NRNP 6540 FINAL EXAM 2026/2027 TESTBANK AND A NEW UPDATED
STUDY GUIDE WITH PRACTICE QUESTIONS COMPLETE ACCURATE EXAM
1. An 82-year-old patient presents for a comprehensive primary-care
evaluation and reports increasing fatigue, occasional dizziness, and difficulty
managing several medications prescribed by different clinicians. The patient
lives independently but has recently fallen twice and says meals are
sometimes skipped because of limited appetite. Which assessment
approach is most appropriate for identifying the interacting medical,
functional, cognitive, nutritional, and social factors contributing to the
patient's current health status?
A. Perform a focused cardiovascular examination only because dizziness is
the primary complaint
B. Obtain a comprehensive geriatric assessment addressing medical,
functional, cognitive, psychosocial, nutritional, and environmental domains
C. Limit the evaluation to medication reconciliation because polypharmacy
is the most likely explanation
D. Schedule separate specialty consultations without completing an
integrated primary-care assessment
Answer: B
2. An 88-year-old patient becomes acutely confused over 24 hours after
developing a urinary infection. The patient's daughter reports that the
patient was fully oriented and independently managing finances one week
earlier. During the examination, attention fluctuates and the patient
alternates between agitation and lethargy. Which diagnosis best explains
this acute change in mental status?
A. Delirium
B. Alzheimer disease
C. Major depressive disorder
D. Mild cognitive impairment
Answer: A
1
, 3. A 76-year-old patient with chronic hypertension, diabetes, osteoarthritis,
and atrial fibrillation takes nine prescription medications and several over-
the-counter products. The patient reports dizziness after standing,
constipation, and two recent falls. Which intervention should the advanced
practice nurse prioritize before simply adding another medication for the
patient's symptoms?
A. Increase the antihypertensive dose to improve cardiovascular protection
B. Add a sedating medication to improve nighttime sleep
C. Conduct a complete medication reconciliation and evaluate for
potentially inappropriate medications and drug interactions
D. Recommend that the patient stop all prescription medications for one
week
Answer: C
4. A 79-year-old patient reports urinary leakage whenever coughing, laughing,
or lifting heavy objects but denies urgency, dysuria, nocturia beyond once
nightly, or difficulty initiating the urinary stream. Which type of urinary
incontinence is most consistent with this presentation?
A. Urge incontinence
B. Overflow incontinence
C. Functional incontinence
D. Stress incontinence
Answer: D
5. A 74-year-old patient with hypertension asks whether occasional dizziness
when rising from a chair is simply an unavoidable consequence of aging.
The clinician measures blood pressure after five minutes supine and again
after standing and observes a significant fall accompanied by symptoms.
Which interpretation is most appropriate?
A. The finding suggests orthostatic hypotension and warrants evaluation for
contributing medications, volume depletion, and autonomic factors
B. The finding is always an expected physiologic consequence of normal
aging and requires no assessment
C. The finding confirms a diagnosis of essential hypertension requiring a
2
, higher medication dose
D. The finding indicates that the patient should permanently avoid standing
without assistance
Answer: A
6. An 81-year-old patient with progressive memory impairment is brought by a
family member because the patient repeatedly asks the same questions,
has become lost while driving familiar routes, and requires assistance with
finances. The symptoms developed gradually over several years without
fluctuations in consciousness. Which diagnosis is most consistent with this
pattern?
A. Acute delirium
B. Major neurocognitive disorder
C. Acute psychotic disorder
D. Adjustment disorder
Answer: B
7. A 78-year-old patient with chronic kidney disease is prescribed a medication
that is substantially eliminated through the kidneys. The patient's serum
creatinine appears only mildly elevated, but the clinician recognizes that
serum creatinine alone may underestimate renal impairment in an older
adult with reduced muscle mass. What is the most appropriate approach?
A. Assume normal renal function because the serum creatinine is within the
laboratory reference range
B. Double the medication dose because older adults metabolize
medications more slowly
C. Estimate renal function using an appropriate kidney-function equation
and adjust therapy when indicated
D. Avoid all medications that undergo renal elimination regardless of the
clinical indication
Answer: C
8. A 72-year-old patient presents with new unilateral leg swelling, warmth,
tenderness, and erythema after a prolonged period of reduced mobility.
3
, The patient denies trauma and has no obvious skin wound. Which condition
should be considered urgently in the differential diagnosis?
A. Chronic venous insufficiency
B. Osteoarthritis
C. Lymphedema
D. Deep vein thrombosis
Answer: D
9. An 84-year-old patient has unintentionally lost 8% of body weight over six
months and reports early satiety, fatigue, and difficulty preparing meals.
The physical examination suggests reduced muscle mass. Which additional
assessment is most important when evaluating this patient's nutritional and
functional risk?
A. Assess dietary intake, swallowing ability, oral health, functional status,
and potential medical or psychosocial contributors
B. Recommend a restrictive low-calorie diet to prevent additional metabolic
complications
C. Assume weight loss is a normal consequence of aging unless severe
cachexia develops
D. Prescribe an appetite suppressant to regulate eating patterns
Answer: A
10. A 77-year-old patient reports gradually worsening difficulty hearing
conversations, particularly when several people are speaking
simultaneously. The patient frequently asks others to repeat themselves but
has no acute neurologic symptoms. Which action is most appropriate
during the primary-care evaluation?
A. Assume the hearing difficulty is normal aging and requires no
intervention
B. Perform or arrange an appropriate hearing assessment and evaluate
potentially reversible contributors
C. Begin a sedative because hearing difficulty commonly results from
anxiety
D. Refer immediately for brain imaging without first evaluating hearing
4
STUDY GUIDE WITH PRACTICE QUESTIONS COMPLETE ACCURATE EXAM
1. An 82-year-old patient presents for a comprehensive primary-care
evaluation and reports increasing fatigue, occasional dizziness, and difficulty
managing several medications prescribed by different clinicians. The patient
lives independently but has recently fallen twice and says meals are
sometimes skipped because of limited appetite. Which assessment
approach is most appropriate for identifying the interacting medical,
functional, cognitive, nutritional, and social factors contributing to the
patient's current health status?
A. Perform a focused cardiovascular examination only because dizziness is
the primary complaint
B. Obtain a comprehensive geriatric assessment addressing medical,
functional, cognitive, psychosocial, nutritional, and environmental domains
C. Limit the evaluation to medication reconciliation because polypharmacy
is the most likely explanation
D. Schedule separate specialty consultations without completing an
integrated primary-care assessment
Answer: B
2. An 88-year-old patient becomes acutely confused over 24 hours after
developing a urinary infection. The patient's daughter reports that the
patient was fully oriented and independently managing finances one week
earlier. During the examination, attention fluctuates and the patient
alternates between agitation and lethargy. Which diagnosis best explains
this acute change in mental status?
A. Delirium
B. Alzheimer disease
C. Major depressive disorder
D. Mild cognitive impairment
Answer: A
1
, 3. A 76-year-old patient with chronic hypertension, diabetes, osteoarthritis,
and atrial fibrillation takes nine prescription medications and several over-
the-counter products. The patient reports dizziness after standing,
constipation, and two recent falls. Which intervention should the advanced
practice nurse prioritize before simply adding another medication for the
patient's symptoms?
A. Increase the antihypertensive dose to improve cardiovascular protection
B. Add a sedating medication to improve nighttime sleep
C. Conduct a complete medication reconciliation and evaluate for
potentially inappropriate medications and drug interactions
D. Recommend that the patient stop all prescription medications for one
week
Answer: C
4. A 79-year-old patient reports urinary leakage whenever coughing, laughing,
or lifting heavy objects but denies urgency, dysuria, nocturia beyond once
nightly, or difficulty initiating the urinary stream. Which type of urinary
incontinence is most consistent with this presentation?
A. Urge incontinence
B. Overflow incontinence
C. Functional incontinence
D. Stress incontinence
Answer: D
5. A 74-year-old patient with hypertension asks whether occasional dizziness
when rising from a chair is simply an unavoidable consequence of aging.
The clinician measures blood pressure after five minutes supine and again
after standing and observes a significant fall accompanied by symptoms.
Which interpretation is most appropriate?
A. The finding suggests orthostatic hypotension and warrants evaluation for
contributing medications, volume depletion, and autonomic factors
B. The finding is always an expected physiologic consequence of normal
aging and requires no assessment
C. The finding confirms a diagnosis of essential hypertension requiring a
2
, higher medication dose
D. The finding indicates that the patient should permanently avoid standing
without assistance
Answer: A
6. An 81-year-old patient with progressive memory impairment is brought by a
family member because the patient repeatedly asks the same questions,
has become lost while driving familiar routes, and requires assistance with
finances. The symptoms developed gradually over several years without
fluctuations in consciousness. Which diagnosis is most consistent with this
pattern?
A. Acute delirium
B. Major neurocognitive disorder
C. Acute psychotic disorder
D. Adjustment disorder
Answer: B
7. A 78-year-old patient with chronic kidney disease is prescribed a medication
that is substantially eliminated through the kidneys. The patient's serum
creatinine appears only mildly elevated, but the clinician recognizes that
serum creatinine alone may underestimate renal impairment in an older
adult with reduced muscle mass. What is the most appropriate approach?
A. Assume normal renal function because the serum creatinine is within the
laboratory reference range
B. Double the medication dose because older adults metabolize
medications more slowly
C. Estimate renal function using an appropriate kidney-function equation
and adjust therapy when indicated
D. Avoid all medications that undergo renal elimination regardless of the
clinical indication
Answer: C
8. A 72-year-old patient presents with new unilateral leg swelling, warmth,
tenderness, and erythema after a prolonged period of reduced mobility.
3
, The patient denies trauma and has no obvious skin wound. Which condition
should be considered urgently in the differential diagnosis?
A. Chronic venous insufficiency
B. Osteoarthritis
C. Lymphedema
D. Deep vein thrombosis
Answer: D
9. An 84-year-old patient has unintentionally lost 8% of body weight over six
months and reports early satiety, fatigue, and difficulty preparing meals.
The physical examination suggests reduced muscle mass. Which additional
assessment is most important when evaluating this patient's nutritional and
functional risk?
A. Assess dietary intake, swallowing ability, oral health, functional status,
and potential medical or psychosocial contributors
B. Recommend a restrictive low-calorie diet to prevent additional metabolic
complications
C. Assume weight loss is a normal consequence of aging unless severe
cachexia develops
D. Prescribe an appetite suppressant to regulate eating patterns
Answer: A
10. A 77-year-old patient reports gradually worsening difficulty hearing
conversations, particularly when several people are speaking
simultaneously. The patient frequently asks others to repeat themselves but
has no acute neurologic symptoms. Which action is most appropriate
during the primary-care evaluation?
A. Assume the hearing difficulty is normal aging and requires no
intervention
B. Perform or arrange an appropriate hearing assessment and evaluate
potentially reversible contributors
C. Begin a sedative because hearing difficulty commonly results from
anxiety
D. Refer immediately for brain imaging without first evaluating hearing
4
