NR 601 PRIMARY CARE OF THE OLDER ADULT 2026/2027 TEST
BANK WITH SOLUTION – 400 COMPREHENSIVE GERIATRIC
NURSING EXAM PREPARATION MATERIAL
CORE DOMAINS
• Geriatric Assessment and Functional Decline
• Polypharmacy and Age-Related Pharmacokinetics
• Cardiovascular and Respiratory Disorders in Aging
• Endocrine and Metabolic Conditions in Older Adults
• Neurological and Cognitive Disorders
• Mental Health and Psychosocial Issues in Aging
• Musculoskeletal and Fall Prevention
• Geriatric Syndromes and Palliative Care
• Regulatory, Ethical, and End-of-Life Decision Making
• Health Promotion and Disease Prevention in Older Adults
INTRODUCTION
This comprehensive examination is designed to assess the advanced clinical
knowledge and decision-making skills required for primary care of the older adult.
It evaluates the learner's ability to integrate geriatric assessment principles,
recognize atypical disease presentations, manage polypharmacy, and address
complex psychosocial and ethical issues unique to aging populations. The exam
employs multiple-choice and scenario-based questions emphasizing real-world
application, evidence-based practice, and patient-centered care. Successful
completion demonstrates readiness to deliver safe, effective, and compassionate
primary care to older adults across diverse clinical settings.
SECTION ONE: QUESTIONS 1–400
,Question 1
An 82-year-old female presents with a three-day history of confusion and
decreased oral intake. She has a history of hypertension, osteoarthritis, and mild
cognitive impairment. Her medications include lisinopril, acetaminophen, and
donepezil. Vital signs reveal temperature 37.2°C, heart rate 102, blood pressure
118/72, respiratory rate 22, and oxygen saturation 94% on room air. Which factor
is most important to assess first in this patient?
A. Serum electrolytes and renal function
B. Urinalysis and urine culture
C. Medication review for recent changes
D. Mental status and baseline cognitive function
RATIONALE: Acute change in mental status in an older adult constitutes
delirium until proven otherwise. The first step is to establish the patient's baseline
cognitive function and characterize the acute change, as this guides the diagnostic
approach. While infection, metabolic derangements, and medication effects are
common precipitants, documenting the baseline and acuity of change is essential
before determining the underlying cause. Delirium is a medical emergency in
older adults and requires prompt identification and management.
Question 2
A 75-year-old male with a history of heart failure with preserved ejection fraction
presents with progressive dyspnea on exertion and lower extremity edema. His
current medications include furosemide 40 mg daily, metoprolol succinate 50 mg
daily, and lisinopril 10 mg daily. Which assessment finding would most suggest
worsening diastolic dysfunction?
A. Elevated B-type natriuretic peptide
B. Bibasilar crackles on auscultation
C. Jugular venous distension without S3 gallop
D. Increased pulmonary artery wedge pressure
RATIONALE: Heart failure with preserved ejection fraction is characterized by
impaired diastolic relaxation, leading to elevated filling pressures. Jugular venous
distension reflects increased right-sided filling pressures, which occurs in diastolic
,dysfunction. An S3 gallop is more characteristic of systolic heart failure. While
BNP may be elevated, it is not specific to diastolic dysfunction. Bibasilar crackles
indicate pulmonary congestion but do not differentiate systolic from diastolic
etiologies. Pulmonary artery wedge pressure measurement requires invasive
monitoring.
Question 3
An 80-year-old female is brought to the clinic by her daughter who reports that
her mother has become increasingly withdrawn and no longer participates in
activities she previously enjoyed. The patient denies sadness but admits to poor
sleep and decreased appetite. Which screening tool is most appropriate for this
patient?
A. Mini-Mental State Examination
B. Geriatric Depression Scale
C. Montreal Cognitive Assessment
D. Clock Drawing Test
RATIONALE: Depression in older adults often presents atypically, with
withdrawal, anhedonia, sleep disturbance, and appetite changes rather than
classic sadness. The Geriatric Depression Scale is specifically designed for older
adults and avoids somatic symptoms that may be attributable to medical illness.
The Mini-Mental State Examination and Montreal Cognitive Assessment screen
for cognitive impairment. The Clock Drawing Test assesses executive function and
visuospatial skills.
Question 4
A 78-year-old male with a history of type 2 diabetes mellitus and chronic kidney
disease presents for routine follow-up. His most recent laboratory results reveal
an estimated glomerular filtration rate of 32 mL/min/1.73m². Which medication
adjustment is most appropriate for this patient?
A. Increase metformin dose to improve glycemic control
B. Continue current metformin dose without change
C. Discontinue metformin due to reduced renal clearance
D. Add a sulfonylurea to replace metformin
, RATIONALE: Metformin is contraindicated in patients with an estimated
glomerular filtration rate below 30 mL/min/1.73m² and should be used with
caution when the rate is between 30 and 45 mL/min/1.73m². In this patient with
a rate of 32 mL/min/1.73m², discontinuation is the safest approach to avoid lactic
acidosis. Increasing the dose would be dangerous. Sulfonylureas carry a high risk
of hypoglycemia in older adults with renal impairment and are not preferred
alternatives.
Question 5
An 85-year-old female presents after a fall at home. She denies loss of
consciousness and has no apparent fractures. She reports feeling dizzy upon
standing. Her blood pressure is 138/76 supine and 102/64 standing. Which
condition is most likely responsible for her fall?
A. Benign paroxysmal positional vertigo
B. Vestibular neuritis
C. Orthostatic hypotension
D. Cerebellar stroke
RATIONALE: Orthostatic hypotension is defined as a drop in systolic blood
pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg
upon standing. This patient's drop from 138/76 to 102/64 meets criteria.
Orthostatic hypotension is a common cause of falls in older adults and may result
from dehydration, medication effects, or autonomic dysfunction. Benign
paroxysmal positional vertigo is triggered by head movement. Vestibular neuritis
presents with acute prolonged vertigo. Cerebellar stroke would present with
additional neurological findings.
Question 6
A 72-year-old female with a history of osteoporosis presents for evaluation of
chronic lower back pain. She has no history of trauma. Physical examination
reveals point tenderness over the mid-thoracic spine. Which imaging study is
most appropriate initially?
A. Plain radiographs of the thoracic spine
B. Magnetic resonance imaging of the thoracic spine
BANK WITH SOLUTION – 400 COMPREHENSIVE GERIATRIC
NURSING EXAM PREPARATION MATERIAL
CORE DOMAINS
• Geriatric Assessment and Functional Decline
• Polypharmacy and Age-Related Pharmacokinetics
• Cardiovascular and Respiratory Disorders in Aging
• Endocrine and Metabolic Conditions in Older Adults
• Neurological and Cognitive Disorders
• Mental Health and Psychosocial Issues in Aging
• Musculoskeletal and Fall Prevention
• Geriatric Syndromes and Palliative Care
• Regulatory, Ethical, and End-of-Life Decision Making
• Health Promotion and Disease Prevention in Older Adults
INTRODUCTION
This comprehensive examination is designed to assess the advanced clinical
knowledge and decision-making skills required for primary care of the older adult.
It evaluates the learner's ability to integrate geriatric assessment principles,
recognize atypical disease presentations, manage polypharmacy, and address
complex psychosocial and ethical issues unique to aging populations. The exam
employs multiple-choice and scenario-based questions emphasizing real-world
application, evidence-based practice, and patient-centered care. Successful
completion demonstrates readiness to deliver safe, effective, and compassionate
primary care to older adults across diverse clinical settings.
SECTION ONE: QUESTIONS 1–400
,Question 1
An 82-year-old female presents with a three-day history of confusion and
decreased oral intake. She has a history of hypertension, osteoarthritis, and mild
cognitive impairment. Her medications include lisinopril, acetaminophen, and
donepezil. Vital signs reveal temperature 37.2°C, heart rate 102, blood pressure
118/72, respiratory rate 22, and oxygen saturation 94% on room air. Which factor
is most important to assess first in this patient?
A. Serum electrolytes and renal function
B. Urinalysis and urine culture
C. Medication review for recent changes
D. Mental status and baseline cognitive function
RATIONALE: Acute change in mental status in an older adult constitutes
delirium until proven otherwise. The first step is to establish the patient's baseline
cognitive function and characterize the acute change, as this guides the diagnostic
approach. While infection, metabolic derangements, and medication effects are
common precipitants, documenting the baseline and acuity of change is essential
before determining the underlying cause. Delirium is a medical emergency in
older adults and requires prompt identification and management.
Question 2
A 75-year-old male with a history of heart failure with preserved ejection fraction
presents with progressive dyspnea on exertion and lower extremity edema. His
current medications include furosemide 40 mg daily, metoprolol succinate 50 mg
daily, and lisinopril 10 mg daily. Which assessment finding would most suggest
worsening diastolic dysfunction?
A. Elevated B-type natriuretic peptide
B. Bibasilar crackles on auscultation
C. Jugular venous distension without S3 gallop
D. Increased pulmonary artery wedge pressure
RATIONALE: Heart failure with preserved ejection fraction is characterized by
impaired diastolic relaxation, leading to elevated filling pressures. Jugular venous
distension reflects increased right-sided filling pressures, which occurs in diastolic
,dysfunction. An S3 gallop is more characteristic of systolic heart failure. While
BNP may be elevated, it is not specific to diastolic dysfunction. Bibasilar crackles
indicate pulmonary congestion but do not differentiate systolic from diastolic
etiologies. Pulmonary artery wedge pressure measurement requires invasive
monitoring.
Question 3
An 80-year-old female is brought to the clinic by her daughter who reports that
her mother has become increasingly withdrawn and no longer participates in
activities she previously enjoyed. The patient denies sadness but admits to poor
sleep and decreased appetite. Which screening tool is most appropriate for this
patient?
A. Mini-Mental State Examination
B. Geriatric Depression Scale
C. Montreal Cognitive Assessment
D. Clock Drawing Test
RATIONALE: Depression in older adults often presents atypically, with
withdrawal, anhedonia, sleep disturbance, and appetite changes rather than
classic sadness. The Geriatric Depression Scale is specifically designed for older
adults and avoids somatic symptoms that may be attributable to medical illness.
The Mini-Mental State Examination and Montreal Cognitive Assessment screen
for cognitive impairment. The Clock Drawing Test assesses executive function and
visuospatial skills.
Question 4
A 78-year-old male with a history of type 2 diabetes mellitus and chronic kidney
disease presents for routine follow-up. His most recent laboratory results reveal
an estimated glomerular filtration rate of 32 mL/min/1.73m². Which medication
adjustment is most appropriate for this patient?
A. Increase metformin dose to improve glycemic control
B. Continue current metformin dose without change
C. Discontinue metformin due to reduced renal clearance
D. Add a sulfonylurea to replace metformin
, RATIONALE: Metformin is contraindicated in patients with an estimated
glomerular filtration rate below 30 mL/min/1.73m² and should be used with
caution when the rate is between 30 and 45 mL/min/1.73m². In this patient with
a rate of 32 mL/min/1.73m², discontinuation is the safest approach to avoid lactic
acidosis. Increasing the dose would be dangerous. Sulfonylureas carry a high risk
of hypoglycemia in older adults with renal impairment and are not preferred
alternatives.
Question 5
An 85-year-old female presents after a fall at home. She denies loss of
consciousness and has no apparent fractures. She reports feeling dizzy upon
standing. Her blood pressure is 138/76 supine and 102/64 standing. Which
condition is most likely responsible for her fall?
A. Benign paroxysmal positional vertigo
B. Vestibular neuritis
C. Orthostatic hypotension
D. Cerebellar stroke
RATIONALE: Orthostatic hypotension is defined as a drop in systolic blood
pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg
upon standing. This patient's drop from 138/76 to 102/64 meets criteria.
Orthostatic hypotension is a common cause of falls in older adults and may result
from dehydration, medication effects, or autonomic dysfunction. Benign
paroxysmal positional vertigo is triggered by head movement. Vestibular neuritis
presents with acute prolonged vertigo. Cerebellar stroke would present with
additional neurological findings.
Question 6
A 72-year-old female with a history of osteoporosis presents for evaluation of
chronic lower back pain. She has no history of trauma. Physical examination
reveals point tenderness over the mid-thoracic spine. Which imaging study is
most appropriate initially?
A. Plain radiographs of the thoracic spine
B. Magnetic resonance imaging of the thoracic spine
