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NURS5461 / NURS 5461 Final Exam Bank: Adult
Gerontology Management Across the Continuum of
Care | 210 NCLEX-Style Questions with Detailed
Rationales (2026/2027 Edition)
Section 1: Foundational Concepts & Health Promotion (Questions
1-20)
1. A 72-year-old male patient asks about the recommended frequency for
the shingles (herpes zoster) vaccine. He received the live zoster vaccine
(Zostavax) five years ago. What is the most appropriate response?
A) "You do not need another shingles vaccine as Zostavax provides
lifelong immunity."
B) "You should receive the recombinant zoster vaccine (Shingrix) now,
as it is recommended regardless of prior Zostavax vaccination."
C) "You need to wait until you are 75 years old to receive the booster for
Zostavax."
D) "You should receive a second dose of Zostavax to boost your
immunity."
Correct Answer: B
Rationale: The CDC recommends the recombinant zoster vaccine
(Shingrix, RZV) for all adults aged 50 years and older, including those
who previously received Zostavax (the live vaccine). Zostavax is no
longer available in the US. RZV is a two-dose series (2-6 months apart)
and has higher efficacy (over 90%) compared to Zostavax. Option A is
incorrect because Zostavax’s efficacy wanes. Option C is incorrect as
there is no age restriction for Shingrix beyond 50. Option D is incorrect
as Zostavax is discontinued.
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2. A 68-year-old African American female with a history of hypertension
is in your clinic for a wellness visit. Her blood pressure is 132/78
mmHg. According to the USPSTF guidelines on screening for
abdominal aortic aneurysm (AAA), what is the appropriate
recommendation?
A) Recommend a one-time abdominal ultrasound due to her age and
history of hypertension.
B) No screening is indicated as her blood pressure is well-controlled.
C) Recommend a one-time abdominal ultrasound due to her age, gender,
and smoking history; however, she is a non-smoker.
D) Recommend screening every five years due to her race and age.
Correct Answer: C
Rationale: The USPSTF recommends one-time screening for AAA with
ultrasonography in men aged 65-75 who have ever smoked. The patient
is a 68-year-old female. Screening for women is only recommended if
they have a significant family history or have ever smoked. While
hypertension is a risk factor, it is not an independent indication for
screening per USPSTF guidelines. The lack of smoking history in this
female patient makes screening not indicated.
3. A 75-year-old patient reports feeling "dizzy and lightheaded" when
standing up from his recliner. His supine BP is 138/80 mmHg, HR 72.
Upon standing, his BP drops to 100/62 mmHg, HR 88. He is on
lisinopril for hypertension. What is the most appropriate initial
intervention?
A) Increase his lisinopril to better control supine hypertension.
B) Discontinue lisinopril immediately and start a calcium channel
blocker.
C) Educate the patient on hydration, rising slowly, and review the timing
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of antihypertensive medication.
D) Order a carotid ultrasound to rule out stenosis.
Correct Answer: C
Rationale: The patient is experiencing orthostatic hypotension, a
common issue in older adults, often exacerbated by antihypertensives.
The initial management is non-pharmacologic: education on rising
slowly, ensuring adequate hydration, and reviewing medications (often
taking antihypertensives at bedtime rather than morning can help).
Option A would worsen the orthostasis. Option B is incorrect because
abrupt discontinuation of an ACE inhibitor can cause rebound
hypertension. Option D is not indicated for orthostatic symptoms
without focal neurological signs.
4. An 80-year-old patient scores a 7/10 on the Patient Health
Questionnaire-9 (PHQ-9). She reports feeling "down, depressed, and
hopeless" nearly every day for the past month. She lives alone and has
no suicidal ideation. What is the priority nursing action?
A) Immediately refer her to a psychiatrist for inpatient admission.
B) Encourage her to increase her social activities and follow up in one
month.
C) Assess for contributing factors such as polypharmacy, social
isolation, and chronic pain.
D) Initiate a selective serotonin reuptake inhibitor (SSRI) without further
assessment.
Correct Answer: C
Rationale: Depression in older adults is often multifactorial. Before
initiating treatment, it is critical to rule out underlying causes (e.g.,
medications like beta-blockers or corticosteroids, hypothyroidism,
chronic pain, social isolation). A PHQ-9 score of 7 indicates mild-
moderate depression. While treatment is needed, immediate inpatient
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admission is not warranted without safety risk. Increasing social
activities is a good intervention but not the priority before a full
assessment. Initiation of an SSRI should be done by a provider after a
thorough assessment.
5. A 70-year-old man with a 40-pack-year smoking history asks about
lung cancer screening. He quit smoking 10 years ago. He has no
respiratory symptoms. According to the USPSTF, what criteria must be
met for him to be eligible for annual screening with low-dose computed
tomography (LDCT)?
A) Age 50-80 years, a 20-pack-year history, and currently smoke or quit
within the past 15 years.
B) Age 55-74 years, a 30-pack-year history, and currently smoke.
C) Age 65-85 years, any smoking history, and a family history of lung
cancer.
D) Age 50-80 years, a 30-pack-year history, and currently smoke or quit
within the past 10 years.
Correct Answer: A
Rationale: The current USPSTF recommendations (updated 2021) for
lung cancer screening with LDCT are: adults aged 50-80 years with a
20-pack-year smoking history who currently smoke or have quit within
the past 15 years. This patient meets the criteria (age 70, 40-pack-year
history, quit 10 years ago). Screening should be discontinued once a
person has not smoked for 15 years or develops a health problem that
substantially limits life expectancy or the ability to undergo curative
lung surgery.
6. During a home visit for a frail 85-year-old with multiple chronic
conditions, you notice 10 prescription bottles on the kitchen table,
including warfarin, digoxin, metformin, and lisinopril. The patient is
unsure what each is for. What is the most critical aspect of medication
NURS5461 / NURS 5461 Final Exam Bank: Adult
Gerontology Management Across the Continuum of
Care | 210 NCLEX-Style Questions with Detailed
Rationales (2026/2027 Edition)
Section 1: Foundational Concepts & Health Promotion (Questions
1-20)
1. A 72-year-old male patient asks about the recommended frequency for
the shingles (herpes zoster) vaccine. He received the live zoster vaccine
(Zostavax) five years ago. What is the most appropriate response?
A) "You do not need another shingles vaccine as Zostavax provides
lifelong immunity."
B) "You should receive the recombinant zoster vaccine (Shingrix) now,
as it is recommended regardless of prior Zostavax vaccination."
C) "You need to wait until you are 75 years old to receive the booster for
Zostavax."
D) "You should receive a second dose of Zostavax to boost your
immunity."
Correct Answer: B
Rationale: The CDC recommends the recombinant zoster vaccine
(Shingrix, RZV) for all adults aged 50 years and older, including those
who previously received Zostavax (the live vaccine). Zostavax is no
longer available in the US. RZV is a two-dose series (2-6 months apart)
and has higher efficacy (over 90%) compared to Zostavax. Option A is
incorrect because Zostavax’s efficacy wanes. Option C is incorrect as
there is no age restriction for Shingrix beyond 50. Option D is incorrect
as Zostavax is discontinued.
,2|Page
2. A 68-year-old African American female with a history of hypertension
is in your clinic for a wellness visit. Her blood pressure is 132/78
mmHg. According to the USPSTF guidelines on screening for
abdominal aortic aneurysm (AAA), what is the appropriate
recommendation?
A) Recommend a one-time abdominal ultrasound due to her age and
history of hypertension.
B) No screening is indicated as her blood pressure is well-controlled.
C) Recommend a one-time abdominal ultrasound due to her age, gender,
and smoking history; however, she is a non-smoker.
D) Recommend screening every five years due to her race and age.
Correct Answer: C
Rationale: The USPSTF recommends one-time screening for AAA with
ultrasonography in men aged 65-75 who have ever smoked. The patient
is a 68-year-old female. Screening for women is only recommended if
they have a significant family history or have ever smoked. While
hypertension is a risk factor, it is not an independent indication for
screening per USPSTF guidelines. The lack of smoking history in this
female patient makes screening not indicated.
3. A 75-year-old patient reports feeling "dizzy and lightheaded" when
standing up from his recliner. His supine BP is 138/80 mmHg, HR 72.
Upon standing, his BP drops to 100/62 mmHg, HR 88. He is on
lisinopril for hypertension. What is the most appropriate initial
intervention?
A) Increase his lisinopril to better control supine hypertension.
B) Discontinue lisinopril immediately and start a calcium channel
blocker.
C) Educate the patient on hydration, rising slowly, and review the timing
,3|Page
of antihypertensive medication.
D) Order a carotid ultrasound to rule out stenosis.
Correct Answer: C
Rationale: The patient is experiencing orthostatic hypotension, a
common issue in older adults, often exacerbated by antihypertensives.
The initial management is non-pharmacologic: education on rising
slowly, ensuring adequate hydration, and reviewing medications (often
taking antihypertensives at bedtime rather than morning can help).
Option A would worsen the orthostasis. Option B is incorrect because
abrupt discontinuation of an ACE inhibitor can cause rebound
hypertension. Option D is not indicated for orthostatic symptoms
without focal neurological signs.
4. An 80-year-old patient scores a 7/10 on the Patient Health
Questionnaire-9 (PHQ-9). She reports feeling "down, depressed, and
hopeless" nearly every day for the past month. She lives alone and has
no suicidal ideation. What is the priority nursing action?
A) Immediately refer her to a psychiatrist for inpatient admission.
B) Encourage her to increase her social activities and follow up in one
month.
C) Assess for contributing factors such as polypharmacy, social
isolation, and chronic pain.
D) Initiate a selective serotonin reuptake inhibitor (SSRI) without further
assessment.
Correct Answer: C
Rationale: Depression in older adults is often multifactorial. Before
initiating treatment, it is critical to rule out underlying causes (e.g.,
medications like beta-blockers or corticosteroids, hypothyroidism,
chronic pain, social isolation). A PHQ-9 score of 7 indicates mild-
moderate depression. While treatment is needed, immediate inpatient
, 4|Page
admission is not warranted without safety risk. Increasing social
activities is a good intervention but not the priority before a full
assessment. Initiation of an SSRI should be done by a provider after a
thorough assessment.
5. A 70-year-old man with a 40-pack-year smoking history asks about
lung cancer screening. He quit smoking 10 years ago. He has no
respiratory symptoms. According to the USPSTF, what criteria must be
met for him to be eligible for annual screening with low-dose computed
tomography (LDCT)?
A) Age 50-80 years, a 20-pack-year history, and currently smoke or quit
within the past 15 years.
B) Age 55-74 years, a 30-pack-year history, and currently smoke.
C) Age 65-85 years, any smoking history, and a family history of lung
cancer.
D) Age 50-80 years, a 30-pack-year history, and currently smoke or quit
within the past 10 years.
Correct Answer: A
Rationale: The current USPSTF recommendations (updated 2021) for
lung cancer screening with LDCT are: adults aged 50-80 years with a
20-pack-year smoking history who currently smoke or have quit within
the past 15 years. This patient meets the criteria (age 70, 40-pack-year
history, quit 10 years ago). Screening should be discontinued once a
person has not smoked for 15 years or develops a health problem that
substantially limits life expectancy or the ability to undergo curative
lung surgery.
6. During a home visit for a frail 85-year-old with multiple chronic
conditions, you notice 10 prescription bottles on the kitchen table,
including warfarin, digoxin, metformin, and lisinopril. The patient is
unsure what each is for. What is the most critical aspect of medication
