1
NRNP 6540 Actual 2025 Final
Exam Questions and Answers
Guaranteed Pass
1. A 72-year-old patient reports weakness and difficulty urinating. The nurse performs
a urinalysis and CBC. Why is a thorough assessment necessary?
A. Symptoms are vague and may indicate aging
B. All body systems interact, and symptoms could indicate various diagnoses
C. The patient may not report all significant information
D. Only urinary symptoms require evaluation
Correct Answer: B (All body systems interact, and symptoms could indicate various
diagnoses)
Rationale: In older adults, symptoms like weakness and urinary issues may stem from
multiple interacting systems (e.g., dehydration, infection, or neurological issues). A
comprehensive assessment ensures accurate diagnosis. NRNP 6540, 2025, p. 12.
2. Which medication is contraindicated in a patient with a history of sulfa allergy?
A. Metformin
B. Furosemide
C. Sulfamethoxazole-trimethoprim
D. Lisinopril
Correct Answer: C (Sulfamethoxazole-trimethoprim)
Rationale: Sulfamethoxazole-trimethoprim is a sulfonamide antibiotic, contraindicated in
patients with sulfa allergies due to risk of hypersensitivity reactions. NRNP 6540, 2025,
p. 132.
3. A 68-year-old patient with hypertension reports dizziness. Blood pressure is 110/70
mmHg. Which medication is most likely causing this?
A. Amlodipine
B. Hydrochlorothiazide
C. Metoprolol
D. Losartan
Correct Answer: C (Metoprolol)
Rationale: Beta-blockers like metoprolol can cause hypotension and dizziness, especially
in older adults due to reduced cardiac output. NRNP 6540, 2025, p. 128.
4. What is the first-line treatment for uncomplicated urinary tract infection in an older
adult?
A. Ciprofloxacin
, 2
B. Nitrofurantoin
C. Amoxicillin
D. Doxycycline
Correct Answer: B (Nitrofurantoin)
Rationale: Nitrofurantoin is first-line for uncomplicated UTIs in older adults due to
efficacy and low resistance rates. NRNP 6540, 2025, p. 134.
5. A 75-year-old patient with type 2 diabetes has a hemoglobin A1c of 8.5%. What is
the next step?
A. Continue current regimen
B. Add metformin
C. Increase insulin dose
D. Order a fasting glucose test
Correct Answer: C (Increase insulin dose)
Rationale: An A1c of 8.5% indicates poor glycemic control. In older adults already on
insulin, increasing the dose is appropriate to achieve a target A1c of <7.5-8%. NRNP
6540, 2025, p. 142.
6. Which vaccine is recommended annually for adults over 65?
A. Tdap
B. Influenza
C. MMR
D. Hepatitis B
Correct Answer: B (Influenza)
Rationale: Annual influenza vaccination is recommended for adults over 65 to prevent
severe respiratory infections. NRNP 6540, 2025, p. 92.
7. A patient with chronic kidney disease (CKD) is prescribed lisinopril. What should
the nurse monitor?
A. Serum potassium
B. Blood glucose
C. Liver enzymes
D. Platelet count
Correct Answer: A (Serum potassium)
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia in CKD patients due to
reduced renal excretion. NRNP 6540, 2025, p. 130.
8. What is a hallmark symptom of pyelonephritis in an older adult?
A. Dysuria only
B. Fever and flank pain
C. Hematuria alone
D. Increased urinary frequency
Correct Answer: B (Fever and flank pain)
Rationale: Pyelonephritis presents with systemic symptoms like fever and flank pain,
distinguishing it from cystitis. NRNP 6540, 2025, p. 136.
9. A 70-year-old patient reports new-onset confusion. What is the nurse’s priority?
A. Administer lorazepam
B. Assess for delirium
C. Encourage rest
D. Order a head CT
, 3
Correct Answer: B (Assess for delirium)
Rationale: Confusion in older adults often indicates delirium, requiring assessment for
underlying causes (e.g., infection, medication). NRNP 6540, 2025, p. 108.
10. Which medication class is first-line for managing heart failure in older adults?
A. Beta-blockers
B. Calcium channel blockers
C. Diuretics
D. ACE inhibitors
Correct Answer: D (ACE inhibitors)
Rationale: ACE inhibitors reduce morbidity and mortality in heart failure by decreasing
preload and afterload. NRNP 6540, 2025, p. 124.
11. A 66-year-old patient with osteoarthritis reports increased pain. What is the first-
line pharmacological treatment?
A. Ibuprofen
B. Prednisone
C. Tramadol
D. Codeine
Correct Answer: A (Ibuprofen)
Rationale: NSAIDs like ibuprofen are first-line for osteoarthritis pain, with monitoring
for GI and renal side effects in older adults. NRNP 6540, 2025, p. 150.
12. What is a common side effect of statins in older adults?
A. Hypoglycemia
B. Muscle pain
C. Hypertension
D. Weight loss
Correct Answer: B (Muscle pain)
Rationale: Statins can cause myalgia or myopathy, particularly in older adults with
polypharmacy. NRNP 6540, 2025, p. 126.
13. A patient with COPD is prescribed albuterol. What should the nurse teach the
patient?
A. Take it once daily
B. Use as needed for shortness of breath
C. Avoid use with oxygen
D. Expect weight gain
Correct Answer: B (Use as needed for shortness of breath)
Rationale: Albuterol, a short-acting beta-agonist, is used PRN for acute COPD
symptoms like dyspnea. NRNP 6540, 2025, p. 120.
14. Which finding suggests dehydration in an older adult?
A. Increased skin turgor
B. Dry mucous membranes
C. Bradycardia
D. Hypertension
Correct Answer: B (Dry mucous membranes)
Rationale: Dry mucous membranes are a reliable sign of dehydration in older adults, as
skin turgor is less accurate due to age-related skin changes. NRNP 6540, 2025, p. 104.
NRNP 6540 Actual 2025 Final
Exam Questions and Answers
Guaranteed Pass
1. A 72-year-old patient reports weakness and difficulty urinating. The nurse performs
a urinalysis and CBC. Why is a thorough assessment necessary?
A. Symptoms are vague and may indicate aging
B. All body systems interact, and symptoms could indicate various diagnoses
C. The patient may not report all significant information
D. Only urinary symptoms require evaluation
Correct Answer: B (All body systems interact, and symptoms could indicate various
diagnoses)
Rationale: In older adults, symptoms like weakness and urinary issues may stem from
multiple interacting systems (e.g., dehydration, infection, or neurological issues). A
comprehensive assessment ensures accurate diagnosis. NRNP 6540, 2025, p. 12.
2. Which medication is contraindicated in a patient with a history of sulfa allergy?
A. Metformin
B. Furosemide
C. Sulfamethoxazole-trimethoprim
D. Lisinopril
Correct Answer: C (Sulfamethoxazole-trimethoprim)
Rationale: Sulfamethoxazole-trimethoprim is a sulfonamide antibiotic, contraindicated in
patients with sulfa allergies due to risk of hypersensitivity reactions. NRNP 6540, 2025,
p. 132.
3. A 68-year-old patient with hypertension reports dizziness. Blood pressure is 110/70
mmHg. Which medication is most likely causing this?
A. Amlodipine
B. Hydrochlorothiazide
C. Metoprolol
D. Losartan
Correct Answer: C (Metoprolol)
Rationale: Beta-blockers like metoprolol can cause hypotension and dizziness, especially
in older adults due to reduced cardiac output. NRNP 6540, 2025, p. 128.
4. What is the first-line treatment for uncomplicated urinary tract infection in an older
adult?
A. Ciprofloxacin
, 2
B. Nitrofurantoin
C. Amoxicillin
D. Doxycycline
Correct Answer: B (Nitrofurantoin)
Rationale: Nitrofurantoin is first-line for uncomplicated UTIs in older adults due to
efficacy and low resistance rates. NRNP 6540, 2025, p. 134.
5. A 75-year-old patient with type 2 diabetes has a hemoglobin A1c of 8.5%. What is
the next step?
A. Continue current regimen
B. Add metformin
C. Increase insulin dose
D. Order a fasting glucose test
Correct Answer: C (Increase insulin dose)
Rationale: An A1c of 8.5% indicates poor glycemic control. In older adults already on
insulin, increasing the dose is appropriate to achieve a target A1c of <7.5-8%. NRNP
6540, 2025, p. 142.
6. Which vaccine is recommended annually for adults over 65?
A. Tdap
B. Influenza
C. MMR
D. Hepatitis B
Correct Answer: B (Influenza)
Rationale: Annual influenza vaccination is recommended for adults over 65 to prevent
severe respiratory infections. NRNP 6540, 2025, p. 92.
7. A patient with chronic kidney disease (CKD) is prescribed lisinopril. What should
the nurse monitor?
A. Serum potassium
B. Blood glucose
C. Liver enzymes
D. Platelet count
Correct Answer: A (Serum potassium)
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia in CKD patients due to
reduced renal excretion. NRNP 6540, 2025, p. 130.
8. What is a hallmark symptom of pyelonephritis in an older adult?
A. Dysuria only
B. Fever and flank pain
C. Hematuria alone
D. Increased urinary frequency
Correct Answer: B (Fever and flank pain)
Rationale: Pyelonephritis presents with systemic symptoms like fever and flank pain,
distinguishing it from cystitis. NRNP 6540, 2025, p. 136.
9. A 70-year-old patient reports new-onset confusion. What is the nurse’s priority?
A. Administer lorazepam
B. Assess for delirium
C. Encourage rest
D. Order a head CT
, 3
Correct Answer: B (Assess for delirium)
Rationale: Confusion in older adults often indicates delirium, requiring assessment for
underlying causes (e.g., infection, medication). NRNP 6540, 2025, p. 108.
10. Which medication class is first-line for managing heart failure in older adults?
A. Beta-blockers
B. Calcium channel blockers
C. Diuretics
D. ACE inhibitors
Correct Answer: D (ACE inhibitors)
Rationale: ACE inhibitors reduce morbidity and mortality in heart failure by decreasing
preload and afterload. NRNP 6540, 2025, p. 124.
11. A 66-year-old patient with osteoarthritis reports increased pain. What is the first-
line pharmacological treatment?
A. Ibuprofen
B. Prednisone
C. Tramadol
D. Codeine
Correct Answer: A (Ibuprofen)
Rationale: NSAIDs like ibuprofen are first-line for osteoarthritis pain, with monitoring
for GI and renal side effects in older adults. NRNP 6540, 2025, p. 150.
12. What is a common side effect of statins in older adults?
A. Hypoglycemia
B. Muscle pain
C. Hypertension
D. Weight loss
Correct Answer: B (Muscle pain)
Rationale: Statins can cause myalgia or myopathy, particularly in older adults with
polypharmacy. NRNP 6540, 2025, p. 126.
13. A patient with COPD is prescribed albuterol. What should the nurse teach the
patient?
A. Take it once daily
B. Use as needed for shortness of breath
C. Avoid use with oxygen
D. Expect weight gain
Correct Answer: B (Use as needed for shortness of breath)
Rationale: Albuterol, a short-acting beta-agonist, is used PRN for acute COPD
symptoms like dyspnea. NRNP 6540, 2025, p. 120.
14. Which finding suggests dehydration in an older adult?
A. Increased skin turgor
B. Dry mucous membranes
C. Bradycardia
D. Hypertension
Correct Answer: B (Dry mucous membranes)
Rationale: Dry mucous membranes are a reliable sign of dehydration in older adults, as
skin turgor is less accurate due to age-related skin changes. NRNP 6540, 2025, p. 104.
