NURS 5461 | NURS5461 Final Exam: Adult
Gerontology Management Across the Continuum of
Care - UTA Updated and Latest Questions and
Correct Answers with Rationale
1. A 72-year-old male presents with increased dyspnea on exertion, paroxysmal nocturnal
dyspnea, and bilateral lower extremity edema. His echocardiogram reveals an ejection
fraction of 35%. Which of the following medication combinations is considered the gold
standard for reducing mortality in this patient?
A. Furosemide and Digoxin
B. Lisinopril, Carvedilol, and Spironolactone
C. Amlodipine and Hydrochlorothiazide
D. Isosorbide mononitrate and Warfarin
Correct Answer: B
Expert Explanation: Heart failure with reduced ejection fraction requires a multi-faceted
pharmacological approach to improve long-term outcomes. Evidence-based guidelines
strongly support the use of ACE inhibitors, beta-blockers, and mineralocorticoid receptor
antagonists to reduce mortality. Lisinopril and Carvedilol work synergistically to
counteract the neurohormonal activation seen in heart failure. Spironolactone is added for
patients with persistent symptoms and low ejection fraction to further decrease the risk of
death. Diuretics like furosemide provide symptomatic relief but have not been proven to
improve survival rates.
2. An 80-year-old female is admitted with an acute change in mental status, characterized by
fluctuating consciousness and visual hallucinations. Her daughter reports that the patient was
fine two days ago but became progressively confused after starting a new medication for
urinary urgency. Which assessment tool is most appropriate to confirm the diagnosis?
A. Confusion Assessment Method (CAM)
B. Geriatric Depression Scale (GDS)
C. Mini-Mental State Examination (MMSE)
D. Patient Health Questionnaire-9 (PHQ-9)
Correct Answer: A
Expert Explanation: The Confusion Assessment Method is the gold standard for
identifying delirium in the clinical setting. Delirium is characterized by an acute onset,
fluctuating course, inattention, and disorganized thinking. Unlike dementia, which is
chronic and progressive, delirium is often reversible once the underlying trigger is
,addressed. The MMSE is more useful for screening cognitive impairment and monitoring
the progression of dementia. Using the CAM ensures that the provider can distinguish
between cognitive decline and an acute medical emergency.
3. A 65-year-old patient with a history of COPD presents with increased cough, purulent
sputum production, and worsening shortness of breath for three days. The patient’s oxygen
saturation is 90% on room air, and chest X-ray shows no infiltrates. What is the most
appropriate initial management for this COPD exacerbation?
A. Admission for intravenous vancomycin and piperacillin-tazobactam
B. Immediate intubation and mechanical ventilation
C. Oral prednisone, an increased dose of short-acting bronchodilators, and an antibiotic
D. High-flow oxygen therapy at 15 liters per minute
Correct Answer: C
Expert Explanation: The management of a COPD exacerbation focuses on reducing airway
inflammation and treating potential bacterial triggers. Systemic corticosteroids like
prednisone help speed recovery and improve lung function during an acute flare.
Bronchodilators are essential for providing rapid relief of bronchospasm and improving
airflow. Antibiotics are indicated when patients present with increased sputum purulence
and volume, suggesting a bacterial infection. Managing this patient in the outpatient setting
is appropriate if they are stable and do not have severe respiratory distress.
4. A 68-year-old male with Type 2 Diabetes Mellitus has a current HbA1c of 8.2% despite
being on Metformin 1000mg twice daily. He has a history of atherosclerotic cardiovascular
disease (ASCVD). According to current guidelines, which medication should be added next?
A. Empagliflozin (SGLT2 inhibitor)
B. Pioglitazone
C. Glipizide
D. Basal Insulin
Correct Answer: A
Expert Explanation: In patients with Type 2 Diabetes and established ASCVD, SGLT2
inhibitors or GLP-1 receptor agonists are prioritized. Empagliflozin has demonstrated
significant cardiovascular benefits, including a reduction in major adverse cardiovascular
events. Metformin remains the first-line therapy, but additional agents must address the
patient’s specific comorbidities. Glipizide carries a higher risk of hypoglycemia and does
not provide cardiovascular protection. Therefore, adding an SGLT2 inhibitor is the most
evidence-based choice for this specific patient profile.
, 5. A 75-year-old male is evaluated for hypertension; his clinic blood pressure is consistently
155/92 mmHg. He has a history of benign prostatic hyperplasia (BPH) and occasional dizzy
spells when standing. Which medication would be most beneficial for managing both
conditions simultaneously?
A. Doxazosin
B. Amlodipine
C. Lisinopril
D. Metoprolol
Correct Answer: A
Expert Explanation: Alpha-1 blockers like Doxazosin are effective for treating both
hypertension and symptoms of BPH. They work by relaxing the smooth muscles in the
bladder neck and prostate, which improves urinary flow. While not typically first-line for
hypertension alone, they are excellent for patients with co-occurring prostatic
enlargement. Care must be taken to monitor for orthostatic hypotension, which is a
common side effect in the elderly. This approach simplifies the medication regimen and
targets multiple issues with a single drug.
6. A 70-year-old patient with Stage 3 Chronic Kidney Disease (CKD) and osteoarthritis asks for
a recommendation for pain management. Which of the following should be avoided to
prevent further decline in renal function?
A. Acetaminophen
B. Glucosamine
C. Topical Diclofenac
D. Ibuprofen
Correct Answer: D
Expert Explanation: Nonsteroidal anti-inflammatory drugs like Ibuprofen can cause
significant renal damage by inhibiting prostaglandins that maintain renal blood flow. In
patients with pre-existing CKD, even short-term use of NSAIDs can lead to acute kidney
injury. Acetaminophen is generally considered the safest systemic analgesic for patients
with renal impairment when used at appropriate doses. Topical agents may be considered
but systemic absorption can still occur, making them less ideal than acetaminophen.
Educating patients with CKD about the dangers of over-the-counter NSAIDs is a critical
component of primary care.
7. Using the CURB-65 criteria, a 78-year-old patient with Community-Acquired Pneumonia
(CAP) presents with Confusion, a Urea of 22 mg/dL, a Respiratory rate of 32, and a Blood
pressure of 88/58. What is the recommended site of care?
A. Outpatient treatment with oral antibiotics
Gerontology Management Across the Continuum of
Care - UTA Updated and Latest Questions and
Correct Answers with Rationale
1. A 72-year-old male presents with increased dyspnea on exertion, paroxysmal nocturnal
dyspnea, and bilateral lower extremity edema. His echocardiogram reveals an ejection
fraction of 35%. Which of the following medication combinations is considered the gold
standard for reducing mortality in this patient?
A. Furosemide and Digoxin
B. Lisinopril, Carvedilol, and Spironolactone
C. Amlodipine and Hydrochlorothiazide
D. Isosorbide mononitrate and Warfarin
Correct Answer: B
Expert Explanation: Heart failure with reduced ejection fraction requires a multi-faceted
pharmacological approach to improve long-term outcomes. Evidence-based guidelines
strongly support the use of ACE inhibitors, beta-blockers, and mineralocorticoid receptor
antagonists to reduce mortality. Lisinopril and Carvedilol work synergistically to
counteract the neurohormonal activation seen in heart failure. Spironolactone is added for
patients with persistent symptoms and low ejection fraction to further decrease the risk of
death. Diuretics like furosemide provide symptomatic relief but have not been proven to
improve survival rates.
2. An 80-year-old female is admitted with an acute change in mental status, characterized by
fluctuating consciousness and visual hallucinations. Her daughter reports that the patient was
fine two days ago but became progressively confused after starting a new medication for
urinary urgency. Which assessment tool is most appropriate to confirm the diagnosis?
A. Confusion Assessment Method (CAM)
B. Geriatric Depression Scale (GDS)
C. Mini-Mental State Examination (MMSE)
D. Patient Health Questionnaire-9 (PHQ-9)
Correct Answer: A
Expert Explanation: The Confusion Assessment Method is the gold standard for
identifying delirium in the clinical setting. Delirium is characterized by an acute onset,
fluctuating course, inattention, and disorganized thinking. Unlike dementia, which is
chronic and progressive, delirium is often reversible once the underlying trigger is
,addressed. The MMSE is more useful for screening cognitive impairment and monitoring
the progression of dementia. Using the CAM ensures that the provider can distinguish
between cognitive decline and an acute medical emergency.
3. A 65-year-old patient with a history of COPD presents with increased cough, purulent
sputum production, and worsening shortness of breath for three days. The patient’s oxygen
saturation is 90% on room air, and chest X-ray shows no infiltrates. What is the most
appropriate initial management for this COPD exacerbation?
A. Admission for intravenous vancomycin and piperacillin-tazobactam
B. Immediate intubation and mechanical ventilation
C. Oral prednisone, an increased dose of short-acting bronchodilators, and an antibiotic
D. High-flow oxygen therapy at 15 liters per minute
Correct Answer: C
Expert Explanation: The management of a COPD exacerbation focuses on reducing airway
inflammation and treating potential bacterial triggers. Systemic corticosteroids like
prednisone help speed recovery and improve lung function during an acute flare.
Bronchodilators are essential for providing rapid relief of bronchospasm and improving
airflow. Antibiotics are indicated when patients present with increased sputum purulence
and volume, suggesting a bacterial infection. Managing this patient in the outpatient setting
is appropriate if they are stable and do not have severe respiratory distress.
4. A 68-year-old male with Type 2 Diabetes Mellitus has a current HbA1c of 8.2% despite
being on Metformin 1000mg twice daily. He has a history of atherosclerotic cardiovascular
disease (ASCVD). According to current guidelines, which medication should be added next?
A. Empagliflozin (SGLT2 inhibitor)
B. Pioglitazone
C. Glipizide
D. Basal Insulin
Correct Answer: A
Expert Explanation: In patients with Type 2 Diabetes and established ASCVD, SGLT2
inhibitors or GLP-1 receptor agonists are prioritized. Empagliflozin has demonstrated
significant cardiovascular benefits, including a reduction in major adverse cardiovascular
events. Metformin remains the first-line therapy, but additional agents must address the
patient’s specific comorbidities. Glipizide carries a higher risk of hypoglycemia and does
not provide cardiovascular protection. Therefore, adding an SGLT2 inhibitor is the most
evidence-based choice for this specific patient profile.
, 5. A 75-year-old male is evaluated for hypertension; his clinic blood pressure is consistently
155/92 mmHg. He has a history of benign prostatic hyperplasia (BPH) and occasional dizzy
spells when standing. Which medication would be most beneficial for managing both
conditions simultaneously?
A. Doxazosin
B. Amlodipine
C. Lisinopril
D. Metoprolol
Correct Answer: A
Expert Explanation: Alpha-1 blockers like Doxazosin are effective for treating both
hypertension and symptoms of BPH. They work by relaxing the smooth muscles in the
bladder neck and prostate, which improves urinary flow. While not typically first-line for
hypertension alone, they are excellent for patients with co-occurring prostatic
enlargement. Care must be taken to monitor for orthostatic hypotension, which is a
common side effect in the elderly. This approach simplifies the medication regimen and
targets multiple issues with a single drug.
6. A 70-year-old patient with Stage 3 Chronic Kidney Disease (CKD) and osteoarthritis asks for
a recommendation for pain management. Which of the following should be avoided to
prevent further decline in renal function?
A. Acetaminophen
B. Glucosamine
C. Topical Diclofenac
D. Ibuprofen
Correct Answer: D
Expert Explanation: Nonsteroidal anti-inflammatory drugs like Ibuprofen can cause
significant renal damage by inhibiting prostaglandins that maintain renal blood flow. In
patients with pre-existing CKD, even short-term use of NSAIDs can lead to acute kidney
injury. Acetaminophen is generally considered the safest systemic analgesic for patients
with renal impairment when used at appropriate doses. Topical agents may be considered
but systemic absorption can still occur, making them less ideal than acetaminophen.
Educating patients with CKD about the dangers of over-the-counter NSAIDs is a critical
component of primary care.
7. Using the CURB-65 criteria, a 78-year-old patient with Community-Acquired Pneumonia
(CAP) presents with Confusion, a Urea of 22 mg/dL, a Respiratory rate of 32, and a Blood
pressure of 88/58. What is the recommended site of care?
A. Outpatient treatment with oral antibiotics
