NR 601 MIDTERM EXAM / ACTUAL EXAM
CHAMBERLAIN UNIVERSITY | QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH RATIONALES
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<LATEST VERSION>
Question 1
A 78-year-old woman with hypertension, osteoarthritis, and mild hearing loss
presents for an annual primary care visit. She reports that she has stopped driving,
has difficulty organizing her medications, and recently missed two utility
payments. She remains independent with bathing, dressing, toileting, and feeding.
Which assessment finding represents the greatest immediate priority for further
evaluation?
A. Difficulty organizing medications
B. Mild hearing loss
C. Osteoarthritis-related morning stiffness
D. Inability to drive
Answer: A
Rationale: Medication management is an instrumental activity of daily living
(IADL) and a change in this ability may indicate cognitive impairment, safety
concerns, or medication-related problems. A decline in IADLs can be clinically
meaningful even when basic ADLs remain intact and should prompt further
evaluation rather than being dismissed as normal aging.
,Question 2
During a comprehensive geriatric assessment, which activity is classified as an
instrumental activity of daily living (IADL)?
A. Transferring from bed to chair
B. Feeding oneself
C. Managing personal finances
D. Toileting independently
Answer: C
Rationale: IADLs are complex activities necessary for independent community
living and include managing finances, medications, transportation, shopping, meal
preparation, and household responsibilities. Bathing, dressing, transferring,
feeding, and toileting are basic ADLs.
Question 3
An 84-year-old man with previously stable cognition is brought to the clinic by his
daughter. Over the past 24 hours, he has become disoriented, alternates between
agitation and drowsiness, and cannot maintain attention during conversation.
Which condition should the nurse practitioner suspect first?
A. Alzheimer disease
B. Delirium
C. Major depressive disorder
D. Mild neurocognitive disorder
Answer: B
Rationale: Delirium is characterized by an acute change in cognition and attention
with a fluctuating course. In an older adult, sudden confusion should trigger an
immediate search for an underlying medical, medication-related, metabolic, or
infectious cause rather than being attributed to chronic dementia.
,Question 4
A 79-year-old patient takes oxybutynin, diphenhydramine nightly, amitriptyline,
and clonazepam. His daughter reports increasing forgetfulness and two falls during
the past month. Which medication-related problem is most concerning?
A. Excessive beta-adrenergic stimulation
B. Cumulative anticholinergic and CNS-active medication burden
C. Reduced absorption of water-soluble medications
D. Inadequate analgesic therapy
Answer: B
Rationale: The 2023 AGS Beers Criteria identifies strong anticholinergic
medications as contributors to confusion, delirium, and falls and recommends
minimizing cumulative anticholinergic exposure. Benzodiazepines also increase
the risk of cognitive impairment, delirium, falls, and fractures in older adults.
Question 5
An 82-year-old patient with chronic kidney disease develops excessive sedation
after receiving a medication primarily eliminated through the kidneys. Which age-
associated pharmacokinetic change most likely contributed?
A. Increased renal clearance
B. Increased total body water
C. Decreased renal drug clearance
D. Increased hepatic enzyme activity
Answer: C
Rationale: Renal function commonly declines with aging, and reduced renal
clearance can increase exposure to medications eliminated primarily by the
kidneys. Drug dosing in older adults should therefore account for renal function
rather than relying solely on chronological age.
, Question 6
A 71-year-old community-dwelling adult has repeated office blood pressure
measurements averaging 134/82 mmHg despite lifestyle counseling. The patient
has no cardiovascular disease, diabetes, or chronic kidney disease and has a low
estimated 10-year cardiovascular risk. Which approach is most consistent with the
2025 ACC/AHA blood pressure guideline?
A. Immediately begin three antihypertensive medications
B. Continue lifestyle intervention and reassess after 3–6 months
C. Consider the blood pressure normal because the systolic pressure is below 140
mmHg
D. Initiate antihypertensive therapy solely because the patient is older than 65
Answer: B
Rationale: The 2025 guideline maintains a treatment goal below 130/80 mmHg.
For adults with average blood pressure ≥130/80 mmHg and lower cardiovascular
risk, medication is recommended when blood pressure remains elevated after an
initial 3–6-month lifestyle trial.
Question 7
A 67-year-old patient with hypertension, obesity, and type 2 diabetes has no
dyspnea, edema, structural cardiac abnormalities, or previous heart failure
symptoms. According to the ACC/AHA/HFSA staging system, which stage of
heart failure best describes this patient?
A. Stage A
B. Stage B
C. Stage C
D. Stage D
Answer: A
Rationale: Stage A represents patients who are at risk for heart failure but have no
symptoms or structural/functional heart disease. Hypertension, diabetes, obesity,
CHAMBERLAIN UNIVERSITY | QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 78-year-old woman with hypertension, osteoarthritis, and mild hearing loss
presents for an annual primary care visit. She reports that she has stopped driving,
has difficulty organizing her medications, and recently missed two utility
payments. She remains independent with bathing, dressing, toileting, and feeding.
Which assessment finding represents the greatest immediate priority for further
evaluation?
A. Difficulty organizing medications
B. Mild hearing loss
C. Osteoarthritis-related morning stiffness
D. Inability to drive
Answer: A
Rationale: Medication management is an instrumental activity of daily living
(IADL) and a change in this ability may indicate cognitive impairment, safety
concerns, or medication-related problems. A decline in IADLs can be clinically
meaningful even when basic ADLs remain intact and should prompt further
evaluation rather than being dismissed as normal aging.
,Question 2
During a comprehensive geriatric assessment, which activity is classified as an
instrumental activity of daily living (IADL)?
A. Transferring from bed to chair
B. Feeding oneself
C. Managing personal finances
D. Toileting independently
Answer: C
Rationale: IADLs are complex activities necessary for independent community
living and include managing finances, medications, transportation, shopping, meal
preparation, and household responsibilities. Bathing, dressing, transferring,
feeding, and toileting are basic ADLs.
Question 3
An 84-year-old man with previously stable cognition is brought to the clinic by his
daughter. Over the past 24 hours, he has become disoriented, alternates between
agitation and drowsiness, and cannot maintain attention during conversation.
Which condition should the nurse practitioner suspect first?
A. Alzheimer disease
B. Delirium
C. Major depressive disorder
D. Mild neurocognitive disorder
Answer: B
Rationale: Delirium is characterized by an acute change in cognition and attention
with a fluctuating course. In an older adult, sudden confusion should trigger an
immediate search for an underlying medical, medication-related, metabolic, or
infectious cause rather than being attributed to chronic dementia.
,Question 4
A 79-year-old patient takes oxybutynin, diphenhydramine nightly, amitriptyline,
and clonazepam. His daughter reports increasing forgetfulness and two falls during
the past month. Which medication-related problem is most concerning?
A. Excessive beta-adrenergic stimulation
B. Cumulative anticholinergic and CNS-active medication burden
C. Reduced absorption of water-soluble medications
D. Inadequate analgesic therapy
Answer: B
Rationale: The 2023 AGS Beers Criteria identifies strong anticholinergic
medications as contributors to confusion, delirium, and falls and recommends
minimizing cumulative anticholinergic exposure. Benzodiazepines also increase
the risk of cognitive impairment, delirium, falls, and fractures in older adults.
Question 5
An 82-year-old patient with chronic kidney disease develops excessive sedation
after receiving a medication primarily eliminated through the kidneys. Which age-
associated pharmacokinetic change most likely contributed?
A. Increased renal clearance
B. Increased total body water
C. Decreased renal drug clearance
D. Increased hepatic enzyme activity
Answer: C
Rationale: Renal function commonly declines with aging, and reduced renal
clearance can increase exposure to medications eliminated primarily by the
kidneys. Drug dosing in older adults should therefore account for renal function
rather than relying solely on chronological age.
, Question 6
A 71-year-old community-dwelling adult has repeated office blood pressure
measurements averaging 134/82 mmHg despite lifestyle counseling. The patient
has no cardiovascular disease, diabetes, or chronic kidney disease and has a low
estimated 10-year cardiovascular risk. Which approach is most consistent with the
2025 ACC/AHA blood pressure guideline?
A. Immediately begin three antihypertensive medications
B. Continue lifestyle intervention and reassess after 3–6 months
C. Consider the blood pressure normal because the systolic pressure is below 140
mmHg
D. Initiate antihypertensive therapy solely because the patient is older than 65
Answer: B
Rationale: The 2025 guideline maintains a treatment goal below 130/80 mmHg.
For adults with average blood pressure ≥130/80 mmHg and lower cardiovascular
risk, medication is recommended when blood pressure remains elevated after an
initial 3–6-month lifestyle trial.
Question 7
A 67-year-old patient with hypertension, obesity, and type 2 diabetes has no
dyspnea, edema, structural cardiac abnormalities, or previous heart failure
symptoms. According to the ACC/AHA/HFSA staging system, which stage of
heart failure best describes this patient?
A. Stage A
B. Stage B
C. Stage C
D. Stage D
Answer: A
Rationale: Stage A represents patients who are at risk for heart failure but have no
symptoms or structural/functional heart disease. Hypertension, diabetes, obesity,
