UNIVERSITY
NR 60 1 MI DT ER M EXAMI NAT I ON
Latest NR 601 Midterm Exam 2026 Prep
Test Bank With Real Exam Practice
Questions And Correct Answers
Course: NR 601 - Primary Care of the
Maturing and Aged Family
Questions: 175 Multiple-Choice Questions
Content: Weeks 1-4 (Geriatric,
Cardiovascular, Respiratory)
Accuracy: 100% Correct Answers - Graded
A+
2 02 6/2 02 7 AC AD EM I C YEAR
, Latest NR 601 Midterm Exam 2026
Prep Test Bank With Real Exam Practice Questions
And Correct Answers
NR 601 - Primary Care of the Maturing and Aged Family | 100% Correct Answers Graded A+
Section 1: Geriatric Assessment and Health Promotion
Comprehensive Geriatric Assessment, Functional Assessment, Health Promotion, Preventive Services, and Normal Aging Changes
(Q1-Q35)
Q1. A 78-year-old female presents to the primary care clinic for her annual wellness visit. The nurse practitioner
(NP) plans to perform a Comprehensive Geriatric Assessment (CGA). Which statement best describes the CGA?
A. A focused physical examination targeting the chief complaint only
B. A brief screening tool to determine the need for skilled nursing facility placement
C. A multidimensional, interdisciplinary diagnostic process evaluating medical, psychosocial, and functional
capabilities [CORRECT]
D. A standardized mental status examination used exclusively for dementia screening
Correct Answer: C
Rationale: The CGA is a multidimensional, interdisciplinary diagnostic process designed to evaluate an older adult's medical, psychosocial,
and functional capabilities. It goes beyond a standard physical exam by incorporating assessment of cognitive function, mood, nutritional
status, functional independence, social support, and environmental safety. Option A is incorrect because the CGA is comprehensive, not
focused solely on the chief complaint. Option B is incorrect because the CGA serves broader purposes than just placement decisions. Option D
is incorrect because the CGA encompasses far more than just cognitive screening; it is a holistic assessment approach foundational to geriatric
primary care.
Q2. Which of the following is considered a normal aging change in the cardiovascular system of older adults?
A. Decreased systemic vascular resistance (SVR) leading to hypotension
B. Increased arterial compliance resulting in improved vessel elasticity
C. Increased left ventricular wall thickness and myocardial fibrosis [CORRECT]
D. Increased maximum heart rate response to exercise
Correct Answer: C
Rationale: Normal aging changes in the cardiovascular system include increased left ventricular wall thickness (concentric hypertrophy),
increased myocardial fibrosis, decreased arterial compliance (increased arterial stiffness), and increased systemic vascular resistance. These
changes contribute to the development of isolated systolic hypertension commonly seen in older adults. Option A is incorrect because SVR
increases, not decreases, with age. Option B is incorrect because arterial compliance decreases, not increases. Option D is incorrect because
maximum heart rate decreases with age (approximately 220 minus age), reducing the heart's ability to respond to exercise demands.
Q3. An NP is conducting a functional assessment on an 82-year-old patient. The patient is independent in bathing,
dressing, toileting, and transferring but requires assistance with shopping and meal preparation. Which
classification best describes this patient?
A. The patient is fully dependent and requires skilled nursing care
B. The patient is independent in all basic ADLs but has instrumental ADL impairments [CORRECT]
C. The patient has moderate dementia requiring supervised care
D. The patient is a safe driver and can live independently without any support
Correct Answer: B
Rationale: This patient demonstrates independence in all basic Activities of Daily Living (ADLs) including bathing, dressing, toileting, and
transferring, but has impairments in Instrumental Activities of Daily Living (IADLs) such as shopping and meal preparation. This pattern is
NR 601 Midterm Exam 2026 Test Bank | Page 1
, common in early functional decline among older adults and signals the need for targeted interventions such as home-delivered meals,
community transportation services, or a home safety evaluation. Option A is incorrect because the patient is independent in basic ADLs.
Option C is incorrect because functional impairment in IADLs alone does not equate to a dementia diagnosis. Option D is incorrect because
the patient already demonstrates IADL dependency requiring support.
Q4. According to the U.S. Preventive Services Task Force (USPSTF) and current CDC/ACIP guidelines, which
immunization should the NP recommend for a 70-year-old patient who has not previously received it?
A. Human papillomavirus (HPV) vaccine series
B. Recombinant zoster vaccine (Shingrix) regardless of prior shingles history [CORRECT]
C. Live attenuated influenza vaccine (LAIV) via nasal spray
D. Meningococcal conjugate vaccine as routine screening
Correct Answer: B
Rationale: The recombinant zoster vaccine (Shingrix) is recommended for all adults aged 50 years and older regardless of prior history of
herpes zoster or receipt of the older live zoster vaccine (Zostavax). Shingrix is a two-dose series separated by 2 to 6 months and is preferred
over the live vaccine due to superior efficacy (>90%) in preventing shingles and postherpetic neuralgia in older adults. Option A is incorrect
because the HPV vaccine is not routinely recommended for adults over age 26. Option C is incorrect because LAIV is contraindicated in
adults aged 50 and older; the inactivated influenza vaccine should be used instead. Option D is incorrect because meningococcal vaccine is not
routine for this age group unless specific risk factors exist.
Q5. A 68-year-old patient reports gradual hearing loss over the past several years, noting difficulty understanding
speech in noisy environments. The NP recognizes this as which type of age-related hearing change?
A. Conductive hearing loss due to otosclerosis
B. Presbycusis, a sensorineural hearing loss affecting high-frequency sounds [CORRECT]
C. Tinnitus-induced hearing impairment
D. Meniere disease with associated vertigo and fluctuating hearing
Correct Answer: B
Rationale: Presbycusis is the most common form of age-related hearing loss, characterized by bilateral, progressive, sensorineural hearing
loss that primarily affects high-frequency sounds. Older adults typically report difficulty understanding speech, especially in noisy
environments, even though they may still hear volume adequately. This occurs due to degenerative changes in the cochlea, loss of hair cells,
and stiffening of the basilar membrane. Option A is incorrect because otosclerosis is a conductive hearing loss caused by abnormal bone
growth in the middle ear, not an age-related change. Option C is incorrect because tinnitus (ringing in the ears) is a symptom, not a cause of
hearing loss. Option D is incorrect because Meniere disease involves episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness,
which is distinct from the gradual, progressive pattern of presbycusis.
Q6. Which screening tool is most appropriate for an NP to use as an initial assessment of cognitive function in a
75-year-old patient during a routine wellness visit?
A. Mini-Mental State Examination (MMSE)
B. Montreal Cognitive Assessment (MoCA) [CORRECT]
C. Wisconsin Card Sorting Test
D. Clock Drawing Test used as the sole screening instrument
Correct Answer: B
Rationale: The Montreal Cognitive Assessment (MoCA) is the preferred initial cognitive screening tool for older adults in primary care
because it is more sensitive than the MMSE for detecting mild cognitive impairment (MCI) and early dementia. The MoCA assesses multiple
cognitive domains including attention, executive function, memory, language, visuospatial skills, and orientation. It is freely available, takes
approximately 10 minutes to administer, and has been validated in diverse populations. Option A is incorrect because the MMSE is less
sensitive for mild cognitive impairment and has known ceiling effects. Option C is incorrect because the Wisconsin Card Sorting Test is a
neuropsychological tool for executive function, not a brief cognitive screen. Option D is incorrect because the Clock Drawing Test should be
used as part of a comprehensive assessment, not as a standalone screening tool.
Q7. A 72-year-old male with a history of hypertension and type 2 diabetes mellitus presents for his annual physical.
His body mass index (BMI) is 32 kg/m2. Which preventive service is most strongly recommended for this patient
based on USPSTF guidelines?
A. Abdominal aortic aneurysm (AAA) screening with ultrasound
B. Diabetes screening with hemoglobin A1c measurement
C. Colorectal cancer screening if not previously completed [CORRECT]
D. Lung cancer screening with low-dose CT
NR 601 Midterm Exam 2026 Test Bank | Page 2
, Correct Answer: C
Rationale: Colorectal cancer screening is strongly recommended by the USPSTF for all adults aged 45 to 75 years. This patient at age 72
falls within the recommended screening age range, and screening should be performed if not previously completed. Appropriate options
include colonoscopy every 10 years, annual fecal immunochemical testing (FIT), or other USPSTF-endorsed modalities. Option A is incorrect
because AAA screening is recommended only for men aged 65 to 75 who have ever smoked, and the clinical scenario does not mention
smoking history. Option B is incorrect because the patient already has a diagnosis of diabetes mellitus, so screening is unnecessary. Option D is
incorrect because lung cancer screening with low-dose CT is recommended for adults aged 50 to 80 with at least a 20 pack-year smoking
history who currently smoke or have quit within the past 15 years, and no such history is described.
Q8. When performing a fall risk assessment on an 80-year-old patient, which factor identified by the NP would be
classified as an intrinsic (intrinsic to the patient) risk factor for falls?
A. Loose throw rugs and poor lighting in the home environment
B. Orthostatic hypotension with a blood pressure drop of 20 mmHg systolic upon standing [CORRECT]
C. Absence of handrails on both sides of the staircase
D. Wearing improperly fitting shoes with smooth soles
Correct Answer: B
Rationale: Intrinsic fall risk factors are those that originate from within the patient, including physiological changes, chronic conditions, and
medication effects. Orthostatic hypotension, defined as a systolic blood pressure drop of 20 mmHg or more or a diastolic drop of 10 mmHg
or more within 3 minutes of standing, is a significant intrinsic risk factor for falls in older adults. It results from age-related impairment in
baroreceptor sensitivity and autonomic nervous system response. Options A, C, and D are all extrinsic (environmental) risk factors because
they originate from the external environment rather than from the patient's own physiological condition.
Q9. An NP is reviewing the recommended immunization schedule for a 66-year-old female patient. In addition to the
annual inactivated influenza vaccine, which vaccines should be administered or updated at this visit?
A. Pneumococcal conjugate vaccine (PCV21) and Tdap booster only
B. COVID-19 updated vaccine, pneumococcal vaccine (if not previously received), and Tdap if not received in the past
10 years [CORRECT]
C. Hepatitis B series and varicella vaccine as routine immunizations
D. Live attenuated zoster vaccine (Zostavax) and meningococcal B vaccine
Correct Answer: B
Rationale: For a 66-year-old patient, the recommended immunizations include the annual inactivated influenza vaccine, the updated
COVID-19 vaccine per CDC guidance, pneumococcal vaccination (PCV21 or PCV15 followed by PPSV23 depending on prior vaccination
history), and a Tdap booster if not received within the past 10 years (replaced by Td every 10 years thereafter). Additionally, the
recombinant zoster vaccine (Shingrix) is recommended for adults 50 and older. Option A is incomplete because it omits the COVID-19 vaccine
which is recommended. Option C is incorrect because Hepatitis B and varicella vaccines are not routine for all 66-year-olds; hepatitis B may
be considered for adults under 60 with diabetes, and varicella is indicated only if the patient is seronegative. Option D is incorrect because
Zostavax (live vaccine) is no longer available in the US, having been replaced by Shingrix, and meningococcal B is not routine for this age
group.
Q10. A 75-year-old patient reports increasing difficulty reading the newspaper and threading needles, describing that
her "arms have become too short." The NP identifies this as which normal aging change?
A. Macular degeneration with central vision loss
B. Presbyopia due to decreased lens elasticity and weakened ciliary muscles [CORRECT]
C. Cataract formation causing cloudy and distorted vision
D. Glaucoma with progressive peripheral visual field loss
Correct Answer: B
Rationale: Presbyopia is the age-related loss of near vision resulting from decreased elasticity of the crystalline lens and weakening of the
ciliary muscles. This progressive condition typically becomes noticeable around age 40 and continues to worsen through the 60s and 70s. The
classic complaint of "arms becoming too short" reflects the need to hold reading material farther away to achieve focus. Unlike macular
degeneration, cataracts, or glaucoma, presbyopia is a normal physiological change, not a pathological condition. Option A is incorrect
because macular degeneration causes central vision distortion (metamorphopsia) and scotomas, not the symmetric near-vision difficulty
described. Option C is incorrect because cataracts cause generalized clouding, glare sensitivity, and decreased color contrast. Option D is
incorrect because glaucoma causes peripheral visual field loss, not near-vision difficulty.
Q11. Which normal aging change in the respiratory system contributes to the decreased effectiveness of cough in
older adults?
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