NR 601 MIDTERM EXAM STUDY GUIDE |PRIMARY CARE OF THE
MATURING & AGED FAMILY |CHAMBERLAIN UNIVERSITY COLLEGE OF
NURSING |WEEKS 1–4 CONTENT | COMPREHENSIVE EXAM PREP
LATEST UPDATE
EXAM CONTENT AREAS:
Week 1: Principles of Primary Care of Older Adults
Week 2: Coronary & Peripheral Vascular Disease
Week 3: Cardiac Arrhythmias & Valvular Disorders
Week 4: Respiratory Disorders
SECTION 1: WEEK 1 – PRINCIPLES OF PRIMARY CARE OF OLDER ADULTS
Aging Theories, Demographics, and Assessment Frameworks (Questions 1–25)
1. Which theory of aging suggests that accumulated cellular damage from free
radicals contributes to the aging process?
A. Programmed aging theory
B. Free radical theory
C. Wear-and-tear theory
D. Immunological theory
Answer: B
Rationale: The free radical theory proposes that oxidative stress from reactive
oxygen species damages DNA, proteins, and lipids over time, leading to cellular
dysfunction and aging. Antioxidants (e.g., vitamins C and E) may mitigate this
damage, though evidence for supplementation is mixed. Programmed aging
theory suggests genetic regulation; wear-and-tear theory implicates mechanical
damage; immunological theory focuses on immune system decline.
2. Which geriatric assessment evaluates medical, functional, and psychosocial
domains to guide care planning?
A. PHQ-9
B. Comprehensive Geriatric Assessment (CGA)
C. CURB-65
D. ASCVD risk calculator
Answer: B
Rationale: CGA evaluates medical problems, cognition, mood, mobility, function,
1
,medications, social support, and environment to create an individualized care
plan. It is the gold standard for geriatric assessment. PHQ-9 screens for
depression; CURB-65 assesses pneumonia severity; ASCVD estimates
cardiovascular risk.
3. An 82-year-old woman values remaining independent and living at home.
Which approach to care best aligns with geriatric best practices?
A. Disease-centered care only
B. Goal-oriented, patient-centered care
C. Hospital-based care for all older adults
D. Provider-directed care without patient input
Answer: B
Rationale: Geriatric care prioritizes function, independence, quality of life,
and the patient's personal goals rather than focusing only on disease treatment.
Disease-centered care ignores the patient's values; hospital-based care is
inappropriate when home care is feasible; provider-directed care without input
violates patient-centered principles.
4. Which one of the following is most true about the Rule of Fourths?
A. One-fourth of geriatric problems are iatrogenic.
B. Little can be done to prevent three-fourths of the problems of aging.
C. For every medical complaint a patient presents with, a careful assessment
can identify three other diagnoses.
D. What used to be called normal aging can be largely explained by processes
that are not normal.
Answer: D
Rationale: The Rule of Fourths categorizes problems as disease (medical
treatment indicated), disuse (activity regimen), misuse (prevent deterioration),
or physiologic aging (adapt and compensate). What was once called "normal
aging" often has identifiable causes that can be addressed. Option C refers to
the concept that multiple problems often coexist, but the core teaching of the
Rule of Fourths is that many age-related changes are modifiable.
5. An 80-year-old female reports difficulty managing medications, finances, and
cooking. Which assessment tool evaluates these abilities?
A. Mini-Mental State Examination (MMSE)
2
,B. Instrumental Activities of Daily Living (IADLs)
C. Activities of Daily Living (ADLs)
D. Geriatric Depression Scale (GDS)
Answer: B
Rationale: IADLs assess complex self-care tasks necessary for independent
living: using the telephone, shopping, food preparation, housekeeping, laundry,
transportation, medication management, and handling finances. ADLs evaluate
basic self-care (bathing, dressing, toileting, transferring, continence,
feeding). MMSE assesses cognition; GDS assesses mood.
6. Geriatric assessments encompass four main domains. Which of the following
correctly identifies these domains?
A. Physical, Mental, Social, Financial
B. Medical, Functional, Psychosocial, Environmental
C. Cardiac, Pulmonary, Renal, Hepatic
D. Cognitive, Emotional, Physical, Spiritual
Answer: B
Rationale: A comprehensive geriatric assessment evaluates medical
(comorbidities, medications), functional (ADLs, IADLs, mobility), psychosocial
(cognition, mood, social support), and environmental (home safety,
accessibility) domains. This holistic approach guides individualized care
planning.
7. Which one of the following is most true about aging changes?
A. Stage 3 and 4 sleep decreases.
B. Renal perfusion is not reduced, but renal function is reduced.
C. Hearing acuity declines beginning in middle age.
D. Prostatic enlargement occurs only in a minority of men.
Answer: A
Rationale: Stage 3 and 4 (deep) sleep decreases significantly with aging,
contributing to sleep disturbances and daytime fatigue. Renal perfusion does
reduce with age (not unchanged). Hearing decline typically begins later in
life, not middle age. Prostatic enlargement (BPH) occurs in the majority of
older men, not a minority.
3
, 8. Which of the following is a normal physiologic change of aging that affects
pharmacokinetics?
A. Increased hepatic blood flow
B. Increased total body water
C. Decreased serum albumin
D. Increased glomerular filtration rate
Answer: C
Rationale: Serum albumin decreases with age, affecting protein binding of
medications (e.g., warfarin, phenytoin), leading to increased free drug levels
and risk of toxicity. Hepatic blood flow and GFR decrease, and total body water
decreases. These changes increase the risk of adverse drug reactions in older
adults.
9. An 80-year-old patient has a new prescription for digoxin. Age-related
decrease in which organ function most affects digoxin clearance?
A. Hepatic metabolism
B. Renal excretion
C. Pulmonary diffusion
D. Gastric absorption
Answer: B
Rationale: Digoxin is primarily renally excreted. Age-related decline in GFR
reduces clearance, increasing risk of toxicity. Dosage adjustment based on
renal function is critical. Hepatic metabolism is less relevant for digoxin;
pulmonary and gastric functions do not significantly affect drug clearance.
10. Which change in the cardiovascular system is considered a normal part of
aging?
A. Increased left ventricular ejection fraction
B. Decreased aortic compliance
C. Increased resting heart rate
D. Decreased systolic blood pressure
Answer: B
Rationale: Arterial stiffness increases with age due to elastin loss and
collagen crosslinking, leading to increased pulse wave velocity and isolated
systolic hypertension. Ejection fraction is preserved; resting heart rate does
4
MATURING & AGED FAMILY |CHAMBERLAIN UNIVERSITY COLLEGE OF
NURSING |WEEKS 1–4 CONTENT | COMPREHENSIVE EXAM PREP
LATEST UPDATE
EXAM CONTENT AREAS:
Week 1: Principles of Primary Care of Older Adults
Week 2: Coronary & Peripheral Vascular Disease
Week 3: Cardiac Arrhythmias & Valvular Disorders
Week 4: Respiratory Disorders
SECTION 1: WEEK 1 – PRINCIPLES OF PRIMARY CARE OF OLDER ADULTS
Aging Theories, Demographics, and Assessment Frameworks (Questions 1–25)
1. Which theory of aging suggests that accumulated cellular damage from free
radicals contributes to the aging process?
A. Programmed aging theory
B. Free radical theory
C. Wear-and-tear theory
D. Immunological theory
Answer: B
Rationale: The free radical theory proposes that oxidative stress from reactive
oxygen species damages DNA, proteins, and lipids over time, leading to cellular
dysfunction and aging. Antioxidants (e.g., vitamins C and E) may mitigate this
damage, though evidence for supplementation is mixed. Programmed aging
theory suggests genetic regulation; wear-and-tear theory implicates mechanical
damage; immunological theory focuses on immune system decline.
2. Which geriatric assessment evaluates medical, functional, and psychosocial
domains to guide care planning?
A. PHQ-9
B. Comprehensive Geriatric Assessment (CGA)
C. CURB-65
D. ASCVD risk calculator
Answer: B
Rationale: CGA evaluates medical problems, cognition, mood, mobility, function,
1
,medications, social support, and environment to create an individualized care
plan. It is the gold standard for geriatric assessment. PHQ-9 screens for
depression; CURB-65 assesses pneumonia severity; ASCVD estimates
cardiovascular risk.
3. An 82-year-old woman values remaining independent and living at home.
Which approach to care best aligns with geriatric best practices?
A. Disease-centered care only
B. Goal-oriented, patient-centered care
C. Hospital-based care for all older adults
D. Provider-directed care without patient input
Answer: B
Rationale: Geriatric care prioritizes function, independence, quality of life,
and the patient's personal goals rather than focusing only on disease treatment.
Disease-centered care ignores the patient's values; hospital-based care is
inappropriate when home care is feasible; provider-directed care without input
violates patient-centered principles.
4. Which one of the following is most true about the Rule of Fourths?
A. One-fourth of geriatric problems are iatrogenic.
B. Little can be done to prevent three-fourths of the problems of aging.
C. For every medical complaint a patient presents with, a careful assessment
can identify three other diagnoses.
D. What used to be called normal aging can be largely explained by processes
that are not normal.
Answer: D
Rationale: The Rule of Fourths categorizes problems as disease (medical
treatment indicated), disuse (activity regimen), misuse (prevent deterioration),
or physiologic aging (adapt and compensate). What was once called "normal
aging" often has identifiable causes that can be addressed. Option C refers to
the concept that multiple problems often coexist, but the core teaching of the
Rule of Fourths is that many age-related changes are modifiable.
5. An 80-year-old female reports difficulty managing medications, finances, and
cooking. Which assessment tool evaluates these abilities?
A. Mini-Mental State Examination (MMSE)
2
,B. Instrumental Activities of Daily Living (IADLs)
C. Activities of Daily Living (ADLs)
D. Geriatric Depression Scale (GDS)
Answer: B
Rationale: IADLs assess complex self-care tasks necessary for independent
living: using the telephone, shopping, food preparation, housekeeping, laundry,
transportation, medication management, and handling finances. ADLs evaluate
basic self-care (bathing, dressing, toileting, transferring, continence,
feeding). MMSE assesses cognition; GDS assesses mood.
6. Geriatric assessments encompass four main domains. Which of the following
correctly identifies these domains?
A. Physical, Mental, Social, Financial
B. Medical, Functional, Psychosocial, Environmental
C. Cardiac, Pulmonary, Renal, Hepatic
D. Cognitive, Emotional, Physical, Spiritual
Answer: B
Rationale: A comprehensive geriatric assessment evaluates medical
(comorbidities, medications), functional (ADLs, IADLs, mobility), psychosocial
(cognition, mood, social support), and environmental (home safety,
accessibility) domains. This holistic approach guides individualized care
planning.
7. Which one of the following is most true about aging changes?
A. Stage 3 and 4 sleep decreases.
B. Renal perfusion is not reduced, but renal function is reduced.
C. Hearing acuity declines beginning in middle age.
D. Prostatic enlargement occurs only in a minority of men.
Answer: A
Rationale: Stage 3 and 4 (deep) sleep decreases significantly with aging,
contributing to sleep disturbances and daytime fatigue. Renal perfusion does
reduce with age (not unchanged). Hearing decline typically begins later in
life, not middle age. Prostatic enlargement (BPH) occurs in the majority of
older men, not a minority.
3
, 8. Which of the following is a normal physiologic change of aging that affects
pharmacokinetics?
A. Increased hepatic blood flow
B. Increased total body water
C. Decreased serum albumin
D. Increased glomerular filtration rate
Answer: C
Rationale: Serum albumin decreases with age, affecting protein binding of
medications (e.g., warfarin, phenytoin), leading to increased free drug levels
and risk of toxicity. Hepatic blood flow and GFR decrease, and total body water
decreases. These changes increase the risk of adverse drug reactions in older
adults.
9. An 80-year-old patient has a new prescription for digoxin. Age-related
decrease in which organ function most affects digoxin clearance?
A. Hepatic metabolism
B. Renal excretion
C. Pulmonary diffusion
D. Gastric absorption
Answer: B
Rationale: Digoxin is primarily renally excreted. Age-related decline in GFR
reduces clearance, increasing risk of toxicity. Dosage adjustment based on
renal function is critical. Hepatic metabolism is less relevant for digoxin;
pulmonary and gastric functions do not significantly affect drug clearance.
10. Which change in the cardiovascular system is considered a normal part of
aging?
A. Increased left ventricular ejection fraction
B. Decreased aortic compliance
C. Increased resting heart rate
D. Decreased systolic blood pressure
Answer: B
Rationale: Arterial stiffness increases with age due to elastin loss and
collagen crosslinking, leading to increased pulse wave velocity and isolated
systolic hypertension. Ejection fraction is preserved; resting heart rate does
4
