NURS 5461 | NURS5461 Exam 2: Adult Gerontology
Management Across the Continuum of Care - UTA
Updated and Latest Questions and Correct
Answers with Rationale
1. A 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents with increased shortness of breath and peripheral edema. His blood pressure is
110/70 mmHg, and his heart rate is 88 bpm. Which medication is the priority to manage fluid
volume overload in this patient?
A. Furosemide
B. Lisinopril
C. Metoprolol Succinate
D. Spironolactone
Correct Answer: A
Expert Explanation: Furosemide is a loop diuretic that is the first-line treatment for
managing acute fluid volume overload in heart failure patients. It works by inhibiting
sodium and chloride reabsorption in the loop of Henle to promote diuresis. Lisinopril and
Metoprolol are essential for long-term survival but do not address acute congestion.
Spironolactone provides mineralocorticoid antagonism but is not used for rapid fluid
removal. Effective management requires close monitoring of serum potassium and renal
function to prevent electrolyte imbalances.
2. A 65-year-old female smoker presents with a chronic cough and progressive dyspnea. Her
pulmonary function test shows an FEV1/FVC ratio of 0.62. Which of the following is the most
appropriate initial long-term maintenance therapy?
A. Long-acting muscarinic antagonist (LAMA)
B. Short-acting beta-agonist (SABA) PRN
C. Oral corticosteroids
D. Theophylline
Correct Answer: A
Expert Explanation: A LAMA is a preferred maintenance treatment for patients with
stable COPD and persistent symptoms according to GOLD guidelines. These medications
provide sustained bronchodilation and reduce the frequency of exacerbations. SABA should
only be used as a rescue medication rather than a primary maintenance strategy. Oral
corticosteroids are reserved for acute exacerbations due to their significant long-term
,systemic side effects. Successful therapy involves patient education on proper inhaler
technique and smoking cessation counseling.
3. A 75-year-old patient with Type 2 Diabetes Mellitus (T2DM) has a current HbA1c of 8.5%.
The patient has a history of Stage 3 chronic kidney disease (eGFR 35 mL/min). Which
medication should be used with caution or avoided?
A. Metformin
B. Sitagliptin
C. Glipizide
D. Pioglitazone
Correct Answer: A
Expert Explanation: Metformin is contraindicated when the eGFR falls below 30 mL/min
and should be used with caution if it is between 30 and 45 mL/min. The risk of lactic
acidosis increases significantly in geriatric patients with declining renal function. Glipizide
can be used but carries a risk of hypoglycemia in the elderly population. Sitagliptin requires
dosage adjustments based on the specific eGFR level to maintain safety. Clinicians must
prioritize regular monitoring of creatinine levels to ensure appropriate dosing of all
glycemic agents.
4. An 80-year-old male is diagnosed with primary hypertension. His blood pressure is
consistently 155/92 mmHg. Which class of medication is often recommended as first-line
therapy for elderly patients with isolated systolic hypertension?
A. Beta-blockers
B. Alpha-blockers
C. Calcium channel blockers
D. Loop diuretics
Correct Answer: C
Expert Explanation: Long-acting dihydropyridine calcium channel blockers are highly
effective for treating isolated systolic hypertension in older adults. They work by reducing
systemic vascular resistance through arterial vasodilation. Beta-blockers are no longer
considered first-line for hypertension unless a specific compelling indication like heart
failure exists. Alpha-blockers are generally avoided due to the high risk of orthostatic
hypotension and falls in the geriatric population. Comprehensive care includes assessing
for side effects such as peripheral edema and monitoring blood pressure in sitting and
standing positions.
, 5. A patient with a history of asthma presents with symptoms occurring daily and nighttime
awakenings twice a week. They are currently using a SABA as needed. What is the next step
in pharmacological management?
A. Start oral prednisone
B. Add a long-acting beta-agonist (LABA) only
C. Add a low-dose inhaled corticosteroid (ICS)
D. Switch to a LAMA
Correct Answer: C
Expert Explanation: The patient’s symptoms suggest moderate persistent asthma,
necessitating the addition of a daily low-dose ICS for inflammation control. Inhaled
corticosteroids are the most effective long-term medications for reducing airway hyper-
responsiveness. LABA therapy should never be used as monotherapy in asthma due to an
increased risk of severe exacerbations. Oral steroids are inappropriate for maintenance
and should be reserved for managing acute, severe episodes. Monitoring peak flow and
assessing trigger avoidance are essential components of the interdisciplinary asthma action
plan.
6. A 60-year-old patient with hypothyroidism is starting Levothyroxine. Which instruction is
vital for ensuring optimal absorption of the medication?
A. Take the medication on an empty stomach 30-60 minutes before breakfast
B. Take the medication with calcium supplements
C. Take the medication with a high-fiber breakfast
D. Take the medication with iron-fortified orange juice
Correct Answer: A
Expert Explanation: Levothyroxine absorption is most consistent when taken on an
empty stomach at least 30 to 60 minutes before food. Fiber, calcium, and iron can
significantly impair the absorption of the hormone in the gastrointestinal tract. Taking it
with breakfast or supplements would lead to fluctuating TSH levels and poor symptom
control. Patients should be advised to wait at least four hours before taking any
medications containing minerals. Education on the importance of consistency in timing
helps achieve euthyroid status efficiently.
7. A 70-year-old patient with atrial fibrillation has a CHADS-VASc score of 4. Which therapy is
most appropriate for stroke prevention?
A. Aspirin 81 mg daily
B. Aspirin 325 mg and Clopidogrel
C. Warfarin or a Direct Oral Anticoagulant (DOAC)
Management Across the Continuum of Care - UTA
Updated and Latest Questions and Correct
Answers with Rationale
1. A 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents with increased shortness of breath and peripheral edema. His blood pressure is
110/70 mmHg, and his heart rate is 88 bpm. Which medication is the priority to manage fluid
volume overload in this patient?
A. Furosemide
B. Lisinopril
C. Metoprolol Succinate
D. Spironolactone
Correct Answer: A
Expert Explanation: Furosemide is a loop diuretic that is the first-line treatment for
managing acute fluid volume overload in heart failure patients. It works by inhibiting
sodium and chloride reabsorption in the loop of Henle to promote diuresis. Lisinopril and
Metoprolol are essential for long-term survival but do not address acute congestion.
Spironolactone provides mineralocorticoid antagonism but is not used for rapid fluid
removal. Effective management requires close monitoring of serum potassium and renal
function to prevent electrolyte imbalances.
2. A 65-year-old female smoker presents with a chronic cough and progressive dyspnea. Her
pulmonary function test shows an FEV1/FVC ratio of 0.62. Which of the following is the most
appropriate initial long-term maintenance therapy?
A. Long-acting muscarinic antagonist (LAMA)
B. Short-acting beta-agonist (SABA) PRN
C. Oral corticosteroids
D. Theophylline
Correct Answer: A
Expert Explanation: A LAMA is a preferred maintenance treatment for patients with
stable COPD and persistent symptoms according to GOLD guidelines. These medications
provide sustained bronchodilation and reduce the frequency of exacerbations. SABA should
only be used as a rescue medication rather than a primary maintenance strategy. Oral
corticosteroids are reserved for acute exacerbations due to their significant long-term
,systemic side effects. Successful therapy involves patient education on proper inhaler
technique and smoking cessation counseling.
3. A 75-year-old patient with Type 2 Diabetes Mellitus (T2DM) has a current HbA1c of 8.5%.
The patient has a history of Stage 3 chronic kidney disease (eGFR 35 mL/min). Which
medication should be used with caution or avoided?
A. Metformin
B. Sitagliptin
C. Glipizide
D. Pioglitazone
Correct Answer: A
Expert Explanation: Metformin is contraindicated when the eGFR falls below 30 mL/min
and should be used with caution if it is between 30 and 45 mL/min. The risk of lactic
acidosis increases significantly in geriatric patients with declining renal function. Glipizide
can be used but carries a risk of hypoglycemia in the elderly population. Sitagliptin requires
dosage adjustments based on the specific eGFR level to maintain safety. Clinicians must
prioritize regular monitoring of creatinine levels to ensure appropriate dosing of all
glycemic agents.
4. An 80-year-old male is diagnosed with primary hypertension. His blood pressure is
consistently 155/92 mmHg. Which class of medication is often recommended as first-line
therapy for elderly patients with isolated systolic hypertension?
A. Beta-blockers
B. Alpha-blockers
C. Calcium channel blockers
D. Loop diuretics
Correct Answer: C
Expert Explanation: Long-acting dihydropyridine calcium channel blockers are highly
effective for treating isolated systolic hypertension in older adults. They work by reducing
systemic vascular resistance through arterial vasodilation. Beta-blockers are no longer
considered first-line for hypertension unless a specific compelling indication like heart
failure exists. Alpha-blockers are generally avoided due to the high risk of orthostatic
hypotension and falls in the geriatric population. Comprehensive care includes assessing
for side effects such as peripheral edema and monitoring blood pressure in sitting and
standing positions.
, 5. A patient with a history of asthma presents with symptoms occurring daily and nighttime
awakenings twice a week. They are currently using a SABA as needed. What is the next step
in pharmacological management?
A. Start oral prednisone
B. Add a long-acting beta-agonist (LABA) only
C. Add a low-dose inhaled corticosteroid (ICS)
D. Switch to a LAMA
Correct Answer: C
Expert Explanation: The patient’s symptoms suggest moderate persistent asthma,
necessitating the addition of a daily low-dose ICS for inflammation control. Inhaled
corticosteroids are the most effective long-term medications for reducing airway hyper-
responsiveness. LABA therapy should never be used as monotherapy in asthma due to an
increased risk of severe exacerbations. Oral steroids are inappropriate for maintenance
and should be reserved for managing acute, severe episodes. Monitoring peak flow and
assessing trigger avoidance are essential components of the interdisciplinary asthma action
plan.
6. A 60-year-old patient with hypothyroidism is starting Levothyroxine. Which instruction is
vital for ensuring optimal absorption of the medication?
A. Take the medication on an empty stomach 30-60 minutes before breakfast
B. Take the medication with calcium supplements
C. Take the medication with a high-fiber breakfast
D. Take the medication with iron-fortified orange juice
Correct Answer: A
Expert Explanation: Levothyroxine absorption is most consistent when taken on an
empty stomach at least 30 to 60 minutes before food. Fiber, calcium, and iron can
significantly impair the absorption of the hormone in the gastrointestinal tract. Taking it
with breakfast or supplements would lead to fluctuating TSH levels and poor symptom
control. Patients should be advised to wait at least four hours before taking any
medications containing minerals. Education on the importance of consistency in timing
helps achieve euthyroid status efficiently.
7. A 70-year-old patient with atrial fibrillation has a CHADS-VASc score of 4. Which therapy is
most appropriate for stroke prevention?
A. Aspirin 81 mg daily
B. Aspirin 325 mg and Clopidogrel
C. Warfarin or a Direct Oral Anticoagulant (DOAC)
