NR601 / NR-601 MIDTERM final EXAM (LATEST 2026): PRIMARY
CARE OF THE MATURING & AGED FAMILY PRACTICUM –
CHAMBERLAIN,150 CORRECT QUESTIONS AND ANSWERS ALREADY
GRADED A+
1
An 82-year-old woman comes for a wellness visit. She lives alone, reports
increased forgetfulness but is still independent with ADLs and IADLs. You screen
for cognitive impairment. Which screening instrument is brief, validated for
primary care, and commonly used to detect mild cognitive impairment and
dementia?
A) PHQ-9
B) Montreal Cognitive Assessment MoCA
C) AUDIT-C
D) Epworth Sleepiness Scale
Correct Answer: B) Montreal Cognitive Assessment MoCA
2
A 78-year-old man has progressive gait instability, frequent shuffling steps, and
stooped posture over months. Family reports decreased facial expression and a
resting tremor. Which diagnosis most closely fits these motor findings and warrants
evaluation for dopaminergic responsive disease?
A) Normal pressure hydrocephalus
B) Parkinson disease
C) Myasthenia gravis
D) Peripheral neuropathy
Correct Answer: B) Parkinson disease
,3
A 76-year-old female with chronic atrial fibrillation is frail and has recurrent falls.
You must reassess her anticoagulation plan. Which clinical approach best balances
stroke prevention and fall-risk concerns in elderly AF patients?
A) Automatically stop anticoagulation whenever any fall occurs
B) Continue to calculate individualized stroke risk with CHA2DS2-VASc and
bleeding risk, consider DOACs at appropriate doses or hold only if bleeding risk is
prohibitive
C) Replace anticoagulation with aspirin only because it is safer
D) Prescribe warfarin to all elderly regardless of falls
Correct Answer: B) Continue to calculate individualized stroke risk with
CHA2DS2-VASc and bleeding risk, consider DOACs at appropriate doses or
hold only if bleeding risk is prohibitive
4
A 70-year-old man complains of new urinary urgency, frequency, and nocturia but
no dysuria or fever. On exam prostate is moderately enlarged without nodules.
Which initial management approach is most appropriate in primary care for benign
prostatic hyperplasia symptoms?
A) Immediate transurethral resection of the prostate
B) Begin alpha-1 blocker therapy and discuss lifestyle measures while monitoring
symptoms
C) Prescribe antibiotics for presumed prostatitis
D) Initiate 5-alpha reductase inhibitor as first-line for immediate relief
Correct Answer: B) Begin alpha-1 blocker therapy and discuss lifestyle
measures while monitoring symptoms
5
An 85-year-old woman presents after a fall at home. She is awake but confused
and on warfarin. CT head shows a small subdural hematoma without mass effect.
,Which immediate consideration is most critical for this anticoagulated elderly
patient?
A) Discharge home with outpatient neurology follow-up
B) Reverse anticoagulation and consult neurosurgery given bleeding on warfarin
C) Start aspirin to prevent future ischemic stroke
D) Ignore anticoagulation and observe only
Correct Answer: B) Reverse anticoagulation and consult neurosurgery given
bleeding on warfarin
6
A 74-year-old patient with multiple chronic medications asks about reducing pill
burden. Which geriatric prescribing principle should you apply first to safely
deprescribe?
A) Stop all medications older than one year
B) Review current medications for indication, benefit, harm, and patient priorities,
then taper those with unclear ongoing benefit
C) Substitute all medications with herbal alternatives
D) Double doses to reduce number of pills
Correct Answer: B) Review current medications for indication, benefit, harm,
and patient priorities, then taper those with unclear ongoing benefit
7
A 79-year-old woman reports new-onset acute confusion, visual hallucinations, and
fluctuating attention that developed over 48 hours after hospitalization. Which
diagnosis is most consistent with these features and requires prompt evaluation?
A) Major neurocognitive disorder
B) Delirium
C) Mild cognitive impairment
D) Dementia with Lewy bodies
Correct Answer: B) Delirium
, 8
A 68-year-old diabetic patient has HbA1c of 8.2 percent and recurrent
hypoglycemia episodes at home. For many older adults with comorbidity and risk
of hypoglycemia, what is an appropriate individualized HbA1c target?
A) Less than 6 percent for all patients
B) More relaxed target, for example 7.5 to 8.5 percent depending on frailty and life
expectancy
C) Always maintain HbA1c at 5 percent
D) No target needed for older adults
Correct Answer: B) More relaxed target, for example 7.5 to 8.5 percent
depending on frailty and life expectancy
9
An 82-year-old woman has recurrent falls and reports dizziness on standing. You
perform orthostatic vitals and find a significant drop in systolic blood pressure
when standing. Which condition is most likely and should be addressed?
A) Orthostatic hypotension possibly medication-related or autonomic dysfunction
B) Pulmonary embolism
C) Acute appendicitis
D) Hyperthyroidism
Correct Answer: A) Orthostatic hypotension possibly medication-related or
autonomic dysfunction
10
A 75-year-old male smoker is seen for preventive care. Which lung cancer
screening recommendation is appropriate for an older adult with a 40 pack-year
history who quit 6 years ago?
A) Annual low-dose CT for adults 50–80 with at least 20 pack-year history who
currently smoke or quit within 15 years, if otherwise eligible
CARE OF THE MATURING & AGED FAMILY PRACTICUM –
CHAMBERLAIN,150 CORRECT QUESTIONS AND ANSWERS ALREADY
GRADED A+
1
An 82-year-old woman comes for a wellness visit. She lives alone, reports
increased forgetfulness but is still independent with ADLs and IADLs. You screen
for cognitive impairment. Which screening instrument is brief, validated for
primary care, and commonly used to detect mild cognitive impairment and
dementia?
A) PHQ-9
B) Montreal Cognitive Assessment MoCA
C) AUDIT-C
D) Epworth Sleepiness Scale
Correct Answer: B) Montreal Cognitive Assessment MoCA
2
A 78-year-old man has progressive gait instability, frequent shuffling steps, and
stooped posture over months. Family reports decreased facial expression and a
resting tremor. Which diagnosis most closely fits these motor findings and warrants
evaluation for dopaminergic responsive disease?
A) Normal pressure hydrocephalus
B) Parkinson disease
C) Myasthenia gravis
D) Peripheral neuropathy
Correct Answer: B) Parkinson disease
,3
A 76-year-old female with chronic atrial fibrillation is frail and has recurrent falls.
You must reassess her anticoagulation plan. Which clinical approach best balances
stroke prevention and fall-risk concerns in elderly AF patients?
A) Automatically stop anticoagulation whenever any fall occurs
B) Continue to calculate individualized stroke risk with CHA2DS2-VASc and
bleeding risk, consider DOACs at appropriate doses or hold only if bleeding risk is
prohibitive
C) Replace anticoagulation with aspirin only because it is safer
D) Prescribe warfarin to all elderly regardless of falls
Correct Answer: B) Continue to calculate individualized stroke risk with
CHA2DS2-VASc and bleeding risk, consider DOACs at appropriate doses or
hold only if bleeding risk is prohibitive
4
A 70-year-old man complains of new urinary urgency, frequency, and nocturia but
no dysuria or fever. On exam prostate is moderately enlarged without nodules.
Which initial management approach is most appropriate in primary care for benign
prostatic hyperplasia symptoms?
A) Immediate transurethral resection of the prostate
B) Begin alpha-1 blocker therapy and discuss lifestyle measures while monitoring
symptoms
C) Prescribe antibiotics for presumed prostatitis
D) Initiate 5-alpha reductase inhibitor as first-line for immediate relief
Correct Answer: B) Begin alpha-1 blocker therapy and discuss lifestyle
measures while monitoring symptoms
5
An 85-year-old woman presents after a fall at home. She is awake but confused
and on warfarin. CT head shows a small subdural hematoma without mass effect.
,Which immediate consideration is most critical for this anticoagulated elderly
patient?
A) Discharge home with outpatient neurology follow-up
B) Reverse anticoagulation and consult neurosurgery given bleeding on warfarin
C) Start aspirin to prevent future ischemic stroke
D) Ignore anticoagulation and observe only
Correct Answer: B) Reverse anticoagulation and consult neurosurgery given
bleeding on warfarin
6
A 74-year-old patient with multiple chronic medications asks about reducing pill
burden. Which geriatric prescribing principle should you apply first to safely
deprescribe?
A) Stop all medications older than one year
B) Review current medications for indication, benefit, harm, and patient priorities,
then taper those with unclear ongoing benefit
C) Substitute all medications with herbal alternatives
D) Double doses to reduce number of pills
Correct Answer: B) Review current medications for indication, benefit, harm,
and patient priorities, then taper those with unclear ongoing benefit
7
A 79-year-old woman reports new-onset acute confusion, visual hallucinations, and
fluctuating attention that developed over 48 hours after hospitalization. Which
diagnosis is most consistent with these features and requires prompt evaluation?
A) Major neurocognitive disorder
B) Delirium
C) Mild cognitive impairment
D) Dementia with Lewy bodies
Correct Answer: B) Delirium
, 8
A 68-year-old diabetic patient has HbA1c of 8.2 percent and recurrent
hypoglycemia episodes at home. For many older adults with comorbidity and risk
of hypoglycemia, what is an appropriate individualized HbA1c target?
A) Less than 6 percent for all patients
B) More relaxed target, for example 7.5 to 8.5 percent depending on frailty and life
expectancy
C) Always maintain HbA1c at 5 percent
D) No target needed for older adults
Correct Answer: B) More relaxed target, for example 7.5 to 8.5 percent
depending on frailty and life expectancy
9
An 82-year-old woman has recurrent falls and reports dizziness on standing. You
perform orthostatic vitals and find a significant drop in systolic blood pressure
when standing. Which condition is most likely and should be addressed?
A) Orthostatic hypotension possibly medication-related or autonomic dysfunction
B) Pulmonary embolism
C) Acute appendicitis
D) Hyperthyroidism
Correct Answer: A) Orthostatic hypotension possibly medication-related or
autonomic dysfunction
10
A 75-year-old male smoker is seen for preventive care. Which lung cancer
screening recommendation is appropriate for an older adult with a 40 pack-year
history who quit 6 years ago?
A) Annual low-dose CT for adults 50–80 with at least 20 pack-year history who
currently smoke or quit within 15 years, if otherwise eligible
