1|Page
NRNP 6540 ADVANCED PRACTICE CARE OF
OLDER ADULTS: 200+ PRACTICE QUESTIONS
WITH RATIONALES FOR MIDTERM & FINAL
EXAM SUCCESS
# Module 1: Foundational Principles of Geriatric Care
## Questions 1-20
**1. An 82-year-old patient presents with new-onset confusion, weight loss, and
fatigue. Which physiological change of aging most directly contributes to atypical
presentation of illness in older adults?**
A) Decreased total body water
B) Diminished homeostatic reserve
C) Increased adipose tissue
D) Decreased glomerular filtration rate
**Correct Answer: B**
**Rationale:** Diminished homeostatic reserve—the decreased ability to maintain
physiological equilibrium—is a hallmark of aging that leads to atypical
presentations of illness. Older adults often present with non-specific symptoms
such as confusion, falls, or functional decline rather than classic disease symptoms.
The other options represent physiological changes but are not primarily responsible
for atypical presentations.
,2|Page
---
**2. A 78-year-old patient is prescribed five medications for various chronic
conditions. The nurse practitioner recognizes that polypharmacy in older adults is a
concern primarily because:**
A) Older adults prefer fewer medications
B) Age-related pharmacokinetic and pharmacodynamic changes increase
medication sensitivity and adverse effects
C) Generic medications are less effective in older adults
D) All medications become toxic after age 75
**Correct Answer: B**
**Rationale:** Age-related changes—reduced renal clearance, decreased hepatic
metabolism, and increased body fat—alter drug distribution and elimination.
Pharmacodynamic changes increase sensitivity to certain medications. These
factors make older adults more vulnerable to adverse drug reactions and drug-drug
interactions.
---
**3. A 75-year-old patient reports feeling "depressed" and "fatigued" over the past
three months. Which screening tool is most appropriate for initial depression
screening in this patient?**
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A) Beck Depression Inventory (BDI)
B) Patient Health Questionnaire (PHQ-9)
C) Geriatric Depression Scale (GDS)
D) Hamilton Depression Rating Scale (HAM-D)
**Correct Answer: C**
**Rationale:** The Geriatric Depression Scale (GDS) is specifically validated for
depression screening in older adults and includes fewer somatic items that may be
confounded by physical illness. While PHQ-9 is widely used, GDS has superior
specificity in geriatric populations.
---
**4. A 72-year-old patient with atrial fibrillation is prescribed warfarin. The NP
should initiate the medication at a lower dose than for a younger patient due to:**
A) Increased hepatic blood flow
B) Decreased hepatic function and increased sensitivity to anticoagulants
C) Increased vitamin K absorption
D) Increased renal clearance
**Correct Answer: B**
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**Rationale:** Age-related decline in hepatic function and increased sensitivity to
warfarin necessitate lower starting doses in older adults. Warfarin has a narrow
therapeutic index, and older patients are at higher risk for bleeding complications.
---
**5. Which statement best describes the Frailty Phenotype as defined by Fried and
colleagues?**
A) Presence of three or more of: unintentional weight loss, self-reported
exhaustion, weakness (low grip strength), slow walking speed, low physical
activity
B) Presence of all of the following: dementia, incontinence, falls, and pressure
ulcers
C) Presence of two or more chronic diseases
D) Presence of functional dependence in activities of daily living
**Correct Answer: A**
**Rationale:** The Fried Frailty Phenotype defines frailty as the presence of three
or more of five criteria: unintentional weight loss, self-reported exhaustion,
weakness, slow walking speed, and low physical activity. Frailty is a distinct
clinical syndrome associated with increased vulnerability to adverse outcomes.
---
NRNP 6540 ADVANCED PRACTICE CARE OF
OLDER ADULTS: 200+ PRACTICE QUESTIONS
WITH RATIONALES FOR MIDTERM & FINAL
EXAM SUCCESS
# Module 1: Foundational Principles of Geriatric Care
## Questions 1-20
**1. An 82-year-old patient presents with new-onset confusion, weight loss, and
fatigue. Which physiological change of aging most directly contributes to atypical
presentation of illness in older adults?**
A) Decreased total body water
B) Diminished homeostatic reserve
C) Increased adipose tissue
D) Decreased glomerular filtration rate
**Correct Answer: B**
**Rationale:** Diminished homeostatic reserve—the decreased ability to maintain
physiological equilibrium—is a hallmark of aging that leads to atypical
presentations of illness. Older adults often present with non-specific symptoms
such as confusion, falls, or functional decline rather than classic disease symptoms.
The other options represent physiological changes but are not primarily responsible
for atypical presentations.
,2|Page
---
**2. A 78-year-old patient is prescribed five medications for various chronic
conditions. The nurse practitioner recognizes that polypharmacy in older adults is a
concern primarily because:**
A) Older adults prefer fewer medications
B) Age-related pharmacokinetic and pharmacodynamic changes increase
medication sensitivity and adverse effects
C) Generic medications are less effective in older adults
D) All medications become toxic after age 75
**Correct Answer: B**
**Rationale:** Age-related changes—reduced renal clearance, decreased hepatic
metabolism, and increased body fat—alter drug distribution and elimination.
Pharmacodynamic changes increase sensitivity to certain medications. These
factors make older adults more vulnerable to adverse drug reactions and drug-drug
interactions.
---
**3. A 75-year-old patient reports feeling "depressed" and "fatigued" over the past
three months. Which screening tool is most appropriate for initial depression
screening in this patient?**
,3|Page
A) Beck Depression Inventory (BDI)
B) Patient Health Questionnaire (PHQ-9)
C) Geriatric Depression Scale (GDS)
D) Hamilton Depression Rating Scale (HAM-D)
**Correct Answer: C**
**Rationale:** The Geriatric Depression Scale (GDS) is specifically validated for
depression screening in older adults and includes fewer somatic items that may be
confounded by physical illness. While PHQ-9 is widely used, GDS has superior
specificity in geriatric populations.
---
**4. A 72-year-old patient with atrial fibrillation is prescribed warfarin. The NP
should initiate the medication at a lower dose than for a younger patient due to:**
A) Increased hepatic blood flow
B) Decreased hepatic function and increased sensitivity to anticoagulants
C) Increased vitamin K absorption
D) Increased renal clearance
**Correct Answer: B**
, 4|Page
**Rationale:** Age-related decline in hepatic function and increased sensitivity to
warfarin necessitate lower starting doses in older adults. Warfarin has a narrow
therapeutic index, and older patients are at higher risk for bleeding complications.
---
**5. Which statement best describes the Frailty Phenotype as defined by Fried and
colleagues?**
A) Presence of three or more of: unintentional weight loss, self-reported
exhaustion, weakness (low grip strength), slow walking speed, low physical
activity
B) Presence of all of the following: dementia, incontinence, falls, and pressure
ulcers
C) Presence of two or more chronic diseases
D) Presence of functional dependence in activities of daily living
**Correct Answer: A**
**Rationale:** The Fried Frailty Phenotype defines frailty as the presence of three
or more of five criteria: unintentional weight loss, self-reported exhaustion,
weakness, slow walking speed, and low physical activity. Frailty is a distinct
clinical syndrome associated with increased vulnerability to adverse outcomes.
---
