NR 601
Final Exam Prep Test Bank
New 2026/2027 Edition
150 Real Exam Questions and Correct Answers
100% Correct Answers Graded A+
Primary Care of the Maturing and Aged Family
Chamberlain University
Comprehensive Geriatric Assessment | Cardiovascular & Respiratory Disorders
Neurological & Musculoskeletal | Endocrine & Metabolic | Gastrointestinal & Renal
Psychiatric & Mental Health | Pharmacotherapy & Polypharmacy | Special Topics
,Section 1: Primary Care of the Older Adult (Comprehensive Geriatric Assessment,
Normal Aging Changes, Health Promotion, & Preventive Services) - Q1-Q25
Q1: A 78-year-old female presents for her annual wellness visit. Which component of the comprehensive geriatric
assessment (CGA) is MOST critical to evaluate first?
A. Cognitive screening using the Mini-Cog
B. Functional status including ADLs and IADLs [CORRECT]
C. Depression screening using the GDS-15
D. Nutritional status using the MNA
Correct Answer: B
Rationale: Functional status assessment using ADLs and IADLs is the foundation of the CGA because it identifies baseline capabilities
and areas of decline affecting safety and independence. While cognitive, depression, and nutritional assessments are essential,
functional status provides the framework for individualized care planning. The CGA is a multidimensional, interdisciplinary diagnostic
process.
Q2: An 82-year-old male has systolic BP of 148 mmHg at today's visit. Per 2026 guidelines for hypertension in
adults 65+, which is the MOST appropriate initial approach?
A. Initiate a thiazide diuretic and lifestyle modifications
B. Reassess BP at follow-up in 1 month
C. Initiate an ACE inhibitor immediately
D. Order ambulatory blood pressure monitoring [CORRECT]
Correct Answer: D
Rationale: Guidelines recommend confirming elevated readings with out-of-office measurements (ABPM or HBPM) before initiating
pharmacologic treatment, especially in older adults prone to white-coat hypertension. A single elevated reading does not warrant
immediate medication. Lifestyle modifications follow confirmation.
Q3: Which is considered a NORMAL age-related change in the cardiovascular system of an older adult?
A. Decreased left ventricular wall thickness
B. Increased arterial stiffness with elevated systolic pressure [CORRECT]
C. Decreased cardiac output at rest
D. Increased maximum heart rate with exercise
Correct Answer: B
Rationale: Increased arterial stiffness (arteriosclerosis) is a normal aging change leading to isolated systolic hypertension and widened
pulse pressure. LV wall thickness increases with aging due to chronic afterload. Cardiac output at rest is preserved. Maximum heart
rate decreases with age (220 minus age).
Q4: A 75-year-old woman with no colorectal cancer history asks about screening. Per 2026 USPSTF, which
method is MOST appropriate?
A. Colonoscopy every 5 years
B. Annual fecal immunochemical test (FIT) [CORRECT]
C. CT colonography every 3 years
D. Flexible sigmoidoscopy every 10 years
Correct Answer: B
Rationale: USPSTF recommends screening adults 45-75 with several methods. For a 75-year-old without elevated risk, annual FIT is
appropriate and non-invasive with good sensitivity. Colonoscopy is every 10 years. The decision to screen 76-85 year-olds should be
individualized.
NR 601 Final Exam Prep 2026/2027 | Page 2
,Q5: An 80-year-old scores 2/5 on Mini-Cog recall and cannot draw a clock. What is the MOST appropriate
interpretation?
A. Normal cognitive function for age
B. Possible cognitive impairment; further evaluation warranted [CORRECT]
C. Severe dementia requiring institutionalization
D. Delirium requiring urgent workup
Correct Answer: B
Rationale: A Mini-Cog score of 0-2 suggests possible cognitive impairment warranting further evaluation. A positive screen does not
confirm dementia; further evaluation with history, exam, labs, and possibly neuropsychological testing is needed. Delirium presents
acutely with fluctuating course.
Q6: A 72-year-old male has difficulty with IADLs and increasing apathy over 6 months. Which tool is MOST
appropriate to screen for depression?
A. PHQ-9
B. GDS-15 (Geriatric Depression Scale) [CORRECT]
C. HAM-D
D. Beck Depression Inventory-II
Correct Answer: B
Rationale: The GDS-15 is specifically validated for older adults using a yes/no format. It avoids somatic items that overlap with
medical conditions, reducing false positives. The PHQ-9 includes somatic items confounded by comorbidities. Depression in older adults
often presents atypically with apathy rather than sadness.
Q7: An 85-year-old living alone is assessed for fall risk. Which finding is the STRONGEST predictor of future
falls?
A. Use of a cane for ambulation
B. History of a fall within the past 12 months [CORRECT]
C. Orthostatic hypotension on examination
D. Age greater than 80 years
Correct Answer: B
Rationale: A prior fall within 12 months is the single strongest predictor of future falls. The TUG test (>12 seconds = increased risk) is
a valid screening tool. While orthostatic hypotension, assistive devices, and age are risk factors, prior falls carry the highest predictive
value.
Q8: Which immunization recommendation for a 70-year-old is CORRECT per 2026 CDC/ACIP guidelines?
A. PCV21 only if immunocompromised
B. Recombinant zoster vaccine (Shingrix) two-dose series regardless of prior zoster [CORRECT]
C. High-dose influenza vaccine only for those 75+
D. Tdap booster every 5 years for all adults over 65
Correct Answer: B
Rationale: Shingrix is recommended for all adults 50+ as a two-dose series regardless of prior zoster history. PCV21 is for all adults
65+. High-dose influenza vaccine is for all adults 65+. Tdap is once, then Td every 10 years.
Q9: A 68-year-old female asks about osteoporosis screening. When should DEXA screening be initiated?
A. At age 65 for all women regardless of risk factors [CORRECT]
B. Immediately, since she is postmenopausal
C. At age 70 for women without risk factors
D. Only if she has sustained a fragility fracture
Correct Answer: A
Rationale: USPSTF recommends universal DEXA screening for women 65+ and younger postmenopausal women at increased risk.
This 68-year-old should be screened. T-scores: normal -1.0 or above, osteopenia -1.0 to -2.5, osteoporosis -2.5 or below.
NR 601 Final Exam Prep 2026/2027 | Page 3
, Q10: Which BEST describes the purpose of evaluating IADLs in a comprehensive geriatric assessment?
A. To determine need for skilled nursing facility placement
B. To assess the patient's ability to live independently in the community [CORRECT]
C. To evaluate risk of pressure ulcer development
D. To measure physical strength and endurance
Correct Answer: B
Rationale: IADLs assess complex activities for independent community living: finances, medications, telephone, shopping, cooking,
housekeeping, and transportation. ADLs are basic self-care. IADL impairment often precedes ADL impairment and should prompt
evaluation for underlying causes.
Q11: A 79-year-old with T-score -2.8 is prescribed alendronate. Which instruction is MOST important?
A. Take with breakfast to improve absorption
B. Remain upright for at least 30 minutes after taking [CORRECT]
C. Take at bedtime for optimal effect
D. Crush the tablet if difficulty swallowing
Correct Answer: B
Rationale: Bisphosphonates must be taken on an empty stomach with water, remaining upright 30-60 minutes to reduce esophageal
irritation risk. Taking with food or at bedtime increases esophageal exposure. Never crush. Ensure adequate calcium (1200 mg/day)
and vitamin D (800-1000 IU/day).
Q12: Which is the MOST appropriate AAA screening test for a 67-year-old male?
A. CT angiography
B. Abdominal ultrasound [CORRECT]
C. MRI
D. Physical examination with abdominal palpation
Correct Answer: B
Rationale: USPSTF recommends one-time abdominal ultrasound for AAA in men 65-75 who have ever smoked. Ultrasound is
non-invasive, cost-effective, with ~95% sensitivity. CT/MRI are for follow-up. Physical exam has poor sensitivity (~40-50%). AAA of
3.0 cm or greater is positive.
Q13: A 76-year-old reports difficulty hearing in crowds. Which is the MOST appropriate initial step?
A. Referral for cochlear implant evaluation
B. Prescription of a hearing amplifier
C. Audiometric evaluation and counseling on hearing aid options [CORRECT]
D. Reassurance that hearing loss is normal aging
Correct Answer: C
Rationale: Presbycusis is the most common hearing loss in older adults. Formal audiometric evaluation followed by hearing aid
counseling is appropriate. Cochlear implants are for severe to profound loss. OTC amplifiers are not equivalent to fitted hearing aids.
Untreated hearing loss is linked to cognitive decline.
Q14: A 73-year-old takes diphenhydramine 25 mg nightly for insomnia. Per 2026 Beers Criteria, which is MOST
appropriate?
A. Continue at current dose
B. Increase to 50 mg for better efficacy
C. Discontinue and recommend non-pharmacological sleep hygiene [CORRECT]
D. Switch to 12.5 mg
Correct Answer: C
Rationale: Diphenhydramine is highly anticholinergic and on the Beers Criteria as potentially inappropriate for older adults. It causes
confusion, dry mouth, constipation, urinary retention, and falls. Non-pharmacological sleep hygiene is first-line. Safer alternatives
include low-dose melatonin (1-3 mg) or doxepin (3-6 mg).
NR 601 Final Exam Prep 2026/2027 | Page 4
Final Exam Prep Test Bank
New 2026/2027 Edition
150 Real Exam Questions and Correct Answers
100% Correct Answers Graded A+
Primary Care of the Maturing and Aged Family
Chamberlain University
Comprehensive Geriatric Assessment | Cardiovascular & Respiratory Disorders
Neurological & Musculoskeletal | Endocrine & Metabolic | Gastrointestinal & Renal
Psychiatric & Mental Health | Pharmacotherapy & Polypharmacy | Special Topics
,Section 1: Primary Care of the Older Adult (Comprehensive Geriatric Assessment,
Normal Aging Changes, Health Promotion, & Preventive Services) - Q1-Q25
Q1: A 78-year-old female presents for her annual wellness visit. Which component of the comprehensive geriatric
assessment (CGA) is MOST critical to evaluate first?
A. Cognitive screening using the Mini-Cog
B. Functional status including ADLs and IADLs [CORRECT]
C. Depression screening using the GDS-15
D. Nutritional status using the MNA
Correct Answer: B
Rationale: Functional status assessment using ADLs and IADLs is the foundation of the CGA because it identifies baseline capabilities
and areas of decline affecting safety and independence. While cognitive, depression, and nutritional assessments are essential,
functional status provides the framework for individualized care planning. The CGA is a multidimensional, interdisciplinary diagnostic
process.
Q2: An 82-year-old male has systolic BP of 148 mmHg at today's visit. Per 2026 guidelines for hypertension in
adults 65+, which is the MOST appropriate initial approach?
A. Initiate a thiazide diuretic and lifestyle modifications
B. Reassess BP at follow-up in 1 month
C. Initiate an ACE inhibitor immediately
D. Order ambulatory blood pressure monitoring [CORRECT]
Correct Answer: D
Rationale: Guidelines recommend confirming elevated readings with out-of-office measurements (ABPM or HBPM) before initiating
pharmacologic treatment, especially in older adults prone to white-coat hypertension. A single elevated reading does not warrant
immediate medication. Lifestyle modifications follow confirmation.
Q3: Which is considered a NORMAL age-related change in the cardiovascular system of an older adult?
A. Decreased left ventricular wall thickness
B. Increased arterial stiffness with elevated systolic pressure [CORRECT]
C. Decreased cardiac output at rest
D. Increased maximum heart rate with exercise
Correct Answer: B
Rationale: Increased arterial stiffness (arteriosclerosis) is a normal aging change leading to isolated systolic hypertension and widened
pulse pressure. LV wall thickness increases with aging due to chronic afterload. Cardiac output at rest is preserved. Maximum heart
rate decreases with age (220 minus age).
Q4: A 75-year-old woman with no colorectal cancer history asks about screening. Per 2026 USPSTF, which
method is MOST appropriate?
A. Colonoscopy every 5 years
B. Annual fecal immunochemical test (FIT) [CORRECT]
C. CT colonography every 3 years
D. Flexible sigmoidoscopy every 10 years
Correct Answer: B
Rationale: USPSTF recommends screening adults 45-75 with several methods. For a 75-year-old without elevated risk, annual FIT is
appropriate and non-invasive with good sensitivity. Colonoscopy is every 10 years. The decision to screen 76-85 year-olds should be
individualized.
NR 601 Final Exam Prep 2026/2027 | Page 2
,Q5: An 80-year-old scores 2/5 on Mini-Cog recall and cannot draw a clock. What is the MOST appropriate
interpretation?
A. Normal cognitive function for age
B. Possible cognitive impairment; further evaluation warranted [CORRECT]
C. Severe dementia requiring institutionalization
D. Delirium requiring urgent workup
Correct Answer: B
Rationale: A Mini-Cog score of 0-2 suggests possible cognitive impairment warranting further evaluation. A positive screen does not
confirm dementia; further evaluation with history, exam, labs, and possibly neuropsychological testing is needed. Delirium presents
acutely with fluctuating course.
Q6: A 72-year-old male has difficulty with IADLs and increasing apathy over 6 months. Which tool is MOST
appropriate to screen for depression?
A. PHQ-9
B. GDS-15 (Geriatric Depression Scale) [CORRECT]
C. HAM-D
D. Beck Depression Inventory-II
Correct Answer: B
Rationale: The GDS-15 is specifically validated for older adults using a yes/no format. It avoids somatic items that overlap with
medical conditions, reducing false positives. The PHQ-9 includes somatic items confounded by comorbidities. Depression in older adults
often presents atypically with apathy rather than sadness.
Q7: An 85-year-old living alone is assessed for fall risk. Which finding is the STRONGEST predictor of future
falls?
A. Use of a cane for ambulation
B. History of a fall within the past 12 months [CORRECT]
C. Orthostatic hypotension on examination
D. Age greater than 80 years
Correct Answer: B
Rationale: A prior fall within 12 months is the single strongest predictor of future falls. The TUG test (>12 seconds = increased risk) is
a valid screening tool. While orthostatic hypotension, assistive devices, and age are risk factors, prior falls carry the highest predictive
value.
Q8: Which immunization recommendation for a 70-year-old is CORRECT per 2026 CDC/ACIP guidelines?
A. PCV21 only if immunocompromised
B. Recombinant zoster vaccine (Shingrix) two-dose series regardless of prior zoster [CORRECT]
C. High-dose influenza vaccine only for those 75+
D. Tdap booster every 5 years for all adults over 65
Correct Answer: B
Rationale: Shingrix is recommended for all adults 50+ as a two-dose series regardless of prior zoster history. PCV21 is for all adults
65+. High-dose influenza vaccine is for all adults 65+. Tdap is once, then Td every 10 years.
Q9: A 68-year-old female asks about osteoporosis screening. When should DEXA screening be initiated?
A. At age 65 for all women regardless of risk factors [CORRECT]
B. Immediately, since she is postmenopausal
C. At age 70 for women without risk factors
D. Only if she has sustained a fragility fracture
Correct Answer: A
Rationale: USPSTF recommends universal DEXA screening for women 65+ and younger postmenopausal women at increased risk.
This 68-year-old should be screened. T-scores: normal -1.0 or above, osteopenia -1.0 to -2.5, osteoporosis -2.5 or below.
NR 601 Final Exam Prep 2026/2027 | Page 3
, Q10: Which BEST describes the purpose of evaluating IADLs in a comprehensive geriatric assessment?
A. To determine need for skilled nursing facility placement
B. To assess the patient's ability to live independently in the community [CORRECT]
C. To evaluate risk of pressure ulcer development
D. To measure physical strength and endurance
Correct Answer: B
Rationale: IADLs assess complex activities for independent community living: finances, medications, telephone, shopping, cooking,
housekeeping, and transportation. ADLs are basic self-care. IADL impairment often precedes ADL impairment and should prompt
evaluation for underlying causes.
Q11: A 79-year-old with T-score -2.8 is prescribed alendronate. Which instruction is MOST important?
A. Take with breakfast to improve absorption
B. Remain upright for at least 30 minutes after taking [CORRECT]
C. Take at bedtime for optimal effect
D. Crush the tablet if difficulty swallowing
Correct Answer: B
Rationale: Bisphosphonates must be taken on an empty stomach with water, remaining upright 30-60 minutes to reduce esophageal
irritation risk. Taking with food or at bedtime increases esophageal exposure. Never crush. Ensure adequate calcium (1200 mg/day)
and vitamin D (800-1000 IU/day).
Q12: Which is the MOST appropriate AAA screening test for a 67-year-old male?
A. CT angiography
B. Abdominal ultrasound [CORRECT]
C. MRI
D. Physical examination with abdominal palpation
Correct Answer: B
Rationale: USPSTF recommends one-time abdominal ultrasound for AAA in men 65-75 who have ever smoked. Ultrasound is
non-invasive, cost-effective, with ~95% sensitivity. CT/MRI are for follow-up. Physical exam has poor sensitivity (~40-50%). AAA of
3.0 cm or greater is positive.
Q13: A 76-year-old reports difficulty hearing in crowds. Which is the MOST appropriate initial step?
A. Referral for cochlear implant evaluation
B. Prescription of a hearing amplifier
C. Audiometric evaluation and counseling on hearing aid options [CORRECT]
D. Reassurance that hearing loss is normal aging
Correct Answer: C
Rationale: Presbycusis is the most common hearing loss in older adults. Formal audiometric evaluation followed by hearing aid
counseling is appropriate. Cochlear implants are for severe to profound loss. OTC amplifiers are not equivalent to fitted hearing aids.
Untreated hearing loss is linked to cognitive decline.
Q14: A 73-year-old takes diphenhydramine 25 mg nightly for insomnia. Per 2026 Beers Criteria, which is MOST
appropriate?
A. Continue at current dose
B. Increase to 50 mg for better efficacy
C. Discontinue and recommend non-pharmacological sleep hygiene [CORRECT]
D. Switch to 12.5 mg
Correct Answer: C
Rationale: Diphenhydramine is highly anticholinergic and on the Beers Criteria as potentially inappropriate for older adults. It causes
confusion, dry mouth, constipation, urinary retention, and falls. Non-pharmacological sleep hygiene is first-line. Safer alternatives
include low-dose melatonin (1-3 mg) or doxepin (3-6 mg).
NR 601 Final Exam Prep 2026/2027 | Page 4
