NSG500 Exam 2 - Advanced Health Assessment (Wilkes University, 2026/2027) Grade A - Verified Answers
NSG500 / NSG 500 Exam 2 (Latest 2026/2027)
Advanced Health Assessment | Questions and Verified Answers | 100% Correct | Grade A
Wilkes University - Nurse Practitioner Program
Instructions: This examination contains 100 multiple-choice questions across 12 sections. Each question
has one best answer. Rationales are provided beneath each question with verified advanced health
assessment clinical reasoning aligned to Wilkes University NSG500 curriculum standards and current NP
certification guidelines (2026-2027).
Section 1: Assessment of the Older Adult (Geriatric Assessment, Functional Status,
& Common Conditions)
Q1: An 82-year-old female is being evaluated during a comprehensive geriatric assessment (CGA). Which
domain is NOT routinely assessed as part of a CGA?
A. Functional status and ADLs/IADLs
B. Cognitive, psychological, and social status
C. Genetic sequencing for heritable cancer syndromes [CORRECT]
D. Environmental and medication review
Correct Answer: C
Rationale: A comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic
process that evaluates medical conditions, functional status (ADLs/IADLs), cognition, psychological state,
social support, and environmental/medication factors. Genetic sequencing for heritable cancer syndromes is
not a routine domain of the CGA and is reserved for targeted oncology or family-history-driven workups.
Including only medical and functional domains would miss the cognitive, psychosocial, and environmental
contributors that drive outcomes in frail older adults.
Q2: A 79-year-old male is assessed using the Katz Index of Independence in ADLs. Which activity is
included in the Katz Index?
A. Shopping, meal preparation, and housework
B. Bathing, dressing, toileting, transferring, continence, and feeding [CORRECT]
C. Managing medications and finances
D. Using the telephone and transportation
Correct Answer: B
Rationale: The Katz Index of Independence in Activities of Daily Living (ADLs) evaluates six basic self-care
tasks: bathing, dressing, toileting, transferring, continence, and feeding. A score of 6 indicates full
independence, while lower scores reflect increasing dependence. The other options describe Instrumental
Activities of Daily Living (IADLs), which are measured by the Lawton IADL Scale and reflect more complex
tasks required for independent community living. Confusing ADLs with IADLs is a common NSG500 error.
Q3: A daughter reports her 76-year-old mother can bathe and dress herself but no longer manages her
own medications, finances, or transportation. The most appropriate tool to quantify this functional loss is:
A. Katz Index of Independence in ADLs
B. Lawton Instrumental Activities of Daily Living (IADL) Scale [CORRECT]
C. Mini-Mental State Examination (MMSE)
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,NSG500 Exam 2 - Advanced Health Assessment (Wilkes University, 2026/2027) Grade A - Verified Answers
D. Timed Up and Go (TUG) test
Correct Answer: B
Rationale: The Lawton IADL Scale assesses higher-level tasks necessary for independent living: telephone
use, shopping, meal preparation, housekeeping, laundry, transportation, medication management, and
handling finances. Because this patient maintains basic ADLs (Katz) but has lost IADL capacity, the Lawton
IADL Scale is the appropriate tool. MMSE assesses cognition, and TUG assesses gait and fall risk, neither of
which directly quantifies IADL function.
Q4: An 80-year-old patient scores 21 on the Mini-Mental State Examination (MMSE). The most accurate
interpretation is:
A. Normal cognition for age
B. Suggestion of cognitive impairment (cutoff <24) [CORRECT]
C. Definitive diagnosis of Alzheimer's dementia
D. Indication of delirium requiring emergent workup
Correct Answer: B
Rationale: The MMSE is scored out of 30, with a score below 24 traditionally suggesting cognitive
impairment. However, the MMSE is a screening tool, not a diagnostic instrument; it cannot distinguish
Alzheimer's dementia from other etiologies or delirium without further clinical correlation. A score of 21
indicates possible impairment and warrants further evaluation (e.g., MoCA, SLUMS, laboratory and imaging
workup) but does not alone establish a diagnosis. Education level and language/cultural factors also
influence MMSE performance.
Q5: Compared with the MMSE, the Montreal Cognitive Assessment (MoCA) is preferred when the clinical
question is:
A. Confirming delirium in an acute care setting
B. Detecting mild cognitive impairment (MCI) using a cutoff <26 [CORRECT]
C. Screening for depression in the elderly
D. Assessing gait and balance
Correct Answer: B
Rationale: The MoCA is more sensitive than the MMSE for detecting mild cognitive impairment (MCI), with a
cutoff of <26 suggesting impairment. The MMSE is better for moderate-to-severe dementia but misses many
MCI cases. Delirium is best screened with tools like the CAM (Confusion Assessment Method), depression
with the PHQ-9 or Geriatric Depression Scale, and gait/balance with the TUG or Berg Balance Scale.
Choosing the MMSE when MCI is suspected is a common NSG500 testing pitfall.
Q6: Which finding on Clock Drawing Test is most concerning for executive dysfunction and possible
dementia?
A. All numbers present and correctly positioned with hands pointing to '11:10'
B. Numbers crowded on one side of the clock or perseveration of hands [CORRECT]
C. Patient refuses to draw the clock
D. Clock drawn in under 30 seconds
Correct Answer: B
Rationale: Clock Drawing evaluates visuospatial construction, executive function, and planning. Errors such
as numbers crowded on one side, perseveration, missing numbers, or hands pointing incorrectly suggest
executive dysfunction commonly seen in dementia (especially Alzheimer's and vascular dementia). A
correctly drawn clock is reassuring. Refusal or speed alone does not carry the same diagnostic weight. The
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, NSG500 Exam 2 - Advanced Health Assessment (Wilkes University, 2026/2027) Grade A - Verified Answers
test is a quick, sensitive screening adjunct to the MMSE or MoCA.
Q7: A 78-year-old male is timed performing the Timed Up and Go (TUG) test. His time is 14.5 seconds.
The correct interpretation is:
A. Normal mobility; no fall-prevention intervention required
B. Increased fall risk (TUG >12 seconds indicates fall risk) [CORRECT]
C. Diagnostic of Parkinson's disease
D. Indicates normal age-related decline only
Correct Answer: B
Rationale: The TUG test requires the patient to rise from a chair, walk 10 feet, turn, return, and sit. A time
greater than 12 seconds indicates increased fall risk and warrants further evaluation and intervention (gait
training, home safety assessment, medication review, vision screening). TUG does not diagnose Parkinson's
disease, and a 14.5-second result is not simply 'normal aging.' Fall-risk stratification is a core NSG500
geriatric competency.
Q8: Which medication class is most consistently associated with falls in older adults and is highlighted in
the Beers Criteria?
A. Statin therapy
B. Sedative-hypnotics and benzodiazepines [CORRECT]
C. Levothyroxine
D. Topical corticosteroids
Correct Answer: B
Rationale: The Beers Criteria identify potentially inappropriate medications in older adults.
Sedative-hypnotics, benzodiazepines, anticholinergics, and certain antihypertensives are strongly associated
with falls, delirium, and cognitive impairment due to age-related changes in hepatic metabolism, renal
clearance, and body composition. Statins, levothyroxine, and topical corticosteroids are not primary fall-risk
medications in the Beers Criteria. Medication reconciliation using Beers is a standard NSG500 competency.
Q9: An 84-year-old nursing home resident has acute onset of fluctuating inattention and disorganized
thinking over 24 hours. The most likely diagnosis and likely contributors are:
A. Dementia; chronic progressive Alzheimer's changes
B. Delirium; infection, medications, dehydration, or metabolic disturbance [CORRECT]
C. Depression; apathy and somatic complaints
D. Normal aging; no workup indicated
Correct Answer: B
Rationale: Delirium is characterized by acute onset, fluctuating course, inattention, and disorganized
thinking. Common precipitants in older adults include infection (especially UTI and pneumonia), medications
(anticholinergics, opioids, sedatives), dehydration, electrolyte/metabolic disturbances, and pain. Dementia is
chronic and progressive, depression presents with mood and somatic complaints, and these symptoms are
never attributable to 'normal aging.' Delirium is a medical emergency requiring prompt identification and
treatment of the underlying cause.
Q10: A 77-year-old widow reports weight loss, fatigue, and apathy but denies sadness. The best
screening tool for depression in this geriatric patient is:
A. PHQ-2 alone
B. Geriatric Depression Scale (GDS) [CORRECT]
Page 3
NSG500 / NSG 500 Exam 2 (Latest 2026/2027)
Advanced Health Assessment | Questions and Verified Answers | 100% Correct | Grade A
Wilkes University - Nurse Practitioner Program
Instructions: This examination contains 100 multiple-choice questions across 12 sections. Each question
has one best answer. Rationales are provided beneath each question with verified advanced health
assessment clinical reasoning aligned to Wilkes University NSG500 curriculum standards and current NP
certification guidelines (2026-2027).
Section 1: Assessment of the Older Adult (Geriatric Assessment, Functional Status,
& Common Conditions)
Q1: An 82-year-old female is being evaluated during a comprehensive geriatric assessment (CGA). Which
domain is NOT routinely assessed as part of a CGA?
A. Functional status and ADLs/IADLs
B. Cognitive, psychological, and social status
C. Genetic sequencing for heritable cancer syndromes [CORRECT]
D. Environmental and medication review
Correct Answer: C
Rationale: A comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic
process that evaluates medical conditions, functional status (ADLs/IADLs), cognition, psychological state,
social support, and environmental/medication factors. Genetic sequencing for heritable cancer syndromes is
not a routine domain of the CGA and is reserved for targeted oncology or family-history-driven workups.
Including only medical and functional domains would miss the cognitive, psychosocial, and environmental
contributors that drive outcomes in frail older adults.
Q2: A 79-year-old male is assessed using the Katz Index of Independence in ADLs. Which activity is
included in the Katz Index?
A. Shopping, meal preparation, and housework
B. Bathing, dressing, toileting, transferring, continence, and feeding [CORRECT]
C. Managing medications and finances
D. Using the telephone and transportation
Correct Answer: B
Rationale: The Katz Index of Independence in Activities of Daily Living (ADLs) evaluates six basic self-care
tasks: bathing, dressing, toileting, transferring, continence, and feeding. A score of 6 indicates full
independence, while lower scores reflect increasing dependence. The other options describe Instrumental
Activities of Daily Living (IADLs), which are measured by the Lawton IADL Scale and reflect more complex
tasks required for independent community living. Confusing ADLs with IADLs is a common NSG500 error.
Q3: A daughter reports her 76-year-old mother can bathe and dress herself but no longer manages her
own medications, finances, or transportation. The most appropriate tool to quantify this functional loss is:
A. Katz Index of Independence in ADLs
B. Lawton Instrumental Activities of Daily Living (IADL) Scale [CORRECT]
C. Mini-Mental State Examination (MMSE)
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,NSG500 Exam 2 - Advanced Health Assessment (Wilkes University, 2026/2027) Grade A - Verified Answers
D. Timed Up and Go (TUG) test
Correct Answer: B
Rationale: The Lawton IADL Scale assesses higher-level tasks necessary for independent living: telephone
use, shopping, meal preparation, housekeeping, laundry, transportation, medication management, and
handling finances. Because this patient maintains basic ADLs (Katz) but has lost IADL capacity, the Lawton
IADL Scale is the appropriate tool. MMSE assesses cognition, and TUG assesses gait and fall risk, neither of
which directly quantifies IADL function.
Q4: An 80-year-old patient scores 21 on the Mini-Mental State Examination (MMSE). The most accurate
interpretation is:
A. Normal cognition for age
B. Suggestion of cognitive impairment (cutoff <24) [CORRECT]
C. Definitive diagnosis of Alzheimer's dementia
D. Indication of delirium requiring emergent workup
Correct Answer: B
Rationale: The MMSE is scored out of 30, with a score below 24 traditionally suggesting cognitive
impairment. However, the MMSE is a screening tool, not a diagnostic instrument; it cannot distinguish
Alzheimer's dementia from other etiologies or delirium without further clinical correlation. A score of 21
indicates possible impairment and warrants further evaluation (e.g., MoCA, SLUMS, laboratory and imaging
workup) but does not alone establish a diagnosis. Education level and language/cultural factors also
influence MMSE performance.
Q5: Compared with the MMSE, the Montreal Cognitive Assessment (MoCA) is preferred when the clinical
question is:
A. Confirming delirium in an acute care setting
B. Detecting mild cognitive impairment (MCI) using a cutoff <26 [CORRECT]
C. Screening for depression in the elderly
D. Assessing gait and balance
Correct Answer: B
Rationale: The MoCA is more sensitive than the MMSE for detecting mild cognitive impairment (MCI), with a
cutoff of <26 suggesting impairment. The MMSE is better for moderate-to-severe dementia but misses many
MCI cases. Delirium is best screened with tools like the CAM (Confusion Assessment Method), depression
with the PHQ-9 or Geriatric Depression Scale, and gait/balance with the TUG or Berg Balance Scale.
Choosing the MMSE when MCI is suspected is a common NSG500 testing pitfall.
Q6: Which finding on Clock Drawing Test is most concerning for executive dysfunction and possible
dementia?
A. All numbers present and correctly positioned with hands pointing to '11:10'
B. Numbers crowded on one side of the clock or perseveration of hands [CORRECT]
C. Patient refuses to draw the clock
D. Clock drawn in under 30 seconds
Correct Answer: B
Rationale: Clock Drawing evaluates visuospatial construction, executive function, and planning. Errors such
as numbers crowded on one side, perseveration, missing numbers, or hands pointing incorrectly suggest
executive dysfunction commonly seen in dementia (especially Alzheimer's and vascular dementia). A
correctly drawn clock is reassuring. Refusal or speed alone does not carry the same diagnostic weight. The
Page 2
, NSG500 Exam 2 - Advanced Health Assessment (Wilkes University, 2026/2027) Grade A - Verified Answers
test is a quick, sensitive screening adjunct to the MMSE or MoCA.
Q7: A 78-year-old male is timed performing the Timed Up and Go (TUG) test. His time is 14.5 seconds.
The correct interpretation is:
A. Normal mobility; no fall-prevention intervention required
B. Increased fall risk (TUG >12 seconds indicates fall risk) [CORRECT]
C. Diagnostic of Parkinson's disease
D. Indicates normal age-related decline only
Correct Answer: B
Rationale: The TUG test requires the patient to rise from a chair, walk 10 feet, turn, return, and sit. A time
greater than 12 seconds indicates increased fall risk and warrants further evaluation and intervention (gait
training, home safety assessment, medication review, vision screening). TUG does not diagnose Parkinson's
disease, and a 14.5-second result is not simply 'normal aging.' Fall-risk stratification is a core NSG500
geriatric competency.
Q8: Which medication class is most consistently associated with falls in older adults and is highlighted in
the Beers Criteria?
A. Statin therapy
B. Sedative-hypnotics and benzodiazepines [CORRECT]
C. Levothyroxine
D. Topical corticosteroids
Correct Answer: B
Rationale: The Beers Criteria identify potentially inappropriate medications in older adults.
Sedative-hypnotics, benzodiazepines, anticholinergics, and certain antihypertensives are strongly associated
with falls, delirium, and cognitive impairment due to age-related changes in hepatic metabolism, renal
clearance, and body composition. Statins, levothyroxine, and topical corticosteroids are not primary fall-risk
medications in the Beers Criteria. Medication reconciliation using Beers is a standard NSG500 competency.
Q9: An 84-year-old nursing home resident has acute onset of fluctuating inattention and disorganized
thinking over 24 hours. The most likely diagnosis and likely contributors are:
A. Dementia; chronic progressive Alzheimer's changes
B. Delirium; infection, medications, dehydration, or metabolic disturbance [CORRECT]
C. Depression; apathy and somatic complaints
D. Normal aging; no workup indicated
Correct Answer: B
Rationale: Delirium is characterized by acute onset, fluctuating course, inattention, and disorganized
thinking. Common precipitants in older adults include infection (especially UTI and pneumonia), medications
(anticholinergics, opioids, sedatives), dehydration, electrolyte/metabolic disturbances, and pain. Dementia is
chronic and progressive, depression presents with mood and somatic complaints, and these symptoms are
never attributable to 'normal aging.' Delirium is a medical emergency requiring prompt identification and
treatment of the underlying cause.
Q10: A 77-year-old widow reports weight loss, fatigue, and apathy but denies sadness. The best
screening tool for depression in this geriatric patient is:
A. PHQ-2 alone
B. Geriatric Depression Scale (GDS) [CORRECT]
Page 3
