NR601 WEEK 5 iHUMAN CASE: CYNTHIA FRANCIS –
150 ORIGINAL PRACTICE QUESTIONS WITH
ANSWERS & RATIONALES
Content covers geriatric assessment, type 2 diabetes management,
hypertension, hyperlipidemia, chronic kidney disease, and polypharmacy in
older adults.
SECTION 1: GERIATRIC ASSESSMENT & AGE-RELATED
CHANGES (Questions 1–25)
Question 1
A 72-year-old patient presents for a routine follow-up. Which physiologic
change of aging most significantly affects drug metabolism?
A) Increased gastric acid production
B) Decreased hepatic blood flow and cytochrome P450 enzyme activity
C) Increased renal blood flow
D) Enhanced first-pass metabolism
Answer: B) Decreased hepatic blood flow and cytochrome P450
enzyme activity
*Rationale: Aging causes decreased hepatic mass, reduced hepatic blood
flow, and diminished cytochrome P450 enzyme activity, all of which reduce
the liver's capacity to metabolize drugs. This prolongs drug half-lives and
increases the risk of drug accumulation and toxicity, particularly for
medications metabolized by Phase I oxidation.*
,Question 2
Which screening tool is most appropriate for assessing a geriatric patient's
functional status?
A) PHQ-9
B) Katz Index of Independence in Activities of Daily Living (ADL)
C) GAD-7
D) AUDIT-C
Answer: B) Katz Index of Independence in Activities of Daily Living
(ADL)
*Rationale: The Katz ADL index assesses six basic functions: bathing,
dressing, toileting, transferring, continence, and feeding. It is a fundamental
geriatric assessment tool that identifies functional limitations and guides
care planning. The PHQ-9 screens for depression, GAD-7 for anxiety, and
AUDIT-C for alcohol use.*
Question 3
An older adult patient reports falling twice in the past month. Which
medication class is most likely contributing to fall risk?
A) ACE inhibitors
B) Benzodiazepines
C) Statins
D) Metformin
Answer: B) Benzodiazepines
Rationale: Benzodiazepines are strongly associated with falls in older adults
due to sedation, dizziness, impaired balance, and cognitive effects. The
Beers Criteria strongly recommends avoiding benzodiazepines in geriatric
patients. Antihypertensives can also cause orthostatic hypotension, but
sedating medications carry the highest risk.
Question 4
The "Timed Up and Go" (TUG) test assesses which geriatric domain?
A) Cognitive function
B) Mobility and fall risk
,C) Nutritional status
D) Hearing acuity
Answer: B) Mobility and fall risk
Rationale: The TUG test measures the time it takes a patient to stand from a
chair, walk 3 meters, turn around, walk back, and sit down. A time of 12
seconds or more indicates an increased fall risk. It is a simple, validated
screening tool for mobility impairment.
Question 5
Which of the following is a normal age-related change in the cardiovascular
system?
A) Increased maximal heart rate
B) Stiffening of large arteries and decreased arterial compliance
C) Increased cardiac output at rest
D) Enhanced baroreceptor sensitivity
Answer: B) Stiffening of large arteries and decreased arterial
compliance
Rationale: Aging causes elastin fragmentation and collagen deposition in
arterial walls, leading to stiffening and decreased compliance. This increases
systolic blood pressure, widens pulse pressure, and contributes to isolated
systolic hypertension, the most common form of hypertension in older
adults.
Question 6
An 80-year-old patient with hypertension reports dizziness upon standing.
Which intervention is most appropriate?
A) Increase the dose of the antihypertensive medication
B) Instruct the patient to change positions slowly and assess for orthostatic
hypotension
C) Discontinue all blood pressure medications
D) Recommend increased fluid restriction
Answer: B) Instruct the patient to change positions slowly and
assess for orthostatic hypotension
, Rationale: Orthostatic hypotension (a drop of ≥20 mmHg systolic or ≥10
mmHg diastolic within 3 minutes of standing) is common in older adults due
to baroreceptor insensitivity and medication effects. Management includes
slow position changes, adequate hydration, and reviewing medications for
potential contributors.
Question 7
Which of the following is characteristic of presbycusis?
A) Sudden onset of unilateral hearing loss
B) Gradual, bilateral, high-frequency sensorineural hearing loss associated
with aging
C) Conductive hearing loss due to cerumen impaction
D) Fluctuating hearing loss with vertigo
Answer: B) Gradual, bilateral, high-frequency sensorineural hearing
loss associated with aging
Rationale: Presbycusis is age-related hearing loss caused by degeneration of
cochlear hair cells and the auditory nerve. It is bilateral, symmetric, and
initially affects high-frequency sounds, making speech discrimination
difficult, especially in noisy environments.
Question 8
The Beers Criteria is used to:
A) Screen for cognitive impairment
B) Identify potentially inappropriate medications (PIMs) for older adults
C) Assess fall risk
D) Evaluate nutritional status
Answer: B) Identify potentially inappropriate medications (PIMs) for
older adults
*Rationale: The American Geriatrics Society Beers Criteria is an explicit list of
medications that should be avoided or used with caution in adults 65 years
and older due to an unfavorable risk-benefit ratio. It is regularly updated and
is an essential tool for geriatric prescribing.*
150 ORIGINAL PRACTICE QUESTIONS WITH
ANSWERS & RATIONALES
Content covers geriatric assessment, type 2 diabetes management,
hypertension, hyperlipidemia, chronic kidney disease, and polypharmacy in
older adults.
SECTION 1: GERIATRIC ASSESSMENT & AGE-RELATED
CHANGES (Questions 1–25)
Question 1
A 72-year-old patient presents for a routine follow-up. Which physiologic
change of aging most significantly affects drug metabolism?
A) Increased gastric acid production
B) Decreased hepatic blood flow and cytochrome P450 enzyme activity
C) Increased renal blood flow
D) Enhanced first-pass metabolism
Answer: B) Decreased hepatic blood flow and cytochrome P450
enzyme activity
*Rationale: Aging causes decreased hepatic mass, reduced hepatic blood
flow, and diminished cytochrome P450 enzyme activity, all of which reduce
the liver's capacity to metabolize drugs. This prolongs drug half-lives and
increases the risk of drug accumulation and toxicity, particularly for
medications metabolized by Phase I oxidation.*
,Question 2
Which screening tool is most appropriate for assessing a geriatric patient's
functional status?
A) PHQ-9
B) Katz Index of Independence in Activities of Daily Living (ADL)
C) GAD-7
D) AUDIT-C
Answer: B) Katz Index of Independence in Activities of Daily Living
(ADL)
*Rationale: The Katz ADL index assesses six basic functions: bathing,
dressing, toileting, transferring, continence, and feeding. It is a fundamental
geriatric assessment tool that identifies functional limitations and guides
care planning. The PHQ-9 screens for depression, GAD-7 for anxiety, and
AUDIT-C for alcohol use.*
Question 3
An older adult patient reports falling twice in the past month. Which
medication class is most likely contributing to fall risk?
A) ACE inhibitors
B) Benzodiazepines
C) Statins
D) Metformin
Answer: B) Benzodiazepines
Rationale: Benzodiazepines are strongly associated with falls in older adults
due to sedation, dizziness, impaired balance, and cognitive effects. The
Beers Criteria strongly recommends avoiding benzodiazepines in geriatric
patients. Antihypertensives can also cause orthostatic hypotension, but
sedating medications carry the highest risk.
Question 4
The "Timed Up and Go" (TUG) test assesses which geriatric domain?
A) Cognitive function
B) Mobility and fall risk
,C) Nutritional status
D) Hearing acuity
Answer: B) Mobility and fall risk
Rationale: The TUG test measures the time it takes a patient to stand from a
chair, walk 3 meters, turn around, walk back, and sit down. A time of 12
seconds or more indicates an increased fall risk. It is a simple, validated
screening tool for mobility impairment.
Question 5
Which of the following is a normal age-related change in the cardiovascular
system?
A) Increased maximal heart rate
B) Stiffening of large arteries and decreased arterial compliance
C) Increased cardiac output at rest
D) Enhanced baroreceptor sensitivity
Answer: B) Stiffening of large arteries and decreased arterial
compliance
Rationale: Aging causes elastin fragmentation and collagen deposition in
arterial walls, leading to stiffening and decreased compliance. This increases
systolic blood pressure, widens pulse pressure, and contributes to isolated
systolic hypertension, the most common form of hypertension in older
adults.
Question 6
An 80-year-old patient with hypertension reports dizziness upon standing.
Which intervention is most appropriate?
A) Increase the dose of the antihypertensive medication
B) Instruct the patient to change positions slowly and assess for orthostatic
hypotension
C) Discontinue all blood pressure medications
D) Recommend increased fluid restriction
Answer: B) Instruct the patient to change positions slowly and
assess for orthostatic hypotension
, Rationale: Orthostatic hypotension (a drop of ≥20 mmHg systolic or ≥10
mmHg diastolic within 3 minutes of standing) is common in older adults due
to baroreceptor insensitivity and medication effects. Management includes
slow position changes, adequate hydration, and reviewing medications for
potential contributors.
Question 7
Which of the following is characteristic of presbycusis?
A) Sudden onset of unilateral hearing loss
B) Gradual, bilateral, high-frequency sensorineural hearing loss associated
with aging
C) Conductive hearing loss due to cerumen impaction
D) Fluctuating hearing loss with vertigo
Answer: B) Gradual, bilateral, high-frequency sensorineural hearing
loss associated with aging
Rationale: Presbycusis is age-related hearing loss caused by degeneration of
cochlear hair cells and the auditory nerve. It is bilateral, symmetric, and
initially affects high-frequency sounds, making speech discrimination
difficult, especially in noisy environments.
Question 8
The Beers Criteria is used to:
A) Screen for cognitive impairment
B) Identify potentially inappropriate medications (PIMs) for older adults
C) Assess fall risk
D) Evaluate nutritional status
Answer: B) Identify potentially inappropriate medications (PIMs) for
older adults
*Rationale: The American Geriatrics Society Beers Criteria is an explicit list of
medications that should be avoided or used with caution in adults 65 years
and older due to an unfavorable risk-benefit ratio. It is regularly updated and
is an essential tool for geriatric prescribing.*
