NURS 5461 | NURS5461 Exam 1: 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 hypertension and osteoarthritis presents for a routine
check-up. According to the Beers Criteria, which of the following medications should be
avoided in this patient to prevent the risk of gastric ulcers and increased blood pressure?
A. Acetaminophen
B. Naproxen
C. Lisinopril
D. Amlodipine
Correct Answer: B
Expert Explanation: The Beers Criteria identifies chronic NSAID use like Naproxen as
potentially inappropriate for older adults due to the high risk of gastrointestinal bleeding
and peptic ulcer disease. NSAIDs can also exacerbate hypertension and impair renal
function in the geriatric population. Acetaminophen is generally the preferred first-line
analgesic for chronic pain in the elderly because it lacks these systemic risks. Lisinopril and
Amlodipine are standard antihypertensive treatments and are not listed as medications to
avoid under these specific criteria. Clinicians should always evaluate the risk-to-benefit
ratio when managing chronic musculoskeletal pain in patients with cardiovascular
comorbidities.
2. An 80-year-old female presents with new-onset confusion, urinary urgency, and a low-
grade fever. Which of the following is the most appropriate next step in her primary care
management?
A. Perform a urinalysis and urine culture
B. Order a head CT scan to rule out a stroke
C. Initiate a low-dose antipsychotic for delirium
D. Prescribe a broad-spectrum antibiotic immediately
Correct Answer: A
Expert Explanation: Confusion and delirium in older adults are frequently the primary
presenting symptoms of a urinary tract infection rather than classic dysuria. Assessing for
infection with a urinalysis and culture is the evidence-based first step to confirm the
diagnosis before starting treatment. Starting antibiotics without a culture can lead to
resistance and may not address the underlying cause if the culture is negative. While a CT
,scan might be necessary later, the presence of urinary symptoms and fever points strongly
toward an infectious etiology. Addressing the underlying infection is the gold standard for
resolving delirium in the geriatric patient population.
3. When managing Type 2 Diabetes in a frail 85-year-old patient with multiple comorbidities,
what is the recommended HbA1c goal according to the American Diabetes Association (ADA)?
A. Less than 6.5%
B. Less than 8.0% or 8.5%
C. Less than 7.0%
D. A1c is not a reliable measure in the elderly
Correct Answer: B
Expert Explanation: The ADA recommends less stringent glycemic goals for older adults
with complex health states or limited life expectancy to prevent hypoglycemia. A target of
8.0% to 8.5% is often appropriate for frail patients where the risks of intensive insulin
therapy outweigh the microvascular benefits. Hypoglycemia in the elderly is associated
with increased risks of falls, fractures, and cognitive decline. Strict control at less than 7.0%
is typically reserved for healthy older adults with long life expectancies. Individualized care
plans must prioritize safety and quality of life over aggressive biochemical targets.
4. A 65-year-old patient is diagnosed with Stage II Heart Failure (NYHA). Which medication
class is indicated for mortality reduction in all patients with reduced ejection fraction?
A. Loop Diuretics
B. Short-acting Nitrates
C. Calcium Channel Blockers
D. ACE Inhibitors
Correct Answer: D
Expert Explanation: ACE Inhibitors are a cornerstone of heart failure management
because they have been proven to reduce mortality and hospitalizations in patients with
reduced ejection fraction. These medications work by blocking the renin-angiotensin-
aldosterone system, thereby reducing afterload and preventing cardiac remodeling. Loop
diuretics are essential for symptom management of fluid overload but do not inherently
reduce long-term mortality rates. Calcium channel blockers are generally avoided in HFrEF
unless specifically indicated for other reasons like rate control. Evidence-based guidelines
emphasize the early initiation of ACE inhibitors or ARBs to improve patient outcomes.
5. Which screening tool is most appropriate for initially assessing cognitive impairment in a
primary care setting for an older adult suspected of having dementia?
A. PHQ-9
B. CAGE Questionnaire
, C. GDS-15
D. Mini-Cog
Correct Answer: D
Expert Explanation: The Mini-Cog is a highly efficient screening tool that combines a
three-item recall test and a clock-drawing test to detect cognitive impairment. It is favored
in primary care settings because it takes only a few minutes to administer and is less
affected by education levels than the MMSE. The PHQ-9 and GDS-15 are used to screen for
depression, which can sometimes mimic dementia symptoms in the elderly. The CAGE
questionnaire is specifically designed for alcohol use disorder screening. Early
identification of cognitive decline allows for better planning and management of the
patient’s care continuum.
6. A 70-year-old female patient with a T-score of -2.8 on her DEXA scan is diagnosed with
osteoporosis. What is the first-line pharmacological treatment recommended for this
patient?
A. Calcium and Vitamin D only
B. Oral Bisphosphonates
C. Estrogen Replacement Therapy
D. Calcitonin Nasal Spray
Correct Answer: B
Expert Explanation: Oral bisphosphonates, such as Alendronate, are considered first-line
therapy for osteoporosis because they significantly increase bone density and reduce
fracture risk. A T-score of -2.5 or lower confirms the diagnosis of osteoporosis and
necessitates pharmacological intervention beyond simple supplementation. Calcium and
Vitamin D are essential adjuncts but are usually insufficient as monotherapy for established
osteoporosis. Estrogen therapy is no longer recommended as primary treatment due to the
risks of cardiovascular events and breast cancer. Calcitonin is generally considered a
second or third-line option and is less effective at preventing fractures.
7. In the management of an older adult with Chronic Obstructive Pulmonary Disease (COPD),
which vaccination is specifically recommended by the CDC to prevent exacerbations?
A. Varicella vaccine
B. Pneumococcal vaccine (PCV20 or PCV15+PPSV23)
C. Hepatitis B vaccine
D. Meningococcal vaccine
Correct Answer: B
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 hypertension and osteoarthritis presents for a routine
check-up. According to the Beers Criteria, which of the following medications should be
avoided in this patient to prevent the risk of gastric ulcers and increased blood pressure?
A. Acetaminophen
B. Naproxen
C. Lisinopril
D. Amlodipine
Correct Answer: B
Expert Explanation: The Beers Criteria identifies chronic NSAID use like Naproxen as
potentially inappropriate for older adults due to the high risk of gastrointestinal bleeding
and peptic ulcer disease. NSAIDs can also exacerbate hypertension and impair renal
function in the geriatric population. Acetaminophen is generally the preferred first-line
analgesic for chronic pain in the elderly because it lacks these systemic risks. Lisinopril and
Amlodipine are standard antihypertensive treatments and are not listed as medications to
avoid under these specific criteria. Clinicians should always evaluate the risk-to-benefit
ratio when managing chronic musculoskeletal pain in patients with cardiovascular
comorbidities.
2. An 80-year-old female presents with new-onset confusion, urinary urgency, and a low-
grade fever. Which of the following is the most appropriate next step in her primary care
management?
A. Perform a urinalysis and urine culture
B. Order a head CT scan to rule out a stroke
C. Initiate a low-dose antipsychotic for delirium
D. Prescribe a broad-spectrum antibiotic immediately
Correct Answer: A
Expert Explanation: Confusion and delirium in older adults are frequently the primary
presenting symptoms of a urinary tract infection rather than classic dysuria. Assessing for
infection with a urinalysis and culture is the evidence-based first step to confirm the
diagnosis before starting treatment. Starting antibiotics without a culture can lead to
resistance and may not address the underlying cause if the culture is negative. While a CT
,scan might be necessary later, the presence of urinary symptoms and fever points strongly
toward an infectious etiology. Addressing the underlying infection is the gold standard for
resolving delirium in the geriatric patient population.
3. When managing Type 2 Diabetes in a frail 85-year-old patient with multiple comorbidities,
what is the recommended HbA1c goal according to the American Diabetes Association (ADA)?
A. Less than 6.5%
B. Less than 8.0% or 8.5%
C. Less than 7.0%
D. A1c is not a reliable measure in the elderly
Correct Answer: B
Expert Explanation: The ADA recommends less stringent glycemic goals for older adults
with complex health states or limited life expectancy to prevent hypoglycemia. A target of
8.0% to 8.5% is often appropriate for frail patients where the risks of intensive insulin
therapy outweigh the microvascular benefits. Hypoglycemia in the elderly is associated
with increased risks of falls, fractures, and cognitive decline. Strict control at less than 7.0%
is typically reserved for healthy older adults with long life expectancies. Individualized care
plans must prioritize safety and quality of life over aggressive biochemical targets.
4. A 65-year-old patient is diagnosed with Stage II Heart Failure (NYHA). Which medication
class is indicated for mortality reduction in all patients with reduced ejection fraction?
A. Loop Diuretics
B. Short-acting Nitrates
C. Calcium Channel Blockers
D. ACE Inhibitors
Correct Answer: D
Expert Explanation: ACE Inhibitors are a cornerstone of heart failure management
because they have been proven to reduce mortality and hospitalizations in patients with
reduced ejection fraction. These medications work by blocking the renin-angiotensin-
aldosterone system, thereby reducing afterload and preventing cardiac remodeling. Loop
diuretics are essential for symptom management of fluid overload but do not inherently
reduce long-term mortality rates. Calcium channel blockers are generally avoided in HFrEF
unless specifically indicated for other reasons like rate control. Evidence-based guidelines
emphasize the early initiation of ACE inhibitors or ARBs to improve patient outcomes.
5. Which screening tool is most appropriate for initially assessing cognitive impairment in a
primary care setting for an older adult suspected of having dementia?
A. PHQ-9
B. CAGE Questionnaire
, C. GDS-15
D. Mini-Cog
Correct Answer: D
Expert Explanation: The Mini-Cog is a highly efficient screening tool that combines a
three-item recall test and a clock-drawing test to detect cognitive impairment. It is favored
in primary care settings because it takes only a few minutes to administer and is less
affected by education levels than the MMSE. The PHQ-9 and GDS-15 are used to screen for
depression, which can sometimes mimic dementia symptoms in the elderly. The CAGE
questionnaire is specifically designed for alcohol use disorder screening. Early
identification of cognitive decline allows for better planning and management of the
patient’s care continuum.
6. A 70-year-old female patient with a T-score of -2.8 on her DEXA scan is diagnosed with
osteoporosis. What is the first-line pharmacological treatment recommended for this
patient?
A. Calcium and Vitamin D only
B. Oral Bisphosphonates
C. Estrogen Replacement Therapy
D. Calcitonin Nasal Spray
Correct Answer: B
Expert Explanation: Oral bisphosphonates, such as Alendronate, are considered first-line
therapy for osteoporosis because they significantly increase bone density and reduce
fracture risk. A T-score of -2.5 or lower confirms the diagnosis of osteoporosis and
necessitates pharmacological intervention beyond simple supplementation. Calcium and
Vitamin D are essential adjuncts but are usually insufficient as monotherapy for established
osteoporosis. Estrogen therapy is no longer recommended as primary treatment due to the
risks of cardiovascular events and breast cancer. Calcitonin is generally considered a
second or third-line option and is less effective at preventing fractures.
7. In the management of an older adult with Chronic Obstructive Pulmonary Disease (COPD),
which vaccination is specifically recommended by the CDC to prevent exacerbations?
A. Varicella vaccine
B. Pneumococcal vaccine (PCV20 or PCV15+PPSV23)
C. Hepatitis B vaccine
D. Meningococcal vaccine
Correct Answer: B
