NURS 5461 | NURS5461 Exam 4: Adult Gerontology
Management Across the Continuum of Care - UTA
Updated and Latest Questions and Correct
Answers with Rationale
1. An 82-year-old male with Parkinson’s disease is experiencing increased ‘off’ periods
despite taking Levodopa-Carbidopa 25/100 mg four times daily. What is the most appropriate
next step in pharmacological management?
A. Discontinue Levodopa immediately to prevent toxicity
B. Add a COMT inhibitor such as Entacapone
C. Switch to high-dose Diazepam for muscle relaxation
D. Prescribe Amitriptyline to manage motor fluctuations
Correct Answer: B
Expert Explanation: Adding a COMT inhibitor like Entacapone helps extend the half-life of
Levodopa and reduces ‘off’ time. This strategy is preferred over increasing the Levodopa
dose which might exacerbate dyskinesias in older adults. Sudden discontinuation of
Levodopa is dangerous and can lead to neuroleptic malignant-like syndrome. Diazepam is
not indicated for Parkinson’s motor symptoms and increases fall risks significantly.
Advanced practice nurses must balance motor symptom control with the potential for
drug-induced side effects.
2. A 75-year-old female presents with a new onset of confusion, tachypnea, and a normal
temperature of 98.4°F. Which geriatric-specific physiological factor most likely masks a typical
fever response in sepsis?
A. Increased metabolic rate
B. Decreased thermoregulatory set point
C. Enhanced peripheral vasoconstriction
D. Heightened sweat gland activity
Correct Answer: B
Expert Explanation: Geriatric patients often fail to mount a traditional febrile response
due to an altered thermoregulatory set point and decreased basal body temperature.
Tachypnea and acute mental status changes are frequently the first signs of systemic
infection in this population. Relying solely on temperature can lead to dangerous delays in
diagnosing sepsis or pneumonia. Metabolic rates actually decrease with age, which further
complicates the heat production needed for fever. Clinicians should maintain a high index
of suspicion when any vital sign or cognitive baseline shifts.
,3. A patient with Rheumatoid Arthritis (RA) is being started on Methotrexate. Which
laboratory monitoring schedule and specific test are critical for safety?
A. Monthly serum calcium levels
B. Weekly Urinalysis for protein
C. Annual Vitamin D screenings
D. Baseline and periodic Liver Function Tests (LFTs) and CBC
Correct Answer: D
Expert Explanation: Methotrexate is a disease-modifying antirheumatic drug (DMARD)
that can cause significant bone marrow suppression and hepatotoxicity. Baseline LFTs and
CBC must be obtained followed by regular monitoring every 8 to 12 weeks once a stable
dose is reached. Pulmonary toxicity is also a rare but serious risk that requires clinical
vigilance. Patients should be educated to report any signs of infection or unusual bruising
immediately. Folic acid supplementation is typically prescribed alongside Methotrexate to
reduce side effects like GI upset and oral ulcers.
4. A 70-year-old patient is diagnosed with Osteoporosis and prescribed Alendronate. Which
administration instruction is vital to prevent esophageal erosion?
A. Take the medication with a full glass of milk
B. Lie down for 30 minutes immediately after ingestion
C. Take the pill at bedtime with a light snack
D. Take with a full glass of water and remain upright for 30 minutes
Correct Answer: D
Expert Explanation: Alendronate, a bisphosphonate, can cause severe esophageal
irritation and ulceration if not handled correctly. Patients must take it with plain water
only, as other beverages can interfere with its very low absorption rate. Remaining upright
for at least 30 minutes ensures the medication passes quickly through the esophagus.
Taking it before the first food or drink of the day is necessary for maximum efficacy. If a
patient cannot remain upright, alternative therapies like IV zoledronic acid should be
considered.
5. When evaluating an 80-year-old for delirium versus dementia, which finding is most
indicative of delirium?
A. Slow, progressive memory loss over 3 years
B. Acute onset of fluctuating levels of consciousness
C. Difficulty finding words during a conversation
D. Stable vital signs and normal sleep-wake cycle
, Correct Answer: B
Expert Explanation: Delirium is characterized by a rapid onset and a fluctuating course of
symptoms throughout the day. In contrast, dementia involves a slow and steady decline in
cognitive function without acute changes in consciousness. Delirium is often triggered by
an underlying medical condition like an infection or medication toxicity. It is considered a
medical emergency in the elderly and requires immediate investigation of the root cause.
Proper assessment using the Confusion Assessment Method (CAM) can help distinguish
these two distinct conditions.
6. According to the Beers Criteria, why should Amitriptyline be avoided in the geriatric
population?
A. It has strong anticholinergic properties increasing fall risk
B. It causes significant hypertension
C. It leads to excessive weight loss
D. It is less effective than newer SSRIs for depression
Correct Answer: A
Expert Explanation: Amitriptyline is a tricyclic antidepressant with highly potent
anticholinergic effects that are poorly tolerated by older adults. These effects include
blurred vision, urinary retention, constipation, and significant orthostatic hypotension. The
resulting sedation and dizziness greatly increase the risk of falls and subsequent fractures.
Alternative treatments for depression or neuropathic pain with better safety profiles
should be prioritized. The Beers Criteria specifically lists this drug as potentially
inappropriate for most elderly patients due to these safety concerns.
7. A 78-year-old patient is post-op day 1 from a total hip arthroplasty. What is the priority
nursing intervention to prevent the most common life-threatening complication?
A. Restricting all fluids to prevent edema
B. Keeping the patient on strict bed rest for 72 hours
C. Administering prophylactic anticoagulation and encouraging early ambulation
D. Applying heat packs to the surgical site
Correct Answer: C
Expert Explanation: Venous thromboembolism (VTE), including DVT and pulmonary
embolism, is a major risk following orthopedic surgery in the elderly. Early mobilization
and pharmacologic prophylaxis are the standard of care to mitigate this risk effectively.
Bed rest actually increases the likelihood of clot formation and should be avoided unless
medically necessary. Sequential compression devices are also used as an adjunct to
anticoagulation therapy. Monitoring for sudden shortness of breath or chest pain is
essential for early detection of a pulmonary embolus.
Management Across the Continuum of Care - UTA
Updated and Latest Questions and Correct
Answers with Rationale
1. An 82-year-old male with Parkinson’s disease is experiencing increased ‘off’ periods
despite taking Levodopa-Carbidopa 25/100 mg four times daily. What is the most appropriate
next step in pharmacological management?
A. Discontinue Levodopa immediately to prevent toxicity
B. Add a COMT inhibitor such as Entacapone
C. Switch to high-dose Diazepam for muscle relaxation
D. Prescribe Amitriptyline to manage motor fluctuations
Correct Answer: B
Expert Explanation: Adding a COMT inhibitor like Entacapone helps extend the half-life of
Levodopa and reduces ‘off’ time. This strategy is preferred over increasing the Levodopa
dose which might exacerbate dyskinesias in older adults. Sudden discontinuation of
Levodopa is dangerous and can lead to neuroleptic malignant-like syndrome. Diazepam is
not indicated for Parkinson’s motor symptoms and increases fall risks significantly.
Advanced practice nurses must balance motor symptom control with the potential for
drug-induced side effects.
2. A 75-year-old female presents with a new onset of confusion, tachypnea, and a normal
temperature of 98.4°F. Which geriatric-specific physiological factor most likely masks a typical
fever response in sepsis?
A. Increased metabolic rate
B. Decreased thermoregulatory set point
C. Enhanced peripheral vasoconstriction
D. Heightened sweat gland activity
Correct Answer: B
Expert Explanation: Geriatric patients often fail to mount a traditional febrile response
due to an altered thermoregulatory set point and decreased basal body temperature.
Tachypnea and acute mental status changes are frequently the first signs of systemic
infection in this population. Relying solely on temperature can lead to dangerous delays in
diagnosing sepsis or pneumonia. Metabolic rates actually decrease with age, which further
complicates the heat production needed for fever. Clinicians should maintain a high index
of suspicion when any vital sign or cognitive baseline shifts.
,3. A patient with Rheumatoid Arthritis (RA) is being started on Methotrexate. Which
laboratory monitoring schedule and specific test are critical for safety?
A. Monthly serum calcium levels
B. Weekly Urinalysis for protein
C. Annual Vitamin D screenings
D. Baseline and periodic Liver Function Tests (LFTs) and CBC
Correct Answer: D
Expert Explanation: Methotrexate is a disease-modifying antirheumatic drug (DMARD)
that can cause significant bone marrow suppression and hepatotoxicity. Baseline LFTs and
CBC must be obtained followed by regular monitoring every 8 to 12 weeks once a stable
dose is reached. Pulmonary toxicity is also a rare but serious risk that requires clinical
vigilance. Patients should be educated to report any signs of infection or unusual bruising
immediately. Folic acid supplementation is typically prescribed alongside Methotrexate to
reduce side effects like GI upset and oral ulcers.
4. A 70-year-old patient is diagnosed with Osteoporosis and prescribed Alendronate. Which
administration instruction is vital to prevent esophageal erosion?
A. Take the medication with a full glass of milk
B. Lie down for 30 minutes immediately after ingestion
C. Take the pill at bedtime with a light snack
D. Take with a full glass of water and remain upright for 30 minutes
Correct Answer: D
Expert Explanation: Alendronate, a bisphosphonate, can cause severe esophageal
irritation and ulceration if not handled correctly. Patients must take it with plain water
only, as other beverages can interfere with its very low absorption rate. Remaining upright
for at least 30 minutes ensures the medication passes quickly through the esophagus.
Taking it before the first food or drink of the day is necessary for maximum efficacy. If a
patient cannot remain upright, alternative therapies like IV zoledronic acid should be
considered.
5. When evaluating an 80-year-old for delirium versus dementia, which finding is most
indicative of delirium?
A. Slow, progressive memory loss over 3 years
B. Acute onset of fluctuating levels of consciousness
C. Difficulty finding words during a conversation
D. Stable vital signs and normal sleep-wake cycle
, Correct Answer: B
Expert Explanation: Delirium is characterized by a rapid onset and a fluctuating course of
symptoms throughout the day. In contrast, dementia involves a slow and steady decline in
cognitive function without acute changes in consciousness. Delirium is often triggered by
an underlying medical condition like an infection or medication toxicity. It is considered a
medical emergency in the elderly and requires immediate investigation of the root cause.
Proper assessment using the Confusion Assessment Method (CAM) can help distinguish
these two distinct conditions.
6. According to the Beers Criteria, why should Amitriptyline be avoided in the geriatric
population?
A. It has strong anticholinergic properties increasing fall risk
B. It causes significant hypertension
C. It leads to excessive weight loss
D. It is less effective than newer SSRIs for depression
Correct Answer: A
Expert Explanation: Amitriptyline is a tricyclic antidepressant with highly potent
anticholinergic effects that are poorly tolerated by older adults. These effects include
blurred vision, urinary retention, constipation, and significant orthostatic hypotension. The
resulting sedation and dizziness greatly increase the risk of falls and subsequent fractures.
Alternative treatments for depression or neuropathic pain with better safety profiles
should be prioritized. The Beers Criteria specifically lists this drug as potentially
inappropriate for most elderly patients due to these safety concerns.
7. A 78-year-old patient is post-op day 1 from a total hip arthroplasty. What is the priority
nursing intervention to prevent the most common life-threatening complication?
A. Restricting all fluids to prevent edema
B. Keeping the patient on strict bed rest for 72 hours
C. Administering prophylactic anticoagulation and encouraging early ambulation
D. Applying heat packs to the surgical site
Correct Answer: C
Expert Explanation: Venous thromboembolism (VTE), including DVT and pulmonary
embolism, is a major risk following orthopedic surgery in the elderly. Early mobilization
and pharmacologic prophylaxis are the standard of care to mitigate this risk effectively.
Bed rest actually increases the likelihood of clot formation and should be avoided unless
medically necessary. Sequential compression devices are also used as an adjunct to
anticoagulation therapy. Monitoring for sudden shortness of breath or chest pain is
essential for early detection of a pulmonary embolus.
