1
NURS5461 Adult Gerontology Management Across
Continuum of Care Quiz 1 2026/2027 Actual Exam -
Complete Questions with Detailed Rationales | 100%
Verified Graded A+ Pass Guaranteed - A+ Graded
Section 1: Transitional Care & Discharge Planning (Questions 1-15)
Q1: An 82-year-old patient with heart failure is being discharged after a 5-day hospitalization for
fluid overload. To reduce the risk of 30-day readmission, which transitional care intervention has
the strongest evidence base?
A. Providing the patient with a printed list of discharge medications only.
B. A scheduled follow-up phone call within 72 hours of discharge by a nurse.
C. Referral to a primary care provider for a visit in 6 weeks.
D. Instruction to the family to monitor weight at home.
B. A scheduled follow-up phone call within 72 hours of discharge by a nurse. [CORRECT]
Correct Answer: B
Rationale: Structured follow-up phone calls within 2-3 days of discharge allow for early
identification of complications, medication reconciliation, and reinforcement of self-
management, which are proven to reduce readmission rates. While medication lists and follow-
up appointments are important, active outreach has a higher impact on readmission prevention
than passive handouts.
Q2: During a discharge planning conference, the nurse practitioner utilizes the "teach-back
method" to assess the patient's understanding of a new medication regimen. Which statement
best describes the correct use of this technique?
A. Asking the patient, "Do you understand how to take these pills?"
B. Providing a written handout and asking the patient to read it later.
C. Asking the patient to explain in their own words how and when to take the medication.
D. Demonstrating the medication administration to the family members only.
,2
C. Asking the patient to explain in their own words how and when to take the medication.
[CORRECT]
Correct Answer: C
Rationale: The teach-back method involves asking the patient to repeat back the information in
their own words to verify understanding. Asking "Do you understand?" elicits a "yes" regardless
of actual comprehension. Demonstration without patient verification does not confirm the
patient's ability to perform the task independently.
Q3: A patient with dementia is being transferred from an acute care hospital to a skilled nursing
facility (SNF). Which component of the transfer is most critical to prevent medication errors?
A. Verbal report to the receiving nurse.
B. Sending the patient's current medication bottles with them.
C. A complete and accurate reconciliation of the medication list sent to the SNF.
D. Copying the admission history and physical to the SNF chart.
C. A complete and accurate reconciliation of the medication list sent to the SNF. [CORRECT]
Correct Answer: C
Rationale: Medication reconciliation is the process of comparing a patient's medication orders to
all of the medications that the patient has been taking. This is the most critical step to prevent
transcription errors, omissions, and duplication of therapy during transitions of care, especially
for complex patients.
Q4: Which model of care delivery emphasizes a team-based approach, comprehensive care
coordination, and the patient being the center of care, often associated with improved outcomes
for chronic disease management?
A. Disease-Specific Management Model
B. Patient-Centered Medical Home (PCMH)
C. Fee-for-Service Model
D. Acute Care Model
, 3
B. Patient-Centered Medical Home (PCMH) [CORRECT]
Correct Answer: B
Rationale: The PCMH model is characterized by whole-person orientation,
coordinated/integrated care, accessible services, and quality/safety. It is specifically designed to
improve chronic disease management and care coordination across the continuum, unlike the
fragmented fee-for-service model.
Q5: A 75-year-old patient is discharged home after a total hip replacement. Which factor is the
strongest predictor of a successful transition to home and avoidance of readmission?
A. The patient lives alone.
B. The presence of a caregiver to assist with activities of daily living.
C. The patient has a home health aide scheduled for 1 hour a week.
D. The patient drives their own car to follow-up appointments.
B. The presence of a caregiver to assist with activities of daily living. [CORRECT]
Correct Answer: B
Rationale: Social support and the availability of a caregiver are critical factors in successful
recovery and adherence to post-discharge instructions. Living alone is a risk factor for poor
outcomes, and limited home health aide hours may not be sufficient for the immediate post-
operative period.
Q6: The Transitional Care Model (TCM) involves advanced practice nurses providing
comprehensive in-hospital and home follow-up. What is the primary focus of the TCM?
A. Reducing the length of stay in the hospital.
B. Preventing adverse events and promoting health during transitions.
C. Decreasing the cost of medications.
D. Focusing solely on end-of-life care.
B. Preventing adverse events and promoting health during transitions. [CORRECT]
Correct Answer: B
NURS5461 Adult Gerontology Management Across
Continuum of Care Quiz 1 2026/2027 Actual Exam -
Complete Questions with Detailed Rationales | 100%
Verified Graded A+ Pass Guaranteed - A+ Graded
Section 1: Transitional Care & Discharge Planning (Questions 1-15)
Q1: An 82-year-old patient with heart failure is being discharged after a 5-day hospitalization for
fluid overload. To reduce the risk of 30-day readmission, which transitional care intervention has
the strongest evidence base?
A. Providing the patient with a printed list of discharge medications only.
B. A scheduled follow-up phone call within 72 hours of discharge by a nurse.
C. Referral to a primary care provider for a visit in 6 weeks.
D. Instruction to the family to monitor weight at home.
B. A scheduled follow-up phone call within 72 hours of discharge by a nurse. [CORRECT]
Correct Answer: B
Rationale: Structured follow-up phone calls within 2-3 days of discharge allow for early
identification of complications, medication reconciliation, and reinforcement of self-
management, which are proven to reduce readmission rates. While medication lists and follow-
up appointments are important, active outreach has a higher impact on readmission prevention
than passive handouts.
Q2: During a discharge planning conference, the nurse practitioner utilizes the "teach-back
method" to assess the patient's understanding of a new medication regimen. Which statement
best describes the correct use of this technique?
A. Asking the patient, "Do you understand how to take these pills?"
B. Providing a written handout and asking the patient to read it later.
C. Asking the patient to explain in their own words how and when to take the medication.
D. Demonstrating the medication administration to the family members only.
,2
C. Asking the patient to explain in their own words how and when to take the medication.
[CORRECT]
Correct Answer: C
Rationale: The teach-back method involves asking the patient to repeat back the information in
their own words to verify understanding. Asking "Do you understand?" elicits a "yes" regardless
of actual comprehension. Demonstration without patient verification does not confirm the
patient's ability to perform the task independently.
Q3: A patient with dementia is being transferred from an acute care hospital to a skilled nursing
facility (SNF). Which component of the transfer is most critical to prevent medication errors?
A. Verbal report to the receiving nurse.
B. Sending the patient's current medication bottles with them.
C. A complete and accurate reconciliation of the medication list sent to the SNF.
D. Copying the admission history and physical to the SNF chart.
C. A complete and accurate reconciliation of the medication list sent to the SNF. [CORRECT]
Correct Answer: C
Rationale: Medication reconciliation is the process of comparing a patient's medication orders to
all of the medications that the patient has been taking. This is the most critical step to prevent
transcription errors, omissions, and duplication of therapy during transitions of care, especially
for complex patients.
Q4: Which model of care delivery emphasizes a team-based approach, comprehensive care
coordination, and the patient being the center of care, often associated with improved outcomes
for chronic disease management?
A. Disease-Specific Management Model
B. Patient-Centered Medical Home (PCMH)
C. Fee-for-Service Model
D. Acute Care Model
, 3
B. Patient-Centered Medical Home (PCMH) [CORRECT]
Correct Answer: B
Rationale: The PCMH model is characterized by whole-person orientation,
coordinated/integrated care, accessible services, and quality/safety. It is specifically designed to
improve chronic disease management and care coordination across the continuum, unlike the
fragmented fee-for-service model.
Q5: A 75-year-old patient is discharged home after a total hip replacement. Which factor is the
strongest predictor of a successful transition to home and avoidance of readmission?
A. The patient lives alone.
B. The presence of a caregiver to assist with activities of daily living.
C. The patient has a home health aide scheduled for 1 hour a week.
D. The patient drives their own car to follow-up appointments.
B. The presence of a caregiver to assist with activities of daily living. [CORRECT]
Correct Answer: B
Rationale: Social support and the availability of a caregiver are critical factors in successful
recovery and adherence to post-discharge instructions. Living alone is a risk factor for poor
outcomes, and limited home health aide hours may not be sufficient for the immediate post-
operative period.
Q6: The Transitional Care Model (TCM) involves advanced practice nurses providing
comprehensive in-hospital and home follow-up. What is the primary focus of the TCM?
A. Reducing the length of stay in the hospital.
B. Preventing adverse events and promoting health during transitions.
C. Decreasing the cost of medications.
D. Focusing solely on end-of-life care.
B. Preventing adverse events and promoting health during transitions. [CORRECT]
Correct Answer: B
