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NRNP 6540 Midterm Exam and Final Exam – Advanced Practice Care of Older Adults (Latest 2026/ 2027 Updates STUDY BUNDLE PACKAGE WITH SOLUTIONS) Questions and Answers
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NRNP 6540 Midterm Exam & Final Exam – Advanced Practice Care of Older Adults (Latest 2026/ 2027 Updates STUDY BUNDLE PACKAGE WITH SOLUTIONS) Questions & An...
swers| Grade A| 100% Correct (Verified Solutions)
NRNP 6540 Final Exam – Advanced Practice
Care of Older Adults | 2026/2027 | 250 Questions
and Correct Answers | Complete Exam PDF
2026 – 2027 EDITIO
...
N | ACTUAL QUESTIONS + CORRECT ANSWERS | COMPLETE EXAM
MATERIAL
High-Yield • Fully Updated • 100% Verified • Board-Style Scenarios
Includes:
Geriatric Syndromes • Chronic Disease Management • Pharmacology • Cognitive Disorders • Functional Assessment •
Acute & Long-Term Care
Exam Overview
Exam Structure
• 260 Total Questions
• Multiple-Choice Format
• Advanced, Case-Based Clinical Scenarios
• Timed Assessment (Board-Style)
• Designed to Identify Knowledge Gaps
Key Domains Covered
• Chronic Illness Management in Older Adults
• Geriatric Pharmacology & Polypharmacy Risks
• Cognitive Impairment & Dementia Care
• Functional, Mobility, & Fall-Risk Assessment
• End-of-Life & Palliative Considerations
• Acute Geriatric Emergencies
• Health Promotion & Disease Prevention
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Introduction
The NRNP 6540 Final Exam provides a comprehensive review of advanced practice concepts specific to the older
adult population. This exam mirrors the complexity and structure of graduate-level and certification-style assessments,
ensuring that learners build the diagnostic reasoning, clinical judgment, and evidence-based decision-making required
for excellence in geriatric care.
Achieving strong performance on this exam is closely associated with success in graduate NP coursework, clinical
rotations, and certification readiness.
Answer Format
• Questions are presented in bold, ensuring clarity and easy readability.
• Correct answers are displayed in GREEN, providing instant recognition.
• Reinforcing:
✔ Advanced geriatric assessment
✔ Pharmacologic reasoning
✔ Diagnostic accuracy
✔ Safe and effective patient care
This structure strengthens mastery of core NRNP 6540 topics and prepares students for real-world advanced practice
care.
What are the cervical cancer screening
recommendations
Age 21-65
> age 65 is not required
What are the requirements for counseling
patients > 65
Exercise, nutrition, tobacco, alcohol
What are the requirements of exercise for
patients 65
Aerobic exercise for 30 minutes three times a week Strength exercise two times a
week
What are the alcohol recommendations for an
adult
one per day for women Per day for men
What are the pneumonia immunization
recommendations for patients >65
Pcv13 first
PPS 23 one year later
What are the zoster immunization
recommendations
All patients over the age of 60-regardless if they have had shingles or chicken pox in the past
Contraindications-allergy to neomycin or gelatin Bone marrow
cancer - such as lymphoma Current chemotherapy or steroids
AIDS patients
3/
23
the major impact of the physiological changes that occur Reduced physiological Reserve-Particularly the cardiac, respiratory, and renal
with aging is systems
Reduced homeostatic mechanisms-That fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance
Changes in the sympathetic response-which contribute to orthostasis and Falls as well as a lack of hypoglycemic response
Impaired immunologic response
the strongest evidence regarding normal
physiological aging is available through
Longitudinal studies
the following statements are true about
laboratory values in older adults
Reference ranges are preferable
Normal ranges may not be applicable for older adults Reference ranges are not
necessarily acceptable values
biochemical individuality is best described as Each individual's variation is often much smaller than that of a larger group
polypharmacy is best described as Even a single med if there is not a clear indication for its use
pharmacokinetic changes with aging is reflective
of
What the body does to the drug
All of the following statements are false about
drug absorption except
Underlying chronic disease has little impact on drug absorption
all of the following statements are true about drug drugs distributed in fat have less intense, more prolonged effect
distribution in the elderly
drugs highly protein bound have greater potential to cause an adverse drug reaction
the fastest way to deliver a drug to the action site is by inhalation
men have faster and more efficient biotransformation of
drugs and this is thought to be due to
testosterone
the cytochrome P system involves enzymes that are generally Inhibited or induced by drugs
a statement not shown to be true about pharmacodynamics
changes with aging
and hand sensitivity to central nervous system drugs
drug responsiveness can be influenced by patients activity level decreased
sensitivity to beta blockers
they do not have a decrease sensitivity to oral anticoagulants
a typical presentation of disease in the elderly is reflected by
all of the following
infection without fever
depression without dysphoric mood
cardiac manifestations of thyroid disease
4/
23
functional abilities are best assessed by Observed assessment of function
What is a reference range in laboratory values How age or sexcan attribute to
The leading cause of death in elderly Travelers worldwide Accidents
What should be avoided in countries where food and water
precautions are to be observed
Salad buffet
What insect precautions are not necessary to prevent
insect-born diseases in the tropics
Using 100% DEET on skin to prevent bites
What is an example of a secondary prevention you could
recommend order for older adults
Check for a fecal occult blood
Ali is a 72-year-old man who recently came to the US from
Nigeria. He reports having BCG vaccination as a child.
Which of the following is correct regarding a TB skin test
Vaccination history is irrelevant, read as usual
A 72-year-old woman and her husband are on a cross
country driving Vacation. After a long day of driving, they
stopped for dinner. Midway through the meal the woman
becomes very short of breath, with chest pain and a feeling of
panic which of the problems is most likely
Pulmonary embolism
Ivan is a 65-year-old man who is new to your practice. He is
a history of COPD, CID, hypertension, and type 2 diabetes.
He has no immunization since his discharge from the military
at age 25. Childhood diseases include chicken pox, measles,
mom's, and German Measles. He prevents for a disease
management visit. Which of the following immunizations
would you recommend for Ivan
Tdap, pneumococcal, influenza, zostovax
Personal health history includes smoking one pack per day,
consuming a case of beer every weekend and working as an
assembler for the past 10 years. Family history is first grew
relatives include hypertension, high cholesterol, heart attack,
and type 2 diabetes. Leo's BMI is 32, BP today is 1:30 over 86
you order a fasting glucose, lipid profile of
Secondary prevention
A local chapter of a nurse practitioner organization has
begun planning a community-based screening for
hypertension at a local congregate living facility. This
population was selected on the basis of
A recognized element of high risk within this group
Performing range of motion exercises on a client who has
had a stroke is an example of which level of prevention
Tertiary prevention
The nurse practitioner demonstrates an understanding of
primary prevention of Falls among the elderly through
which management plan
Provide information about medications, side effects, and interactions
5/
23
An example of an active strategy of health promotion for an
individual to accomplish would be
Beginning a Stress Management program
You are working with an older male adult with a long
history of alcohol abuse and a 30-year history of smoking. In
recommending an intervention for this client you're
responsibility is to
Chest x-ray at the same time of PPD test
What is primary prevention measures to decrease the incidence of disease
What is secondary prevention? treating or controlling a disease or condition after it occurs
What is tertiary prevention? Rehabilitative therapies and monitoring of health to prevent complications or
further illness, injury, or disability
What are some recommendations not to use with dementia
patients
Do not use antipsychotics as first line drug
Do not recommend percutaneous feeding tubes
Only use metformin in patients with Hemoglobin A1c of less than 7.5
What trip details are considered high risk in the elderly patient Longer than 3 weeks
Mission, medical tourism, volunteerism, visiting friends or relatives Traveling
alone
Adventure-backpacking scuba diving
Hostile, Budget Hotel, camp
What is malaria chemoprophylaxis Subtropical areas in Africa South America, and South Asia
What is travelers diarrhea -bacterial or parasitic -usually lasts 2-3 days -self limiting usually -only treat if severely ill, high fever, or lasts >7 days
Treat with fluoroquinolones
What are the exercise recommendations for older adults Strengthen muscles
The best recommendation for a patient who states they have
no equipment to exercise would be
Improvise with recommended objects at home that can be used
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When the nurse practitioner recommends exercise for
sedentary older adult, which of the following pieces of
advice should be considered for all types of exercise
Start low and go slow
The evidence reflects that comprehensive geriatric assessment
should be conducted
Targeting the vulnerable and frail elderly
Evidence-based geriatric assessment instruments available
to the clinician
Include screening, evaluation, and measurement instruments in multiple domains
When interviewing the older adult with the suspected
dementia, it is most important that
The Examiner should use short simple questionand recognize nonverbal signs of
discomfort
What are dimensions of symptomology Onset, location, absence of associated symptoms
What is the best approach to taking a health history Start with open-ended questions
A review of The Evidence relative to screening of the elderly
reveals the highest evidence rating for
Hearing screening
Assessment of vital signs in the elderly reflect Older adults can be septic with the temperature within normal limits
What is true about nutrition intake in the elderly The serum albumin is a good reflection of protein stores
What is reflective of functional decline in older adults A functional decline is synonymous with Advanced staged
The leading cause of traumatic death in the elderly Falls
Timing of the get and go test enhances its sensitivity the process
should take less than
16 seconds
A validated tool for assessing cognitive function specific to
dementia
Confusion assessment method
The medical outcome study short form 36 Remains the gold
standard of quality of life instruments it measures
Physical, mental, and social domains
What is the half-life of albumin 21 days
7/
23
What is the average lifespan of pre-albumin 1 to 2 days
Short-term malnutrition level Pre-albumen of less than 10
A complex syndrome characterized by loss of weight, mostly
due to loss of muscle mass resulting from metabolic
abnormalities due to disease
cachexia
What are the domains of comprehensive geriatric assessment Physical health
Functional Health
Psychological health
Socioeconomic support
Quality of life measures
what is the 4Ms Framework in geriatric assessment what matters, medication, mentation, mobility
The term geriatric syndrome is best described as Condition that has multiple underlying factors and involves multiple systems
The anal wink reflex is used to test Sensation and Prudential nerve function
Atypical presentation of acute coronary syndrome is More common in females
What disease can mimic an often coexist with myocardial
infarctions in elderly with coronary artery disease
Esophageal disease
Thoracic aortic dissection presents typically as Severe retrosternal CP that radiates to the back and both arms
Medications known to contribute to constipation include Stimulant laxatives
Anticholinergic drugs Iron
Bordetella pertussis is best described as Subacute cough lasting greater than 2 weeks
The routine testing of tuberculosis should occur in all of the
following vulnerable populations
Nursing home residents Prison
inmates Immunocompromised
patients
What is true about fluid balance in the elderly Thirst response decreases as a person ages Total
body water decreases with age
African Americans have higher rates of dehydration than white Americans
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23
Distinguishing delirium from dementia can be problematic
since they may coexist the primary consideration in the
differential is
Rapid change and fluctuating course of cognitive function
Presbystasis age-related decline in equilibrium or dynamic balance
If dizziness has a predictable pattern associated with it common
the clinician should first consider
Hypoglycemia
What are contributing factors to dysphagia Anticholinergics
Drugs that increase reflux
Inadequate intake of fluids with medication and meals
NRNP 6540 Midterm Exam – Advanced Practice
Care of Older Adults | 2026/2027 |Questions and
Correct Answers | Complete Exam PDF
2026 – 2027 EDITION |
...
ACTUAL QUESTIONS + CORRECT ANSWERS | COMPLETE EXAM
MATERIAL
High-Yield • Fully Updated • 100% Verified • Board-Style Scenarios
Includes:
Geriatric Syndromes • Chronic Disease Management • Pharmacology • Cognitive Disorders • Functional Assessment •
Acute & Long-Term Care
Exam Overview
Exam Structure
• Total Questions
• Multiple-Choice Format
• Advanced, Case-Based Clinical Scenarios
• Timed Assessment (Board-Style)
• Designed to Identify Knowledge Gaps
Key Domains Covered
• Chronic Illness Management in Older Adults
• Geriatric Pharmacology & Polypharmacy Risks
• Cognitive Impairment & Dementia Care
• Functional, Mobility, & Fall-Risk Assessment
• End-of-Life & Palliative Considerations
• Acute Geriatric Emergencies
• Health Promotion & Disease Prevention
1
/
2
/
Introduction
The NRNP 6540 Final Exam provides a comprehensive review of advanced practice concepts specific to the older
adult population. This exam mirrors the complexity and structure of graduate-level and certification-style assessments,
ensuring that learners build the diagnostic reasoning, clinical judgment, and evidence-based decision-making required
for excellence in geriatric care.
Achieving strong performance on this exam is closely associated with success in graduate NP coursework, clinical
rotations, and certification readiness.
Answer Format
• Questions are presented in bold, ensuring clarity and easy readability.
• Correct answers are displayed in GREEN, providing instant recognition.
• Reinforcing:
✔ Advanced geriatric assessment
✔ Pharmacologic reasoning
✔ Diagnostic accuracy
✔ Safe and effective patient care
This structure strengthens mastery of core NRNP 6540 topics and prepares students for real-world advanced practice
care.
What are the physiological changes of aging 1. Reduced physiological reserve of most body systems
2. Reduced homeostatic mechanisms that fail to adjust
3. Changes in the sympathetic response
4. Impaired immunological function- infection risk is greater and autoimmune
diseases are more prevalent.
What factors influence lab value interpretation in the older adult 1. physiological changes with aging
2. the prevalence of chronic disease
3. changes in nutritional and fluid intake
4. Lifestyle
What lab values is important Creatinine clearance, GFR and renal function
What are examples of drugs are eliminated renally Digoxin, H2 blockers, lithium and water-soluable antibiotics
What are the two formulas to evaluate the kidney function The Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD)
What neurological conditions commonly have an initial onset
in older age?
Parkinson's, dementia, stroke, and complex partial seizures
3
/
What are geriatric syndromes Diseases that involve multiple systems and have more than one underlying cause
What are the geriatric syndrome giants currently Frailty, anorexia of aging, sarcopenia and cognitive impariment
What are bimodal presentations of disease Diseases that can present in a younger age and an older age.
What are examples of bimodal diseases? Psoriasis, Inflammatory bowel disease, Ulcerative Colitis, Crohn's disease, Hodgkin's
lymphoma, and myasthenia gravis
What is primary prevention? Activities to prevent the occurrence of a disease or adverse, including mental health
What is secondary prevention Tasks directed towards detection of a disease or adverse health condition in an
asymptomatic individual who has risk factors
What is tertiary prevention The management of existing conditions to prevent disability and minimize
complications to prevent disability for optimal function
What is the key to increasing geriatric physical activity motivation
What is the nutrition screening tool for community dwelling
older adults
Mini-Nutritional Assessment (MNA)
What factors affect maintaining a healthy balanced diet in 1. Chronic illness and disability-related to ADLs like shopping and meal preparation,
geriatrics? 2. Financial hardships-limit food choices
3. Prescribed medications-affects absorption of nutrients, sense of taste or appetite
4. Depression or social isolation
5. Obesity
What is a big influence of geriatric functionality and quality of
life?
Injury prevention
What are important 6 areas of geriatric safety prevention 1. Safe storage and removal of firearms
2. Fall prevention
3. Wearing seatbelts
4. no drinking and driving
5. Having a working smoke detector
6. Keeping hot water set below 120 degrees
Periodic screening of gums and mouth can screen for what? 1. Oral cancer
2. ill-fitting or poorly functioning dentures
3. Periodontal disease
4. Erosion of dentin
5. dependence on others for dental resources
4
/
What screening tools are covered by Medicare? 1. HIV
2. Alcohol misuse
3. Smoking cessation
4. Depression
5. High blood pressure
6. Blood glucose r/t cardiovascular risk assessment
7. Lipids screening
8. Mammography until aged 75
9. Osteoporosis
10. Colorectal cancer
What are the immunizations recommended for geriatrics? 1. influenza- annually for all over 50
2. Tetanus-diphtheria (Tdap)-once in a lifetime booster, then every 10 years
3. Pneumococcal -1 time dose of PCV13 at 65 years old then PPSV23 1 year (12
months) later
4. Hep B for high risk persons 1st dose then 6 months later 2nd dose, the 4-6 mos
later the 3rd dose
5. Shingrix for zoster
What are contraindications for exercise therapy 1. unstable angina
2. uncompensated heart failure
3. Severe anemia
4. Uncontrolled blood glucose
5. Unstable aortic aneurysm
6. Uncontrolled hypertension or tachycardia
7. Severe dehydration or heat stroke
8. Low oxygen saturation
What are the benefits of exercise? Strengthen muscles Maintain
flexibility Promote balance
Build and maintain bone mass
Prevent injury
Improve daily functioning, especially in elderly Prevent
chronic disease
What assessment screening tool evaluates functional
decline?
How long is the time frame?
The Timed Get up and go Test
16 seconds.
What screening tool is used for domestic violence? HITS
What screening tool is used for cognitive and affective
disorders like dementia, delirium,depression and spiritual
health
1. Mini-Mental SE,
2. The mini-Cog and
3. the Montreal Cognitive (MoCA),
4. Geriatric Depression scale
5. HOPE, and SPIRIT
agitation Change in behavior,-repeating questions, arguing,
Labs- CBC, CMP, B12, TSH
Tx-Psychotropic meds ( Abilify, Risperdal) - antiseizure meds (Tegretol, Lamictal)
anxiolytics- alprazolam, diazepam
Alcoholism alcohol misuse-tachycardia, peripheral neuropathy, tremors
Labs- SBIRT
Tx- sobriety or total abstinence
what is anxiety? what labs? what meds? excessive worry difficult to control-poor health, financial insecurity, etc.
Labs- CBC, CMP, TSH Geriatric Anxiety Inventory screening
TX- start low and go slow-SSRIs-Escitalopram, sertraline, citalopram
5
/
What are the 5 domains of a comprehensive geriatric
assessment
1. Physical health,
2. functional health
3. psychological health
4. socioenvironmental supports
5. quality of life
What 3 things do a comprehensive geriatric assessment
do?
1. Identifies care needs
2. Plans care
3. Improves outcomes
What is the most frequently used criteria for evaluating drug
use?
The BEERS criteria, the STOPP criteria and the START criteria
What are 9 biomarkers of nutritional deficiency? 1. Prealbumin,
2. transferrin,
3. albumin,
4. chemistries,
5. cbc,
6. vitamin B12,
7. folate,
8. vitamin D and
9. thyroid panel
What bipolar disorder? What labs? What meds? S and Sx: Euphoria or irritability, depression, hypomania, rapid speech and
irritability, can begin after 50, assess with DIGFAST or SIGECAPS Labs- cbc, cmp, tox screen, u/a, thyroid function, rpr
Meds: Mood stabilizers-lithium valproic acid, and the antipsychotics- quetiapine and olanzapine
Depression symptoms? Labs? Tx? SIGECAPS measures the disturbance in:
Sleep Interest
Guilt Energy
Concentration Appetite
Psychomotor slowing
Suicidal Ideation
Labs assist in causative factors
Tx-Beahvior stabilizer-Haldol, mood stabilizer- olanzapine, risperidone, quetiapine
Dementia, Iabs and, Tx A slowly progressive global cognitive decline- confusion, disorientation
Labs: cbc, electrolytes, glucose, BUN, Cr. LFTs, TSH, folate, syphilis serology and UA, Mini mental or MoCA
Tx- Cholinesterase inhibitors - donepezil, rivastigmine, galantamine or Namenda
Depression, labs, tx? A pervasive feeling of sadness, discouragement, can start at age 60.
Labs- electrolytes, hormone levels, nutritional deficiency, B13 and vitamin D deficiency
Tx- SNRI's- duloxetine, Effexor, SNRIs-citalopram, escitalipram, sertraline
elder abuse Any knowing, intentional, or negligent act by a caregiver or any other person to an
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