NR601 WEEK 8 FINAL EXAM COMPLETE ACTUAL
EXAM QUESTIONS AND ANSWERS MASTER
GUIDE (QUESTIONS AND ANSWERS WITH
BOLDED RATIONALES)
This comprehensive question advanced study repository provides
board-style multiple-choice questions, accurate answers, and clear,
bolded rationales tailored for primary care of the maturing and aged
family. It meticulously covers high-yield geriatric topics including
Beers Criteria medication safety, cognitive screenings, chronic
disease management, and complex age-adjusted pharmacology.
Designed specifically for nurse practitioner students, this master
guide functions as an exceptional resource to secure top marks on
your midterm and final proctored examinations.
Question 1
An 82-year-old female presents for a routine wellness exam. Her daughter
notes that the patient has become increasingly frail and had a mechanical
fall three weeks ago. Which of the following validated screening tools is
most appropriate to specifically assess this patient's functional mobility and
fall risk in the primary care setting?
A) PHQ-9
B) Timed Up and Go (TUG) test
C) MMSE
D) CAM assessment
Answer: B
Rationale: The Timed Up and Go (TUG) test is a validated tool used to
assess an older adult's mobility, balance, and fall risk. A time of 12
seconds or more indicates a high risk for falls. PHQ-9 screens for
depression, MMSE evaluates cognitive impairment, and the CAM tool
is utilized to detect delirium.
,Question 2
A 74-year-old male with a history of hypertension and chronic kidney
disease (Stage 3a) presents with acute knee pain diagnosed as gouty
arthritis. Which of the following agents is preferred for acute management,
avoiding medications that accelerate renal decline?
A) High-dose Ibuprofen
B) Indomethacin
C) Low-dose Colchicine
D) Systemic Corticosteroids
Answer: D
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like
ibuprofen and indomethacin should be avoided in older adults with
chronic kidney disease due to the risk of acute kidney injury and fluid
retention. While colchicine can be used, it requires strict renal dosing
adjustments and carries toxicity risks. Short-course systemic or intra-
articular corticosteroids are highly effective and preferred in this
scenario to protect renal function.
Question 3
According to the American Geriatrics Society (AGS) Beers Criteria, which
of the following medications should be avoided in an 80-year-old patient
due to an exceptionally high risk of orthostatic hypotension, falls, and
anticholinergic adverse effects?
A) Amitriptyline
B) Sertraline
C) Lisinopril
D) Metformin
Answer: A
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with potent
anticholinergic properties. The Beers Criteria strongly recommends
avoiding TCAs in older adults because they cause sedation, blurred
,vision, dry mouth, urinary retention, and significant orthostatic
hypotension, which directly correlates to an increased risk of falls
and fractures.
Question 4
A 68-year-old postmenopausal female presents to establish care. Her
DEXA scan reveals a T-score of -2.7 in the lumbar spine. She has no
history of fractures. What is the correct diagnostic interpretation and initial
first-line pharmacological recommendation?
A) Osteopenia; Vitamin D3 50,000 IU weekly
B) Osteoporosis; Alendronate
C) Osteopenia; Hormone Replacement Therapy
D) Osteoporosis; Teriparatide
Answer: B
Rationale: A T-score of -2.5 or lower on a DEXA scan confirms a
diagnosis of osteoporosis. Oral bisphosphonates, such as
alendronate, serve as the first-line pharmacological choice to reduce
bone turnover and minimize future fracture risks, provided the patient
can remain upright for 30 minutes and has adequate renal function.
Question 5
An 88-year-old resident of an assisted living facility is brought to the clinic
by staff who report a sudden change in mental status over the past 24
hours. The patient is fluctuating between extreme lethargy and agitation,
and is hallucinating. What is the most likely underlying diagnosis?
A) Alzheimer's disease
B) Vascular dementia
C) Delirium
D) Major Depressive Disorder
Answer: C
Rationale: Delirium is characterized by an acute, fluctuating alteration
in mental status, disturbances in attention, and disorganized thinking.
, Dementia has a slow, progressive onset over months or years. The
sudden presentation and fluctuating course described are classic
hallmarks of delirium, often triggered by underlying acute infections
(like a UTI), dehydration, or medication changes.
Question 6
A 79-year-old male patient presents with complaints of a weak urinary
stream, hesitancy, and nocturia three times per night. Digital rectal
examination reveals a smooth, firm, symmetrically enlarged prostate
without nodules. His PSA is 2.4 ng/mL. Which medication class offers the
fastest relief for his dynamic obstructive symptoms?
A) 5-alpha-reductase inhibitors (e.g., Finasteride)
B) Alpha-1 adrenergic antagonists (e.g., Tamsulosin)
C) Anticholinergics (e.g., Oxybutynin)
D) Phosphodiesterase-5 inhibitors (e.g., Sildenafil)
Answer: B
Rationale: Alpha-1 adrenergic antagonists like tamsulosin work
rapidly (within days) by relaxing the smooth muscle of the bladder
neck and prostate capsule. 5-alpha-reductase inhibitors reduce
prostate size but require 6 to 12 months to achieve symptomatic
efficacy. Anticholinergics can exacerbate urinary retention in older
males with BPH.
Question 7
A 71-year-old female with a long history of Type 2 Diabetes Mellitus
presents for a checkup. The nurse practitioner emphasizes checking the
patient's feet at every visit. What is the primary clinical objective of
performing the 10-g monofilament test during these examinations?
A) To assess for peripheral arterial disease
B) To evaluate deep tendon reflexes
C) To screen for loss of protective sensation (LOPS)
D) To identify early Charcot arthropathy
EXAM QUESTIONS AND ANSWERS MASTER
GUIDE (QUESTIONS AND ANSWERS WITH
BOLDED RATIONALES)
This comprehensive question advanced study repository provides
board-style multiple-choice questions, accurate answers, and clear,
bolded rationales tailored for primary care of the maturing and aged
family. It meticulously covers high-yield geriatric topics including
Beers Criteria medication safety, cognitive screenings, chronic
disease management, and complex age-adjusted pharmacology.
Designed specifically for nurse practitioner students, this master
guide functions as an exceptional resource to secure top marks on
your midterm and final proctored examinations.
Question 1
An 82-year-old female presents for a routine wellness exam. Her daughter
notes that the patient has become increasingly frail and had a mechanical
fall three weeks ago. Which of the following validated screening tools is
most appropriate to specifically assess this patient's functional mobility and
fall risk in the primary care setting?
A) PHQ-9
B) Timed Up and Go (TUG) test
C) MMSE
D) CAM assessment
Answer: B
Rationale: The Timed Up and Go (TUG) test is a validated tool used to
assess an older adult's mobility, balance, and fall risk. A time of 12
seconds or more indicates a high risk for falls. PHQ-9 screens for
depression, MMSE evaluates cognitive impairment, and the CAM tool
is utilized to detect delirium.
,Question 2
A 74-year-old male with a history of hypertension and chronic kidney
disease (Stage 3a) presents with acute knee pain diagnosed as gouty
arthritis. Which of the following agents is preferred for acute management,
avoiding medications that accelerate renal decline?
A) High-dose Ibuprofen
B) Indomethacin
C) Low-dose Colchicine
D) Systemic Corticosteroids
Answer: D
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like
ibuprofen and indomethacin should be avoided in older adults with
chronic kidney disease due to the risk of acute kidney injury and fluid
retention. While colchicine can be used, it requires strict renal dosing
adjustments and carries toxicity risks. Short-course systemic or intra-
articular corticosteroids are highly effective and preferred in this
scenario to protect renal function.
Question 3
According to the American Geriatrics Society (AGS) Beers Criteria, which
of the following medications should be avoided in an 80-year-old patient
due to an exceptionally high risk of orthostatic hypotension, falls, and
anticholinergic adverse effects?
A) Amitriptyline
B) Sertraline
C) Lisinopril
D) Metformin
Answer: A
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with potent
anticholinergic properties. The Beers Criteria strongly recommends
avoiding TCAs in older adults because they cause sedation, blurred
,vision, dry mouth, urinary retention, and significant orthostatic
hypotension, which directly correlates to an increased risk of falls
and fractures.
Question 4
A 68-year-old postmenopausal female presents to establish care. Her
DEXA scan reveals a T-score of -2.7 in the lumbar spine. She has no
history of fractures. What is the correct diagnostic interpretation and initial
first-line pharmacological recommendation?
A) Osteopenia; Vitamin D3 50,000 IU weekly
B) Osteoporosis; Alendronate
C) Osteopenia; Hormone Replacement Therapy
D) Osteoporosis; Teriparatide
Answer: B
Rationale: A T-score of -2.5 or lower on a DEXA scan confirms a
diagnosis of osteoporosis. Oral bisphosphonates, such as
alendronate, serve as the first-line pharmacological choice to reduce
bone turnover and minimize future fracture risks, provided the patient
can remain upright for 30 minutes and has adequate renal function.
Question 5
An 88-year-old resident of an assisted living facility is brought to the clinic
by staff who report a sudden change in mental status over the past 24
hours. The patient is fluctuating between extreme lethargy and agitation,
and is hallucinating. What is the most likely underlying diagnosis?
A) Alzheimer's disease
B) Vascular dementia
C) Delirium
D) Major Depressive Disorder
Answer: C
Rationale: Delirium is characterized by an acute, fluctuating alteration
in mental status, disturbances in attention, and disorganized thinking.
, Dementia has a slow, progressive onset over months or years. The
sudden presentation and fluctuating course described are classic
hallmarks of delirium, often triggered by underlying acute infections
(like a UTI), dehydration, or medication changes.
Question 6
A 79-year-old male patient presents with complaints of a weak urinary
stream, hesitancy, and nocturia three times per night. Digital rectal
examination reveals a smooth, firm, symmetrically enlarged prostate
without nodules. His PSA is 2.4 ng/mL. Which medication class offers the
fastest relief for his dynamic obstructive symptoms?
A) 5-alpha-reductase inhibitors (e.g., Finasteride)
B) Alpha-1 adrenergic antagonists (e.g., Tamsulosin)
C) Anticholinergics (e.g., Oxybutynin)
D) Phosphodiesterase-5 inhibitors (e.g., Sildenafil)
Answer: B
Rationale: Alpha-1 adrenergic antagonists like tamsulosin work
rapidly (within days) by relaxing the smooth muscle of the bladder
neck and prostate capsule. 5-alpha-reductase inhibitors reduce
prostate size but require 6 to 12 months to achieve symptomatic
efficacy. Anticholinergics can exacerbate urinary retention in older
males with BPH.
Question 7
A 71-year-old female with a long history of Type 2 Diabetes Mellitus
presents for a checkup. The nurse practitioner emphasizes checking the
patient's feet at every visit. What is the primary clinical objective of
performing the 10-g monofilament test during these examinations?
A) To assess for peripheral arterial disease
B) To evaluate deep tendon reflexes
C) To screen for loss of protective sensation (LOPS)
D) To identify early Charcot arthropathy
