GERONTOLOGY HESI WGU D439 EXAM
VERIFIED QUESTIONS AND RATIONALISED
ANSWERS GRADED A+.
1. A community-dwelling older adult with mild cognitive impairment lives alone and manages
medications independently. Which intervention is most likely to support safe medication
management while respecting autonomy?
A. Arrange for a home health aide to administer all medications.
B. Provide a weekly pill organizer and teach the client to use it.
C. Switch to liquid formulations of all medications for easier administration.
D. Transfer the client to a skilled nursing facility for medication oversight.
Answer: B
Rationale: A weekly pill organizer promotes independence and supports memory deficits without
removing autonomy. Home health aide (A) undermines autonomy; liquid formulations (C) are not
always available and may not address the cognitive issue; transfer (D) is premature and restrictive.
2. Which pharmacokinetic change in older adults most significantly increases the risk of toxicity
for water-soluble drugs?
A. Increased hepatic blood flow
B. Decreased lean body mass
C. Increased glomerular filtration rate
D. Decreased total body water
Answer: D
Rationale: Decreased total body water reduces the volume of distribution for water-soluble drugs,
leading to higher plasma concentrations and increased risk of toxicity. Hepatic blood flow (A)
decreases, not increases; lean body mass (B) affects distribution of fat-soluble drugs; GFR (C)
decreases, increasing drug accumulation.
3. An older adult with a history of recurrent falls and osteoporosis is prescribed a bisphosphonate.
Which instruction is essential to prevent a serious adverse effect?
A. Take the medication with a full glass of milk.
B. Remain upright for at least 30 minutes after taking.
C. Chew the tablet thoroughly before swallowing.
D. Take the medication at bedtime to minimize nausea.
Answer: B
Rationale: Bisphosphonates can cause severe esophagitis if the pill lodges in the esophagus; remaining
upright for 30 minutes reduces this risk. Milk (A) may interfere with absorption; tablets should be
swallowed whole (C); bedtime (D) increases risk of reflux and esophageal injury.
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,4. An older adult with advanced dementia is admitted with a hip fracture. The family requests no
life-sustaining treatments. Which ethical principle is most directly upheld by honoring this
request?
A. Beneficence
B. Nonmaleficence
C. Autonomy
D. Justice
Answer: C
Rationale: Autonomy respects the patient's (or surrogate's) right to make informed decisions about care.
Beneficence (A) focuses on doing good; nonmaleficence (B) on avoiding harm; justice (D) on fairness. In
this scenario, honoring the family's request respects the patient's previously expressed wishes, reflecting
autonomy.
5. Which physiological change in the aging cardiovascular system contributes most to the increased
prevalence of isolated systolic hypertension?
A. Decreased aortic compliance
B. Reduced baroreceptor sensitivity
C. Increased left ventricular contractility
D. Decreased peripheral vascular resistance
Answer: A
Rationale: Decreased aortic compliance (stiffening) leads to higher systolic pressure and wider pulse
pressure, characteristic of isolated systolic hypertension. Reduced baroreceptor sensitivity (B) impairs
blood pressure regulation but is not the direct cause; contractility (C) decreases; peripheral resistance
(D) increases, not decreases.
6. An older adult with type 2 diabetes and chronic kidney disease (eGFR 30 mL/min) is being
started on a new antidiabetic agent. Which medication class is contraindicated at this level of renal
function?
A. DPP-4 inhibitors
B. SGLT2 inhibitors
C. Sulfonylureas
D. Metformin
Answer: D
Rationale: Metformin is contraindicated when eGFR <30 mL/min due to risk of lactic acidosis. DPP-4
inhibitors (A) require dose adjustment but are not contraindicated; SGLT2 inhibitors (B) lose efficacy
and are not recommended; sulfonylureas (C) carry hypoglycemia risk but are not absolutely
contraindicated.
7. An older adult with no known allergies develops a pruritic, maculopapular rash 5 days after
starting a new antibiotic. What is the most appropriate initial action?
A. Administer diphenhydramine and continue the antibiotic.
B. Discontinue the antibiotic and monitor for progression.
Page 2
, C. Apply topical corticosteroids and schedule a follow-up.
D. Switch to a different antibiotic from the same class.
Answer: B
Rationale: A new rash after starting an antibiotic is likely a drug eruption; the antibiotic should be
discontinued to prevent progression to more severe reactions. Antihistamines (A) may mask symptoms;
topical steroids (C) treat symptoms but do not address cause; switching within the same class (D) risks
cross-reactivity.
8. Which assessment finding in an older adult is most indicative of delirium rather than dementia?
A. Gradual onset of memory loss over years
B. Fluctuating level of consciousness with acute onset
C. Consistent difficulty with problem-solving
D. Long-standing personality changes
Answer: B
Rationale: Delirium is characterized by acute onset and fluctuating consciousness, whereas dementia has
gradual onset and stable cognitive decline. Options A, C, and D are more typical of dementia. The acute
change and fluctuation are key distinguishing features.
9. An older adult with heart failure and hypertension is prescribed lisinopril and furosemide.
Which laboratory value requires the most immediate attention?
A. Serum potassium 5.6 mEq/L
B. Serum sodium 135 mEq/L
C. Blood urea nitrogen 22 mg/dL
D. Serum creatinine 0.9 mg/dL
Answer: A
Rationale: Lisinopril (ACE inhibitor) can cause hyperkalemia, especially with concurrent furosemide
(which can cause hypokalemia but also volume depletion). A potassium of 5.6 mEq/L is elevated and
may lead to cardiac arrhythmias. Hyponatremia (B) is mild; BUN (C) and creatinine (D) are within
normal limits.
10. Which intervention is most effective in preventing pressure injuries in an older adult who is
bedridden?
A. Massage bony prominences with lotion daily.
B. Reposition the client every 2 hours.
C. Use a donut-shaped cushion under the sacrum.
D. Apply a moisture barrier cream after each incontinence episode.
Answer: B
Rationale: Regular repositioning (every 2 hours) relieves pressure and prevents tissue ischemia.
Massaging bony prominences (A) can damage capillaries; donut cushions (C) can cause pressure
points; moisture barrier (D) addresses moisture but not pressure, the primary cause.
Page 3
VERIFIED QUESTIONS AND RATIONALISED
ANSWERS GRADED A+.
1. A community-dwelling older adult with mild cognitive impairment lives alone and manages
medications independently. Which intervention is most likely to support safe medication
management while respecting autonomy?
A. Arrange for a home health aide to administer all medications.
B. Provide a weekly pill organizer and teach the client to use it.
C. Switch to liquid formulations of all medications for easier administration.
D. Transfer the client to a skilled nursing facility for medication oversight.
Answer: B
Rationale: A weekly pill organizer promotes independence and supports memory deficits without
removing autonomy. Home health aide (A) undermines autonomy; liquid formulations (C) are not
always available and may not address the cognitive issue; transfer (D) is premature and restrictive.
2. Which pharmacokinetic change in older adults most significantly increases the risk of toxicity
for water-soluble drugs?
A. Increased hepatic blood flow
B. Decreased lean body mass
C. Increased glomerular filtration rate
D. Decreased total body water
Answer: D
Rationale: Decreased total body water reduces the volume of distribution for water-soluble drugs,
leading to higher plasma concentrations and increased risk of toxicity. Hepatic blood flow (A)
decreases, not increases; lean body mass (B) affects distribution of fat-soluble drugs; GFR (C)
decreases, increasing drug accumulation.
3. An older adult with a history of recurrent falls and osteoporosis is prescribed a bisphosphonate.
Which instruction is essential to prevent a serious adverse effect?
A. Take the medication with a full glass of milk.
B. Remain upright for at least 30 minutes after taking.
C. Chew the tablet thoroughly before swallowing.
D. Take the medication at bedtime to minimize nausea.
Answer: B
Rationale: Bisphosphonates can cause severe esophagitis if the pill lodges in the esophagus; remaining
upright for 30 minutes reduces this risk. Milk (A) may interfere with absorption; tablets should be
swallowed whole (C); bedtime (D) increases risk of reflux and esophageal injury.
Page 1
,4. An older adult with advanced dementia is admitted with a hip fracture. The family requests no
life-sustaining treatments. Which ethical principle is most directly upheld by honoring this
request?
A. Beneficence
B. Nonmaleficence
C. Autonomy
D. Justice
Answer: C
Rationale: Autonomy respects the patient's (or surrogate's) right to make informed decisions about care.
Beneficence (A) focuses on doing good; nonmaleficence (B) on avoiding harm; justice (D) on fairness. In
this scenario, honoring the family's request respects the patient's previously expressed wishes, reflecting
autonomy.
5. Which physiological change in the aging cardiovascular system contributes most to the increased
prevalence of isolated systolic hypertension?
A. Decreased aortic compliance
B. Reduced baroreceptor sensitivity
C. Increased left ventricular contractility
D. Decreased peripheral vascular resistance
Answer: A
Rationale: Decreased aortic compliance (stiffening) leads to higher systolic pressure and wider pulse
pressure, characteristic of isolated systolic hypertension. Reduced baroreceptor sensitivity (B) impairs
blood pressure regulation but is not the direct cause; contractility (C) decreases; peripheral resistance
(D) increases, not decreases.
6. An older adult with type 2 diabetes and chronic kidney disease (eGFR 30 mL/min) is being
started on a new antidiabetic agent. Which medication class is contraindicated at this level of renal
function?
A. DPP-4 inhibitors
B. SGLT2 inhibitors
C. Sulfonylureas
D. Metformin
Answer: D
Rationale: Metformin is contraindicated when eGFR <30 mL/min due to risk of lactic acidosis. DPP-4
inhibitors (A) require dose adjustment but are not contraindicated; SGLT2 inhibitors (B) lose efficacy
and are not recommended; sulfonylureas (C) carry hypoglycemia risk but are not absolutely
contraindicated.
7. An older adult with no known allergies develops a pruritic, maculopapular rash 5 days after
starting a new antibiotic. What is the most appropriate initial action?
A. Administer diphenhydramine and continue the antibiotic.
B. Discontinue the antibiotic and monitor for progression.
Page 2
, C. Apply topical corticosteroids and schedule a follow-up.
D. Switch to a different antibiotic from the same class.
Answer: B
Rationale: A new rash after starting an antibiotic is likely a drug eruption; the antibiotic should be
discontinued to prevent progression to more severe reactions. Antihistamines (A) may mask symptoms;
topical steroids (C) treat symptoms but do not address cause; switching within the same class (D) risks
cross-reactivity.
8. Which assessment finding in an older adult is most indicative of delirium rather than dementia?
A. Gradual onset of memory loss over years
B. Fluctuating level of consciousness with acute onset
C. Consistent difficulty with problem-solving
D. Long-standing personality changes
Answer: B
Rationale: Delirium is characterized by acute onset and fluctuating consciousness, whereas dementia has
gradual onset and stable cognitive decline. Options A, C, and D are more typical of dementia. The acute
change and fluctuation are key distinguishing features.
9. An older adult with heart failure and hypertension is prescribed lisinopril and furosemide.
Which laboratory value requires the most immediate attention?
A. Serum potassium 5.6 mEq/L
B. Serum sodium 135 mEq/L
C. Blood urea nitrogen 22 mg/dL
D. Serum creatinine 0.9 mg/dL
Answer: A
Rationale: Lisinopril (ACE inhibitor) can cause hyperkalemia, especially with concurrent furosemide
(which can cause hypokalemia but also volume depletion). A potassium of 5.6 mEq/L is elevated and
may lead to cardiac arrhythmias. Hyponatremia (B) is mild; BUN (C) and creatinine (D) are within
normal limits.
10. Which intervention is most effective in preventing pressure injuries in an older adult who is
bedridden?
A. Massage bony prominences with lotion daily.
B. Reposition the client every 2 hours.
C. Use a donut-shaped cushion under the sacrum.
D. Apply a moisture barrier cream after each incontinence episode.
Answer: B
Rationale: Regular repositioning (every 2 hours) relieves pressure and prevents tissue ischemia.
Massaging bony prominences (A) can damage capillaries; donut cushions (C) can cause pressure
points; moisture barrier (D) addresses moisture but not pressure, the primary cause.
Page 3
