NR 601 FiNal Exam 2026/2027 – PRimaRy
CaRE oF thE agiNg Family Q&a with a+
aNswERs
An 86-year-old female comes to your office for a wellness visit. Her blood pressure
is 125/70 mmHg, pulse 69 beats per min, and respiratory rate 18 breaths per min.
She is well appearing and reports she is up to date on her routine vaccinations.
She introduces her partner of 35 years whom she would like to make medical
decisions for her in case she becomes unable to make decisions for herself. She
reports that she and her partner are not married. She asks if she needs any
further documentation to ensure her goals of care are followed. Which one of the
following would be the most appropriate recommendation for this patient and her
partner? - Answer-Advise them to file an advanced directive.
. An 81-year-old transgender female with history of depression and
hyperlipidemia presents to your clinic for routine care. She endorses a history of
smoking, currently smoking 1 pack per day, and occasionally drinks a glass of wine,
although she denies illicit drug use. She reports she takes atorvastatin 20 mg and
subcutaneous estrogen therapy. - Answer-Counseling on smoking cessation
An 80-year-old woman has no weight loss, no pain, and no distention but over 2
years increasingly complains of constipation despite adequate medical treatment.
A colonoscopy is negative. An abdominal CT is performed. It reveals well-
circumscribed pelvic masses, the largest adherent to the ovarian ligament. The
best first step is: - Answer-Invite her to return with a family member and have a
long talk about the diagnostic and therapeutic options.
,An 85-year-old man with chronic obstructive pulmonary disease presents to your
office with his daughter with the complaint of new onset chest pain, shortness of
breath, and cough. He is clearly tachypneic and has tactile fremitus and egophany
and crackles heard at the right lung base. His daughter just wants you to give him
an antibiotic pill so that she can take him home. You are concerned that he might
need to be hospitalized and require IV antibiotics. What statement is true? -
Answer-Treatment decisions for pneumonia are based on its severity, the
presence of comorbid illnesses, and a prior history of MRSA or Pseudomonas
respiratory infection.
An 80-year-old woman that you follow in a nursing home has an acute decline in
her mental status. She has a fever >100° F, but no other focal complaints or
findings on physical examination except for a chronic indwelling urinary catheter.
What statement is true? - Answer-Fever in an older adult with an indwelling
urinary catheter is an appropriate indication to start empiric antibiotic therapy.
An 82-year-old woman receives oral amoxicillin-clavulate for a skin abscess on her
leg. She develops new onset of frequent watery stool that persists for several days
after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen,
toxin, and polymerase chain reaction (PCR). The antigen and PCR are both
positive. She has never had C. difficile infection before. What one statement is the
best answer regarding her management? - Answer-Either vancomycin or
fidaxomicin are recommended for the first episode of C. difficile infection.
An 84-year-old male with history of stroke without residual deficit, systolic heart
failure, and type 2 diabetes presents to clinic for follow-up. He is independently
, living in a retirement community and still works part time on a golf course. He
currently takes aspirin 81 mg, metoprolol tartrate 25 mg BID (twice a day),
furosemide 20 mg BID, and lisinopril 10 mg daily. He reports his last colonoscopy
was 8 years ago, with no abnormality. He reports he is sexually active with men
and women, engaging in receptive oral, receptive anal, and penetrative sex. He
states he has had over three sexual partners in the last year with intermittent
condom use. What sexually transmitted infection testing should be offered? -
Answer-Urine testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine? - Answer-It has greater risk of
adverse effects with its twice-daily formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times
per night. His other lower urinary tract symptoms are slow stream, occasional
urgency, and urgency-related leakage once weekly. Medical problems include
poorly controlled hypertension, diastolic heart failure, hyperlipidemia,
osteoarthritis, and prediabetes. His medications include lisinopril 20 mg daily,
metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg
twice daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily.
Amlodipine 5 mg daily was recently added by his cardiologist. On review of
systems, Mr. A complains that nocturia is causing daytime fatigue, and he is more
constipated. Physical examination is notable for blood pressure 162/83 mmHg,
heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged prostate, and
21 pretibial edema. Your next step in management should be: - Answer-Stop
amlodipine and increase lisinopril.
The daughter of a 79-year-old woman notes that her mother, who has dementia
and lives with her, is wetting herself when she attends her new day program.
Program staff have requested that "something be done" as she is requiring a
clothes change nearly every time she is there. She cannot describe the
CaRE oF thE agiNg Family Q&a with a+
aNswERs
An 86-year-old female comes to your office for a wellness visit. Her blood pressure
is 125/70 mmHg, pulse 69 beats per min, and respiratory rate 18 breaths per min.
She is well appearing and reports she is up to date on her routine vaccinations.
She introduces her partner of 35 years whom she would like to make medical
decisions for her in case she becomes unable to make decisions for herself. She
reports that she and her partner are not married. She asks if she needs any
further documentation to ensure her goals of care are followed. Which one of the
following would be the most appropriate recommendation for this patient and her
partner? - Answer-Advise them to file an advanced directive.
. An 81-year-old transgender female with history of depression and
hyperlipidemia presents to your clinic for routine care. She endorses a history of
smoking, currently smoking 1 pack per day, and occasionally drinks a glass of wine,
although she denies illicit drug use. She reports she takes atorvastatin 20 mg and
subcutaneous estrogen therapy. - Answer-Counseling on smoking cessation
An 80-year-old woman has no weight loss, no pain, and no distention but over 2
years increasingly complains of constipation despite adequate medical treatment.
A colonoscopy is negative. An abdominal CT is performed. It reveals well-
circumscribed pelvic masses, the largest adherent to the ovarian ligament. The
best first step is: - Answer-Invite her to return with a family member and have a
long talk about the diagnostic and therapeutic options.
,An 85-year-old man with chronic obstructive pulmonary disease presents to your
office with his daughter with the complaint of new onset chest pain, shortness of
breath, and cough. He is clearly tachypneic and has tactile fremitus and egophany
and crackles heard at the right lung base. His daughter just wants you to give him
an antibiotic pill so that she can take him home. You are concerned that he might
need to be hospitalized and require IV antibiotics. What statement is true? -
Answer-Treatment decisions for pneumonia are based on its severity, the
presence of comorbid illnesses, and a prior history of MRSA or Pseudomonas
respiratory infection.
An 80-year-old woman that you follow in a nursing home has an acute decline in
her mental status. She has a fever >100° F, but no other focal complaints or
findings on physical examination except for a chronic indwelling urinary catheter.
What statement is true? - Answer-Fever in an older adult with an indwelling
urinary catheter is an appropriate indication to start empiric antibiotic therapy.
An 82-year-old woman receives oral amoxicillin-clavulate for a skin abscess on her
leg. She develops new onset of frequent watery stool that persists for several days
after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen,
toxin, and polymerase chain reaction (PCR). The antigen and PCR are both
positive. She has never had C. difficile infection before. What one statement is the
best answer regarding her management? - Answer-Either vancomycin or
fidaxomicin are recommended for the first episode of C. difficile infection.
An 84-year-old male with history of stroke without residual deficit, systolic heart
failure, and type 2 diabetes presents to clinic for follow-up. He is independently
, living in a retirement community and still works part time on a golf course. He
currently takes aspirin 81 mg, metoprolol tartrate 25 mg BID (twice a day),
furosemide 20 mg BID, and lisinopril 10 mg daily. He reports his last colonoscopy
was 8 years ago, with no abnormality. He reports he is sexually active with men
and women, engaging in receptive oral, receptive anal, and penetrative sex. He
states he has had over three sexual partners in the last year with intermittent
condom use. What sexually transmitted infection testing should be offered? -
Answer-Urine testing, blood testing, anal swab, and oropharyngeal swab
Which of the following is true about tolterodine? - Answer-It has greater risk of
adverse effects with its twice-daily formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times
per night. His other lower urinary tract symptoms are slow stream, occasional
urgency, and urgency-related leakage once weekly. Medical problems include
poorly controlled hypertension, diastolic heart failure, hyperlipidemia,
osteoarthritis, and prediabetes. His medications include lisinopril 20 mg daily,
metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg
twice daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily.
Amlodipine 5 mg daily was recently added by his cardiologist. On review of
systems, Mr. A complains that nocturia is causing daytime fatigue, and he is more
constipated. Physical examination is notable for blood pressure 162/83 mmHg,
heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged prostate, and
21 pretibial edema. Your next step in management should be: - Answer-Stop
amlodipine and increase lisinopril.
The daughter of a 79-year-old woman notes that her mother, who has dementia
and lives with her, is wetting herself when she attends her new day program.
Program staff have requested that "something be done" as she is requiring a
clothes change nearly every time she is there. She cannot describe the
