NR601 Midterm Exam [Chamberlain]
Primary Care of Maturing & Aged Family
Practicum - Actual Questions & Verified A+
Answers
SECTION 1: Geriatric Assessment & Foundations (Questions 1-10)
1. During a home visit you notice an 84-year-old woman rises from an armless chair only after
several attempts and uses the furniture to steady herself while walking. Which element of the
CGA is most appropriate to complete next?
A) Mini-Cog
B) Timed Up-and-Go (TUG)
C) PHQ-9
D) Katz ADL score
Correct Answer: B) Timed Up-and-Go (TUG)
Detailed Explanation: Observed difficulty rising and steadying herself is a red flag for falls. The
TUG is the quickest validated screen for mobility and fall risk; ≥12 s predicts future falls.
Mini-Cog (A) addresses cognition, PHQ-9 (C) screens for depression, and Katz (D) measures
basic ADLs—none directly quantify gait/balance.
2. An 80-kg, 78-year-old man with stable SCr 1.3 mg/dL needs renal dosing for empagliflozin.
Which estimate best guides prescribing?
A) 24-h urine creatinine clearance
B) Cockcroft-Gault creatinine clearance
C) CKD-EPI 2021 eGFR
D) Serum cystatin C level
Correct Answer: C) CKD-EPI 2021 eGFR
Detailed Explanation: 2024 FDA labeling allows CKD-EPI eGFR for all meds except narrow
therapeutic-index drugs. It is more accurate than Cockcroft-Gault (B) across the age span,
avoids 24-h urine collection errors (A), and is less costly than cystatin C (D).
3. Which screening instrument is recommended by the 2023 AGS/BGS guidelines as the single
best initial tool for fall risk in community-dwelling elders?
A) Berg Balance Scale
B) Tinetti Performance-Oriented Mobility Assessment
C) Stay Independent Brochure 12-item checklist
D) TUG
Correct Answer: C) Stay Independent Brochure 12-item checklist
Detailed Explanation: AGS/BGS 2023 update endorses the 12-item “Stay Independent”
self-checklist as the quickest, validated first-step screen; positive score triggers multifactorial
assessment. Berg (A) and Tinetti (B) are longer performance tests, while TUG (D) is a
second-tier measure.
, 4. According to the 2024 USPSTF, which approach to prostate-cancer screening in a healthy
70-year-old man is appropriate?
A) DRE plus PSA annually
B) PSA every 2 years until 75
C) Individualized discussion with shared decision-making
D) Routine screening discouraged regardless of health
Correct Answer: C) Individualized discussion with shared decision-making
Detailed Explanation: USPSTF 2024 maintains Grade C for 70-75 y: potential small benefit but
higher false-positive harm. Clinicians should discuss life expectancy, preferences, and risks.
Routine (A, B) or blanket discouragement (D) is not guideline-concordant.
5. The “Get the Medications Right” initiative (2024) emphasizes deprescribing in elders by
targeting drugs with high anticholinergic burden. Which drug pair below has the highest
combined Anticholinergic Cognitive Burden (ACB) score?
A) Oxybutynin 5 mg BID + diphenhydramine 25 mg HS
B) Furosemide 20 mg daily + metoprolol 50 mg BID
C) Atorvastatin 20 mg HS + omeprazole 20 mg daily
D) Apixaban 5 mg BID + amlodipine 5 mg daily
Correct Answer: A) Oxybutynin 5 mg BID + diphenhydramine 25 mg HS
Detailed Explanation: Oxybutynin (ACB 3) and diphenhydramine (ACB 3) yield total 6—well
above the ≥3 threshold linked to delirium. The other pairs have zero anticholinergic activity.
6. You plan influenza vaccination for an 82-year-old resident of a long-term care facility. Which
2024-2025 product is preferentially recommended by CDC for adults ≥65 y?
A) Standard-dose quadrivalent IM
B) High-dose quadrivalent (HD-IIV4) or adjuvanted quadrivalent (aIIV4)
C) Live-attenuated intranasal
D) Recombinant trivalent
Correct Answer: B) High-dose quadrivalent (HD-IIV4) or adjuvanted quadrivalent (aIIV4)
Detailed Explanation: CDC 2024 prefers HD-IIV4 or aIIV4 in ≥65 y because they reduce
influenza-related hospitalizations ~25% more than standard dose. Live intranasal (C) is
contraindicated in elders; recombinant trivalent (D) is no longer marketed.
7. A 79-year-old woman reports new urinary urgency. Which one finding differentiates
overactive bladder (OAB) from polyuria due to nocturnal global polyuria?
A) Bladder outlet obstruction on uroflowmetry
B) Nocturnal urine volume >33% of 24-h output while sleeping
C) Positive urinalysis for leukocyte esterase
D) Post-void residual >200 mL
Correct Answer: B) Nocturnal urine volume >33% of 24-h output while sleeping
Detailed Explanation: Global polyuria is defined as nighttime urine >33% of total; OAB volume
is normal. Outlet obstruction (A) and high PVR (D) suggest retention, while pyuria (C)
indicates infection—neither distinguishes volume-related urgency.
8. When teaching a 77-year-old about exercise, which FITT recommendation aligns with 2024
HHS Physical Activity Guidelines for Americans?
A) 300 min/week moderate intensity, no strength training required
B) 150 min/week moderate + 2 days strength + balance training
Primary Care of Maturing & Aged Family
Practicum - Actual Questions & Verified A+
Answers
SECTION 1: Geriatric Assessment & Foundations (Questions 1-10)
1. During a home visit you notice an 84-year-old woman rises from an armless chair only after
several attempts and uses the furniture to steady herself while walking. Which element of the
CGA is most appropriate to complete next?
A) Mini-Cog
B) Timed Up-and-Go (TUG)
C) PHQ-9
D) Katz ADL score
Correct Answer: B) Timed Up-and-Go (TUG)
Detailed Explanation: Observed difficulty rising and steadying herself is a red flag for falls. The
TUG is the quickest validated screen for mobility and fall risk; ≥12 s predicts future falls.
Mini-Cog (A) addresses cognition, PHQ-9 (C) screens for depression, and Katz (D) measures
basic ADLs—none directly quantify gait/balance.
2. An 80-kg, 78-year-old man with stable SCr 1.3 mg/dL needs renal dosing for empagliflozin.
Which estimate best guides prescribing?
A) 24-h urine creatinine clearance
B) Cockcroft-Gault creatinine clearance
C) CKD-EPI 2021 eGFR
D) Serum cystatin C level
Correct Answer: C) CKD-EPI 2021 eGFR
Detailed Explanation: 2024 FDA labeling allows CKD-EPI eGFR for all meds except narrow
therapeutic-index drugs. It is more accurate than Cockcroft-Gault (B) across the age span,
avoids 24-h urine collection errors (A), and is less costly than cystatin C (D).
3. Which screening instrument is recommended by the 2023 AGS/BGS guidelines as the single
best initial tool for fall risk in community-dwelling elders?
A) Berg Balance Scale
B) Tinetti Performance-Oriented Mobility Assessment
C) Stay Independent Brochure 12-item checklist
D) TUG
Correct Answer: C) Stay Independent Brochure 12-item checklist
Detailed Explanation: AGS/BGS 2023 update endorses the 12-item “Stay Independent”
self-checklist as the quickest, validated first-step screen; positive score triggers multifactorial
assessment. Berg (A) and Tinetti (B) are longer performance tests, while TUG (D) is a
second-tier measure.
, 4. According to the 2024 USPSTF, which approach to prostate-cancer screening in a healthy
70-year-old man is appropriate?
A) DRE plus PSA annually
B) PSA every 2 years until 75
C) Individualized discussion with shared decision-making
D) Routine screening discouraged regardless of health
Correct Answer: C) Individualized discussion with shared decision-making
Detailed Explanation: USPSTF 2024 maintains Grade C for 70-75 y: potential small benefit but
higher false-positive harm. Clinicians should discuss life expectancy, preferences, and risks.
Routine (A, B) or blanket discouragement (D) is not guideline-concordant.
5. The “Get the Medications Right” initiative (2024) emphasizes deprescribing in elders by
targeting drugs with high anticholinergic burden. Which drug pair below has the highest
combined Anticholinergic Cognitive Burden (ACB) score?
A) Oxybutynin 5 mg BID + diphenhydramine 25 mg HS
B) Furosemide 20 mg daily + metoprolol 50 mg BID
C) Atorvastatin 20 mg HS + omeprazole 20 mg daily
D) Apixaban 5 mg BID + amlodipine 5 mg daily
Correct Answer: A) Oxybutynin 5 mg BID + diphenhydramine 25 mg HS
Detailed Explanation: Oxybutynin (ACB 3) and diphenhydramine (ACB 3) yield total 6—well
above the ≥3 threshold linked to delirium. The other pairs have zero anticholinergic activity.
6. You plan influenza vaccination for an 82-year-old resident of a long-term care facility. Which
2024-2025 product is preferentially recommended by CDC for adults ≥65 y?
A) Standard-dose quadrivalent IM
B) High-dose quadrivalent (HD-IIV4) or adjuvanted quadrivalent (aIIV4)
C) Live-attenuated intranasal
D) Recombinant trivalent
Correct Answer: B) High-dose quadrivalent (HD-IIV4) or adjuvanted quadrivalent (aIIV4)
Detailed Explanation: CDC 2024 prefers HD-IIV4 or aIIV4 in ≥65 y because they reduce
influenza-related hospitalizations ~25% more than standard dose. Live intranasal (C) is
contraindicated in elders; recombinant trivalent (D) is no longer marketed.
7. A 79-year-old woman reports new urinary urgency. Which one finding differentiates
overactive bladder (OAB) from polyuria due to nocturnal global polyuria?
A) Bladder outlet obstruction on uroflowmetry
B) Nocturnal urine volume >33% of 24-h output while sleeping
C) Positive urinalysis for leukocyte esterase
D) Post-void residual >200 mL
Correct Answer: B) Nocturnal urine volume >33% of 24-h output while sleeping
Detailed Explanation: Global polyuria is defined as nighttime urine >33% of total; OAB volume
is normal. Outlet obstruction (A) and high PVR (D) suggest retention, while pyuria (C)
indicates infection—neither distinguishes volume-related urgency.
8. When teaching a 77-year-old about exercise, which FITT recommendation aligns with 2024
HHS Physical Activity Guidelines for Americans?
A) 300 min/week moderate intensity, no strength training required
B) 150 min/week moderate + 2 days strength + balance training
