NRNP 6540 FINAL EXAM LATEST ACTUAL
EXAM WITH QUESTIONS AND CORRECT
ANSWERS AND DETAILED RATIONALES
GRADED A+
1. A 76-year-old female presents with an unhealed leg wound
from a fall one month ago. Physical exam reveals clean,
approximated wound edges with surrounding mild erythema
and tenderness, but no purulent drainage or systemic signs.
Which statement best explains this delayed healing to the
patient?
A. Malnutrition is preventing proper tissue assembly.
B. Prophylactic oral antibiotics are required immediately to clear
subclinical infection.
C. Skin renewal turnover time increases to approximately 87 days
in older adults compared to 20 days in youth.
D. A short course of topical corticosteroid ointment will accelerate
skin closure.
Correct Answer: C
Rationale: Skin cell renewal turnover time lengthens significantly
with age—from approximately 20 days in young individuals to
about 87 days in older adults—leading to slower wound healing.
In the absence of clinical signs of infection, prophylactic
antibiotics or unproven therapies are inappropriate.
,2. While conducting rounds in a long-term care facility, a
nurse practitioner notes that an 85-year-old patient has
excoriated arms and skin shearing near the elbows. What
physiological change of aging primarily contributes to this
vulnerability?
A. Loss of bone density in the distal upper extremities.
B. Redistribution of subcutaneous fat to the abdomen and thighs,
leaving bony prominences exposed to friction and pressure.
C. Severe weight loss causing muscle wasting and gait instability.
D. Psychogenic picking behaviors secondary to cognitive
impairment.
Correct Answer: B
Rationale: As individuals age, subcutaneous fat shifts away from
the face, hands, and peripheral areas toward the abdomen and
thighs, leaving bony surfaces vulnerable to shearing forces,
friction, and pressure injury.
3. An 91-year-old resident presents with multiple lacerations
and ecchymoses across both forearms. While skin fragility
accounts for easy bruising, why must the clinician
investigate further?
A. Skin markings are always benign signs of normal senescent
changes.
B. Lacerations and unexplained bruising can be key indicators of
caregiver inadequacy or maltreatment.
C. Skin tears indicate immediate progression to systemic
hematologic failure.
,D. The presence of bruising confirms physical abuse without
requiring additional evidence.
Correct Answer: B
Rationale: Although fragile blood vessels make older adults
prone to bruising, distinct or poorly healing lesions and lacerations
can signal insufficient caregiving or abuse, requiring thorough
assessment.
4. Upon evaluating a patient's lower extremity, a clinician
identifies an infected lesion that formed over a pre-existing
abrasion. How is a secondary lesion defined?
A. A lesion that arises directly from structural changes or
complications within a primary lesion.
B. A malignant transformation caused by systemic bacterial
toxins.
C. An unavoidable dermal change inherent to the normal
chronological aging process.
D. A skin lesion that develops exclusively due to underlying
systemic organ failure.
Correct Answer: A
Rationale: Secondary lesions result from modification, infection,
or trauma affecting a pre-existing primary lesion.
5. An 88-year-old patient presents with a nodular skin growth
on the dorsal surface of her hand that she wants evaluated.
Which clinical feature most strongly warrants obtaining a
diagnostic skin biopsy?
A. The growth impedes her ability to wear rings comfortably.
, B. The growth has recently altered in size, started bleeding, or
become painful.
C. The lesion appeared following a minor superficial scrape.
D. The patient reports recently switching to a new laundry
detergent.
Correct Answer: B
Rationale: Biopsy is indicated when a lesion shows red-flag
characteristics for malignancy, such as changes in color/size,
pain, or spontaneous bleeding.
6. A 60-year-old male arrives at an urgent care clinic after a
campfire incident. Examination of his left arm reveals an area
of red, tender skin alongside an adjacent region displaying
fluid-filled blisters. How should these burn areas be
classified?
A. First-degree burn only
B. Second-degree burn only
C. First- and second-degree burns
D. Second- and third-degree burns
Correct Answer: C
Rationale: Erythematous, painful skin without blistering
characterizes a first-degree superficial burn, while blister
formation involving the dermal layer indicates a second-degree
burn.
7. Which intervention represents a primary prevention
strategy for an 80-year-old patient who continues to smoke
cigarettes in bed?
EXAM WITH QUESTIONS AND CORRECT
ANSWERS AND DETAILED RATIONALES
GRADED A+
1. A 76-year-old female presents with an unhealed leg wound
from a fall one month ago. Physical exam reveals clean,
approximated wound edges with surrounding mild erythema
and tenderness, but no purulent drainage or systemic signs.
Which statement best explains this delayed healing to the
patient?
A. Malnutrition is preventing proper tissue assembly.
B. Prophylactic oral antibiotics are required immediately to clear
subclinical infection.
C. Skin renewal turnover time increases to approximately 87 days
in older adults compared to 20 days in youth.
D. A short course of topical corticosteroid ointment will accelerate
skin closure.
Correct Answer: C
Rationale: Skin cell renewal turnover time lengthens significantly
with age—from approximately 20 days in young individuals to
about 87 days in older adults—leading to slower wound healing.
In the absence of clinical signs of infection, prophylactic
antibiotics or unproven therapies are inappropriate.
,2. While conducting rounds in a long-term care facility, a
nurse practitioner notes that an 85-year-old patient has
excoriated arms and skin shearing near the elbows. What
physiological change of aging primarily contributes to this
vulnerability?
A. Loss of bone density in the distal upper extremities.
B. Redistribution of subcutaneous fat to the abdomen and thighs,
leaving bony prominences exposed to friction and pressure.
C. Severe weight loss causing muscle wasting and gait instability.
D. Psychogenic picking behaviors secondary to cognitive
impairment.
Correct Answer: B
Rationale: As individuals age, subcutaneous fat shifts away from
the face, hands, and peripheral areas toward the abdomen and
thighs, leaving bony surfaces vulnerable to shearing forces,
friction, and pressure injury.
3. An 91-year-old resident presents with multiple lacerations
and ecchymoses across both forearms. While skin fragility
accounts for easy bruising, why must the clinician
investigate further?
A. Skin markings are always benign signs of normal senescent
changes.
B. Lacerations and unexplained bruising can be key indicators of
caregiver inadequacy or maltreatment.
C. Skin tears indicate immediate progression to systemic
hematologic failure.
,D. The presence of bruising confirms physical abuse without
requiring additional evidence.
Correct Answer: B
Rationale: Although fragile blood vessels make older adults
prone to bruising, distinct or poorly healing lesions and lacerations
can signal insufficient caregiving or abuse, requiring thorough
assessment.
4. Upon evaluating a patient's lower extremity, a clinician
identifies an infected lesion that formed over a pre-existing
abrasion. How is a secondary lesion defined?
A. A lesion that arises directly from structural changes or
complications within a primary lesion.
B. A malignant transformation caused by systemic bacterial
toxins.
C. An unavoidable dermal change inherent to the normal
chronological aging process.
D. A skin lesion that develops exclusively due to underlying
systemic organ failure.
Correct Answer: A
Rationale: Secondary lesions result from modification, infection,
or trauma affecting a pre-existing primary lesion.
5. An 88-year-old patient presents with a nodular skin growth
on the dorsal surface of her hand that she wants evaluated.
Which clinical feature most strongly warrants obtaining a
diagnostic skin biopsy?
A. The growth impedes her ability to wear rings comfortably.
, B. The growth has recently altered in size, started bleeding, or
become painful.
C. The lesion appeared following a minor superficial scrape.
D. The patient reports recently switching to a new laundry
detergent.
Correct Answer: B
Rationale: Biopsy is indicated when a lesion shows red-flag
characteristics for malignancy, such as changes in color/size,
pain, or spontaneous bleeding.
6. A 60-year-old male arrives at an urgent care clinic after a
campfire incident. Examination of his left arm reveals an area
of red, tender skin alongside an adjacent region displaying
fluid-filled blisters. How should these burn areas be
classified?
A. First-degree burn only
B. Second-degree burn only
C. First- and second-degree burns
D. Second- and third-degree burns
Correct Answer: C
Rationale: Erythematous, painful skin without blistering
characterizes a first-degree superficial burn, while blister
formation involving the dermal layer indicates a second-degree
burn.
7. Which intervention represents a primary prevention
strategy for an 80-year-old patient who continues to smoke
cigarettes in bed?
