2026/2027
NR 601 Midterm Exam Primary
Care of the Maturing and Aged
2026/2027 Comprehensive Study
Guide, Practice Questions, Test Bank
Review, and Exam Preparation
Manual
Question 1:
A 68-year-old man experienced a brief episode of right-sided weakness, slurred
speech, and confusion that resolved within an hour. A CT scan performed in the
emergency department is normal. Which of the following is the most appropriate next
step in management?
A. Reassure the patient that symptoms are unlikely to recur
B. Identify and address modifiable cardiovascular risk factors
C. Administer aspirin 81 mg immediately and discharge the patient
D. Order a stat electroencephalogram and provide oxygen therapy
Correct Answer: B. Identify and address modifiable cardiovascular risk factors
Rationale: The patient's symptoms are consistent with a transient ischemic attack
(TIA), which serves as a warning sign for future stroke. Even when imaging is normal
and symptoms resolve, evaluation and modification of risk factors such as
hypertension, diabetes, smoking, obesity, hyperlipidemia, and sedentary lifestyle are
critical. Option A is incorrect because TIAs significantly increase future stroke risk.
Option C may be part of treatment but does not address comprehensive secondary
prevention. Option D is not indicated because the presentation is more consistent with
cerebrovascular disease than seizure activity.
Question 2:
A 56-year-old male undergoes routine diabetes screening. His fasting plasma glucose
level is 96 mg/dL. According to current screening recommendations, when should
diabetes screening be repeated?
A. Repeat fasting plasma glucose in 3 years
B. Start metformin 500 mg twice daily
C. Repeat fasting plasma glucose in 1 year
D. Refer immediately for ophthalmologic evaluation
,2026/2027
Correct Answer: A. Repeat fasting plasma glucose in 3 years
Rationale: A fasting plasma glucose level below 100 mg/dL is considered normal.
Individuals with normal screening results generally require repeat screening every
three years unless risk factors change. Metformin therapy is not indicated for normal
glucose levels. Annual testing is unnecessary in low-risk individuals with normal
results. Ophthalmology referrals are recommended for diagnosed diabetics, not
patients with normal screening results.
Question 3:
A 57-year-old woman reports persistent worry about finances, difficulty concentrating,
irritability, and insomnia following her husband's recent job loss. She is diagnosed
with generalized anxiety disorder. Which medication is considered first-line
pharmacologic therapy?
A. Diazepam
B. Clonazepam
C. Aripiprazole
D. Paroxetine
Correct Answer: D. Paroxetine
Rationale: Selective serotonin reuptake inhibitors (SSRIs), including paroxetine, are
considered first-line treatment for generalized anxiety disorder. Benzodiazepines such
as diazepam and clonazepam may provide short-term relief but carry risks of
dependence and are not preferred for long-term management. Aripiprazole is an
atypical antipsychotic and is not considered first-line therapy for anxiety disorders.
Question 4:
Which cardiac dysrhythmia is characterized by the absence of organized atrial activity
and the presence of fibrillatory waves?
A. Atrioventricular block
B. Atrial tachycardia
C. Atrial fibrillation
D. Atrial flutter
Correct Answer: C. Atrial fibrillation
Rationale: Atrial fibrillation is the most common sustained cardiac arrhythmia and is
characterized by chaotic atrial electrical activity resulting in fibrillatory waves and an
irregularly irregular ventricular rhythm. Atrial flutter typically produces a sawtooth
pattern. AV block involves conduction abnormalities, while atrial tachycardia is an
organized rapid atrial rhythm.
,2026/2027
Question 5:
Which statement regarding atrophic vaginitis is correct?
A. Symptoms are identical in all women
B. It creates a more acidic vaginal environment
C. It contributes to recurrent urinary tract infections
D. Vaginal lubricants are ineffective
Correct Answer: C. It contributes to recurrent urinary tract infections
Rationale: Atrophic vaginitis results from estrogen deficiency after menopause,
causing thinning of vaginal tissues and increased vaginal pH. These changes
predispose women to urinary tract infections. Symptoms vary among individuals.
Lubricants are often helpful in reducing discomfort and dyspareunia, making option D
incorrect.
Question 6:
Which screening tool is most appropriate for evaluating a patient suspected of having
delirium?
A. Saint Louis University Mental Status Examination (SLUMS)
B. Montreal Cognitive Assessment (MoCA)
C. Lawton Instrumental Activities of Daily Living Scale
D. Confusion Assessment Method (CAM)
Correct Answer: D. Confusion Assessment Method (CAM)
Rationale: The CAM is specifically designed to identify delirium and assesses acute
onset, fluctuating course, inattention, and altered consciousness. SLUMS and MoCA
are cognitive screening tools more commonly used for dementia assessment. The
Lawton Scale evaluates functional independence rather than cognitive status.
Question 7:
Which medication can effectively treat both pain and dyspnea in patients receiving
end-of-life care?
A. Lorazepam
B. Gabapentin
C. Methadone
D. Morphine
Correct Answer: D. Morphine
, 2026/2027
Rationale: Morphine is highly effective in relieving both pain and dyspnea. It
decreases respiratory distress by reducing the sensation of breathlessness and
improving comfort. Lorazepam may reduce anxiety but does not directly treat pain.
Gabapentin primarily treats neuropathic pain. Methadone is an opioid but is not
generally the preferred first-line choice in this situation.
Question 8:
Which annual screening recommendation is most appropriate for an elderly patient
with type 2 diabetes?
A. Gastroenterology consultation
B. Colonoscopy every year
C. Routine urology follow-up
D. Comprehensive ophthalmologic examination
Correct Answer: D. Comprehensive ophthalmologic examination
Rationale: Diabetic retinopathy is a major cause of vision loss. Annual dilated eye
examinations are recommended for diabetic patients to detect retinal complications
early. Routine gastroenterology and urology evaluations are not universally indicated.
Colonoscopy intervals depend on individual risk and findings.
Question 9:
Which characteristic most clearly distinguishes delirium from dementia?
A. Short-term memory impairment
B. Personality changes
C. Acute onset
D. Impaired attention
Correct Answer: C. Acute onset
Rationale: Delirium develops rapidly over hours to days, whereas dementia develops
gradually over months or years. Memory impairment and attention deficits can occur
in both conditions. The acute onset and fluctuating course are hallmark features of
delirium.
Question 10:
Where do most hospice patients die?
A. Hospital
B. Inpatient hospice unit
C. Nursing home
D. Home
NR 601 Midterm Exam Primary
Care of the Maturing and Aged
2026/2027 Comprehensive Study
Guide, Practice Questions, Test Bank
Review, and Exam Preparation
Manual
Question 1:
A 68-year-old man experienced a brief episode of right-sided weakness, slurred
speech, and confusion that resolved within an hour. A CT scan performed in the
emergency department is normal. Which of the following is the most appropriate next
step in management?
A. Reassure the patient that symptoms are unlikely to recur
B. Identify and address modifiable cardiovascular risk factors
C. Administer aspirin 81 mg immediately and discharge the patient
D. Order a stat electroencephalogram and provide oxygen therapy
Correct Answer: B. Identify and address modifiable cardiovascular risk factors
Rationale: The patient's symptoms are consistent with a transient ischemic attack
(TIA), which serves as a warning sign for future stroke. Even when imaging is normal
and symptoms resolve, evaluation and modification of risk factors such as
hypertension, diabetes, smoking, obesity, hyperlipidemia, and sedentary lifestyle are
critical. Option A is incorrect because TIAs significantly increase future stroke risk.
Option C may be part of treatment but does not address comprehensive secondary
prevention. Option D is not indicated because the presentation is more consistent with
cerebrovascular disease than seizure activity.
Question 2:
A 56-year-old male undergoes routine diabetes screening. His fasting plasma glucose
level is 96 mg/dL. According to current screening recommendations, when should
diabetes screening be repeated?
A. Repeat fasting plasma glucose in 3 years
B. Start metformin 500 mg twice daily
C. Repeat fasting plasma glucose in 1 year
D. Refer immediately for ophthalmologic evaluation
,2026/2027
Correct Answer: A. Repeat fasting plasma glucose in 3 years
Rationale: A fasting plasma glucose level below 100 mg/dL is considered normal.
Individuals with normal screening results generally require repeat screening every
three years unless risk factors change. Metformin therapy is not indicated for normal
glucose levels. Annual testing is unnecessary in low-risk individuals with normal
results. Ophthalmology referrals are recommended for diagnosed diabetics, not
patients with normal screening results.
Question 3:
A 57-year-old woman reports persistent worry about finances, difficulty concentrating,
irritability, and insomnia following her husband's recent job loss. She is diagnosed
with generalized anxiety disorder. Which medication is considered first-line
pharmacologic therapy?
A. Diazepam
B. Clonazepam
C. Aripiprazole
D. Paroxetine
Correct Answer: D. Paroxetine
Rationale: Selective serotonin reuptake inhibitors (SSRIs), including paroxetine, are
considered first-line treatment for generalized anxiety disorder. Benzodiazepines such
as diazepam and clonazepam may provide short-term relief but carry risks of
dependence and are not preferred for long-term management. Aripiprazole is an
atypical antipsychotic and is not considered first-line therapy for anxiety disorders.
Question 4:
Which cardiac dysrhythmia is characterized by the absence of organized atrial activity
and the presence of fibrillatory waves?
A. Atrioventricular block
B. Atrial tachycardia
C. Atrial fibrillation
D. Atrial flutter
Correct Answer: C. Atrial fibrillation
Rationale: Atrial fibrillation is the most common sustained cardiac arrhythmia and is
characterized by chaotic atrial electrical activity resulting in fibrillatory waves and an
irregularly irregular ventricular rhythm. Atrial flutter typically produces a sawtooth
pattern. AV block involves conduction abnormalities, while atrial tachycardia is an
organized rapid atrial rhythm.
,2026/2027
Question 5:
Which statement regarding atrophic vaginitis is correct?
A. Symptoms are identical in all women
B. It creates a more acidic vaginal environment
C. It contributes to recurrent urinary tract infections
D. Vaginal lubricants are ineffective
Correct Answer: C. It contributes to recurrent urinary tract infections
Rationale: Atrophic vaginitis results from estrogen deficiency after menopause,
causing thinning of vaginal tissues and increased vaginal pH. These changes
predispose women to urinary tract infections. Symptoms vary among individuals.
Lubricants are often helpful in reducing discomfort and dyspareunia, making option D
incorrect.
Question 6:
Which screening tool is most appropriate for evaluating a patient suspected of having
delirium?
A. Saint Louis University Mental Status Examination (SLUMS)
B. Montreal Cognitive Assessment (MoCA)
C. Lawton Instrumental Activities of Daily Living Scale
D. Confusion Assessment Method (CAM)
Correct Answer: D. Confusion Assessment Method (CAM)
Rationale: The CAM is specifically designed to identify delirium and assesses acute
onset, fluctuating course, inattention, and altered consciousness. SLUMS and MoCA
are cognitive screening tools more commonly used for dementia assessment. The
Lawton Scale evaluates functional independence rather than cognitive status.
Question 7:
Which medication can effectively treat both pain and dyspnea in patients receiving
end-of-life care?
A. Lorazepam
B. Gabapentin
C. Methadone
D. Morphine
Correct Answer: D. Morphine
, 2026/2027
Rationale: Morphine is highly effective in relieving both pain and dyspnea. It
decreases respiratory distress by reducing the sensation of breathlessness and
improving comfort. Lorazepam may reduce anxiety but does not directly treat pain.
Gabapentin primarily treats neuropathic pain. Methadone is an opioid but is not
generally the preferred first-line choice in this situation.
Question 8:
Which annual screening recommendation is most appropriate for an elderly patient
with type 2 diabetes?
A. Gastroenterology consultation
B. Colonoscopy every year
C. Routine urology follow-up
D. Comprehensive ophthalmologic examination
Correct Answer: D. Comprehensive ophthalmologic examination
Rationale: Diabetic retinopathy is a major cause of vision loss. Annual dilated eye
examinations are recommended for diabetic patients to detect retinal complications
early. Routine gastroenterology and urology evaluations are not universally indicated.
Colonoscopy intervals depend on individual risk and findings.
Question 9:
Which characteristic most clearly distinguishes delirium from dementia?
A. Short-term memory impairment
B. Personality changes
C. Acute onset
D. Impaired attention
Correct Answer: C. Acute onset
Rationale: Delirium develops rapidly over hours to days, whereas dementia develops
gradually over months or years. Memory impairment and attention deficits can occur
in both conditions. The acute onset and fluctuating course are hallmark features of
delirium.
Question 10:
Where do most hospice patients die?
A. Hospital
B. Inpatient hospice unit
C. Nursing home
D. Home
