Walden University NRNP 6540 Final Exam (pdf) | 2026/2027 | Adv
Practice Older Adults | Gerontology
**1. A 78-year-old female presents with a 3-month history of progressive
forgetfulness, difficulty managing her finances, and getting lost in familiar
places. Her family reports she has become more withdrawn and irritable.
Which of the following is the most appropriate initial diagnostic tool?**
A) MRI of the brain
B) Montreal Cognitive Assessment (MoCA)
C) Lumbar puncture
D) Electroencephalogram (EEG)
**Correct Answer: B**
**Rationale:** The Montreal Cognitive Assessment (MoCA) is a validated
screening tool for cognitive impairment that assesses multiple domains
including memory, attention, executive function, and language. It is more
sensitive than the MMSE for detecting mild cognitive impairment and early
dementia. MRI may be indicated after cognitive screening if structural
abnormalities are suspected.
---
**2. A 72-year-old male with a history of hypertension and type 2 diabetes is
taking lisinopril, metformin, and atorvastatin. He reports a new onset of a
non-productive cough that has been present for 3 weeks. Which medication
is most likely causing this side effect?**
A) Metformin
B) Atorvastatin
C) Lisinopril
,D) All of the above
**Correct Answer: C**
**Rationale:** Lisinopril, an ACE inhibitor, is a common cause of a persistent
dry cough due to the accumulation of bradykinin. This side effect occurs in
up to 20% of patients. Switching to an ARB (e.g., losartan) is an appropriate
alternative. Metformin causes GI side effects, and atorvastatin causes
myalgias.
---
**3. A 65-year-old female presents with acute onset of confusion, lethargy,
and a temperature of 101.2°F. Her family reports she has been having
urinary frequency and urgency. Urinalysis shows positive nitrites and
leukocyte esterase. What is the most likely diagnosis?**
A) Urinary tract infection (UTI) with delirium
B) Alzheimer's disease
C) Cerebrovascular accident
D) Medication side effect
**Correct Answer: A**
**Rationale:** Delirium in older adults is often caused by infections, with
urinary tract infections being the most common precipitant. The acute onset
of confusion, fever, and urinary symptoms strongly suggest a UTI with
associated delirium. Prompt treatment with antibiotics is indicated.
---
,**4. Which of the following is a screening tool for frailty in older adults?**
A) Mini-Mental State Examination (MMSE)
B) Fried Frailty Phenotype
C) Geriatric Depression Scale (GDS)
D) Confusion Assessment Method (CAM)
**Correct Answer: B**
**Rationale:** The Fried Frailty Phenotype assesses five criteria:
unintentional weight loss, exhaustion, low physical activity, slow gait speed,
and weakness. Frailty is a state of increased vulnerability to stressors and is
associated with adverse outcomes including falls, hospitalization, and
mortality.
---
**5. Which of the following is a common cause of dizziness in older adults?**
A) Orthostatic hypotension
B) Benign paroxysmal positional vertigo (BPPV)
C) Medication side effects
D) All of the above
**Correct Answer: D**
, **Rationale:** Dizziness in older adults is multifactorial and can be caused by
orthostatic hypotension, BPPV, medication side effects, vestibular disorders,
and cardiovascular conditions. A thorough evaluation including medication
review, orthostatic blood pressure measurement, and assessment for BPPV is
essential.
---
**6. A 75-year-old male is being treated for heart failure with reduced
ejection fraction. Which of the following medications is part of guideline-
directed medical therapy (GDMT) for HFrEF?**
A) Metoprolol succinate
B) Digoxin
C) Furosemide
D) Hydralazine
**Correct Answer: A**
**Rationale:** Metoprolol succinate is a beta-blocker that is part of GDMT for
HFrEF and has been shown to reduce mortality. Digoxin is used for symptom
control but does not reduce mortality. Furosemide is used for symptom
management but does not provide mortality benefit. Hydralazine is used in
African American patients.
---
**7. A patient with chronic kidney disease (CKD) is taking a phosphate
binder. The nurse practitioner should instruct the patient to take this
medication:**
Practice Older Adults | Gerontology
**1. A 78-year-old female presents with a 3-month history of progressive
forgetfulness, difficulty managing her finances, and getting lost in familiar
places. Her family reports she has become more withdrawn and irritable.
Which of the following is the most appropriate initial diagnostic tool?**
A) MRI of the brain
B) Montreal Cognitive Assessment (MoCA)
C) Lumbar puncture
D) Electroencephalogram (EEG)
**Correct Answer: B**
**Rationale:** The Montreal Cognitive Assessment (MoCA) is a validated
screening tool for cognitive impairment that assesses multiple domains
including memory, attention, executive function, and language. It is more
sensitive than the MMSE for detecting mild cognitive impairment and early
dementia. MRI may be indicated after cognitive screening if structural
abnormalities are suspected.
---
**2. A 72-year-old male with a history of hypertension and type 2 diabetes is
taking lisinopril, metformin, and atorvastatin. He reports a new onset of a
non-productive cough that has been present for 3 weeks. Which medication
is most likely causing this side effect?**
A) Metformin
B) Atorvastatin
C) Lisinopril
,D) All of the above
**Correct Answer: C**
**Rationale:** Lisinopril, an ACE inhibitor, is a common cause of a persistent
dry cough due to the accumulation of bradykinin. This side effect occurs in
up to 20% of patients. Switching to an ARB (e.g., losartan) is an appropriate
alternative. Metformin causes GI side effects, and atorvastatin causes
myalgias.
---
**3. A 65-year-old female presents with acute onset of confusion, lethargy,
and a temperature of 101.2°F. Her family reports she has been having
urinary frequency and urgency. Urinalysis shows positive nitrites and
leukocyte esterase. What is the most likely diagnosis?**
A) Urinary tract infection (UTI) with delirium
B) Alzheimer's disease
C) Cerebrovascular accident
D) Medication side effect
**Correct Answer: A**
**Rationale:** Delirium in older adults is often caused by infections, with
urinary tract infections being the most common precipitant. The acute onset
of confusion, fever, and urinary symptoms strongly suggest a UTI with
associated delirium. Prompt treatment with antibiotics is indicated.
---
,**4. Which of the following is a screening tool for frailty in older adults?**
A) Mini-Mental State Examination (MMSE)
B) Fried Frailty Phenotype
C) Geriatric Depression Scale (GDS)
D) Confusion Assessment Method (CAM)
**Correct Answer: B**
**Rationale:** The Fried Frailty Phenotype assesses five criteria:
unintentional weight loss, exhaustion, low physical activity, slow gait speed,
and weakness. Frailty is a state of increased vulnerability to stressors and is
associated with adverse outcomes including falls, hospitalization, and
mortality.
---
**5. Which of the following is a common cause of dizziness in older adults?**
A) Orthostatic hypotension
B) Benign paroxysmal positional vertigo (BPPV)
C) Medication side effects
D) All of the above
**Correct Answer: D**
, **Rationale:** Dizziness in older adults is multifactorial and can be caused by
orthostatic hypotension, BPPV, medication side effects, vestibular disorders,
and cardiovascular conditions. A thorough evaluation including medication
review, orthostatic blood pressure measurement, and assessment for BPPV is
essential.
---
**6. A 75-year-old male is being treated for heart failure with reduced
ejection fraction. Which of the following medications is part of guideline-
directed medical therapy (GDMT) for HFrEF?**
A) Metoprolol succinate
B) Digoxin
C) Furosemide
D) Hydralazine
**Correct Answer: A**
**Rationale:** Metoprolol succinate is a beta-blocker that is part of GDMT for
HFrEF and has been shown to reduce mortality. Digoxin is used for symptom
control but does not reduce mortality. Furosemide is used for symptom
management but does not provide mortality benefit. Hydralazine is used in
African American patients.
---
**7. A patient with chronic kidney disease (CKD) is taking a phosphate
binder. The nurse practitioner should instruct the patient to take this
medication:**
