NRNP 6540 MIDTERM EXAM LATEST WITH
QUESTIONS AND ANSWERS (VERIFIED
ANSWERS).
An 82-year-old female presents with progressive fatigue and low-
grade pedal edema over three weeks. Echocardiography
demonstrates an ejection fraction of 58%, left ventricular
concentric hypertrophy, and an elevated 𝐸/𝑒′ ratio. Which
underlying pathophysiology best explains her clinical condition?
Correct Answer: Age-related arterial stiffening and concentric
left ventricular remodeling leading to impaired diastolic
relaxation and Heart Failure with Preserved Ejection Fraction
(HFpEF).
A 78-year-old male with a history of hypertension and
osteoarthritis presents with new-onset acute confusion, anorexia,
and lethargy over 36 hours. He denies chest pain, dyspnea, or
cough. ECG shows subtle T-wave inversions in leads V4–V6 and
troponin is elevated. What clinical principle does this scenario
illustrate?
Correct Answer: Older adults frequently manifest Acute
Coronary Syndrome (ACS) through atypical "anginal
equivalents" such as delirium, functional decline, and
weakness rather than substernal chest discomfort.
An 85-year-old frail female residing in a long-term care facility has
a resting sitting blood pressure of 154/82 mmHg. Upon standing
for two minutes, her blood pressure drops to 126/68 mmHg,
,accompanied by transient lightheadedness. What is the most
appropriate initial management strategy?
Correct Answer: Adjust or consolidate her antihypertensive
regimen to prioritize symptom management, prevent orthostatic
falls, and establish individualized blood pressure targets rather
than pursuing aggressive systolic reduction.
An 81-year-old patient with long-standing isolated systolic
hypertension exhibits a blood pressure reading of 168/70 mmHg.
What structural vascular alteration associated with chronological
aging directly drives this widening pulse pressure?
Correct Answer: Degeneration of elastin fibers and increased
collagen deposition within large conduit arterial walls, leading to
increased vascular stiffness and decreased arterial compliance.
A 76-year-old male reports burning calf pain when walking 150
feet that resolves after resting for 5 minutes. Physical exam
reveals shiny, hairless lower extremities with absent posterior
tibial pulses. Which bedside diagnostic test is indicated to confirm
the underlying diagnosis?
Correct Answer: Ankle-Brachial Index (ABI) measurement; a value
≤ 0.90 confirms Peripheral Arterial Disease (PAD).
A non-healing right toe ulcer in an 80-year-old patient with type 2
diabetes yields an ABI of 0.32. How should this finding be
clinically interpreted?
Correct Answer: An ABI ≤ 0.40 signifies severe peripheral arterial
disease with critical limb ischemia, carrying a high risk of tissue
loss and requiring immediate vascular surgery evaluation.
,An 83-year-old patient presents with a deep, circular, well-
demarcated wound on the lateral malleolus with a pale wound
bed and cool skin. The patient experiences severe localized pain
that worsens when elevating the extremity. What is the etiology of
this wound?
Correct Answer: Arterial insufficiency secondary to severe
peripheral atherosclerosis causing critical tissue hypoxia.
A 74-year-old female presents with a shallow, irregularly shaped
ulcer superior to the medial malleolus, accompanied by bilateral
lower leg edema and hyperpigmentation (hemosiderin staining).
What is the primary non-pharmacological treatment once arterial
insufficiency is ruled out?
Correct Answer: High-yield multi-layer compression therapy
combined with lower extremity elevation above heart level.
Prior to applying high-compression bandaging for lower extremity
venous stasis edema, which diagnostic assessment must be
completed to prevent iatrogenic necrosis?
Correct Answer: Arterial perfusion assessment via Ankle-Brachial
Index (ABI) to rule out significant coexisting Peripheral Arterial
Disease.
An 80-year-old patient with newly detected non-valvular atrial
fibrillation has a CHA₂DS₂-VASc score of 5 and a HAS-BLED
score of 3. What principle guides anticoagulant therapy selection?
Correct Answer: Anticoagulation is strongly indicated to reduce
thromboembolic stroke risk, provided bleeding risks are mitigated
through modifiable risk factor management and shared decision-
making regarding frailty and fall potential.
, An 84-year-old male presents with exertional syncope and a late-
systolic crescendo-decrescendo murmur heard best at the right
upper sternal border with radiation to the carotids. What
degenerative cardiac pathology is most likely?
Correct Answer: Calcific aortic stenosis.
A 82-year-old patient with severe symptomatic aortic stenosis is
evaluated as high surgical risk due to frailty and severe
pulmonary disease. What invasive intervention represents the
standard of care?
Correct Answer: Transcatheter Aortic Valve Replacement (TAVR).
A 72-year-old chronic smoker presents with progressive exertional
dyspnea. Post-bronchodilator spirometry demonstrates an
FEV1 /FVC ratio of 0.64 and an FEV1 of 58% predicted. What
diagnostic conclusion is drawn?
Correct Answer: A post-bronchodilator FEV1 /FVC < 0.70
establishes persistent airflow obstruction, confirming Moderate
Chronic Obstructive Pulmonary Disease (COPD).
An 86-year-old patient experiences recurrent lightheadedness
after standing up. Age-related changes in which physiological
mechanism impair the immediate compensatory vasoconstrictive
response?
Correct Answer: Blunted arterial baroreceptor sensitivity coupled
with reduced beta-adrenergic responsiveness.
An 89-year-old resident of an assisted living facility displays acute
lethargy, hypothermia, and functional decline. Lungs display mild
right base crackles, and chest X-ray confirms a right lower lobe
QUESTIONS AND ANSWERS (VERIFIED
ANSWERS).
An 82-year-old female presents with progressive fatigue and low-
grade pedal edema over three weeks. Echocardiography
demonstrates an ejection fraction of 58%, left ventricular
concentric hypertrophy, and an elevated 𝐸/𝑒′ ratio. Which
underlying pathophysiology best explains her clinical condition?
Correct Answer: Age-related arterial stiffening and concentric
left ventricular remodeling leading to impaired diastolic
relaxation and Heart Failure with Preserved Ejection Fraction
(HFpEF).
A 78-year-old male with a history of hypertension and
osteoarthritis presents with new-onset acute confusion, anorexia,
and lethargy over 36 hours. He denies chest pain, dyspnea, or
cough. ECG shows subtle T-wave inversions in leads V4–V6 and
troponin is elevated. What clinical principle does this scenario
illustrate?
Correct Answer: Older adults frequently manifest Acute
Coronary Syndrome (ACS) through atypical "anginal
equivalents" such as delirium, functional decline, and
weakness rather than substernal chest discomfort.
An 85-year-old frail female residing in a long-term care facility has
a resting sitting blood pressure of 154/82 mmHg. Upon standing
for two minutes, her blood pressure drops to 126/68 mmHg,
,accompanied by transient lightheadedness. What is the most
appropriate initial management strategy?
Correct Answer: Adjust or consolidate her antihypertensive
regimen to prioritize symptom management, prevent orthostatic
falls, and establish individualized blood pressure targets rather
than pursuing aggressive systolic reduction.
An 81-year-old patient with long-standing isolated systolic
hypertension exhibits a blood pressure reading of 168/70 mmHg.
What structural vascular alteration associated with chronological
aging directly drives this widening pulse pressure?
Correct Answer: Degeneration of elastin fibers and increased
collagen deposition within large conduit arterial walls, leading to
increased vascular stiffness and decreased arterial compliance.
A 76-year-old male reports burning calf pain when walking 150
feet that resolves after resting for 5 minutes. Physical exam
reveals shiny, hairless lower extremities with absent posterior
tibial pulses. Which bedside diagnostic test is indicated to confirm
the underlying diagnosis?
Correct Answer: Ankle-Brachial Index (ABI) measurement; a value
≤ 0.90 confirms Peripheral Arterial Disease (PAD).
A non-healing right toe ulcer in an 80-year-old patient with type 2
diabetes yields an ABI of 0.32. How should this finding be
clinically interpreted?
Correct Answer: An ABI ≤ 0.40 signifies severe peripheral arterial
disease with critical limb ischemia, carrying a high risk of tissue
loss and requiring immediate vascular surgery evaluation.
,An 83-year-old patient presents with a deep, circular, well-
demarcated wound on the lateral malleolus with a pale wound
bed and cool skin. The patient experiences severe localized pain
that worsens when elevating the extremity. What is the etiology of
this wound?
Correct Answer: Arterial insufficiency secondary to severe
peripheral atherosclerosis causing critical tissue hypoxia.
A 74-year-old female presents with a shallow, irregularly shaped
ulcer superior to the medial malleolus, accompanied by bilateral
lower leg edema and hyperpigmentation (hemosiderin staining).
What is the primary non-pharmacological treatment once arterial
insufficiency is ruled out?
Correct Answer: High-yield multi-layer compression therapy
combined with lower extremity elevation above heart level.
Prior to applying high-compression bandaging for lower extremity
venous stasis edema, which diagnostic assessment must be
completed to prevent iatrogenic necrosis?
Correct Answer: Arterial perfusion assessment via Ankle-Brachial
Index (ABI) to rule out significant coexisting Peripheral Arterial
Disease.
An 80-year-old patient with newly detected non-valvular atrial
fibrillation has a CHA₂DS₂-VASc score of 5 and a HAS-BLED
score of 3. What principle guides anticoagulant therapy selection?
Correct Answer: Anticoagulation is strongly indicated to reduce
thromboembolic stroke risk, provided bleeding risks are mitigated
through modifiable risk factor management and shared decision-
making regarding frailty and fall potential.
, An 84-year-old male presents with exertional syncope and a late-
systolic crescendo-decrescendo murmur heard best at the right
upper sternal border with radiation to the carotids. What
degenerative cardiac pathology is most likely?
Correct Answer: Calcific aortic stenosis.
A 82-year-old patient with severe symptomatic aortic stenosis is
evaluated as high surgical risk due to frailty and severe
pulmonary disease. What invasive intervention represents the
standard of care?
Correct Answer: Transcatheter Aortic Valve Replacement (TAVR).
A 72-year-old chronic smoker presents with progressive exertional
dyspnea. Post-bronchodilator spirometry demonstrates an
FEV1 /FVC ratio of 0.64 and an FEV1 of 58% predicted. What
diagnostic conclusion is drawn?
Correct Answer: A post-bronchodilator FEV1 /FVC < 0.70
establishes persistent airflow obstruction, confirming Moderate
Chronic Obstructive Pulmonary Disease (COPD).
An 86-year-old patient experiences recurrent lightheadedness
after standing up. Age-related changes in which physiological
mechanism impair the immediate compensatory vasoconstrictive
response?
Correct Answer: Blunted arterial baroreceptor sensitivity coupled
with reduced beta-adrenergic responsiveness.
An 89-year-old resident of an assisted living facility displays acute
lethargy, hypothermia, and functional decline. Lungs display mild
right base crackles, and chest X-ray confirms a right lower lobe
