NR 601 MIDTERM EXAM
Primary Care of the Maturing & Aged Family — Premium Original Practice Questions & Rationales
Expanded exam-preparation bank • Adult & geriatric primary care • Clinical reasoning • High-yield explanations
Important: This is an independently written study resource. It is not affiliated with, endorsed by, or a reproduction of
Chamberlain University or Stuvia. It does not claim to contain actual, leaked, recalled, or verified examination questions.
NR 601 — Independent Primary Care Study Resource Page 1
, ENDOCRINE: THYROID & AGING
Question: An older adult presents with fatigue, constipation, weight gain, dry cool skin and reduced
interest in usual activities. Which diagnosis belongs high on the differential?
A. Hyperthyroidism
B. Hypothyroidism
C. Acute appendicitis
D. Otitis media
Correct Answer: B. Hypothyroidism
Rationale: Hypothyroidism may present with fatigue, cold intolerance, constipation, weight gain, dry skin and slowed
cognition or mood. Older adults may have less classic symptoms, so the differential should remain broad.
Exam Tip: Exam tip: In older adults, classic endocrine symptoms may be subtle or atypical.
Question: An older adult taking stable levothyroxine returns for follow-up. Which laboratory test is
most useful for routine dose assessment in primary hypothyroidism?
A. TSH
B. Troponin
C. BNP
D. Lipase
Correct Answer: A. TSH
Rationale: TSH is the primary laboratory marker used to monitor replacement in most patients with primary
hypothyroidism. Interpretation should account for the clinical situation and timing of therapy changes.
Exam Tip: Clinical pearl: Recheck timing after a dose change should allow the hypothalamic-pituitary-thyroid axis to reach
a new steady state.
Question: Why is levothyroxine generally started cautiously in an older adult with hypothyroidism?
A. To prevent angina or arrhythmias from excessive thyroid replacement
B. To prevent constipation
C. To increase LDL cholesterol
D. To cause weight gain
Correct Answer: A. To prevent angina or arrhythmias from excessive thyroid replacement
Rationale: Thyroid hormone increases metabolic and cardiovascular demand. In an older adult, particularly one with
underlying coronary disease, aggressive replacement can precipitate ischemia or arrhythmia.
Exam Tip: Exam trap: 'Start low and go slow' is especially important when cardiac reserve is limited.
NR 601 — Independent Primary Care Study Resource Page 2
Primary Care of the Maturing & Aged Family — Premium Original Practice Questions & Rationales
Expanded exam-preparation bank • Adult & geriatric primary care • Clinical reasoning • High-yield explanations
Important: This is an independently written study resource. It is not affiliated with, endorsed by, or a reproduction of
Chamberlain University or Stuvia. It does not claim to contain actual, leaked, recalled, or verified examination questions.
NR 601 — Independent Primary Care Study Resource Page 1
, ENDOCRINE: THYROID & AGING
Question: An older adult presents with fatigue, constipation, weight gain, dry cool skin and reduced
interest in usual activities. Which diagnosis belongs high on the differential?
A. Hyperthyroidism
B. Hypothyroidism
C. Acute appendicitis
D. Otitis media
Correct Answer: B. Hypothyroidism
Rationale: Hypothyroidism may present with fatigue, cold intolerance, constipation, weight gain, dry skin and slowed
cognition or mood. Older adults may have less classic symptoms, so the differential should remain broad.
Exam Tip: Exam tip: In older adults, classic endocrine symptoms may be subtle or atypical.
Question: An older adult taking stable levothyroxine returns for follow-up. Which laboratory test is
most useful for routine dose assessment in primary hypothyroidism?
A. TSH
B. Troponin
C. BNP
D. Lipase
Correct Answer: A. TSH
Rationale: TSH is the primary laboratory marker used to monitor replacement in most patients with primary
hypothyroidism. Interpretation should account for the clinical situation and timing of therapy changes.
Exam Tip: Clinical pearl: Recheck timing after a dose change should allow the hypothalamic-pituitary-thyroid axis to reach
a new steady state.
Question: Why is levothyroxine generally started cautiously in an older adult with hypothyroidism?
A. To prevent angina or arrhythmias from excessive thyroid replacement
B. To prevent constipation
C. To increase LDL cholesterol
D. To cause weight gain
Correct Answer: A. To prevent angina or arrhythmias from excessive thyroid replacement
Rationale: Thyroid hormone increases metabolic and cardiovascular demand. In an older adult, particularly one with
underlying coronary disease, aggressive replacement can precipitate ischemia or arrhythmia.
Exam Tip: Exam trap: 'Start low and go slow' is especially important when cardiac reserve is limited.
NR 601 — Independent Primary Care Study Resource Page 2
