NR603 Adult-Gerontology Primary Care Week 8
Final Exam Verified Solutions Pack
Practice Exam – Version 1
1. An 82-year-old female presents with a 3-day history of confusion, urinary frequency, and suprapubic
discomfort. Which diagnosis should be suspected first?
A. Dementia
B. Urinary tract infection
C. Dehydration
D. Depression
Correct Answer: B
Rationale: New-onset confusion in an older adult with urinary frequency and suprapubic discomfort is highly
suggestive of a urinary tract infection. In older adults, UTI often presents with altered mental status rather
than classic dysuria. Dementia is chronic and progressive, not acute. Dehydration and depression do not
typically cause urinary frequency with suprapubic pain.
2. A 75-year-old male with a history of hypertension presents with a blood pressure of 190/100 mm Hg. He
denies headache, chest pain, or visual changes. What is the most appropriate management?
A. Immediate intravenous antihypertensive therapy
B. Oral antihypertensive adjustment with close follow-up
C. Referral to the emergency department
D. No intervention needed
Correct Answer: B
Rationale: This is hypertensive urgency (BP >180/120 without end-organ damage). Management includes
adjusting oral antihypertensives and close follow-up. Intravenous therapy and ED referral are reserved for
hypertensive emergencies with end-organ damage.
3. An 80-year-old female presents with a 6-month history of progressive memory loss and difficulty
performing familiar tasks. Which diagnosis is most likely?
A. Delirium
B. Alzheimer's disease
C. Depression
D. Parkinson's disease
Correct Answer: B
,Rationale: Progressive memory loss and difficulty with familiar tasks over months suggest Alzheimer's
disease. Delirium is acute and fluctuating. Depression may cause pseudodementia but is typically
reversible. Parkinson's disease initially presents with motor symptoms.
4. A 70-year-old male presents with nocturia, hesitancy, and weak urinary stream. Which condition is most
likely?
A. Prostate cancer
B. Benign prostatic hyperplasia
C. Urinary tract infection
D. Bladder cancer
Correct Answer: B
Rationale: BPH is the most common cause of lower urinary tract symptoms in older men. Prostate cancer
may present similarly but is suspected when PSA is elevated or nodules are palpated. UTI causes acute
symptoms. Bladder cancer typically presents with painless hematuria.
5. An 85-year-old female presents with a hip fracture after a fall. Which factor most increases her risk for
falls?
A. Hypertension
B. Osteoporosis
C. Diabetes
D. Hyperlipidemia
Correct Answer: B
Rationale: Osteoporosis increases the risk of fractures from falls but does not directly cause falls. However,
among the options, it is the most relevant to fall-related injury. Hypertension, diabetes, and hyperlipidemia
may contribute to falls through complications but are less directly related.
6. A 78-year-old male presents with fatigue, pallor, and pica. Which laboratory finding is most consistent with
iron deficiency anemia?
A. Elevated ferritin
B. Low ferritin
C. Elevated vitamin B12
D. Low MCV and low ferritin
Correct Answer: D
Rationale: Iron deficiency anemia is characterized by microcytic anemia with low ferritin. Elevated ferritin
suggests iron overload. Vitamin B12 deficiency causes macrocytic anemia.
, 7. An 80-year-old female presents with a new onset of atrial fibrillation. Which medication is appropriate for
rate control?
A. Amiodarone
B. Metoprolol
C. Flecainide
D. Sotalol
Correct Answer: B
Rationale: Beta-blockers such as metoprolol are first-line for rate control in atrial fibrillation. Amiodarone,
flecainide, and sotalol are antiarrhythmic medications used for rhythm control.
8. A 72-year-old male presents with sudden onset of severe abdominal pain and distension. Which condition
should be suspected?
A. Gastroenteritis
B. Bowel obstruction
C. Irritable bowel syndrome
D. Diverticulitis
Correct Answer: B
Rationale: Sudden onset of severe abdominal pain and distension in an older adult suggests bowel
obstruction. Gastroenteritis causes diarrhea and vomiting. IBS causes chronic intermittent pain.
Diverticulitis causes left lower quadrant pain and fever.
9. An 85-year-old female presents with a new onset of confusion. Which condition should be ruled out first?
A. Dementia
B. Delirium
C. Depression
D. Psychosis
Correct Answer: B
Rationale: Delirium is an acute change in mental status that requires immediate evaluation for underlying
causes such as infection, medication effects, or metabolic abnormalities. Dementia is chronic and
progressive. Depression and psychosis are psychiatric diagnoses.
10. A 68-year-old male presents with a painless, firm nodule on his neck. He has a history of smoking. What
is the most concerning diagnosis?
A. Lymphoma
B. Thyroid nodule
C. Head and neck cancer
D. Lipoma
Final Exam Verified Solutions Pack
Practice Exam – Version 1
1. An 82-year-old female presents with a 3-day history of confusion, urinary frequency, and suprapubic
discomfort. Which diagnosis should be suspected first?
A. Dementia
B. Urinary tract infection
C. Dehydration
D. Depression
Correct Answer: B
Rationale: New-onset confusion in an older adult with urinary frequency and suprapubic discomfort is highly
suggestive of a urinary tract infection. In older adults, UTI often presents with altered mental status rather
than classic dysuria. Dementia is chronic and progressive, not acute. Dehydration and depression do not
typically cause urinary frequency with suprapubic pain.
2. A 75-year-old male with a history of hypertension presents with a blood pressure of 190/100 mm Hg. He
denies headache, chest pain, or visual changes. What is the most appropriate management?
A. Immediate intravenous antihypertensive therapy
B. Oral antihypertensive adjustment with close follow-up
C. Referral to the emergency department
D. No intervention needed
Correct Answer: B
Rationale: This is hypertensive urgency (BP >180/120 without end-organ damage). Management includes
adjusting oral antihypertensives and close follow-up. Intravenous therapy and ED referral are reserved for
hypertensive emergencies with end-organ damage.
3. An 80-year-old female presents with a 6-month history of progressive memory loss and difficulty
performing familiar tasks. Which diagnosis is most likely?
A. Delirium
B. Alzheimer's disease
C. Depression
D. Parkinson's disease
Correct Answer: B
,Rationale: Progressive memory loss and difficulty with familiar tasks over months suggest Alzheimer's
disease. Delirium is acute and fluctuating. Depression may cause pseudodementia but is typically
reversible. Parkinson's disease initially presents with motor symptoms.
4. A 70-year-old male presents with nocturia, hesitancy, and weak urinary stream. Which condition is most
likely?
A. Prostate cancer
B. Benign prostatic hyperplasia
C. Urinary tract infection
D. Bladder cancer
Correct Answer: B
Rationale: BPH is the most common cause of lower urinary tract symptoms in older men. Prostate cancer
may present similarly but is suspected when PSA is elevated or nodules are palpated. UTI causes acute
symptoms. Bladder cancer typically presents with painless hematuria.
5. An 85-year-old female presents with a hip fracture after a fall. Which factor most increases her risk for
falls?
A. Hypertension
B. Osteoporosis
C. Diabetes
D. Hyperlipidemia
Correct Answer: B
Rationale: Osteoporosis increases the risk of fractures from falls but does not directly cause falls. However,
among the options, it is the most relevant to fall-related injury. Hypertension, diabetes, and hyperlipidemia
may contribute to falls through complications but are less directly related.
6. A 78-year-old male presents with fatigue, pallor, and pica. Which laboratory finding is most consistent with
iron deficiency anemia?
A. Elevated ferritin
B. Low ferritin
C. Elevated vitamin B12
D. Low MCV and low ferritin
Correct Answer: D
Rationale: Iron deficiency anemia is characterized by microcytic anemia with low ferritin. Elevated ferritin
suggests iron overload. Vitamin B12 deficiency causes macrocytic anemia.
, 7. An 80-year-old female presents with a new onset of atrial fibrillation. Which medication is appropriate for
rate control?
A. Amiodarone
B. Metoprolol
C. Flecainide
D. Sotalol
Correct Answer: B
Rationale: Beta-blockers such as metoprolol are first-line for rate control in atrial fibrillation. Amiodarone,
flecainide, and sotalol are antiarrhythmic medications used for rhythm control.
8. A 72-year-old male presents with sudden onset of severe abdominal pain and distension. Which condition
should be suspected?
A. Gastroenteritis
B. Bowel obstruction
C. Irritable bowel syndrome
D. Diverticulitis
Correct Answer: B
Rationale: Sudden onset of severe abdominal pain and distension in an older adult suggests bowel
obstruction. Gastroenteritis causes diarrhea and vomiting. IBS causes chronic intermittent pain.
Diverticulitis causes left lower quadrant pain and fever.
9. An 85-year-old female presents with a new onset of confusion. Which condition should be ruled out first?
A. Dementia
B. Delirium
C. Depression
D. Psychosis
Correct Answer: B
Rationale: Delirium is an acute change in mental status that requires immediate evaluation for underlying
causes such as infection, medication effects, or metabolic abnormalities. Dementia is chronic and
progressive. Depression and psychosis are psychiatric diagnoses.
10. A 68-year-old male presents with a painless, firm nodule on his neck. He has a history of smoking. What
is the most concerning diagnosis?
A. Lymphoma
B. Thyroid nodule
C. Head and neck cancer
D. Lipoma
