NSG6020 Advanced Health Assessment
and Diagnostic Reasoning
Week 9 Comprehensive Examination
Geriatric and Older Adult Health Assessment
Questions and Answers Updated ()
Verified Answers with Advanced Practice Nursing Rationales
55 Multiple-Choice Questions | 6 Content Sections
Cognitive Levels: 25% Recall | 50% Application | 25% Analysis
,Section 1: Comprehensive Geriatric Assessment (Physical, Cognitive,
Functional, Psychological, and Social Assessment) - Q1-15
Q1. A 78-year-old female presents to the clinic for her annual wellness visit. The advanced practice nurse (APN)
plans to perform a comprehensive geriatric assessment (CGA). Which of the following domains is NOT a
standard component of a CGA?
A. Cardiovascular stress testing with echocardiography [CORRECT]
B. Functional status assessment including ADLs and IADLs
C. Cognitive screening using validated instruments
D. Medication review with polypharmacy evaluation
Correct Answer: A
Rationale: Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process designed to
determine an older person's medical, psychological, and functional capabilities. Standard CGA domains include physical
health, functional status (ADLs/IADLs), cognitive assessment, psychological status (depression screening), social support,
and environmental safety. Cardiovascular stress testing with echocardiography is a specialized diagnostic procedure, not a
standard CGA component. The CGA focuses on geriatric-specific functional and cognitive evaluation rather than
organ-specific diagnostic testing.
Q2. During a comprehensive geriatric assessment, the APN uses the Katz Index of Activities of Daily Living
(ADLs). Which of the following activities is included in the Katz Index?
A. Managing finances
B. Bathing [CORRECT]
C. Shopping for groceries
D. Using the telephone
Correct Answer: B
Rationale: The Katz Index of ADLs assesses six fundamental self-care activities: bathing, dressing, toileting, transferring,
continence, and feeding. Managing finances, shopping, and using the telephone are instrumental activities of daily living
(IADLs) measured by the Lawton IADL Scale, not the Katz Index. Differentiating between ADLs and IADLs is critical for
APNs because loss of ADLs indicates greater functional decline and dependency than loss of IADLs alone.
Q3. An 82-year-old patient is being assessed using the Lawton Instrumental Activities of Daily Living (IADL)
Scale. The APN notes the patient is unable to manage medications, prepare meals, or use the telephone
independently. These findings suggest the patient has difficulty in which of the following areas?
A. Basic self-care tasks necessary for survival
B. Complex tasks requiring higher-order cognitive and organizational abilities [CORRECT]
C. Physical mobility and ambulation capacity
D. Psychological adjustment and coping mechanisms
Correct Answer: B
Rationale: The Lawton IADL Scale measures eight instrumental activities: ability to use the telephone, shopping, food
preparation, housekeeping, laundry, transportation, medication management, and ability to handle finances. These tasks
require higher-order cognitive processing, executive function, and organizational ability compared to basic ADLs. Difficulty
, with IADLs often represents early cognitive decline or functional impairment. Loss of IADLs typically precedes loss of ADLs
in progressive conditions such as dementia.
Q4. The APN is conducting a social assessment as part of a CGA for a 75-year-old widower who lives alone.
Which of the following is the most appropriate screening tool to evaluate this patient for social isolation?
A. Mini-Mental State Examination (MMSE)
B. Lubben Social Network Scale (LSNS-6) [CORRECT]
C. Geriatric Depression Scale (GDS-15)
D. Timed Up and Go (TUG) test
Correct Answer: B
Rationale: The Lubben Social Network Scale (LSNS-6) is a validated, brief instrument specifically designed to assess social
isolation and social support in older adults. It measures the size and closeness of the patient's social network including family
and friends. The MMSE assesses cognitive function, the GDS screens for depression, and the TUG evaluates mobility and
fall risk. Social isolation is a significant geriatric syndrome associated with increased morbidity, mortality, and healthcare
utilization, making its assessment essential in every CGA.
Q5. A 70-year-old male is brought to the clinic by his daughter, who reports he has become increasingly
forgetful over the past six months. The APN selects the Montreal Cognitive Assessment (MoCA) for initial
cognitive screening. Which of the following best describes an advantage of the MoCA over the Mini-Mental
State Examination (MMSE)?
A. The MoCA takes significantly less time to administer
B. The MoCA is more sensitive for detecting mild cognitive impairment (MCI) [CORRECT]
C. The MoCA does not require any patient participation
D. The MoCA screens for depression simultaneously with cognition
Correct Answer: B
Rationale: The MoCA was specifically developed to be more sensitive than the MMSE for detecting mild cognitive
impairment (MCI), which the MMSE often misses. While the MMSE is better known, it has limited sensitivity for identifying
early cognitive changes. The MoCA assesses multiple cognitive domains including attention, executive function, memory,
language, visuospatial skills, and abstraction. A MoCA score below 26 out of 30 suggests cognitive impairment, and one
point is added for patients with 12 or fewer years of formal education to adjust for educational attainment.
Q6. During a CGA, the APN assesses the nutritional status of an 85-year-old female who appears thin and
reports a 15-pound weight loss over the past year. Which screening tool is most appropriate for initial nutritional
risk assessment in this patient?
A. Mini Nutritional Assessment (MNA) [CORRECT]
B. Body Mass Index (BMI) alone
C. 24-hour dietary recall
D. Complete blood count (CBC)
Correct Answer: A
Rationale: The Mini Nutritional Assessment (MNA) is a validated, widely used screening tool specifically designed for older
adults that evaluates nutritional status through 18 items covering anthropometric measurements, dietary intake, and global
assessment. While BMI and dietary recall provide useful information, the MNA provides a comprehensive, geriatric-specific
and Diagnostic Reasoning
Week 9 Comprehensive Examination
Geriatric and Older Adult Health Assessment
Questions and Answers Updated ()
Verified Answers with Advanced Practice Nursing Rationales
55 Multiple-Choice Questions | 6 Content Sections
Cognitive Levels: 25% Recall | 50% Application | 25% Analysis
,Section 1: Comprehensive Geriatric Assessment (Physical, Cognitive,
Functional, Psychological, and Social Assessment) - Q1-15
Q1. A 78-year-old female presents to the clinic for her annual wellness visit. The advanced practice nurse (APN)
plans to perform a comprehensive geriatric assessment (CGA). Which of the following domains is NOT a
standard component of a CGA?
A. Cardiovascular stress testing with echocardiography [CORRECT]
B. Functional status assessment including ADLs and IADLs
C. Cognitive screening using validated instruments
D. Medication review with polypharmacy evaluation
Correct Answer: A
Rationale: Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process designed to
determine an older person's medical, psychological, and functional capabilities. Standard CGA domains include physical
health, functional status (ADLs/IADLs), cognitive assessment, psychological status (depression screening), social support,
and environmental safety. Cardiovascular stress testing with echocardiography is a specialized diagnostic procedure, not a
standard CGA component. The CGA focuses on geriatric-specific functional and cognitive evaluation rather than
organ-specific diagnostic testing.
Q2. During a comprehensive geriatric assessment, the APN uses the Katz Index of Activities of Daily Living
(ADLs). Which of the following activities is included in the Katz Index?
A. Managing finances
B. Bathing [CORRECT]
C. Shopping for groceries
D. Using the telephone
Correct Answer: B
Rationale: The Katz Index of ADLs assesses six fundamental self-care activities: bathing, dressing, toileting, transferring,
continence, and feeding. Managing finances, shopping, and using the telephone are instrumental activities of daily living
(IADLs) measured by the Lawton IADL Scale, not the Katz Index. Differentiating between ADLs and IADLs is critical for
APNs because loss of ADLs indicates greater functional decline and dependency than loss of IADLs alone.
Q3. An 82-year-old patient is being assessed using the Lawton Instrumental Activities of Daily Living (IADL)
Scale. The APN notes the patient is unable to manage medications, prepare meals, or use the telephone
independently. These findings suggest the patient has difficulty in which of the following areas?
A. Basic self-care tasks necessary for survival
B. Complex tasks requiring higher-order cognitive and organizational abilities [CORRECT]
C. Physical mobility and ambulation capacity
D. Psychological adjustment and coping mechanisms
Correct Answer: B
Rationale: The Lawton IADL Scale measures eight instrumental activities: ability to use the telephone, shopping, food
preparation, housekeeping, laundry, transportation, medication management, and ability to handle finances. These tasks
require higher-order cognitive processing, executive function, and organizational ability compared to basic ADLs. Difficulty
, with IADLs often represents early cognitive decline or functional impairment. Loss of IADLs typically precedes loss of ADLs
in progressive conditions such as dementia.
Q4. The APN is conducting a social assessment as part of a CGA for a 75-year-old widower who lives alone.
Which of the following is the most appropriate screening tool to evaluate this patient for social isolation?
A. Mini-Mental State Examination (MMSE)
B. Lubben Social Network Scale (LSNS-6) [CORRECT]
C. Geriatric Depression Scale (GDS-15)
D. Timed Up and Go (TUG) test
Correct Answer: B
Rationale: The Lubben Social Network Scale (LSNS-6) is a validated, brief instrument specifically designed to assess social
isolation and social support in older adults. It measures the size and closeness of the patient's social network including family
and friends. The MMSE assesses cognitive function, the GDS screens for depression, and the TUG evaluates mobility and
fall risk. Social isolation is a significant geriatric syndrome associated with increased morbidity, mortality, and healthcare
utilization, making its assessment essential in every CGA.
Q5. A 70-year-old male is brought to the clinic by his daughter, who reports he has become increasingly
forgetful over the past six months. The APN selects the Montreal Cognitive Assessment (MoCA) for initial
cognitive screening. Which of the following best describes an advantage of the MoCA over the Mini-Mental
State Examination (MMSE)?
A. The MoCA takes significantly less time to administer
B. The MoCA is more sensitive for detecting mild cognitive impairment (MCI) [CORRECT]
C. The MoCA does not require any patient participation
D. The MoCA screens for depression simultaneously with cognition
Correct Answer: B
Rationale: The MoCA was specifically developed to be more sensitive than the MMSE for detecting mild cognitive
impairment (MCI), which the MMSE often misses. While the MMSE is better known, it has limited sensitivity for identifying
early cognitive changes. The MoCA assesses multiple cognitive domains including attention, executive function, memory,
language, visuospatial skills, and abstraction. A MoCA score below 26 out of 30 suggests cognitive impairment, and one
point is added for patients with 12 or fewer years of formal education to adjust for educational attainment.
Q6. During a CGA, the APN assesses the nutritional status of an 85-year-old female who appears thin and
reports a 15-pound weight loss over the past year. Which screening tool is most appropriate for initial nutritional
risk assessment in this patient?
A. Mini Nutritional Assessment (MNA) [CORRECT]
B. Body Mass Index (BMI) alone
C. 24-hour dietary recall
D. Complete blood count (CBC)
Correct Answer: A
Rationale: The Mini Nutritional Assessment (MNA) is a validated, widely used screening tool specifically designed for older
adults that evaluates nutritional status through 18 items covering anthropometric measurements, dietary intake, and global
assessment. While BMI and dietary recall provide useful information, the MNA provides a comprehensive, geriatric-specific
