MCPHS NUR 807 FINAL EXAM QUESTIONS
WITH COMPLETE SOLUTIONS |100%
GUARANTEED PASS
SECTION 1: GERIATRIC SYNDROMES AND PHARMACOLOGY
(Questions 1-30)
Question 1
A 74-year-old female with Parkinson's disease presents with dream-enactment
behaviors, including punching and kicking in bed. She has injured her spouse
twice. What is the most likely diagnosis and first-line treatment?
A) Nightmare disorder; prazosin
B) REM sleep behavior disorder; melatonin 3–12 mg at bedtime
C) Sleep terrors; clonazepam
D) Periodic limb movement disorder; ropinirole
Correct Answer: B) REM sleep behavior disorder; melatonin 3–12 mg at bedtime
*Rationale: REM sleep behavior disorder (RBD) is common in synucleinopathies such as
Parkinson's disease and Lewy body dementia. Melatonin is first-line due to better
,tolerability in older adults; clonazepam is effective but associated with fall risk and
cognitive side effects .
Question 2
An 80-year-old man with mild cognitive impairment and anxiety is started on
lorazepam 0.5 mg BID prn. One month later, his daughter reports increased
confusion and a fall. What is the most appropriate action?
A) Increase lorazepam to 1 mg to better control anxiety
B) Discontinue lorazepam and initiate scheduled buspirone or SSRI
C) Add donepezil
D) Continue lorazepam but add fall precautions
Correct Answer: B) Discontinue lorazepam and initiate scheduled buspirone or SSRI
*Rationale: Benzodiazepines are associated with cognitive impairment and falls in older
adults per the Beers Criteria. The medication should be discontinued (tapered) and a safer
alternative used for anxiety. Buspirone or an SSRI are preferred .
Question 3
Which of the following medications is most anticholinergic and should be avoided
in older adults per the Beers Criteria?
A) Citalopram
B) Amitriptyline
C) Sertraline
D) Escitalopram
,Correct Answer: B) Amitriptyline
*Rationale: Amitriptyline is a tricyclic antidepressant with high anticholinergic properties
and is listed on the Beers Criteria as a medication to avoid in older adults due to risks of
cognitive decline, confusion, and falls .
Question 4
Donepezil, rivastigmine, and galantamine require what consideration when
initiated in older adults?
A) Starting at maintenance dose is recommended
B) Gradual titration over 4–6 weeks to minimize GI side effects
C) No titration is needed
D) They should be taken with food only
Correct Answer: B) Gradual titration over 4–6 weeks to minimize GI side effects
*Rationale: Cholinesterase inhibitors require gradual titration to minimize
gastrointestinal side effects (nausea, vomiting, diarrhea). Typical titration intervals are 4–6
weeks. Starting at maintenance dose would cause intolerability .
Question 5
A 68-year-old male with type 2 diabetes, hypertension, and chronic kidney disease
(eGFR 35 mL/min) is diagnosed with major depression. Which antidepressant
requires dose adjustment based on renal function?
A) Escitalopram
B) Duloxetine
C) Sertraline
D) Bupropion
, Correct Answer: B) Duloxetine
*Rationale: Duloxetine is contraindicated or requires dose reduction in severe renal
impairment (eGFR <30). In moderate impairment, caution is advised. Escitalopram,
sertraline, and bupropion are generally safe without dose adjustment in CKD .
Question 6
Which of the following is a characteristic feature of Lewy body dementia that
helps distinguish it from Alzheimer's disease?
A) Early and prominent short-term memory loss
B) Fluctuating cognition, visual hallucinations, and parkinsonism
C) Aphasia and apraxia
D) Preservation of executive function
Correct Answer: B) Fluctuating cognition, visual hallucinations, and parkinsonism
*Rationale: Core features of Dementia with Lewy Bodies (DLB) include fluctuating
cognition, recurrent well-formed visual hallucinations, REM sleep behavior disorder, and
parkinsonism. Memory impairment may be less prominent early on compared to
Alzheimer's disease .
Question 7
An 88-year-old woman with moderate dementia is hospitalized for pneumonia. On
the second night, she becomes agitated, tries to climb out of bed, and screams
that people are trying to kill her. Which nonpharmacologic intervention should be
attempted first?
WITH COMPLETE SOLUTIONS |100%
GUARANTEED PASS
SECTION 1: GERIATRIC SYNDROMES AND PHARMACOLOGY
(Questions 1-30)
Question 1
A 74-year-old female with Parkinson's disease presents with dream-enactment
behaviors, including punching and kicking in bed. She has injured her spouse
twice. What is the most likely diagnosis and first-line treatment?
A) Nightmare disorder; prazosin
B) REM sleep behavior disorder; melatonin 3–12 mg at bedtime
C) Sleep terrors; clonazepam
D) Periodic limb movement disorder; ropinirole
Correct Answer: B) REM sleep behavior disorder; melatonin 3–12 mg at bedtime
*Rationale: REM sleep behavior disorder (RBD) is common in synucleinopathies such as
Parkinson's disease and Lewy body dementia. Melatonin is first-line due to better
,tolerability in older adults; clonazepam is effective but associated with fall risk and
cognitive side effects .
Question 2
An 80-year-old man with mild cognitive impairment and anxiety is started on
lorazepam 0.5 mg BID prn. One month later, his daughter reports increased
confusion and a fall. What is the most appropriate action?
A) Increase lorazepam to 1 mg to better control anxiety
B) Discontinue lorazepam and initiate scheduled buspirone or SSRI
C) Add donepezil
D) Continue lorazepam but add fall precautions
Correct Answer: B) Discontinue lorazepam and initiate scheduled buspirone or SSRI
*Rationale: Benzodiazepines are associated with cognitive impairment and falls in older
adults per the Beers Criteria. The medication should be discontinued (tapered) and a safer
alternative used for anxiety. Buspirone or an SSRI are preferred .
Question 3
Which of the following medications is most anticholinergic and should be avoided
in older adults per the Beers Criteria?
A) Citalopram
B) Amitriptyline
C) Sertraline
D) Escitalopram
,Correct Answer: B) Amitriptyline
*Rationale: Amitriptyline is a tricyclic antidepressant with high anticholinergic properties
and is listed on the Beers Criteria as a medication to avoid in older adults due to risks of
cognitive decline, confusion, and falls .
Question 4
Donepezil, rivastigmine, and galantamine require what consideration when
initiated in older adults?
A) Starting at maintenance dose is recommended
B) Gradual titration over 4–6 weeks to minimize GI side effects
C) No titration is needed
D) They should be taken with food only
Correct Answer: B) Gradual titration over 4–6 weeks to minimize GI side effects
*Rationale: Cholinesterase inhibitors require gradual titration to minimize
gastrointestinal side effects (nausea, vomiting, diarrhea). Typical titration intervals are 4–6
weeks. Starting at maintenance dose would cause intolerability .
Question 5
A 68-year-old male with type 2 diabetes, hypertension, and chronic kidney disease
(eGFR 35 mL/min) is diagnosed with major depression. Which antidepressant
requires dose adjustment based on renal function?
A) Escitalopram
B) Duloxetine
C) Sertraline
D) Bupropion
, Correct Answer: B) Duloxetine
*Rationale: Duloxetine is contraindicated or requires dose reduction in severe renal
impairment (eGFR <30). In moderate impairment, caution is advised. Escitalopram,
sertraline, and bupropion are generally safe without dose adjustment in CKD .
Question 6
Which of the following is a characteristic feature of Lewy body dementia that
helps distinguish it from Alzheimer's disease?
A) Early and prominent short-term memory loss
B) Fluctuating cognition, visual hallucinations, and parkinsonism
C) Aphasia and apraxia
D) Preservation of executive function
Correct Answer: B) Fluctuating cognition, visual hallucinations, and parkinsonism
*Rationale: Core features of Dementia with Lewy Bodies (DLB) include fluctuating
cognition, recurrent well-formed visual hallucinations, REM sleep behavior disorder, and
parkinsonism. Memory impairment may be less prominent early on compared to
Alzheimer's disease .
Question 7
An 88-year-old woman with moderate dementia is hospitalized for pneumonia. On
the second night, she becomes agitated, tries to climb out of bed, and screams
that people are trying to kill her. Which nonpharmacologic intervention should be
attempted first?
