NR601 Final Exam
Study Guide
2026 – 2027 Academic Year
150 Practice Questions with Rationales
Evidence-Based Clinical Reasoning
Geriatric & Primary Care
Advanced Practice Nursing
, Geriatric Assessment and Preventive Care
Comprehensive Geriatric Assessment (CGA), Immunizations, Screenings, and Fall Prevention
Which of the following is the single most beneficial preventive intervention for an older adult who smokes?
A. Annual influenza vaccination
B. Smoking cessation counseling and intervention
C. Low-dose aspirin therapy
D. Annual comprehensive metabolic panel
Correct Answer: B
Smoking cessation is the single most beneficial preventive intervention for older adults who smoke, as it reduces cardiovascular
risk, cancer risk, and respiratory disease progression. The USPSTF recommends that clinicians ask all adults about tobacco use
and provide cessation interventions. While influenza vaccination and aspirin therapy have roles in prevention, they do not match
the magnitude of benefit achieved by quitting smoking.
A 72-year-old patient presents for an annual wellness visit. Which component is NOT part of a Comprehensive
Geriatric Assessment (CGA)?
A. Functional status assessment (ADLs/IADLs)
B. Cognitive screening
C. Surgical risk stratification score
D. Nutritional evaluation
Correct Answer: C
A CGA is a multidimensional, interdisciplinary diagnostic process designed to determine a frail elderly person's medical,
psychological, and functional capabilities. Core components include functional status (ADLs/IADLs), cognitive screening,
nutritional evaluation, fall risk assessment, and psychosocial evaluation. Surgical risk stratification scores (e.g., ACS-NSQIP) are
perioperative tools and are not components of a standard CGA.
According to current immunization recommendations, which vaccine should be administered to a 68-year-old
who has never received a pneumococcal vaccine?
A. PCV13 followed by PPSV23 in one year
B. PCV20 alone
C. PPSV23 alone
D. PCV15 followed by PPSV23
Correct Answer: B
Current ACIP recommendations state that adults aged 65 years and older who have never received a pneumococcal vaccine
should receive PCV20 alone. PCV20 covers 20 serotypes and eliminates the need for a sequential dosing regimen. The older
PCV13/PPSV23 sequential schedule has been replaced for vaccine-naive older adults.
A 65-year-old patient with type 2 diabetes mellitus asks about recommended screenings. Which screening is
most important to order annually?
A. Colonoscopy
B. DEXA scan for bone density
C. Comprehensive dilated eye examination
D. Low-dose CT of the chest
Correct Answer: C
, The American Diabetes Association recommends an annual comprehensive dilated eye examination for all patients with type 2
diabetes to screen for diabetic retinopathy, the leading cause of blindness in working-age adults. Colonoscopy is recommended
every 10 years for average-risk adults starting at age 45. DEXA screening is typically every 2 years based on risk. LDCT is for
lung cancer screening in those with significant smoking history.
A 55-year-old patient has a 30 pack-year smoking history and currently smokes. Which lung cancer screening
modality is recommended?
A. Chest X-ray annually
B. Sputum cytology every 6 months
C. Low-dose computed tomography (LDCT) annually
D. MRI of the chest every 2 years
Correct Answer: C
The USPSTF recommends annual screening with LDCT for adults aged 50-80 who have at least a 20 pack-year smoking history
and currently smoke or have quit within the past 15 years. LDCT has been shown to reduce lung cancer mortality by 15-20% in
high-risk populations compared to chest X-ray. Sputum cytology and MRI are not recommended screening modalities for lung
cancer.
For colorectal cancer screening in an average-risk 50-year-old, which recommendation is most appropriate?
A. Colonoscopy every 5 years
B. Colonoscopy every 10 years
C. Flexible sigmoidoscopy every 10 years
D. CT colonography every 2 years
Correct Answer: B
For average-risk adults, colonoscopy every 10 years is the recommended screening interval. If polyps are found, the interval
shortens based on the number, size, and type of polyps. Flexible sigmoidoscopy is recommended every 5-10 years. CT
colonography is every 5 years. The 10-year interval for colonoscopy is based on the estimated time for an adenomatous polyp to
progress to cancer.
Which assessment tool is most appropriate for evaluating fall risk in an older adult by observing their ability to
rise from a chair, walk, turn, and return?
A. Katz ADL Index
B. Timed Up and Go (TUG) test
C. Mini-Cog
D. PHQ-9
Correct Answer: B
The Timed Up and Go (TUG) test assesses mobility, balance, and fall risk by measuring the time it takes a patient to rise from a
standard chair, walk 3 meters, turn around, walk back, and sit down. A time greater than 12 seconds indicates increased fall risk.
The Katz ADL Index measures functional independence in basic activities. Mini-Cog screens for cognitive impairment. PHQ-9
screens for depression.
The Katz Index of Activities of Daily Living (ADLs) assesses independence in how many core activities?
A. 4
B. 6
C. 8
D. 10
Correct Answer: B
, The Katz ADL Index assesses independence in 6 core activities: bathing, dressing, toileting, transferring, continence, and feeding.
Each activity is scored as independent or dependent. The index is widely used in geriatric assessment to determine the level of
functional assistance needed and to track changes in functional status over time.
Which screening tool is used to identify older adults at risk for malnutrition?
A. Morse Fall Scale
B. Mini Nutritional Assessment (MNA)
C. CAGE questionnaire
D. GAD-7
Correct Answer: B
The Mini Nutritional Assessment (MNA) is a validated screening tool specifically designed to identify older adults at risk for
malnutrition. It includes questions on dietary intake, weight loss, mobility, psychological stress, and BMI. A score of 17-23.5
indicates risk for malnutrition, and below 17 indicates malnourished status. The Morse Fall Scale assesses fall risk, CAGE
assesses alcohol use, and GAD-7 assesses anxiety.
When initiating an exercise program for a frail 78-year-old, which principle is most important?
A. Begin with high-intensity interval training
B. Start low and go slow
C. Restrict exercise to seated activities only
D. Avoid resistance training entirely
Correct Answer: B
The "start low and go slow" principle is fundamental when initiating exercise in frail older adults. This approach minimizes the
risk of injury, cardiovascular events, and musculoskeletal strain while allowing the patient to gradually adapt. Exercise should
eventually include aerobic, resistance, flexibility, and balance components. Completely restricting exercise or beginning at high
intensity are both inappropriate for this population.
A 70-year-old patient with no history of cardiovascular disease presents for a routine visit. How often should
blood pressure be screened?
A. Every 6 months
B. Annually
C. Every 2 years
D. Every 5 years
Correct Answer: B
Current guidelines recommend annual blood pressure screening for adults aged 40 and older, or more frequently if blood
pressure is elevated or if the patient has risk factors such as diabetes, CKD, or cardiovascular disease. The 2017 ACC/AHA
guidelines define hypertension as ≥130/80 mmHg, making regular screening critical for early detection and management.
A 65-year-old woman undergoes DEXA scanning. Her T-score at the femoral neck is -2.0. How is this result
interpreted?
A. Normal bone density
B. Osteopenia
C. Osteoporosis
D. Severe osteoporosis
Correct Answer: B
According to WHO criteria, a T-score of -1.0 to -2.4 indicates osteopenia (low bone mass). A T-score of -2.5 or below indicates
osteoporosis, and a T-score of -2.5 or below with fragility fractures indicates severe osteoporosis. A T-score of -1.0 or above is
Study Guide
2026 – 2027 Academic Year
150 Practice Questions with Rationales
Evidence-Based Clinical Reasoning
Geriatric & Primary Care
Advanced Practice Nursing
, Geriatric Assessment and Preventive Care
Comprehensive Geriatric Assessment (CGA), Immunizations, Screenings, and Fall Prevention
Which of the following is the single most beneficial preventive intervention for an older adult who smokes?
A. Annual influenza vaccination
B. Smoking cessation counseling and intervention
C. Low-dose aspirin therapy
D. Annual comprehensive metabolic panel
Correct Answer: B
Smoking cessation is the single most beneficial preventive intervention for older adults who smoke, as it reduces cardiovascular
risk, cancer risk, and respiratory disease progression. The USPSTF recommends that clinicians ask all adults about tobacco use
and provide cessation interventions. While influenza vaccination and aspirin therapy have roles in prevention, they do not match
the magnitude of benefit achieved by quitting smoking.
A 72-year-old patient presents for an annual wellness visit. Which component is NOT part of a Comprehensive
Geriatric Assessment (CGA)?
A. Functional status assessment (ADLs/IADLs)
B. Cognitive screening
C. Surgical risk stratification score
D. Nutritional evaluation
Correct Answer: C
A CGA is a multidimensional, interdisciplinary diagnostic process designed to determine a frail elderly person's medical,
psychological, and functional capabilities. Core components include functional status (ADLs/IADLs), cognitive screening,
nutritional evaluation, fall risk assessment, and psychosocial evaluation. Surgical risk stratification scores (e.g., ACS-NSQIP) are
perioperative tools and are not components of a standard CGA.
According to current immunization recommendations, which vaccine should be administered to a 68-year-old
who has never received a pneumococcal vaccine?
A. PCV13 followed by PPSV23 in one year
B. PCV20 alone
C. PPSV23 alone
D. PCV15 followed by PPSV23
Correct Answer: B
Current ACIP recommendations state that adults aged 65 years and older who have never received a pneumococcal vaccine
should receive PCV20 alone. PCV20 covers 20 serotypes and eliminates the need for a sequential dosing regimen. The older
PCV13/PPSV23 sequential schedule has been replaced for vaccine-naive older adults.
A 65-year-old patient with type 2 diabetes mellitus asks about recommended screenings. Which screening is
most important to order annually?
A. Colonoscopy
B. DEXA scan for bone density
C. Comprehensive dilated eye examination
D. Low-dose CT of the chest
Correct Answer: C
, The American Diabetes Association recommends an annual comprehensive dilated eye examination for all patients with type 2
diabetes to screen for diabetic retinopathy, the leading cause of blindness in working-age adults. Colonoscopy is recommended
every 10 years for average-risk adults starting at age 45. DEXA screening is typically every 2 years based on risk. LDCT is for
lung cancer screening in those with significant smoking history.
A 55-year-old patient has a 30 pack-year smoking history and currently smokes. Which lung cancer screening
modality is recommended?
A. Chest X-ray annually
B. Sputum cytology every 6 months
C. Low-dose computed tomography (LDCT) annually
D. MRI of the chest every 2 years
Correct Answer: C
The USPSTF recommends annual screening with LDCT for adults aged 50-80 who have at least a 20 pack-year smoking history
and currently smoke or have quit within the past 15 years. LDCT has been shown to reduce lung cancer mortality by 15-20% in
high-risk populations compared to chest X-ray. Sputum cytology and MRI are not recommended screening modalities for lung
cancer.
For colorectal cancer screening in an average-risk 50-year-old, which recommendation is most appropriate?
A. Colonoscopy every 5 years
B. Colonoscopy every 10 years
C. Flexible sigmoidoscopy every 10 years
D. CT colonography every 2 years
Correct Answer: B
For average-risk adults, colonoscopy every 10 years is the recommended screening interval. If polyps are found, the interval
shortens based on the number, size, and type of polyps. Flexible sigmoidoscopy is recommended every 5-10 years. CT
colonography is every 5 years. The 10-year interval for colonoscopy is based on the estimated time for an adenomatous polyp to
progress to cancer.
Which assessment tool is most appropriate for evaluating fall risk in an older adult by observing their ability to
rise from a chair, walk, turn, and return?
A. Katz ADL Index
B. Timed Up and Go (TUG) test
C. Mini-Cog
D. PHQ-9
Correct Answer: B
The Timed Up and Go (TUG) test assesses mobility, balance, and fall risk by measuring the time it takes a patient to rise from a
standard chair, walk 3 meters, turn around, walk back, and sit down. A time greater than 12 seconds indicates increased fall risk.
The Katz ADL Index measures functional independence in basic activities. Mini-Cog screens for cognitive impairment. PHQ-9
screens for depression.
The Katz Index of Activities of Daily Living (ADLs) assesses independence in how many core activities?
A. 4
B. 6
C. 8
D. 10
Correct Answer: B
, The Katz ADL Index assesses independence in 6 core activities: bathing, dressing, toileting, transferring, continence, and feeding.
Each activity is scored as independent or dependent. The index is widely used in geriatric assessment to determine the level of
functional assistance needed and to track changes in functional status over time.
Which screening tool is used to identify older adults at risk for malnutrition?
A. Morse Fall Scale
B. Mini Nutritional Assessment (MNA)
C. CAGE questionnaire
D. GAD-7
Correct Answer: B
The Mini Nutritional Assessment (MNA) is a validated screening tool specifically designed to identify older adults at risk for
malnutrition. It includes questions on dietary intake, weight loss, mobility, psychological stress, and BMI. A score of 17-23.5
indicates risk for malnutrition, and below 17 indicates malnourished status. The Morse Fall Scale assesses fall risk, CAGE
assesses alcohol use, and GAD-7 assesses anxiety.
When initiating an exercise program for a frail 78-year-old, which principle is most important?
A. Begin with high-intensity interval training
B. Start low and go slow
C. Restrict exercise to seated activities only
D. Avoid resistance training entirely
Correct Answer: B
The "start low and go slow" principle is fundamental when initiating exercise in frail older adults. This approach minimizes the
risk of injury, cardiovascular events, and musculoskeletal strain while allowing the patient to gradually adapt. Exercise should
eventually include aerobic, resistance, flexibility, and balance components. Completely restricting exercise or beginning at high
intensity are both inappropriate for this population.
A 70-year-old patient with no history of cardiovascular disease presents for a routine visit. How often should
blood pressure be screened?
A. Every 6 months
B. Annually
C. Every 2 years
D. Every 5 years
Correct Answer: B
Current guidelines recommend annual blood pressure screening for adults aged 40 and older, or more frequently if blood
pressure is elevated or if the patient has risk factors such as diabetes, CKD, or cardiovascular disease. The 2017 ACC/AHA
guidelines define hypertension as ≥130/80 mmHg, making regular screening critical for early detection and management.
A 65-year-old woman undergoes DEXA scanning. Her T-score at the femoral neck is -2.0. How is this result
interpreted?
A. Normal bone density
B. Osteopenia
C. Osteoporosis
D. Severe osteoporosis
Correct Answer: B
According to WHO criteria, a T-score of -1.0 to -2.4 indicates osteopenia (low bone mass). A T-score of -2.5 or below indicates
osteoporosis, and a T-score of -2.5 or below with fragility fractures indicates severe osteoporosis. A T-score of -1.0 or above is
