Chamberlain University College of Nursing - NR
601: Primary Care of the Maturing and Aged Family
Final Exam Review - Complete Question Bank with
Answers and Rationales
Latest Update: 2026-2027 Academic Year | Comprehensive
Review for NR 601 Final Examination
SECTION 1: URINARY INCONTINENCE (UI)
Question 1
What is the most common type of urinary incontinence (UI) in men and women?
Answer: Men - urgency incontinence; Women - stress incontinence
Rationale: The pathophysiology of incontinence differs between sexes due to anatomical
and physiological differences. Men typically experience urgency incontinence related to
prostate issues, while women more commonly experience stress incontinence related to
pelvic floor weakness from childbirth, hormonal changes, and anatomical factors.
Understanding this distinction is crucial for appropriate diagnosis and treatment planning in
the older adult population.
Question 2
What is urge urinary incontinence?
Answer: Feeling of needing to go right away; rush to the bathroom
Rationale: Urge incontinence, also known as overactive bladder (OAB), is characterized by a
sudden, compelling desire to urinate that is difficult to defer. It results from involuntary
detrusor muscle contractions during bladder filling. Patients describe a strong, often
uncontrollable urge to void that may result in leakage before reaching the toilet. This
condition significantly impacts quality of life and requires targeted interventions.
Question 3
What is stress urinary incontinence?
,Answer: Leakage triggered by sneezing, coughing, laughing, or pressure
Rationale: Stress incontinence occurs when increased intra-abdominal pressure overwhelms
the urethral sphincter's ability to maintain closure. Activities that increase abdominal
pressure (coughing, sneezing, laughing, exercise, heavy lifting) cause urine leakage. This is
primarily due to urethral hypermobility or intrinsic sphincter deficiency, often related to
pelvic floor muscle weakness from childbirth, surgery, or age-related changes.
Question 4
What is mixed incontinence?
Answer: Both stress and urgency incontinence
Rationale: Mixed incontinence is the coexistence of both stress and urge incontinence
symptoms. Patients experience leakage with physical exertion AND a strong, sudden urge to
void. This is the most common type of incontinence in older women and requires a
comprehensive treatment approach addressing both components. Successful management
often requires a combination of behavioral, pharmacological, and sometimes surgical
interventions.
Question 5
What are the risk factors for urinary incontinence?
Answer: Female gender, obesity, diabetes mellitus, depression, stroke, fecal incontinence,
hysterectomy
Rationale: These risk factors increase the likelihood of developing UI through various
mechanisms. Female anatomy and pelvic floor trauma (childbirth, hysterectomy) predispose
to stress incontinence. Obesity increases intra-abdominal pressure. Diabetes can cause
neuropathic bladder dysfunction. Stroke and depression affect mobility, cognition, and
toileting behaviors. Fecal incontinence often coexists with UI due to shared pelvic floor
dysfunction. Identifying these risk factors helps guide preventive and therapeutic strategies.
Question 6
What is the first-line therapy for most older patients with urinary incontinence?
Answer: Behavioral therapy
Rationale: Behavioral therapy is recommended as first-line treatment because it is effective,
non-invasive, and has no adverse effects. It addresses the underlying causes of incontinence
,without the risks associated with medications or surgery. Behavioral interventions are
particularly suitable for older adults who may be more susceptible to medication side
effects. The American Geriatrics Society strongly recommends behavioral therapy as the
initial approach for UI in older adults.
Question 7
What does behavioral therapy for urinary incontinence include?
Answer:
• Weight loss
• Stop caffeinated beverages and alcohol
• Minimize fluid intake at night
• Stop smoking
• Loop diuretics should be taken in the afternoon
• Bladder training
• Kegel exercises
• Prompted voiding
Rationale: These interventions address modifiable factors contributing to UI. Caffeine and
alcohol are bladder irritants and diuretics. Smoking increases intra-abdominal pressure
through coughing. Weight loss reduces pressure on the bladder. Timing of diuretic
administration prevents nighttime voiding. Bladder training, Kegel exercises, and prompted
voiding improve bladder control and pelvic floor strength. This comprehensive approach
addresses multiple contributing factors and can significantly reduce symptoms.
Question 8
Which medication can be used for overactive bladder (OAB) and what is its side effect?
Answer: Myrbetriq (mirabegron); can cause high blood pressure
Rationale: Myrbetriq is a beta-3 adrenergic agonist that relaxes the detrusor muscle,
increasing bladder capacity. Unlike anticholinergics, it does not cause cognitive side effects,
making it a preferred option for older adults. However, hypertension is a significant side
effect requiring blood pressure monitoring, especially in older patients who may already
have cardiovascular disease. This medication should be used cautiously in patients with pre-
existing hypertension.
, Question 9
What medications can be used for urge incontinence and OAB? What is their drug class?
Answer: Detrol (tolterodine), Ditropan (oxybutynin)
Drug class: Anticholinergics/Antimuscarinics
Rationale: Anticholinergic medications reduce involuntary bladder contractions by blocking
acetylcholine at muscarinic receptors in the bladder. They decrease detrusor overactivity,
increase bladder capacity, and reduce urgency and frequency. However, they have significant
systemic anticholinergic effects including dry mouth, constipation, and cognitive impairment,
which is why they must be used cautiously in older adults. The Beers Criteria recommends
avoiding these medications in older adults with cognitive impairment.
Question 10
According to the BEERS criteria, in which patients should antimuscarinics and
anticholinergics be avoided?
Answer: Patients with dementia or cognitive impairment
Rationale: The BEERS Criteria, a guideline for potentially inappropriate medication use in
older adults, specifically warns against anticholinergics in patients with cognitive
impairment. These medications can worsen cognitive function, cause confusion, and
increase the risk of falls. They also have the potential to accelerate cognitive decline. For
patients with dementia, alternative treatments such as beta-3 agonists should be
considered. This is a crucial prescribing consideration for nurse practitioners.
Question 11
What is the gold standard treatment for women with stress incontinence?
Answer: Surgery
Rationale: Surgical intervention, particularly mid-urethral sling procedures, is considered the
gold standard for stress urinary incontinence when conservative measures fail. Surgery
provides mechanical support to the urethra, preventing leakage during physical stress.
Success rates are high (>80%), but surgical risks including infection, bleeding, and
complications must be considered. This option is typically reserved for patients who have
not responded to or are not candidates for conservative management.
601: Primary Care of the Maturing and Aged Family
Final Exam Review - Complete Question Bank with
Answers and Rationales
Latest Update: 2026-2027 Academic Year | Comprehensive
Review for NR 601 Final Examination
SECTION 1: URINARY INCONTINENCE (UI)
Question 1
What is the most common type of urinary incontinence (UI) in men and women?
Answer: Men - urgency incontinence; Women - stress incontinence
Rationale: The pathophysiology of incontinence differs between sexes due to anatomical
and physiological differences. Men typically experience urgency incontinence related to
prostate issues, while women more commonly experience stress incontinence related to
pelvic floor weakness from childbirth, hormonal changes, and anatomical factors.
Understanding this distinction is crucial for appropriate diagnosis and treatment planning in
the older adult population.
Question 2
What is urge urinary incontinence?
Answer: Feeling of needing to go right away; rush to the bathroom
Rationale: Urge incontinence, also known as overactive bladder (OAB), is characterized by a
sudden, compelling desire to urinate that is difficult to defer. It results from involuntary
detrusor muscle contractions during bladder filling. Patients describe a strong, often
uncontrollable urge to void that may result in leakage before reaching the toilet. This
condition significantly impacts quality of life and requires targeted interventions.
Question 3
What is stress urinary incontinence?
,Answer: Leakage triggered by sneezing, coughing, laughing, or pressure
Rationale: Stress incontinence occurs when increased intra-abdominal pressure overwhelms
the urethral sphincter's ability to maintain closure. Activities that increase abdominal
pressure (coughing, sneezing, laughing, exercise, heavy lifting) cause urine leakage. This is
primarily due to urethral hypermobility or intrinsic sphincter deficiency, often related to
pelvic floor muscle weakness from childbirth, surgery, or age-related changes.
Question 4
What is mixed incontinence?
Answer: Both stress and urgency incontinence
Rationale: Mixed incontinence is the coexistence of both stress and urge incontinence
symptoms. Patients experience leakage with physical exertion AND a strong, sudden urge to
void. This is the most common type of incontinence in older women and requires a
comprehensive treatment approach addressing both components. Successful management
often requires a combination of behavioral, pharmacological, and sometimes surgical
interventions.
Question 5
What are the risk factors for urinary incontinence?
Answer: Female gender, obesity, diabetes mellitus, depression, stroke, fecal incontinence,
hysterectomy
Rationale: These risk factors increase the likelihood of developing UI through various
mechanisms. Female anatomy and pelvic floor trauma (childbirth, hysterectomy) predispose
to stress incontinence. Obesity increases intra-abdominal pressure. Diabetes can cause
neuropathic bladder dysfunction. Stroke and depression affect mobility, cognition, and
toileting behaviors. Fecal incontinence often coexists with UI due to shared pelvic floor
dysfunction. Identifying these risk factors helps guide preventive and therapeutic strategies.
Question 6
What is the first-line therapy for most older patients with urinary incontinence?
Answer: Behavioral therapy
Rationale: Behavioral therapy is recommended as first-line treatment because it is effective,
non-invasive, and has no adverse effects. It addresses the underlying causes of incontinence
,without the risks associated with medications or surgery. Behavioral interventions are
particularly suitable for older adults who may be more susceptible to medication side
effects. The American Geriatrics Society strongly recommends behavioral therapy as the
initial approach for UI in older adults.
Question 7
What does behavioral therapy for urinary incontinence include?
Answer:
• Weight loss
• Stop caffeinated beverages and alcohol
• Minimize fluid intake at night
• Stop smoking
• Loop diuretics should be taken in the afternoon
• Bladder training
• Kegel exercises
• Prompted voiding
Rationale: These interventions address modifiable factors contributing to UI. Caffeine and
alcohol are bladder irritants and diuretics. Smoking increases intra-abdominal pressure
through coughing. Weight loss reduces pressure on the bladder. Timing of diuretic
administration prevents nighttime voiding. Bladder training, Kegel exercises, and prompted
voiding improve bladder control and pelvic floor strength. This comprehensive approach
addresses multiple contributing factors and can significantly reduce symptoms.
Question 8
Which medication can be used for overactive bladder (OAB) and what is its side effect?
Answer: Myrbetriq (mirabegron); can cause high blood pressure
Rationale: Myrbetriq is a beta-3 adrenergic agonist that relaxes the detrusor muscle,
increasing bladder capacity. Unlike anticholinergics, it does not cause cognitive side effects,
making it a preferred option for older adults. However, hypertension is a significant side
effect requiring blood pressure monitoring, especially in older patients who may already
have cardiovascular disease. This medication should be used cautiously in patients with pre-
existing hypertension.
, Question 9
What medications can be used for urge incontinence and OAB? What is their drug class?
Answer: Detrol (tolterodine), Ditropan (oxybutynin)
Drug class: Anticholinergics/Antimuscarinics
Rationale: Anticholinergic medications reduce involuntary bladder contractions by blocking
acetylcholine at muscarinic receptors in the bladder. They decrease detrusor overactivity,
increase bladder capacity, and reduce urgency and frequency. However, they have significant
systemic anticholinergic effects including dry mouth, constipation, and cognitive impairment,
which is why they must be used cautiously in older adults. The Beers Criteria recommends
avoiding these medications in older adults with cognitive impairment.
Question 10
According to the BEERS criteria, in which patients should antimuscarinics and
anticholinergics be avoided?
Answer: Patients with dementia or cognitive impairment
Rationale: The BEERS Criteria, a guideline for potentially inappropriate medication use in
older adults, specifically warns against anticholinergics in patients with cognitive
impairment. These medications can worsen cognitive function, cause confusion, and
increase the risk of falls. They also have the potential to accelerate cognitive decline. For
patients with dementia, alternative treatments such as beta-3 agonists should be
considered. This is a crucial prescribing consideration for nurse practitioners.
Question 11
What is the gold standard treatment for women with stress incontinence?
Answer: Surgery
Rationale: Surgical intervention, particularly mid-urethral sling procedures, is considered the
gold standard for stress urinary incontinence when conservative measures fail. Surgery
provides mechanical support to the urethra, preventing leakage during physical stress.
Success rates are high (>80%), but surgical risks including infection, bleeding, and
complications must be considered. This option is typically reserved for patients who have
not responded to or are not candidates for conservative management.
