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NURS 5461 ADULT GERONTOLOGY MANAGEMENT QUESTIONS EXAM
QUESTIONS AND CORRECT ANSWERS LATEST EDITION 2026
NURS 5461 Adult Gerontology Management — Exam Content Blueprint
SECTION A: GERIATRIC ASSESSMENT & PHARMACOLOGY (Questions 1–50)
1. A 78-year-old patient with atrial fibrillation, hypertension, and stage 3 CKD is prescribed
apixaban. Which laboratory value requires the most urgent reassessment before continuing
therapy?
A) Hemoglobin 12.5 g/dL
B) Serum creatinine 2.8 mg/dL (eGFR 22 mL/min/1.73m²)
C) Platelet count 180,000/µL
D) INR 1.1
Answer: B
Rationale: Apixaban requires dose reduction or avoidance in severe renal impairment (eGFR <
25 mL/min). A serum creatinine of 2.8 with eGFR 22 indicates severe CKD, increasing bleeding
risk from anticoagulation.
2. An 82-year-old woman is prescribed a new medication. According to the Beers Criteria,
which of the following medications should be avoided in older adults due to high risk of
adverse effects?
A) Lisinopril
B) Metformin
C) Diphenhydramine
D) Atorvastatin
Answer: C
Rationale: First-generation antihistamines like diphenhydramine are on the Beers list due to
potent anticholinergic effects, causing confusion, dry mouth, urinary retention, and increased
fall risk in older adults.
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3. A 75-year-old man presents for a comprehensive geriatric assessment. Which domain of
assessment is most critical for determining his ability to live independently?
A) Vision and hearing screening
B) Activities of daily living (ADLs) and instrumental ADLs (IADLs)
C) Cardiac stress testing
D) Bone density scan
Answer: B
Rationale: ADLs (bathing, dressing, toileting) and IADLs (managing medications, finances,
transportation) directly determine functional independence and care needs in older adults.
4. An 80-year-old woman with dementia is started on donepezil. Which adverse effect
warrants the most immediate clinical attention?
A) Nausea and diarrhea
B) Bradycardia and syncope
C) Vivid dreams
D) Muscle cramps
Answer: B
Rationale: Cholinesterase inhibitors can cause symptomatic bradycardia and syncope, increasing
fall risk. Heart rate should be monitored, especially in patients with conduction abnormalities or
on beta-blockers.
5. A 70-year-old man is taking 12 medications. Which intervention is most appropriate to
reduce his risk of adverse drug events?
A) Add a proton pump inhibitor for gastric protection
B) Perform a comprehensive medication review and deprescribe where appropriate
C) Switch all medications to once-daily dosing
D) Refer to cardiology for medication management
Answer: B
Rationale: Polypharmacy (≥5 medications) increases adverse drug event risk. Structured
medication review with deprescribing of medications lacking clear indication is the most
effective intervention.
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6. A 68-year-old woman presents with new-onset confusion. Which medication class is most
commonly implicated as a precipitant of delirium in older adults?
A) Beta-blockers
B) Anticholinergics
C) Calcium channel blockers
D) Proton pump inhibitors
Answer: B
Rationale: Anticholinergic medications (e.g., diphenhydramine, oxybutynin, tricyclic
antidepressants) are among the most common precipitants of delirium in older adults due to
their central nervous system effects.
7. An 85-year-old man with CKD stage 4 (eGFR 22) requires pain management for
osteoarthritis. Which analgesic is safest to initiate?
A) Ibuprofen 400 mg every 6 hours
B) Naproxen 500 mg twice daily
C) Acetaminophen 500 mg every 8 hours as needed
D) Ketorolac 30 mg IV every 6 hours
Answer: C
Rationale: Acetaminophen is the preferred analgesic in CKD and older adults. NSAIDs
(ibuprofen, naproxen, ketorolac) are nephrotoxic and increase risk of acute kidney injury, fluid
retention, and GI bleeding.
8. A 76-year-old woman has a hemoglobin A1c of 8.2%. She lives alone and has mild cognitive
impairment. Which HbA1c target is most appropriate for this patient?
A) < 6.5%
B) < 7.0%
C) < 7.5–8.0%
D) < 8.5–9.0%
Answer: C
Rationale: For older adults with cognitive impairment and limited life expectancy, less stringent
glycemic control (HbA1c < 7.5–8.0%) is recommended to avoid hypoglycemia, which carries
greater immediate risk than hyperglycemia.
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NURS 5461 ADULT GERONTOLOGY MANAGEMENT QUESTIONS EXAM
QUESTIONS AND CORRECT ANSWERS LATEST EDITION 2026
NURS 5461 Adult Gerontology Management — Exam Content Blueprint
SECTION A: GERIATRIC ASSESSMENT & PHARMACOLOGY (Questions 1–50)
1. A 78-year-old patient with atrial fibrillation, hypertension, and stage 3 CKD is prescribed
apixaban. Which laboratory value requires the most urgent reassessment before continuing
therapy?
A) Hemoglobin 12.5 g/dL
B) Serum creatinine 2.8 mg/dL (eGFR 22 mL/min/1.73m²)
C) Platelet count 180,000/µL
D) INR 1.1
Answer: B
Rationale: Apixaban requires dose reduction or avoidance in severe renal impairment (eGFR <
25 mL/min). A serum creatinine of 2.8 with eGFR 22 indicates severe CKD, increasing bleeding
risk from anticoagulation.
2. An 82-year-old woman is prescribed a new medication. According to the Beers Criteria,
which of the following medications should be avoided in older adults due to high risk of
adverse effects?
A) Lisinopril
B) Metformin
C) Diphenhydramine
D) Atorvastatin
Answer: C
Rationale: First-generation antihistamines like diphenhydramine are on the Beers list due to
potent anticholinergic effects, causing confusion, dry mouth, urinary retention, and increased
fall risk in older adults.
1|Page
,2
3. A 75-year-old man presents for a comprehensive geriatric assessment. Which domain of
assessment is most critical for determining his ability to live independently?
A) Vision and hearing screening
B) Activities of daily living (ADLs) and instrumental ADLs (IADLs)
C) Cardiac stress testing
D) Bone density scan
Answer: B
Rationale: ADLs (bathing, dressing, toileting) and IADLs (managing medications, finances,
transportation) directly determine functional independence and care needs in older adults.
4. An 80-year-old woman with dementia is started on donepezil. Which adverse effect
warrants the most immediate clinical attention?
A) Nausea and diarrhea
B) Bradycardia and syncope
C) Vivid dreams
D) Muscle cramps
Answer: B
Rationale: Cholinesterase inhibitors can cause symptomatic bradycardia and syncope, increasing
fall risk. Heart rate should be monitored, especially in patients with conduction abnormalities or
on beta-blockers.
5. A 70-year-old man is taking 12 medications. Which intervention is most appropriate to
reduce his risk of adverse drug events?
A) Add a proton pump inhibitor for gastric protection
B) Perform a comprehensive medication review and deprescribe where appropriate
C) Switch all medications to once-daily dosing
D) Refer to cardiology for medication management
Answer: B
Rationale: Polypharmacy (≥5 medications) increases adverse drug event risk. Structured
medication review with deprescribing of medications lacking clear indication is the most
effective intervention.
2|Page
, 3
6. A 68-year-old woman presents with new-onset confusion. Which medication class is most
commonly implicated as a precipitant of delirium in older adults?
A) Beta-blockers
B) Anticholinergics
C) Calcium channel blockers
D) Proton pump inhibitors
Answer: B
Rationale: Anticholinergic medications (e.g., diphenhydramine, oxybutynin, tricyclic
antidepressants) are among the most common precipitants of delirium in older adults due to
their central nervous system effects.
7. An 85-year-old man with CKD stage 4 (eGFR 22) requires pain management for
osteoarthritis. Which analgesic is safest to initiate?
A) Ibuprofen 400 mg every 6 hours
B) Naproxen 500 mg twice daily
C) Acetaminophen 500 mg every 8 hours as needed
D) Ketorolac 30 mg IV every 6 hours
Answer: C
Rationale: Acetaminophen is the preferred analgesic in CKD and older adults. NSAIDs
(ibuprofen, naproxen, ketorolac) are nephrotoxic and increase risk of acute kidney injury, fluid
retention, and GI bleeding.
8. A 76-year-old woman has a hemoglobin A1c of 8.2%. She lives alone and has mild cognitive
impairment. Which HbA1c target is most appropriate for this patient?
A) < 6.5%
B) < 7.0%
C) < 7.5–8.0%
D) < 8.5–9.0%
Answer: C
Rationale: For older adults with cognitive impairment and limited life expectancy, less stringent
glycemic control (HbA1c < 7.5–8.0%) is recommended to avoid hypoglycemia, which carries
greater immediate risk than hyperglycemia.
3|Page
