NURS 5461 Final Assessment -Adult Gerontology
Management Across the Continuum of Care (UTA
2026) Graded A+
Q1. An 82-year-old patient with advanced COPD presents with worsening dyspnea and
cachexia. Which management strategy best aligns with palliative care principles?
A. Escalate to mechanical ventilation
B. Initiate aggressive nutritional supplementation
C. Focus on symptom relief and quality of life
C. Refer for lung transplant evaluation
Rationale: Palliative care emphasizes comfort, dignity, and symptom management
rather than curative or aggressive interventions in advanced disease.
Q2. A 70-year-old male with type 2 diabetes and CKD stage 3 is prescribed metformin.
What is the most appropriate provider action?
A. Continue metformin without adjustment
B. Discontinue metformin due to renal impairment
B. Increase metformin dose for glycemic control
C. Add sulfonylurea immediately
Rationale: Metformin is contraindicated in moderate-to-severe renal impairment due to
risk of lactic acidosis.
Q3. In transitional care planning for an older adult post-hip fracture surgery, which
intervention most reduces hospital readmission risk?
A. Prescribing additional analgesics
B. Scheduling follow-up in 6 months
C. Coordinating home health services and PT
C. Providing discharge paperwork only
Rationale: Coordinated multidisciplinary follow-up with home health and physical
therapy reduces readmission and improves functional recovery.
Q4. A 76-year-old female with atrial fibrillation is prescribed warfarin. Which factor most
influences anticoagulation management in geriatric patients?
A. Patient preference for oral medications
B. Polypharmacy and drug-drug interactions
B. Cost of INR monitoring
C. Family support availability
Rationale: Polypharmacy increases risk of adverse drug interactions, requiring vigilant
monitoring in older adults.
Q5. Which screening tool is most appropriate for detecting early cognitive decline in
older adults during primary care visits?
A. PHQ-9
B. GAD-7
,C. Mini-Cog
C. Beck Depression Inventory
Rationale: The Mini-Cog is validated for quick cognitive screening in geriatric
populations.
Q6. An 84-year-old with CHF is discharged home. Which intervention most supports
successful self-management?
A. Provide a 30-day supply of diuretics
B. Teach daily weight monitoring and symptom reporting
B. Schedule cardiology follow-up in 12 months
C. Encourage unrestricted fluid intake
Rationale: Daily weights and symptom recognition empower patients to detect fluid
overload early.
Q7. Which immunization is most critical for adults ≥65 years to reduce morbidity?
A. HPV vaccine
B. Pneumococcal vaccine
B. Varicella vaccine
C. Hepatitis A vaccine
Rationale: Pneumococcal vaccination reduces risk of pneumonia and invasive disease
in older adults.
Q8. A 72-year-old with osteoporosis is prescribed bisphosphonates. What teaching is
essential?
A. Take with milk
B. Remain upright for 30 minutes after ingestion
B. Crush tablets for easier swallowing
C. Take at bedtime
Rationale: Upright positioning prevents esophageal irritation and ulceration.
Q9. Which intervention best addresses polypharmacy in geriatric patients?
A. Prescribe additional supplements
B. Conduct regular medication reconciliation
B. Encourage patients to self-adjust doses
C. Avoid deprescribing
Rationale: Medication reconciliation reduces duplication, interactions, and adverse
events.
Q10. An older adult with dementia becomes agitated in the evening. What is the most
appropriate management?
A. Increase daytime caffeine intake
B. Administer benzodiazepines routinely
C. Implement structured routines and reduce stimuli
C. Encourage late-night exercise
Rationale: Non-pharmacologic interventions are first-line for sundowning behaviors.
, Q11. Which lab value requires immediate provider action in a patient on digoxin?
A. Potassium 4.2 mEq/L
B. Potassium 2.8 mEq/L
B. Magnesium 1.9 mg/dL
C. Sodium 138 mEq/L
Rationale: Hypokalemia increases risk of digoxin toxicity.
Q12. A 68-year-old with depression and insomnia is prescribed trazodone. What is the
primary safety concern?
A. Hypertension
B. Orthostatic hypotension and fall risk
B. Weight gain
C. Constipation
Rationale: Trazodone can cause orthostatic hypotension, increasing fall risk in older
adults.
Q13. Which intervention most effectively prevents delirium in hospitalized older adults?
A. Routine sedative use
B. Early mobilization and orientation strategies
B. Restrict family visits
C. Limit hydration
Rationale: Mobility and orientation reduce delirium incidence.
Q14. A 75-year-old with hypertension is started on hydrochlorothiazide. Which lab
should be monitored?
A. Hemoglobin
B. Potassium
B. Platelets
C. Calcium
Rationale: Thiazide diuretics can cause hypokalemia.
Q15. Which intervention best supports safe opioid prescribing in older adults?
A. Prescribe long-acting opioids first
B. Start low, go slow, and reassess frequently
B. Avoid non-opioid alternatives
C. Encourage self-escalation of doses
Rationale: Older adults are more sensitive to opioids; cautious titration is essential.
Q16. A 79-year-old with diabetes develops foot ulcers. What is the priority intervention?
A. Encourage barefoot walking
B. Refer to podiatry and initiate wound care
B. Increase carbohydrate intake
C. Delay treatment until infection occurs
Rationale: Early podiatry referral prevents complications and supports healing.
Q17. Which screening is recommended annually for adults ≥65 with diabetes?
Management Across the Continuum of Care (UTA
2026) Graded A+
Q1. An 82-year-old patient with advanced COPD presents with worsening dyspnea and
cachexia. Which management strategy best aligns with palliative care principles?
A. Escalate to mechanical ventilation
B. Initiate aggressive nutritional supplementation
C. Focus on symptom relief and quality of life
C. Refer for lung transplant evaluation
Rationale: Palliative care emphasizes comfort, dignity, and symptom management
rather than curative or aggressive interventions in advanced disease.
Q2. A 70-year-old male with type 2 diabetes and CKD stage 3 is prescribed metformin.
What is the most appropriate provider action?
A. Continue metformin without adjustment
B. Discontinue metformin due to renal impairment
B. Increase metformin dose for glycemic control
C. Add sulfonylurea immediately
Rationale: Metformin is contraindicated in moderate-to-severe renal impairment due to
risk of lactic acidosis.
Q3. In transitional care planning for an older adult post-hip fracture surgery, which
intervention most reduces hospital readmission risk?
A. Prescribing additional analgesics
B. Scheduling follow-up in 6 months
C. Coordinating home health services and PT
C. Providing discharge paperwork only
Rationale: Coordinated multidisciplinary follow-up with home health and physical
therapy reduces readmission and improves functional recovery.
Q4. A 76-year-old female with atrial fibrillation is prescribed warfarin. Which factor most
influences anticoagulation management in geriatric patients?
A. Patient preference for oral medications
B. Polypharmacy and drug-drug interactions
B. Cost of INR monitoring
C. Family support availability
Rationale: Polypharmacy increases risk of adverse drug interactions, requiring vigilant
monitoring in older adults.
Q5. Which screening tool is most appropriate for detecting early cognitive decline in
older adults during primary care visits?
A. PHQ-9
B. GAD-7
,C. Mini-Cog
C. Beck Depression Inventory
Rationale: The Mini-Cog is validated for quick cognitive screening in geriatric
populations.
Q6. An 84-year-old with CHF is discharged home. Which intervention most supports
successful self-management?
A. Provide a 30-day supply of diuretics
B. Teach daily weight monitoring and symptom reporting
B. Schedule cardiology follow-up in 12 months
C. Encourage unrestricted fluid intake
Rationale: Daily weights and symptom recognition empower patients to detect fluid
overload early.
Q7. Which immunization is most critical for adults ≥65 years to reduce morbidity?
A. HPV vaccine
B. Pneumococcal vaccine
B. Varicella vaccine
C. Hepatitis A vaccine
Rationale: Pneumococcal vaccination reduces risk of pneumonia and invasive disease
in older adults.
Q8. A 72-year-old with osteoporosis is prescribed bisphosphonates. What teaching is
essential?
A. Take with milk
B. Remain upright for 30 minutes after ingestion
B. Crush tablets for easier swallowing
C. Take at bedtime
Rationale: Upright positioning prevents esophageal irritation and ulceration.
Q9. Which intervention best addresses polypharmacy in geriatric patients?
A. Prescribe additional supplements
B. Conduct regular medication reconciliation
B. Encourage patients to self-adjust doses
C. Avoid deprescribing
Rationale: Medication reconciliation reduces duplication, interactions, and adverse
events.
Q10. An older adult with dementia becomes agitated in the evening. What is the most
appropriate management?
A. Increase daytime caffeine intake
B. Administer benzodiazepines routinely
C. Implement structured routines and reduce stimuli
C. Encourage late-night exercise
Rationale: Non-pharmacologic interventions are first-line for sundowning behaviors.
, Q11. Which lab value requires immediate provider action in a patient on digoxin?
A. Potassium 4.2 mEq/L
B. Potassium 2.8 mEq/L
B. Magnesium 1.9 mg/dL
C. Sodium 138 mEq/L
Rationale: Hypokalemia increases risk of digoxin toxicity.
Q12. A 68-year-old with depression and insomnia is prescribed trazodone. What is the
primary safety concern?
A. Hypertension
B. Orthostatic hypotension and fall risk
B. Weight gain
C. Constipation
Rationale: Trazodone can cause orthostatic hypotension, increasing fall risk in older
adults.
Q13. Which intervention most effectively prevents delirium in hospitalized older adults?
A. Routine sedative use
B. Early mobilization and orientation strategies
B. Restrict family visits
C. Limit hydration
Rationale: Mobility and orientation reduce delirium incidence.
Q14. A 75-year-old with hypertension is started on hydrochlorothiazide. Which lab
should be monitored?
A. Hemoglobin
B. Potassium
B. Platelets
C. Calcium
Rationale: Thiazide diuretics can cause hypokalemia.
Q15. Which intervention best supports safe opioid prescribing in older adults?
A. Prescribe long-acting opioids first
B. Start low, go slow, and reassess frequently
B. Avoid non-opioid alternatives
C. Encourage self-escalation of doses
Rationale: Older adults are more sensitive to opioids; cautious titration is essential.
Q16. A 79-year-old with diabetes develops foot ulcers. What is the priority intervention?
A. Encourage barefoot walking
B. Refer to podiatry and initiate wound care
B. Increase carbohydrate intake
C. Delay treatment until infection occurs
Rationale: Early podiatry referral prevents complications and supports healing.
Q17. Which screening is recommended annually for adults ≥65 with diabetes?
