NSG500 Exam 2 - Advanced Health Assessment | Wilkes University | 2026/2027
NSG500 / NSG 500 Exam 2
Advanced Health Assessment Complete Review
Latest Edition | Wilkes University
Questions and Verified Answers | 100% Correct | Grade A
Comprehensive 100-Question Review covering Geriatric Assessment, Obstetric & Gynecologic
Assessment, Pediatric Assessment, Mental Health & Psychiatric Assessment, Nutritional
Assessment, Cultural & Spiritual Assessment, Violence/Abuse/Trauma, Occupational &
Environmental Health, Advanced Physical Examination Techniques, Diagnostic Reasoning,
Documentation & Communication, and Integrated Clinical Case Scenarios.
Section 1: Geriatric Assessment (Functional, Cognitive, & Geriatric Syndromes)
Q1: An 82-year-old female is referred to the clinic for a comprehensive geriatric assessment (CGA). The NP
understands that the primary purpose of CGA is to:
A. Provide a single diagnostic label to guide pharmacologic treatment
B. Evaluate multidimensional domains (functional, cognitive, psychosocial, medical) to guide individualized
care planning [CORRECT]
C. Replace the standard history and physical examination in older adults
D. Determine eligibility for nursing home placement within 30 days
Correct Answer: B
Rationale: Comprehensive Geriatric Assessment (CGA) is a multidimensional, interdisciplinary diagnostic process that
evaluates functional status, cognition, mood, polypharmacy, social support, nutrition, and medical comorbidities to develop
an individualized, coordinated plan of care. CGA reduces mortality, reduces hospital admissions, and improves cognitive
function and independence in older adults. It does not replace the H&P;, nor is it designed solely for institutional placement;
rather, it informs patient-centered goals of care.
Page 1 | Grade A Review | 100% Verified Answers
, NSG500 Exam 2 - Advanced Health Assessment | Wilkes University | 2026/2027
Q2: A 78-year-old male is being evaluated for functional independence. The NP uses the Katz Index of
Activities of Daily Living (ADLs). Which of the following functions is assessed by the Katz Index?
A. Using the telephone, managing finances, and shopping
B. Bathing, dressing, toileting, transferring, continence, and feeding [CORRECT]
C. Preparing meals, doing laundry, and managing medications
D. Walking 50 feet, climbing one flight of stairs, and doing heavy housework
Correct Answer: B
Rationale: The Katz Index of ADLs assesses six basic self-care activities: bathing, dressing, toileting, transferring,
continence, and feeding. These represent basic survival skills. Options A, C, and D describe Instrumental Activities of Daily
Living (IADLs), which are assessed using the Lawton Scale and reflect higher-level independent living tasks (telephone use,
finances, shopping, meal prep, housekeeping, laundry, transportation, and medication management).
Q3: A 76-year-old woman scores 5/8 on the Lawton IADL Scale. The NP correctly interprets this score as
indicating:
A. Complete independence in all instrumental activities
B. Need for full-time skilled nursing facility care
C. Moderate impairment requiring assistance with complex daily tasks such as finances and medications
[CORRECT]
D. Cognitive impairment requiring urgent neurologic evaluation
Correct Answer: C
Rationale: The Lawton IADL Scale ranges from 0 (low function, dependent) to 8 (high function, independent) for women;
for men, the scale is 0-5 because some items (meal prep, housekeeping, laundry) were historically not assessed. A score of
5/8 indicates moderate functional impairment, suggesting the patient needs assistance with more complex daily tasks
(finances, medications, transportation, shopping). IADL decline typically precedes ADL decline, making it an early marker
of functional loss. It does not directly measure cognition, although cognitive impairment is a common cause of IADL
decline.
Q4: A 79-year-old male presents with his daughter, who reports he has become more forgetful over the past 6
months. Which cognitive screening tool is most sensitive for detecting mild cognitive impairment (MCI)?
A. Mini-Mental State Examination (MMSE)
B. Montreal Cognitive Assessment (MoCA) [CORRECT]
C. Clock Drawing Test alone
D. Geriatric Depression Scale (GDS)
Correct Answer: B
Rationale: The Montreal Cognitive Assessment (MoCA) is more sensitive than the MMSE for detecting mild cognitive
impairment (MCI) and early Alzheimer disease. MoCA (30-point scale; cut-off <26) assesses executive function, attention,
language, abstraction, delayed recall, and orientation. The MMSE is better for moderate-to-severe dementia but is less
sensitive at the MCI stage. The Clock Drawing Test is a useful adjunct but lacks sensitivity as a standalone screen. The GDS
screens for depression, which can mimic dementia (pseudodementia).
Page 2 | Grade A Review | 100% Verified Answers
, NSG500 Exam 2 - Advanced Health Assessment | Wilkes University | 2026/2027
Q5: An 81-year-old female is assessed using the Timed Up and Go (TUG) test. She takes 16 seconds to
complete the task. The NP interprets this finding as:
A. Normal mobility for her age; no further intervention needed
B. Borderline; reassess in 12 months
C. Increased risk for falls; initiate multifactorial fall risk intervention [CORRECT]
D. Diagnostic of Parkinson disease; refer to neurology
Correct Answer: C
Rationale: The Timed Up and Go (TUG) test measures the time it takes a patient to rise from a chair, walk 3 meters, turn,
walk back, and sit down. A time of ≥ 12 seconds indicates increased fall risk in community-dwelling older adults; ≥ 14
seconds further predicts falls. A time of 16 seconds is clearly abnormal and warrants multifactorial fall risk assessment and
intervention (medication review, balance/strength training, vision and hearing evaluation, home safety assessment, vitamin
D supplementation, and orthostatic vital signs). TUG is not diagnostic of Parkinson disease, although bradykinesia may
prolong time.
Q6: A 74-year-old male complains of blurred vision when reading and difficulty seeing road signs while
driving at night. He notes that bright lights cause significant glare. The most likely diagnosis is:
A. Presbyopia, a normal age-related loss of accommodation
B. Open-angle glaucoma, characterized by gradual peripheral vision loss
C. Age-related cataract, characterized by lens opacification and glare [CORRECT]
D. Macular degeneration, characterized by central vision loss and metamorphopsia
Correct Answer: C
Rationale: Age-related cataract presents with progressive blurred vision, glare (especially with night driving), decreased
color vividness, and frequent eyeglass prescription changes. It results from opacification of the crystalline lens. Presbyopia
causes near vision difficulty only (loss of accommodation). Open-angle glaucoma is typically painless with gradual
peripheral field loss (not glare). Macular degeneration causes central visual distortion (metamorphopsia) and scotomas.
Cataracts are confirmed by slit-lamp examination and treated with surgical extraction when functional impairment warrants.
Q7: An 80-year-old female is brought by her family because of acute confusion that began 2 days ago. She is
febrile, incontinent, and has a Foley catheter. Mental status examination reveals fluctuating attention and
disorientation. Which of the following is the most likely diagnosis?
A. Alzheimer dementia, given the cognitive impairment
B. Vascular dementia, given the acute onset
C. Delirium, likely secondary to urinary tract infection [CORRECT]
D. Late-onset schizophrenia with disorganized behavior
Correct Answer: C
Rationale: Delirium is characterized by acute onset (hours to days), fluctuating course, inattention, disorganized thinking,
and altered level of consciousness. It is a medical emergency and most often precipitated by infection (UTI, pneumonia),
medications, dehydration, metabolic disturbance, or pain. The Confusion Assessment Method (CAM) requires acute onset,
fluctuation, inattention, and either disorganized thinking or altered consciousness. Dementia is typically insidious and
progressive without fluctuation. Immediate workup includes CBC, CMP, urinalysis, chest X-ray, and medication review.
Page 3 | Grade A Review | 100% Verified Answers
, NSG500 Exam 2 - Advanced Health Assessment | Wilkes University | 2026/2027
Q8: A 76-year-old male takes 12 prescription medications including oxybutynin, amitriptyline, and diazepam.
According to the Beers Criteria, these medications are:
A. Recommended first-line agents for geriatric anxiety and incontinence
B. Potentially inappropriate due to anticholinergic burden, sedation, and fall risk [CORRECT]
C. Safe as long as liver function tests are within normal limits
D. Appropriate if eGFR exceeds 60 mL/min
Correct Answer: B
Rationale: The AGS Beers Criteria identifies potentially inappropriate medications (PIMs) in older adults. Oxybutynin and
amitriptyline have strong anticholinergic effects causing confusion, dry mouth, constipation, urinary retention, and falls.
Diazepam has a long half-life in older adults (up to 100 hours) causing prolonged sedation and falls. These should be
avoided or used with caution; safer alternatives exist (e.g., mirabegron for overactive bladder, SSRIs for depression).
Polypharmacy (>=5 medications) increases adverse drug event risk. Apply the 'start low, go slow' principle and deprescribe
whenever possible.
Q9: A 70-year-old female is found on examination to have a stage 2 pressure injury on her sacrum. Which
finding characterizes a stage 2 pressure injury?
A. Intact skin with non-blanchable erythema
B. Partial-thickness loss of skin with exposed dermis (pink/red wound bed) [CORRECT]
C. Full-thickness tissue loss with visible subcutaneous fat
D. Full-thickness loss with exposed bone, tendon, or muscle
Correct Answer: B
Rationale: NPIAP pressure injury staging: Stage 1 = intact skin with non-blanchable erythema. Stage 2 = partial-thickness
loss of epidermis and dermis presenting as a pink/red, moist wound bed (may present as an intact or ruptured serum-filled
blister). Stage 3 = full-thickness loss with visible subcutaneous fat (no exposed bone, muscle, or tendon). Stage 4 =
full-thickness loss with exposed bone, tendon, or muscle. Unstageable = full-thickness loss obscured by slough/eschar. Deep
tissue pressure injury = persistent non-blanchable deep red, maroon, or purple discoloration.
Q10: An 85-year-old male with advanced COPD and heart failure discusses his wishes regarding end-of-life
care. He completes a document naming his daughter to make healthcare decisions if he becomes incapacitated.
This document is best described as a:
A. Living will
B. Do-Not-Resuscitate (DNR) order
C. Durable Power of Attorney for Health Care (DPOA-HC) [CORRECT]
D. Physician Orders for Life-Sustaining Treatment (POLST)
Correct Answer: C
Rationale: A Durable Power of Attorney for Health Care (DPOA-HC, or healthcare proxy) is a legal document that
designates a surrogate decision-maker to make healthcare decisions when the patient loses capacity. A living will specifies
the patient's wishes regarding life-sustaining treatment in terminal illness or persistent vegetative state but does not name a
decision-maker. A DNR order is a medical order limiting resuscitation. POLST/MOLST forms are portable medical orders
translating goals of care into actionable orders (CPR, intubation, hospitalization, artificial nutrition).
Page 4 | Grade A Review | 100% Verified Answers
NSG500 / NSG 500 Exam 2
Advanced Health Assessment Complete Review
Latest Edition | Wilkes University
Questions and Verified Answers | 100% Correct | Grade A
Comprehensive 100-Question Review covering Geriatric Assessment, Obstetric & Gynecologic
Assessment, Pediatric Assessment, Mental Health & Psychiatric Assessment, Nutritional
Assessment, Cultural & Spiritual Assessment, Violence/Abuse/Trauma, Occupational &
Environmental Health, Advanced Physical Examination Techniques, Diagnostic Reasoning,
Documentation & Communication, and Integrated Clinical Case Scenarios.
Section 1: Geriatric Assessment (Functional, Cognitive, & Geriatric Syndromes)
Q1: An 82-year-old female is referred to the clinic for a comprehensive geriatric assessment (CGA). The NP
understands that the primary purpose of CGA is to:
A. Provide a single diagnostic label to guide pharmacologic treatment
B. Evaluate multidimensional domains (functional, cognitive, psychosocial, medical) to guide individualized
care planning [CORRECT]
C. Replace the standard history and physical examination in older adults
D. Determine eligibility for nursing home placement within 30 days
Correct Answer: B
Rationale: Comprehensive Geriatric Assessment (CGA) is a multidimensional, interdisciplinary diagnostic process that
evaluates functional status, cognition, mood, polypharmacy, social support, nutrition, and medical comorbidities to develop
an individualized, coordinated plan of care. CGA reduces mortality, reduces hospital admissions, and improves cognitive
function and independence in older adults. It does not replace the H&P;, nor is it designed solely for institutional placement;
rather, it informs patient-centered goals of care.
Page 1 | Grade A Review | 100% Verified Answers
, NSG500 Exam 2 - Advanced Health Assessment | Wilkes University | 2026/2027
Q2: A 78-year-old male is being evaluated for functional independence. The NP uses the Katz Index of
Activities of Daily Living (ADLs). Which of the following functions is assessed by the Katz Index?
A. Using the telephone, managing finances, and shopping
B. Bathing, dressing, toileting, transferring, continence, and feeding [CORRECT]
C. Preparing meals, doing laundry, and managing medications
D. Walking 50 feet, climbing one flight of stairs, and doing heavy housework
Correct Answer: B
Rationale: The Katz Index of ADLs assesses six basic self-care activities: bathing, dressing, toileting, transferring,
continence, and feeding. These represent basic survival skills. Options A, C, and D describe Instrumental Activities of Daily
Living (IADLs), which are assessed using the Lawton Scale and reflect higher-level independent living tasks (telephone use,
finances, shopping, meal prep, housekeeping, laundry, transportation, and medication management).
Q3: A 76-year-old woman scores 5/8 on the Lawton IADL Scale. The NP correctly interprets this score as
indicating:
A. Complete independence in all instrumental activities
B. Need for full-time skilled nursing facility care
C. Moderate impairment requiring assistance with complex daily tasks such as finances and medications
[CORRECT]
D. Cognitive impairment requiring urgent neurologic evaluation
Correct Answer: C
Rationale: The Lawton IADL Scale ranges from 0 (low function, dependent) to 8 (high function, independent) for women;
for men, the scale is 0-5 because some items (meal prep, housekeeping, laundry) were historically not assessed. A score of
5/8 indicates moderate functional impairment, suggesting the patient needs assistance with more complex daily tasks
(finances, medications, transportation, shopping). IADL decline typically precedes ADL decline, making it an early marker
of functional loss. It does not directly measure cognition, although cognitive impairment is a common cause of IADL
decline.
Q4: A 79-year-old male presents with his daughter, who reports he has become more forgetful over the past 6
months. Which cognitive screening tool is most sensitive for detecting mild cognitive impairment (MCI)?
A. Mini-Mental State Examination (MMSE)
B. Montreal Cognitive Assessment (MoCA) [CORRECT]
C. Clock Drawing Test alone
D. Geriatric Depression Scale (GDS)
Correct Answer: B
Rationale: The Montreal Cognitive Assessment (MoCA) is more sensitive than the MMSE for detecting mild cognitive
impairment (MCI) and early Alzheimer disease. MoCA (30-point scale; cut-off <26) assesses executive function, attention,
language, abstraction, delayed recall, and orientation. The MMSE is better for moderate-to-severe dementia but is less
sensitive at the MCI stage. The Clock Drawing Test is a useful adjunct but lacks sensitivity as a standalone screen. The GDS
screens for depression, which can mimic dementia (pseudodementia).
Page 2 | Grade A Review | 100% Verified Answers
, NSG500 Exam 2 - Advanced Health Assessment | Wilkes University | 2026/2027
Q5: An 81-year-old female is assessed using the Timed Up and Go (TUG) test. She takes 16 seconds to
complete the task. The NP interprets this finding as:
A. Normal mobility for her age; no further intervention needed
B. Borderline; reassess in 12 months
C. Increased risk for falls; initiate multifactorial fall risk intervention [CORRECT]
D. Diagnostic of Parkinson disease; refer to neurology
Correct Answer: C
Rationale: The Timed Up and Go (TUG) test measures the time it takes a patient to rise from a chair, walk 3 meters, turn,
walk back, and sit down. A time of ≥ 12 seconds indicates increased fall risk in community-dwelling older adults; ≥ 14
seconds further predicts falls. A time of 16 seconds is clearly abnormal and warrants multifactorial fall risk assessment and
intervention (medication review, balance/strength training, vision and hearing evaluation, home safety assessment, vitamin
D supplementation, and orthostatic vital signs). TUG is not diagnostic of Parkinson disease, although bradykinesia may
prolong time.
Q6: A 74-year-old male complains of blurred vision when reading and difficulty seeing road signs while
driving at night. He notes that bright lights cause significant glare. The most likely diagnosis is:
A. Presbyopia, a normal age-related loss of accommodation
B. Open-angle glaucoma, characterized by gradual peripheral vision loss
C. Age-related cataract, characterized by lens opacification and glare [CORRECT]
D. Macular degeneration, characterized by central vision loss and metamorphopsia
Correct Answer: C
Rationale: Age-related cataract presents with progressive blurred vision, glare (especially with night driving), decreased
color vividness, and frequent eyeglass prescription changes. It results from opacification of the crystalline lens. Presbyopia
causes near vision difficulty only (loss of accommodation). Open-angle glaucoma is typically painless with gradual
peripheral field loss (not glare). Macular degeneration causes central visual distortion (metamorphopsia) and scotomas.
Cataracts are confirmed by slit-lamp examination and treated with surgical extraction when functional impairment warrants.
Q7: An 80-year-old female is brought by her family because of acute confusion that began 2 days ago. She is
febrile, incontinent, and has a Foley catheter. Mental status examination reveals fluctuating attention and
disorientation. Which of the following is the most likely diagnosis?
A. Alzheimer dementia, given the cognitive impairment
B. Vascular dementia, given the acute onset
C. Delirium, likely secondary to urinary tract infection [CORRECT]
D. Late-onset schizophrenia with disorganized behavior
Correct Answer: C
Rationale: Delirium is characterized by acute onset (hours to days), fluctuating course, inattention, disorganized thinking,
and altered level of consciousness. It is a medical emergency and most often precipitated by infection (UTI, pneumonia),
medications, dehydration, metabolic disturbance, or pain. The Confusion Assessment Method (CAM) requires acute onset,
fluctuation, inattention, and either disorganized thinking or altered consciousness. Dementia is typically insidious and
progressive without fluctuation. Immediate workup includes CBC, CMP, urinalysis, chest X-ray, and medication review.
Page 3 | Grade A Review | 100% Verified Answers
, NSG500 Exam 2 - Advanced Health Assessment | Wilkes University | 2026/2027
Q8: A 76-year-old male takes 12 prescription medications including oxybutynin, amitriptyline, and diazepam.
According to the Beers Criteria, these medications are:
A. Recommended first-line agents for geriatric anxiety and incontinence
B. Potentially inappropriate due to anticholinergic burden, sedation, and fall risk [CORRECT]
C. Safe as long as liver function tests are within normal limits
D. Appropriate if eGFR exceeds 60 mL/min
Correct Answer: B
Rationale: The AGS Beers Criteria identifies potentially inappropriate medications (PIMs) in older adults. Oxybutynin and
amitriptyline have strong anticholinergic effects causing confusion, dry mouth, constipation, urinary retention, and falls.
Diazepam has a long half-life in older adults (up to 100 hours) causing prolonged sedation and falls. These should be
avoided or used with caution; safer alternatives exist (e.g., mirabegron for overactive bladder, SSRIs for depression).
Polypharmacy (>=5 medications) increases adverse drug event risk. Apply the 'start low, go slow' principle and deprescribe
whenever possible.
Q9: A 70-year-old female is found on examination to have a stage 2 pressure injury on her sacrum. Which
finding characterizes a stage 2 pressure injury?
A. Intact skin with non-blanchable erythema
B. Partial-thickness loss of skin with exposed dermis (pink/red wound bed) [CORRECT]
C. Full-thickness tissue loss with visible subcutaneous fat
D. Full-thickness loss with exposed bone, tendon, or muscle
Correct Answer: B
Rationale: NPIAP pressure injury staging: Stage 1 = intact skin with non-blanchable erythema. Stage 2 = partial-thickness
loss of epidermis and dermis presenting as a pink/red, moist wound bed (may present as an intact or ruptured serum-filled
blister). Stage 3 = full-thickness loss with visible subcutaneous fat (no exposed bone, muscle, or tendon). Stage 4 =
full-thickness loss with exposed bone, tendon, or muscle. Unstageable = full-thickness loss obscured by slough/eschar. Deep
tissue pressure injury = persistent non-blanchable deep red, maroon, or purple discoloration.
Q10: An 85-year-old male with advanced COPD and heart failure discusses his wishes regarding end-of-life
care. He completes a document naming his daughter to make healthcare decisions if he becomes incapacitated.
This document is best described as a:
A. Living will
B. Do-Not-Resuscitate (DNR) order
C. Durable Power of Attorney for Health Care (DPOA-HC) [CORRECT]
D. Physician Orders for Life-Sustaining Treatment (POLST)
Correct Answer: C
Rationale: A Durable Power of Attorney for Health Care (DPOA-HC, or healthcare proxy) is a legal document that
designates a surrogate decision-maker to make healthcare decisions when the patient loses capacity. A living will specifies
the patient's wishes regarding life-sustaining treatment in terminal illness or persistent vegetative state but does not name a
decision-maker. A DNR order is a medical order limiting resuscitation. POLST/MOLST forms are portable medical orders
translating goals of care into actionable orders (CPR, intubation, hospitalization, artificial nutrition).
Page 4 | Grade A Review | 100% Verified Answers
