NRNP 6540 FINAL EXAM CHAMBERLAIN UNIVERSITY
ACTUAL EXAM QUESTIONS AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
Question 1
A 79-year-old woman is admitted with pneumonia. Her daughter reports that the
patient was oriented and independent at baseline but became disorganized and
repeatedly attempted to leave her room several hours after admission. The patient
alternates between periods of agitation and drowsiness. Which finding most
strongly supports a diagnosis of delirium rather than dementia?
A. Progressive difficulty managing finances over 18 months
B. Fluctuating attention and awareness developing over several hours
C. Increasing difficulty remembering familiar names over 2 years
D. Gradual decline in executive functioning and judgment
Answer: B
Rationale: Delirium is characterized by an acute onset and fluctuating disturbance
in attention and awareness. Dementia typically develops gradually over months to
years with progressive cognitive decline. Acute illness, hospitalization,
medications, hypoxia, and infection are common delirium precipitants in older
adults.
Question 2
An 82-year-old man presents for a comprehensive geriatric assessment. His wife
reports that he has unintentionally lost 12 lb during the past 6 months. He reports
fatigue, walks more slowly than he did last year, and spends most of the day sitting
in a chair. Grip strength is reduced. Which interpretation is most appropriate?
A. He meets criteria for frailty based on multiple physical deficits
B. He has dementia because functional activity has declined
C. He has normal age-related changes without evidence of a syndrome
D. He has depression because weight loss is present
,Answer: A
Rationale: The Fried frailty phenotype includes unintentional weight loss,
exhaustion, weakness/low grip strength, slow walking speed, and low physical
activity. Three or more criteria support frailty. Frailty is a physical syndrome and
should not automatically be attributed to normal aging, dementia, or depression.
Question 3
A 77-year-old patient with hypertension, chronic kidney disease, osteoarthritis, and
insomnia takes nine prescription medications and several over-the-counter
products. At today's visit, the patient reports dizziness and two recent falls. Which
medication-related issue should the nurse practitioner investigate first?
A. Potential anticholinergic medication burden
B. Adequacy of calcium supplementation
C. Daily vitamin B12 intake
D. Use of topical emollients
Answer: A
Rationale: Polypharmacy and medications with anticholinergic properties can
contribute to confusion, urinary retention, constipation, blurred vision, sedation,
and falls in older adults. A medication reconciliation should identify potentially
inappropriate medications and drug-drug or drug-disease interactions.
Question 4
An 86-year-old man with advanced dementia has become increasingly agitated
during evening hours. His daughter asks for a medication to "knock him out"
because she can no longer manage his behavior. Which intervention should be
recommended initially?
A. Begin a benzodiazepine at bedtime
B. Use a stimulant during the afternoon
C. Identify environmental and medical causes of agitation
D. Administer a sedating medication whenever he becomes restless
,Answer: C
Rationale: Behavioral symptoms in dementia should initially be managed with
nonpharmacologic interventions and assessment for reversible causes such as pain,
infection, constipation, urinary retention, medication effects, hunger, sleep
disruption, or environmental overstimulation. Sedating medications can increase
falls, cognitive impairment, and other adverse outcomes.
Question 5
An 81-year-old woman with cognitive impairment is being evaluated for possible
depression. She cannot reliably complete a conventional self-report depression
questionnaire because of her memory deficits. Which assessment tool is most
appropriate?
A. Mini-Cog
B. Cornell Scale for Depression in Dementia
C. Montreal Cognitive Assessment
D. Timed Up and Go test
Answer: B
Rationale: The Cornell Scale for Depression in Dementia is designed to assess
depressive symptoms in individuals with cognitive impairment and incorporates
information from observation and caregivers. The Mini-Cog and Montreal
Cognitive Assessment evaluate cognition, while the Timed Up and Go evaluates
mobility and fall risk.
Question 6
A 74-year-old patient reports becoming lightheaded when standing from a chair.
Blood pressure is 138/76 mm Hg while seated and 112/64 mm Hg after standing.
Which intervention is most appropriate?
A. Increase the patient's benzodiazepine dose at bedtime
B. Evaluate medications and hydration status
, C. Recommend prolonged bed rest
D. Restrict all oral fluids
Answer: B
Rationale: The substantial decline in blood pressure after standing is consistent
with orthostatic hypotension. Older adults with this problem should be assessed for
volume depletion and medications that lower blood pressure or impair autonomic
responses. Orthostatic hypotension is an important modifiable contributor to falls.
Question 7
A 90-year-old woman with advanced dementia has severe difficulty swallowing
and has experienced recurrent aspiration events. Her family asks whether
placement of a feeding tube will prevent aspiration and improve survival. Which
response is most appropriate?
A. "A feeding tube reliably prevents aspiration pneumonia."
B. "A feeding tube is expected to eliminate pressure injuries."
C. "Feeding tubes have not been shown to provide those benefits in advanced
dementia."
D. "A feeding tube should always be placed when oral intake decreases."
Answer: C
Rationale: In advanced dementia, feeding tubes have not demonstrated reliable
benefits in prolonging survival, preventing aspiration, or preventing pressure
injuries. Goals-of-care discussions should address comfort, individualized hand
feeding, advance directives, and the patient's previously expressed preferences.
ACTUAL EXAM QUESTIONS AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
Question 1
A 79-year-old woman is admitted with pneumonia. Her daughter reports that the
patient was oriented and independent at baseline but became disorganized and
repeatedly attempted to leave her room several hours after admission. The patient
alternates between periods of agitation and drowsiness. Which finding most
strongly supports a diagnosis of delirium rather than dementia?
A. Progressive difficulty managing finances over 18 months
B. Fluctuating attention and awareness developing over several hours
C. Increasing difficulty remembering familiar names over 2 years
D. Gradual decline in executive functioning and judgment
Answer: B
Rationale: Delirium is characterized by an acute onset and fluctuating disturbance
in attention and awareness. Dementia typically develops gradually over months to
years with progressive cognitive decline. Acute illness, hospitalization,
medications, hypoxia, and infection are common delirium precipitants in older
adults.
Question 2
An 82-year-old man presents for a comprehensive geriatric assessment. His wife
reports that he has unintentionally lost 12 lb during the past 6 months. He reports
fatigue, walks more slowly than he did last year, and spends most of the day sitting
in a chair. Grip strength is reduced. Which interpretation is most appropriate?
A. He meets criteria for frailty based on multiple physical deficits
B. He has dementia because functional activity has declined
C. He has normal age-related changes without evidence of a syndrome
D. He has depression because weight loss is present
,Answer: A
Rationale: The Fried frailty phenotype includes unintentional weight loss,
exhaustion, weakness/low grip strength, slow walking speed, and low physical
activity. Three or more criteria support frailty. Frailty is a physical syndrome and
should not automatically be attributed to normal aging, dementia, or depression.
Question 3
A 77-year-old patient with hypertension, chronic kidney disease, osteoarthritis, and
insomnia takes nine prescription medications and several over-the-counter
products. At today's visit, the patient reports dizziness and two recent falls. Which
medication-related issue should the nurse practitioner investigate first?
A. Potential anticholinergic medication burden
B. Adequacy of calcium supplementation
C. Daily vitamin B12 intake
D. Use of topical emollients
Answer: A
Rationale: Polypharmacy and medications with anticholinergic properties can
contribute to confusion, urinary retention, constipation, blurred vision, sedation,
and falls in older adults. A medication reconciliation should identify potentially
inappropriate medications and drug-drug or drug-disease interactions.
Question 4
An 86-year-old man with advanced dementia has become increasingly agitated
during evening hours. His daughter asks for a medication to "knock him out"
because she can no longer manage his behavior. Which intervention should be
recommended initially?
A. Begin a benzodiazepine at bedtime
B. Use a stimulant during the afternoon
C. Identify environmental and medical causes of agitation
D. Administer a sedating medication whenever he becomes restless
,Answer: C
Rationale: Behavioral symptoms in dementia should initially be managed with
nonpharmacologic interventions and assessment for reversible causes such as pain,
infection, constipation, urinary retention, medication effects, hunger, sleep
disruption, or environmental overstimulation. Sedating medications can increase
falls, cognitive impairment, and other adverse outcomes.
Question 5
An 81-year-old woman with cognitive impairment is being evaluated for possible
depression. She cannot reliably complete a conventional self-report depression
questionnaire because of her memory deficits. Which assessment tool is most
appropriate?
A. Mini-Cog
B. Cornell Scale for Depression in Dementia
C. Montreal Cognitive Assessment
D. Timed Up and Go test
Answer: B
Rationale: The Cornell Scale for Depression in Dementia is designed to assess
depressive symptoms in individuals with cognitive impairment and incorporates
information from observation and caregivers. The Mini-Cog and Montreal
Cognitive Assessment evaluate cognition, while the Timed Up and Go evaluates
mobility and fall risk.
Question 6
A 74-year-old patient reports becoming lightheaded when standing from a chair.
Blood pressure is 138/76 mm Hg while seated and 112/64 mm Hg after standing.
Which intervention is most appropriate?
A. Increase the patient's benzodiazepine dose at bedtime
B. Evaluate medications and hydration status
, C. Recommend prolonged bed rest
D. Restrict all oral fluids
Answer: B
Rationale: The substantial decline in blood pressure after standing is consistent
with orthostatic hypotension. Older adults with this problem should be assessed for
volume depletion and medications that lower blood pressure or impair autonomic
responses. Orthostatic hypotension is an important modifiable contributor to falls.
Question 7
A 90-year-old woman with advanced dementia has severe difficulty swallowing
and has experienced recurrent aspiration events. Her family asks whether
placement of a feeding tube will prevent aspiration and improve survival. Which
response is most appropriate?
A. "A feeding tube reliably prevents aspiration pneumonia."
B. "A feeding tube is expected to eliminate pressure injuries."
C. "Feeding tubes have not been shown to provide those benefits in advanced
dementia."
D. "A feeding tube should always be placed when oral intake decreases."
Answer: C
Rationale: In advanced dementia, feeding tubes have not demonstrated reliable
benefits in prolonging survival, preventing aspiration, or preventing pressure
injuries. Goals-of-care discussions should address comfort, individualized hand
feeding, advance directives, and the patient's previously expressed preferences.
