NURS 5461/ NURS5461 Final Comprehensive Exam
Adult Gerontology Management Across the
Continuum of Care Guide| UTA
(Latest 2026/2027 Update) 100% Verified
Questions & Answers | Grade A | 100 questions
Q1: An 82-year-old patient is being discharged from the hospital to a Skilled Nursing Facility
(SNF) for rehabilitation after a hip fracture. To qualify for Medicare Part A coverage in the SNF,
which of the following criteria must be met?
A. The patient must have been an inpatient in the hospital for at least 4 nights.
B. The patient requires daily skilled nursing care or rehabilitation services. [CORRECT]
C. The patient must be admitted to the SNF within 10 days of hospital discharge.
D. The patient must require custodial care only for assistance with ADLs.
Correct Answer: B
Rationale: Medicare Part A covers SNF stays if the patient requires daily skilled care (rehab or
nursing) that can only be provided in a SNF on an inpatient basis. A 3-night hospital stay is
required, not 4, and custodial care is not covered. Admission generally must be within 30 days,
but the immediate clinical necessity is the daily skilled need.
Q2: Which transitional care model focuses on preventing readmissions by using a "Discharge
Advocate" to help patients understand medications and follow-up appointments?
A. Project RED (Re-Engineered Discharge) [CORRECT]
B. BOOST (Better Outcomes for Older Adults through Safe Transitions)
C. The Guided Care Model
D. The Transitional Care Model (TCM)
,Correct Answer: A
Rationale: Project RED utilizes patient-centered Discharge Advocates to ensure patients
understand their discharge plan, medication reconciliation, and follow-up, specifically targeting
readmission reduction. BOOST is a toolkit for hospitals but is broader; TCM involves advanced
practice nurses providing home visits.
Q3: A patient with end-stage COPD requiring prolonged mechanical ventilation is being
evaluated for discharge. Which setting is most appropriate for this patient’s level of acuity?
A. Skilled Nursing Facility (SNF)
B. Inpatient Rehabilitation Facility (IRF)
C. Long-Term Acute Care Hospital (LTAC) [CORRECT]
D. Assisted Living Facility (ALF)
Correct Answer: C
Rationale: LTACs are designed for patients who require extended acute care (average stay >25
days) such as prolonged ventilator weaning or complex wound care, which exceeds the typical
length of stay in an acute care hospital. SNFs generally do not accept ventilator-dependent
patients unless they have specific subacute units, and IRFs focus on intensive rehab rather than
acute medical management.
Q4: Medicare Part A Home Health benefits require that the patient be considered "homebound."
Which scenario best describes the homebound status?
A. The patient drives themselves to church weekly but finds it exhausting.
B. The patient leaves home only for medical appointments or short infrequent outings for
non-medical reasons, resulting in a considerable and taxing effort. [CORRECT]
C. The patient is able to grocery shop independently once a week.
D. The patient attends adult day care 5 days a week for socialization.
Correct Answer: B
Rationale: Medicare defines homebound as leaving home infrequently and requiring a taxing
effort. Absences for medical treatment or short non-medical outings (like a haircut) are permitted
if they require significant assistance or effort. Regular independent outings for social or shopping
purposes generally disqualify the patient.
.
,Q5: When transferring a patient from an Acute Care Hospital to an Inpatient Rehabilitation
Facility (IRF), which "75% Rule" criteria must be considered?
A. 75% of the patients in the facility must be over the age of 65.
B. 75% of the patients must require at least two hours of therapy per day.
C. 75% of the facility's patients must have one of 13 specific conditions requiring intensive
rehabilitation. [CORRECT]
D. 75% of the patients must be discharged within 2 weeks.
Correct Answer: C
Rationale: The 75% Rule (Compliance Act) requires that IRFs admit a high percentage of
patients who have specific medical conditions (like stroke, spinal cord injury, or major multiple
trauma) requiring intensive rehab, ensuring the facility serves those who most need that level of
care rather than those needing subacute care.
Q6: A nurse is performing medication reconciliation for a patient moving from the hospital to an
Assisted Living Facility (ALF). The patient was on a "holding" dose of digoxin in the hospital.
The discharge orders list digoxin. What is the nurse's priority action?
A. Fax the order to the ALF and assume they will fill it.
B. Verify if the digoxin was a pre-existing medication or started during the hospitalization
and confirm the indication. [CORRECT]
C. Withhold the medication until the patient sees their primary care provider in 2 weeks.
D. Reduce the dose by 50% due to the transition to a lower level of care.
Correct Answer: B
Rationale: Medication reconciliation requires verifying the home list vs. hospital list. "Holding"
meds in the hospital are often discontinued at discharge unless specifically restarted. Verifying
the indication prevents restarting unnecessary medications that were perhaps inappropriate for
the elderly (Beers Criteria).
.
, Q7: Which of the following is a key component of the "Teach-Back" method during discharge
education for an older adult?
A. Asking the patient if they understand the instructions.
B. Handing the patient a written pamphlet and reading it aloud to them.
C. Asking the patient to explain in their own words what they will do at home to manage
their condition. [CORRECT]
D. Quizzing the patient on the side effects of every medication listed.
Correct Answer: C
Rationale: The Teach-Back method involves asking the patient to repeat back the instructions in
their own words to confirm understanding. Simply asking "Do you understand?" usually results
in a "yes" regardless of actual comprehension.
Q8: A patient is admitted to an SNF. The Minimum Data Set (MDS) assessment must be
completed within how many days of admission to determine reimbursement and care planning?
A. 7 days
B. 14 days
C. 5 days for Medicare A [CORRECT]
D. 30 days
Correct Answer: C
Rationale: For Medicare Part A stays in a SNF, the Scheduled 5-day assessment (OBRA) must
be completed to set the baseline for the RUG-IV/Case Mix payment and care plan. A 14-day
assessment is also required, but the 5-day is the initial comprehensive one.
.
Adult Gerontology Management Across the
Continuum of Care Guide| UTA
(Latest 2026/2027 Update) 100% Verified
Questions & Answers | Grade A | 100 questions
Q1: An 82-year-old patient is being discharged from the hospital to a Skilled Nursing Facility
(SNF) for rehabilitation after a hip fracture. To qualify for Medicare Part A coverage in the SNF,
which of the following criteria must be met?
A. The patient must have been an inpatient in the hospital for at least 4 nights.
B. The patient requires daily skilled nursing care or rehabilitation services. [CORRECT]
C. The patient must be admitted to the SNF within 10 days of hospital discharge.
D. The patient must require custodial care only for assistance with ADLs.
Correct Answer: B
Rationale: Medicare Part A covers SNF stays if the patient requires daily skilled care (rehab or
nursing) that can only be provided in a SNF on an inpatient basis. A 3-night hospital stay is
required, not 4, and custodial care is not covered. Admission generally must be within 30 days,
but the immediate clinical necessity is the daily skilled need.
Q2: Which transitional care model focuses on preventing readmissions by using a "Discharge
Advocate" to help patients understand medications and follow-up appointments?
A. Project RED (Re-Engineered Discharge) [CORRECT]
B. BOOST (Better Outcomes for Older Adults through Safe Transitions)
C. The Guided Care Model
D. The Transitional Care Model (TCM)
,Correct Answer: A
Rationale: Project RED utilizes patient-centered Discharge Advocates to ensure patients
understand their discharge plan, medication reconciliation, and follow-up, specifically targeting
readmission reduction. BOOST is a toolkit for hospitals but is broader; TCM involves advanced
practice nurses providing home visits.
Q3: A patient with end-stage COPD requiring prolonged mechanical ventilation is being
evaluated for discharge. Which setting is most appropriate for this patient’s level of acuity?
A. Skilled Nursing Facility (SNF)
B. Inpatient Rehabilitation Facility (IRF)
C. Long-Term Acute Care Hospital (LTAC) [CORRECT]
D. Assisted Living Facility (ALF)
Correct Answer: C
Rationale: LTACs are designed for patients who require extended acute care (average stay >25
days) such as prolonged ventilator weaning or complex wound care, which exceeds the typical
length of stay in an acute care hospital. SNFs generally do not accept ventilator-dependent
patients unless they have specific subacute units, and IRFs focus on intensive rehab rather than
acute medical management.
Q4: Medicare Part A Home Health benefits require that the patient be considered "homebound."
Which scenario best describes the homebound status?
A. The patient drives themselves to church weekly but finds it exhausting.
B. The patient leaves home only for medical appointments or short infrequent outings for
non-medical reasons, resulting in a considerable and taxing effort. [CORRECT]
C. The patient is able to grocery shop independently once a week.
D. The patient attends adult day care 5 days a week for socialization.
Correct Answer: B
Rationale: Medicare defines homebound as leaving home infrequently and requiring a taxing
effort. Absences for medical treatment or short non-medical outings (like a haircut) are permitted
if they require significant assistance or effort. Regular independent outings for social or shopping
purposes generally disqualify the patient.
.
,Q5: When transferring a patient from an Acute Care Hospital to an Inpatient Rehabilitation
Facility (IRF), which "75% Rule" criteria must be considered?
A. 75% of the patients in the facility must be over the age of 65.
B. 75% of the patients must require at least two hours of therapy per day.
C. 75% of the facility's patients must have one of 13 specific conditions requiring intensive
rehabilitation. [CORRECT]
D. 75% of the patients must be discharged within 2 weeks.
Correct Answer: C
Rationale: The 75% Rule (Compliance Act) requires that IRFs admit a high percentage of
patients who have specific medical conditions (like stroke, spinal cord injury, or major multiple
trauma) requiring intensive rehab, ensuring the facility serves those who most need that level of
care rather than those needing subacute care.
Q6: A nurse is performing medication reconciliation for a patient moving from the hospital to an
Assisted Living Facility (ALF). The patient was on a "holding" dose of digoxin in the hospital.
The discharge orders list digoxin. What is the nurse's priority action?
A. Fax the order to the ALF and assume they will fill it.
B. Verify if the digoxin was a pre-existing medication or started during the hospitalization
and confirm the indication. [CORRECT]
C. Withhold the medication until the patient sees their primary care provider in 2 weeks.
D. Reduce the dose by 50% due to the transition to a lower level of care.
Correct Answer: B
Rationale: Medication reconciliation requires verifying the home list vs. hospital list. "Holding"
meds in the hospital are often discontinued at discharge unless specifically restarted. Verifying
the indication prevents restarting unnecessary medications that were perhaps inappropriate for
the elderly (Beers Criteria).
.
, Q7: Which of the following is a key component of the "Teach-Back" method during discharge
education for an older adult?
A. Asking the patient if they understand the instructions.
B. Handing the patient a written pamphlet and reading it aloud to them.
C. Asking the patient to explain in their own words what they will do at home to manage
their condition. [CORRECT]
D. Quizzing the patient on the side effects of every medication listed.
Correct Answer: C
Rationale: The Teach-Back method involves asking the patient to repeat back the instructions in
their own words to confirm understanding. Simply asking "Do you understand?" usually results
in a "yes" regardless of actual comprehension.
Q8: A patient is admitted to an SNF. The Minimum Data Set (MDS) assessment must be
completed within how many days of admission to determine reimbursement and care planning?
A. 7 days
B. 14 days
C. 5 days for Medicare A [CORRECT]
D. 30 days
Correct Answer: C
Rationale: For Medicare Part A stays in a SNF, the Scheduled 5-day assessment (OBRA) must
be completed to set the baseline for the RUG-IV/Case Mix payment and care plan. A 14-day
assessment is also required, but the 5-day is the initial comprehensive one.
.
