NURS 5461 | NURS5461 Exam 3: Adult Gerontology
Management Across the Continuum of Care - UTA
Updated and Latest Questions and Correct
Answers with Rationale
1. An 82-year-old patient with heart failure and stage 3 chronic kidney disease presents with
new onset confusion and a heart rate of 52 bpm. Which medication on the patient’s list is
most likely contributing to these symptoms?
A. Digoxin
B. Lisinopril
C. Furosemide
D. Atorvastatin
Correct Answer: A
Expert Explanation: Digoxin has a narrow therapeutic index and is primarily cleared by
the kidneys, making older adults with CKD highly susceptible to toxicity. Clinical
manifestations of toxicity often include bradycardia, visual changes, and neuropsychiatric
symptoms like confusion. In the geriatric population, even ‘normal’ serum levels can
sometimes cause toxic effects due to changes in volume of distribution. Healthcare
providers must monitor renal function and serum electrolytes closely when prescribing
this medication to older patients. Management involves withholding the drug and
monitoring the patient for resolution of symptoms and stabilization of heart rate.
2. When managing a 78-year-old patient with multiple chronic conditions, which assessment
tool is most appropriate for evaluating the patient’s ability to live independently in the
community?
A. Katz Index of Independence in Activities of Daily Living
B. Geriatric Depression Scale (GDS)
C. Mini-Mental State Examination (MMSE)
D. Lawton Instrumental Activities of Daily Living (IADL) Scale
Correct Answer: D
Expert Explanation: The Lawton IADL scale assesses more complex tasks such as
telephone use, shopping, food preparation, and medication management. These tasks are
essential for independent living in a community setting compared to basic self-care tasks.
The Katz Index focuses on basic ADLs like bathing and dressing, which are necessary for
survival but not necessarily independent community living. Assessing IADLs helps
clinicians identify early functional decline and the need for support services. Using this tool
,facilitates the development of a comprehensive care plan tailored to the patient’s specific
functional needs.
3. A 75-year-old female patient is being discharged from the hospital following a hip
replacement. To ensure a safe transition and prevent readmission, which intervention is the
highest priority for the nurse practitioner?
A. Ordering a home health aide for daily bathing
B. Performing a comprehensive medication reconciliation
C. Scheduling a follow-up appointment in six weeks
D. Providing a pamphlet on osteoporosis prevention
Correct Answer: B
Expert Explanation: Medication errors are a primary cause of hospital readmissions
during the transitional care period for older adults. Medication reconciliation involves
comparing the hospital discharge list with the pre-hospitalization regimen to identify
discrepancies or omissions. This process helps prevent polypharmacy, adverse drug
events, and therapeutic duplications that often occur during care transitions. Clear
communication regarding medication changes must be shared with the patient, their
family, and the primary care provider. Effective reconciliation serves as a cornerstone of
patient safety in the continuum of geriatric care.
4. According to the Beers Criteria, which of the following medications should be avoided in
older adults due to the high risk of orthostatic hypotension and falls?
A. Metformin
B. Amlodipine
C. Sertraline
D. Terazosin
Correct Answer: D
Expert Explanation: Terazosin is an alpha-1 blocker commonly used for BPH but carries a
high risk of orthostatic hypotension in the elderly. The Beers Criteria recommend avoiding
these agents for hypertension treatment because of the increased risk of syncope and falls.
Older adults have diminished baroreflex sensitivity, making them more vulnerable to rapid
drops in blood pressure upon standing. If used for BPH, the patient should be closely
monitored and educated on slow position changes. Alternative treatments with better
safety profiles should be considered first-line for managing urinary symptoms or
hypertension.
5. A frail 85-year-old male with Type 2 Diabetes has a history of multiple falls and a current
HbA1c of 7.2%. What is the most appropriate action based on geriatric clinical guidelines?
A. Intensify therapy to reach an HbA1c goal of < 6.5%
, B. Maintain the current regimen as the goal is < 7.0%
C. Consider de-intensifying therapy to a goal HbA1c of 7.5% - 8.0%
D. Discontinue all diabetic medications immediately
Correct Answer: C
Expert Explanation: In frail older adults with multiple comorbidities and limited life
expectancy, the risk of hypoglycemia often outweighs the benefits of tight glycemic control.
Current guidelines recommend more relaxed HbA1c targets, typically between 7.5% and
8.0%, to prevent adverse events. Hypoglycemia in the elderly is strongly associated with
falls, fractures, cognitive impairment, and increased mortality. Management should focus
on quality of life and preventing symptomatic hyperglycemia rather than strict vascular
protection. Therefore, de-intensifying the treatment plan is a patient-centered approach to
reducing the risk of harm.
6. An 80-year-old patient is diagnosed with Delirium. Which characteristic is most helpful in
distinguishing delirium from dementia?
A. Impairment in memory
B. Acute onset and fluctuating course
C. Presence of hallucinations
D. Difficulty with word finding
Correct Answer: B
Expert Explanation: Delirium is characterized by a rapid, acute onset and a course that
fluctuates throughout the day, often worsening at night. In contrast, dementia usually
follows a slow, progressive, and stable decline over several years. While memory loss and
hallucinations can occur in both, the temporal pattern of symptoms is the key diagnostic
feature. Identifying the underlying cause of delirium is critical as it is often reversible once
the medical trigger is treated. Healthcare providers should use the Confusion Assessment
Method (CAM) to assist in the bedside diagnosis of delirium.
7. A nurse practitioner is evaluating a 70-year-old for urinary incontinence. The patient
reports leaking small amounts of urine when laughing or coughing. This is most consistent
with:
A. Stress incontinence
B. Overflow incontinence
C. Functional incontinence
D. Urge incontinence
Correct Answer: A
Management Across the Continuum of Care - UTA
Updated and Latest Questions and Correct
Answers with Rationale
1. An 82-year-old patient with heart failure and stage 3 chronic kidney disease presents with
new onset confusion and a heart rate of 52 bpm. Which medication on the patient’s list is
most likely contributing to these symptoms?
A. Digoxin
B. Lisinopril
C. Furosemide
D. Atorvastatin
Correct Answer: A
Expert Explanation: Digoxin has a narrow therapeutic index and is primarily cleared by
the kidneys, making older adults with CKD highly susceptible to toxicity. Clinical
manifestations of toxicity often include bradycardia, visual changes, and neuropsychiatric
symptoms like confusion. In the geriatric population, even ‘normal’ serum levels can
sometimes cause toxic effects due to changes in volume of distribution. Healthcare
providers must monitor renal function and serum electrolytes closely when prescribing
this medication to older patients. Management involves withholding the drug and
monitoring the patient for resolution of symptoms and stabilization of heart rate.
2. When managing a 78-year-old patient with multiple chronic conditions, which assessment
tool is most appropriate for evaluating the patient’s ability to live independently in the
community?
A. Katz Index of Independence in Activities of Daily Living
B. Geriatric Depression Scale (GDS)
C. Mini-Mental State Examination (MMSE)
D. Lawton Instrumental Activities of Daily Living (IADL) Scale
Correct Answer: D
Expert Explanation: The Lawton IADL scale assesses more complex tasks such as
telephone use, shopping, food preparation, and medication management. These tasks are
essential for independent living in a community setting compared to basic self-care tasks.
The Katz Index focuses on basic ADLs like bathing and dressing, which are necessary for
survival but not necessarily independent community living. Assessing IADLs helps
clinicians identify early functional decline and the need for support services. Using this tool
,facilitates the development of a comprehensive care plan tailored to the patient’s specific
functional needs.
3. A 75-year-old female patient is being discharged from the hospital following a hip
replacement. To ensure a safe transition and prevent readmission, which intervention is the
highest priority for the nurse practitioner?
A. Ordering a home health aide for daily bathing
B. Performing a comprehensive medication reconciliation
C. Scheduling a follow-up appointment in six weeks
D. Providing a pamphlet on osteoporosis prevention
Correct Answer: B
Expert Explanation: Medication errors are a primary cause of hospital readmissions
during the transitional care period for older adults. Medication reconciliation involves
comparing the hospital discharge list with the pre-hospitalization regimen to identify
discrepancies or omissions. This process helps prevent polypharmacy, adverse drug
events, and therapeutic duplications that often occur during care transitions. Clear
communication regarding medication changes must be shared with the patient, their
family, and the primary care provider. Effective reconciliation serves as a cornerstone of
patient safety in the continuum of geriatric care.
4. According to the Beers Criteria, which of the following medications should be avoided in
older adults due to the high risk of orthostatic hypotension and falls?
A. Metformin
B. Amlodipine
C. Sertraline
D. Terazosin
Correct Answer: D
Expert Explanation: Terazosin is an alpha-1 blocker commonly used for BPH but carries a
high risk of orthostatic hypotension in the elderly. The Beers Criteria recommend avoiding
these agents for hypertension treatment because of the increased risk of syncope and falls.
Older adults have diminished baroreflex sensitivity, making them more vulnerable to rapid
drops in blood pressure upon standing. If used for BPH, the patient should be closely
monitored and educated on slow position changes. Alternative treatments with better
safety profiles should be considered first-line for managing urinary symptoms or
hypertension.
5. A frail 85-year-old male with Type 2 Diabetes has a history of multiple falls and a current
HbA1c of 7.2%. What is the most appropriate action based on geriatric clinical guidelines?
A. Intensify therapy to reach an HbA1c goal of < 6.5%
, B. Maintain the current regimen as the goal is < 7.0%
C. Consider de-intensifying therapy to a goal HbA1c of 7.5% - 8.0%
D. Discontinue all diabetic medications immediately
Correct Answer: C
Expert Explanation: In frail older adults with multiple comorbidities and limited life
expectancy, the risk of hypoglycemia often outweighs the benefits of tight glycemic control.
Current guidelines recommend more relaxed HbA1c targets, typically between 7.5% and
8.0%, to prevent adverse events. Hypoglycemia in the elderly is strongly associated with
falls, fractures, cognitive impairment, and increased mortality. Management should focus
on quality of life and preventing symptomatic hyperglycemia rather than strict vascular
protection. Therefore, de-intensifying the treatment plan is a patient-centered approach to
reducing the risk of harm.
6. An 80-year-old patient is diagnosed with Delirium. Which characteristic is most helpful in
distinguishing delirium from dementia?
A. Impairment in memory
B. Acute onset and fluctuating course
C. Presence of hallucinations
D. Difficulty with word finding
Correct Answer: B
Expert Explanation: Delirium is characterized by a rapid, acute onset and a course that
fluctuates throughout the day, often worsening at night. In contrast, dementia usually
follows a slow, progressive, and stable decline over several years. While memory loss and
hallucinations can occur in both, the temporal pattern of symptoms is the key diagnostic
feature. Identifying the underlying cause of delirium is critical as it is often reversible once
the medical trigger is treated. Healthcare providers should use the Confusion Assessment
Method (CAM) to assist in the bedside diagnosis of delirium.
7. A nurse practitioner is evaluating a 70-year-old for urinary incontinence. The patient
reports leaking small amounts of urine when laughing or coughing. This is most consistent
with:
A. Stress incontinence
B. Overflow incontinence
C. Functional incontinence
D. Urge incontinence
Correct Answer: A
