NRNP 6540 MIDTERM EXAM – EXAM QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALE | 2027 Q&A | INSTANT DOWNLOAD PDF
1. An older adult reports decreased appetite and a 6-kg unintentional weight loss
over the past 6 months. Which finding most strongly suggests clinically significant
nutritional risk?
A. Preference for smaller meals
B. Occasional constipation
C. Unintentional weight loss with reduced food intake
D. Increased fluid consumption
Rationale: Unintentional weight loss combined with reduced intake is an important indicator of
malnutrition risk in older adults. It warrants further nutritional assessment rather than
reassurance based solely on body weight.
2. During a comprehensive geriatric assessment, which area distinguishes it from a
routine physical examination?
A. Evaluation of medical, functional, cognitive, psychological, and social domains
B. Assessment of vital signs without functional screening
C. Review of only the patient's current medications
D. Evaluation of only the chief complaint
Rationale: Comprehensive geriatric assessment evaluates multiple interacting domains that
influence an older adult's health, independence, and quality of life. A routine examination
generally has a narrower clinical focus.
3. An older patient has difficulty managing finances, preparing meals, and arranging
transportation but can bathe and dress independently. Which interpretation is
most appropriate?
A. The patient has impaired basic activities of daily living
B. The patient has delirium
C. The patient has impaired cognition by definition
D. The patient has limitations in instrumental activities of daily living
Rationale: Instrumental activities of daily living include complex tasks such as finances,
transportation, shopping, cooking, and medication management. Basic ADLs include bathing,
dressing, toileting, transferring, feeding, and continence.
4. Which assessment finding is most suggestive of frailty rather than normal
physiologic aging?
,A. Mild presbyopia
B. Unintentional weight loss, weakness, and reduced physical activity
C. Slightly slower reaction time
D. Decreased skin elasticity
Rationale: Frailty is characterized by increased vulnerability to stressors and commonly
includes weakness, exhaustion, weight loss, and reduced activity. Normal aging alone does not
explain a cluster of these findings.
5. A clinician wants to screen an older adult for nutritional problems efficiently
during an outpatient visit. Which tool is most appropriate?
A. Mini-Cog
B. Timed Up and Go
C. Mini Nutritional Assessment
D. Geriatric Depression Scale
Rationale: The Mini Nutritional Assessment is specifically designed to identify malnutrition or
risk of malnutrition in older adults. The other tools evaluate cognition, mobility, or mood.
6. An older adult has a BMI within the traditionally accepted normal range but has
lost 8% of body weight unintentionally over several months. How should the
clinician interpret this finding?
A. Nutritional risk is unlikely because BMI is normal
B. The weight change is expected with aging
C. The patient should simply be encouraged to exercise more
D. The unintentional weight loss warrants evaluation for nutritional and medical causes
Rationale: BMI alone does not exclude malnutrition. Significant unintentional weight loss may
reflect inadequate intake, disease, medication effects, depression, swallowing problems, or
social factors.
7. Which situation best illustrates ageism in healthcare?
A. Adjusting medication doses for reduced renal function
B. Screening for fall risk
C. Assuming an older patient's symptoms are unavoidable because of age
D. Asking about the patient's functional goals
Rationale: Ageism involves stereotypes, prejudice, or discriminatory assumptions based on age.
Attributing potentially treatable symptoms solely to aging can delay diagnosis and appropriate
treatment.
8. An older adult says, “There is no point in exercising because I am already old.”
Which response best promotes behavior change?
, A. “Exercise is mandatory at your age.”
B. “Let's identify an activity you enjoy and set a realistic starting goal.”
C. “You should exercise for an hour every day.”
D. “Your family should make sure you exercise.”
Rationale: Motivational approaches are more effective when they respect autonomy and connect
activity with the patient's preferences and achievable goals. Collaborative goal setting can
improve adherence.
9. Which physiological change associated with aging most directly increases
concern about dehydration?
A. Increased total body water
B. Increased thirst sensation
C. Increased renal concentrating ability
D. Reduced total body water and diminished thirst response
Rationale: Older adults may have less total body water and a blunted thirst response, increasing
susceptibility to dehydration, particularly during illness, heat exposure, or reduced access to
fluids.
10. An older adult becomes acutely confused over several hours after developing a
urinary infection. Which feature most strongly favors delirium?
A. Gradual decline over several years
B. Stable short-term memory impairment
C. Acute onset with fluctuating attention and awareness
D. Long-standing difficulty finding words
Rationale: Delirium is characterized by an acute and fluctuating disturbance in attention and
awareness. Dementia generally develops more gradually and does not typically fluctuate
dramatically over hours.
11. A patient with cognitive impairment repeatedly attempts to leave the clinic
because she believes she needs to “go home.” Which initial approach is most
appropriate?
A. Physically restrain the patient
B. Argue that she is already home
C. Ignore the behavior
D. Assess for unmet needs, environmental triggers, and potential causes of wandering
Rationale: Wandering can reflect unmet needs, anxiety, confusion, environmental cues, or
attempts to reach a familiar place. Identifying and addressing the underlying trigger is safer
than confrontation or unnecessary restraint.
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALE | 2027 Q&A | INSTANT DOWNLOAD PDF
1. An older adult reports decreased appetite and a 6-kg unintentional weight loss
over the past 6 months. Which finding most strongly suggests clinically significant
nutritional risk?
A. Preference for smaller meals
B. Occasional constipation
C. Unintentional weight loss with reduced food intake
D. Increased fluid consumption
Rationale: Unintentional weight loss combined with reduced intake is an important indicator of
malnutrition risk in older adults. It warrants further nutritional assessment rather than
reassurance based solely on body weight.
2. During a comprehensive geriatric assessment, which area distinguishes it from a
routine physical examination?
A. Evaluation of medical, functional, cognitive, psychological, and social domains
B. Assessment of vital signs without functional screening
C. Review of only the patient's current medications
D. Evaluation of only the chief complaint
Rationale: Comprehensive geriatric assessment evaluates multiple interacting domains that
influence an older adult's health, independence, and quality of life. A routine examination
generally has a narrower clinical focus.
3. An older patient has difficulty managing finances, preparing meals, and arranging
transportation but can bathe and dress independently. Which interpretation is
most appropriate?
A. The patient has impaired basic activities of daily living
B. The patient has delirium
C. The patient has impaired cognition by definition
D. The patient has limitations in instrumental activities of daily living
Rationale: Instrumental activities of daily living include complex tasks such as finances,
transportation, shopping, cooking, and medication management. Basic ADLs include bathing,
dressing, toileting, transferring, feeding, and continence.
4. Which assessment finding is most suggestive of frailty rather than normal
physiologic aging?
,A. Mild presbyopia
B. Unintentional weight loss, weakness, and reduced physical activity
C. Slightly slower reaction time
D. Decreased skin elasticity
Rationale: Frailty is characterized by increased vulnerability to stressors and commonly
includes weakness, exhaustion, weight loss, and reduced activity. Normal aging alone does not
explain a cluster of these findings.
5. A clinician wants to screen an older adult for nutritional problems efficiently
during an outpatient visit. Which tool is most appropriate?
A. Mini-Cog
B. Timed Up and Go
C. Mini Nutritional Assessment
D. Geriatric Depression Scale
Rationale: The Mini Nutritional Assessment is specifically designed to identify malnutrition or
risk of malnutrition in older adults. The other tools evaluate cognition, mobility, or mood.
6. An older adult has a BMI within the traditionally accepted normal range but has
lost 8% of body weight unintentionally over several months. How should the
clinician interpret this finding?
A. Nutritional risk is unlikely because BMI is normal
B. The weight change is expected with aging
C. The patient should simply be encouraged to exercise more
D. The unintentional weight loss warrants evaluation for nutritional and medical causes
Rationale: BMI alone does not exclude malnutrition. Significant unintentional weight loss may
reflect inadequate intake, disease, medication effects, depression, swallowing problems, or
social factors.
7. Which situation best illustrates ageism in healthcare?
A. Adjusting medication doses for reduced renal function
B. Screening for fall risk
C. Assuming an older patient's symptoms are unavoidable because of age
D. Asking about the patient's functional goals
Rationale: Ageism involves stereotypes, prejudice, or discriminatory assumptions based on age.
Attributing potentially treatable symptoms solely to aging can delay diagnosis and appropriate
treatment.
8. An older adult says, “There is no point in exercising because I am already old.”
Which response best promotes behavior change?
, A. “Exercise is mandatory at your age.”
B. “Let's identify an activity you enjoy and set a realistic starting goal.”
C. “You should exercise for an hour every day.”
D. “Your family should make sure you exercise.”
Rationale: Motivational approaches are more effective when they respect autonomy and connect
activity with the patient's preferences and achievable goals. Collaborative goal setting can
improve adherence.
9. Which physiological change associated with aging most directly increases
concern about dehydration?
A. Increased total body water
B. Increased thirst sensation
C. Increased renal concentrating ability
D. Reduced total body water and diminished thirst response
Rationale: Older adults may have less total body water and a blunted thirst response, increasing
susceptibility to dehydration, particularly during illness, heat exposure, or reduced access to
fluids.
10. An older adult becomes acutely confused over several hours after developing a
urinary infection. Which feature most strongly favors delirium?
A. Gradual decline over several years
B. Stable short-term memory impairment
C. Acute onset with fluctuating attention and awareness
D. Long-standing difficulty finding words
Rationale: Delirium is characterized by an acute and fluctuating disturbance in attention and
awareness. Dementia generally develops more gradually and does not typically fluctuate
dramatically over hours.
11. A patient with cognitive impairment repeatedly attempts to leave the clinic
because she believes she needs to “go home.” Which initial approach is most
appropriate?
A. Physically restrain the patient
B. Argue that she is already home
C. Ignore the behavior
D. Assess for unmet needs, environmental triggers, and potential causes of wandering
Rationale: Wandering can reflect unmet needs, anxiety, confusion, environmental cues, or
attempts to reach a familiar place. Identifying and addressing the underlying trigger is safer
than confrontation or unnecessary restraint.
