1
NR 601 FINAL EXAM (ACTUAL 2026) — 180 COMPLEX QUESTIONS
WITH DETAILED RATIONALES | VERIFIED ANSWERS |
CHAMBERLAIN UNIVERSITY
PAGE 1 (Q1-Q2)
Q1. A 68-year-old woman complains of urine leakage when she
sneezes, laughs, or strains. She denies dysuria, frequency, and
nocturia. Urinalysis is negative. What is the most likely diagnosis?
A) Urge incontinence
B) Stress incontinence
C) Overflow incontinence
D) Functional incontinence
Answer: B) Stress incontinence
Rationale: Stress incontinence is characterized by involuntary loss
of urine during increases in intra-abdominal pressure (coughing,
sneezing, laughing, straining). It is due to weak pelvic floor
muscles and urethral hypermobility. Urinalysis is typically normal.
Q2. Which of the following is NOT a characteristic of delirium?
A) Acute onset
B) Fluctuating course
C) Coherent thought process
D) Worse in the evening
,2
Answer: C) Coherent thought process
Rationale:Delirium is characterized by acute onset, fluctuating
level of consciousness, inattention, disorganized thinking, and
often worsens at night (sundowning). Coherent thought process is
not a feature; disorganized thinking is.
PAGE 2 (Q3-Q4)
Q3. According to palliative care principles, most elderly patients
die:
A) At home
B) In institutions
C) Alone
D) In pain
Answer: B) In institutions
Rationale* Despite preferences to die at home, most elderly
patients die in institutional settings such as hospitals or nursing
homes. Palliative care aims to improve quality of life regardless of
setting.
Q4. Agnosia in dementia is defined as:
A) Inability to recognize objects
B) Inability to understand language
C) Inability to use language
D) Inability to remember events
,3
Answer: A) Inability to recognize objects
Rationale: Agnosia is the inability to recognize familiar objects
despite intact sensory function. It is a cortical symptom seen in
Alzheimer's and other dementias. Aphasia is language impairment;
amnesia is memory loss.
PAGE 3 (Q5-Q6)
Q5. A 52-year-old woman has a fasting plasma glucose of 123
mg/dL. What is the next best step?
A) Repeat fasting glucose in 1 month
B) Start metformin 500 mg BID
C) Repeat fasting plasma glucose in one year
D) Repeat fasting glucose in three years
Answer: A) Repeat fasting glucose in 1 month
Rationale: A fasting glucose of 100–125 mg/dL indicates
prediabetes. According to ADA, diagnosis of diabetes requires two
abnormal tests. A single elevated fasting glucose should be
repeated to confirm before initiating pharmacotherapy.
Q6. When treating depression in dementia, which medication is a
poor choice?
A) Sertraline
B) Amitriptyline
C) Fluoxetine
D) Mirtazapine
, 4
Answer: B) Amitriptyline
Rationale: Tricyclic antidepressants like amitriptyline have strong
anticholinergic effects, which can worsen cognition and cause
delirium in older adults with dementia. SSRIs (sertraline, fluoxetine)
and mirtazapine are preferred.
PAGE 4 (Q7-Q8)
Q7. A male patient with BMI 30 has a fasting glucose of 130 mg/dL.
What is the next action?
A) Repeat fasting glucose
B) Start metformin 500 mg BID
C) Repeat fasting glucose in 1 year
D) Call patient and report normal
Answer: A) Repeat fasting glucose
Rationale: A fasting glucose ≥126 mg/dL is diagnostic of diabetes if
confirmed. A single value is insufficient; repeat testing is required.
Metformin is initiated after confirmation and lifestyle counseling.
NR 601 FINAL EXAM (ACTUAL 2026) — 180 COMPLEX QUESTIONS
WITH DETAILED RATIONALES | VERIFIED ANSWERS |
CHAMBERLAIN UNIVERSITY
PAGE 1 (Q1-Q2)
Q1. A 68-year-old woman complains of urine leakage when she
sneezes, laughs, or strains. She denies dysuria, frequency, and
nocturia. Urinalysis is negative. What is the most likely diagnosis?
A) Urge incontinence
B) Stress incontinence
C) Overflow incontinence
D) Functional incontinence
Answer: B) Stress incontinence
Rationale: Stress incontinence is characterized by involuntary loss
of urine during increases in intra-abdominal pressure (coughing,
sneezing, laughing, straining). It is due to weak pelvic floor
muscles and urethral hypermobility. Urinalysis is typically normal.
Q2. Which of the following is NOT a characteristic of delirium?
A) Acute onset
B) Fluctuating course
C) Coherent thought process
D) Worse in the evening
,2
Answer: C) Coherent thought process
Rationale:Delirium is characterized by acute onset, fluctuating
level of consciousness, inattention, disorganized thinking, and
often worsens at night (sundowning). Coherent thought process is
not a feature; disorganized thinking is.
PAGE 2 (Q3-Q4)
Q3. According to palliative care principles, most elderly patients
die:
A) At home
B) In institutions
C) Alone
D) In pain
Answer: B) In institutions
Rationale* Despite preferences to die at home, most elderly
patients die in institutional settings such as hospitals or nursing
homes. Palliative care aims to improve quality of life regardless of
setting.
Q4. Agnosia in dementia is defined as:
A) Inability to recognize objects
B) Inability to understand language
C) Inability to use language
D) Inability to remember events
,3
Answer: A) Inability to recognize objects
Rationale: Agnosia is the inability to recognize familiar objects
despite intact sensory function. It is a cortical symptom seen in
Alzheimer's and other dementias. Aphasia is language impairment;
amnesia is memory loss.
PAGE 3 (Q5-Q6)
Q5. A 52-year-old woman has a fasting plasma glucose of 123
mg/dL. What is the next best step?
A) Repeat fasting glucose in 1 month
B) Start metformin 500 mg BID
C) Repeat fasting plasma glucose in one year
D) Repeat fasting glucose in three years
Answer: A) Repeat fasting glucose in 1 month
Rationale: A fasting glucose of 100–125 mg/dL indicates
prediabetes. According to ADA, diagnosis of diabetes requires two
abnormal tests. A single elevated fasting glucose should be
repeated to confirm before initiating pharmacotherapy.
Q6. When treating depression in dementia, which medication is a
poor choice?
A) Sertraline
B) Amitriptyline
C) Fluoxetine
D) Mirtazapine
, 4
Answer: B) Amitriptyline
Rationale: Tricyclic antidepressants like amitriptyline have strong
anticholinergic effects, which can worsen cognition and cause
delirium in older adults with dementia. SSRIs (sertraline, fluoxetine)
and mirtazapine are preferred.
PAGE 4 (Q7-Q8)
Q7. A male patient with BMI 30 has a fasting glucose of 130 mg/dL.
What is the next action?
A) Repeat fasting glucose
B) Start metformin 500 mg BID
C) Repeat fasting glucose in 1 year
D) Call patient and report normal
Answer: A) Repeat fasting glucose
Rationale: A fasting glucose ≥126 mg/dL is diagnostic of diabetes if
confirmed. A single value is insufficient; repeat testing is required.
Metformin is initiated after confirmation and lifestyle counseling.
