscopy
,D) Bone scan
Correct Answer: C. The definitive diagnosis of gout is made by
identifying monosodium urate crystals in synovial fluid using polarized
light microscopy .
3. Which medication is most commonly associated with triggering or
worsening gout in older adult patients, particularly those with
hypertension?
A) Lisinopril
B) Metformin
C) Thiazide diuretics
D) Atorvastatin
Correct Answer: C. Thiazide diuretics are well-known for increasing
serum uric acid levels and are a common contributing factor to gout in
older adults .
4. According to the American College of Cardiology/American Heart
Association (ACC/AHA) staging system for heart failure, a patient who
has structural heart disease but has never exhibited signs or
symptoms of heart failure is classified as:
A) Stage A
B) Stage B
C) Stage C
D) Stage D
Correct Answer: B. Stage B (Pre-HF) is defined by the presence of
structural heart disease (e.g., left ventricular hypertrophy, valvular
disease) without current or past symptoms of heart failure .
5. A patient taking a new medication for hypertension reports a
persistent, dry cough. Which antihypertensive is most likely
,responsible for this side effect?
A) Amlodipine
B) Metoprolol
C) Hydrochlorothiazide
D) Lisinopril
Correct Answer: D. ACE inhibitors like lisinopril are notorious for
causing a dry, non-productive cough due to the accumulation of
bradykinin.
6. Which of the following describes a normal physiological change that
occurs in the heart with aging?
A) Increased elasticity of the heart valves
B) Thickening and stiffening of heart valves due to fibrosis and sclerosis
C) Decreased size of the left atrium
D) Increased cardiac output at rest
Correct Answer: B. Valvular thickening and stiffening due to fibrosis and
sclerosis are age-related changes that can lead to murmurs and
decreased cardiac efficiency.
7. What is the recommended initial imaging modality for diagnosing
and evaluating structural heart disease and dysfunction noninvasively
in an older adult?
A) Chest X-ray
B) Electrocardiogram (ECG)
C) Echocardiogram
D) Cardiac MRI
Correct Answer: C. An echocardiogram is the best noninvasive tool to
assess cardiac structure, function, valve morphology, and ejection
fraction.
, 8. The American Geriatrics Society Beers Criteria is primarily a tool for
evaluating medication safety in which population?
A) All adults with polypharmacy
B) Patients over the age of 50
C) Adults over the age of 65
D) Patients in hospice care only
Correct Answer: C. The Beers Criteria is specifically designed for use in
adults aged 65 and older to identify potentially inappropriate
medications .
9. What is the prevalence of depression in nursing home residents
compared to community-dwelling older adults?
A) It is roughly the same
B) 2-3 times greater
C) 3-4 times greater
D) 5-6 times greater
Correct Answer: C. The prevalence of depression is significantly higher
in nursing home residents, approximately 3-4 times greater than in
community-living older adults.
10. A 65-year-old patient presents with a sharp-angled curvature of
the spine on examination. This finding is most accurately referred to
as:
A) Kyphosis
B) Scoliosis
C) Gibbus
D) Lordosis
Correct Answer: C. A gibbus is a sharp, angular kyphotic deformity,
often associated with conditions like osteoporosis (vertebral collapse)
or tuberculosis.
