NURS 5461 Quiz 1 Practice Test Bank | Advanced Practice
Nursing Core Concepts - Original Multiple-Choice Questions
& Clinical Rationales
Ace your first graduate nursing evaluation with this comprehensive NURS 5461 Quiz 1
practice test bank featuring high-yield, original multiple-choice questions. Master critical
advanced practice domains, including evidence-based primary care interventions,
health promotion frameworks, advanced epidemiological concepts, and clinical
decision-making models. Every original question is paired with a high-yield clinical
rationale designed to sharpen your diagnostic reasoning skills and guarantee a top
score on your quiz.
1. Which age-related change most significantly affects drug metabolism in older
adults?
A) Increased gastric acid production
B) Decreased hepatic blood flow and cytochrome P450 activity
C) Increased renal tubular secretion
D) Increased serum albumin levels
Rationale: Hepatic blood flow decreases by 40-50% with age, and cytochrome P450
enzyme activity declines. This reduces first-pass metabolism, increasing bioavailability and
half-life of many drugs.
2. Which phase of drug metabolism is most affected by aging?
A) Phase I (oxidation/reduction via CYP450)
,B) Phase II (conjugation)
C) Phase III (transport)
D) Absorption
Rationale: Phase I metabolism (oxidation and reduction via the cytochrome P450 system)
is most affected by aging, leading to prolonged drug half-lives and increased toxicity risk.
3. A 78-year-old client is prescribed a medication that is highly protein-bound.
Which age-related change increases the risk of toxicity?
A) Increased albumin levels
B) Decreased albumin levels
C) Increased body water
D) Increased lean body mass
Rationale: Albumin levels decrease with age, especially during illness. Less albumin
means more free (unbound) active drug, increasing the risk of toxicity for highly protein-
bound medications.
4. Which of the following drugs is most likely to accumulate and cause toxicity in
an older adult due to reduced renal clearance?
A) Amoxicillin
B) Digoxin
C) Acetaminophen
D) Atorvastatin
Rationale: Digoxin is primarily excreted unchanged by the kidneys. Age-related decline in
renal function leads to accumulation and increased risk of toxicity.
,5. What is the most appropriate initial approach when prescribing a new
medication for an 82-year-old client?
A) Start at the standard adult dose
B) Start at a lower dose and titrate slowly
C) Start at a higher dose and taper down
D) Avoid all medications
Rationale: The principle "start low, go slow" applies to geriatric prescribing. Age-related
pharmacokinetic changes require lower initial doses with gradual titration.
6. Which medication is on the Beers Criteria due to increased risk of falls and
fractures?
A) Lisinopril
B) Lorazepam
C) Metformin
D) Atorvastatin
Rationale: Benzodiazepines (e.g., lorazepam) are on the Beers Criteria due to increased
risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older
adults.
7. Which medication is on the Beers Criteria due to strong anticholinergic effects?
A) Sertraline
B) Diphenhydramine
, C) Metoprolol
D) Losartan
Rationale: First-generation antihistamines like diphenhydramine are on the Beers Criteria
due to strong anticholinergic effects, including confusion, dry mouth, urinary retention,
and constipation.
8. What is the "prescribing cascade"?
A) Prescribing multiple medications for one condition
B) Treating medication side effects with additional medications
C) Tapering medications gradually
D) Prescribing generic medications
Rationale: The prescribing cascade occurs when a new problem is not recognized as
medication-related and is treated with another medication, potentially leading to further
adverse effects.
9. Which class of medications is most likely to cause orthostatic hypotension in
older adults?
A) Alpha-blockers
B) Beta-blockers
C) Calcium channel blockers
D) Statins
Rationale: Alpha-blockers (e.g., doxazosin, terazosin) cause vasodilation and are
associated with orthostatic hypotension, increasing fall risk in older adults.
Nursing Core Concepts - Original Multiple-Choice Questions
& Clinical Rationales
Ace your first graduate nursing evaluation with this comprehensive NURS 5461 Quiz 1
practice test bank featuring high-yield, original multiple-choice questions. Master critical
advanced practice domains, including evidence-based primary care interventions,
health promotion frameworks, advanced epidemiological concepts, and clinical
decision-making models. Every original question is paired with a high-yield clinical
rationale designed to sharpen your diagnostic reasoning skills and guarantee a top
score on your quiz.
1. Which age-related change most significantly affects drug metabolism in older
adults?
A) Increased gastric acid production
B) Decreased hepatic blood flow and cytochrome P450 activity
C) Increased renal tubular secretion
D) Increased serum albumin levels
Rationale: Hepatic blood flow decreases by 40-50% with age, and cytochrome P450
enzyme activity declines. This reduces first-pass metabolism, increasing bioavailability and
half-life of many drugs.
2. Which phase of drug metabolism is most affected by aging?
A) Phase I (oxidation/reduction via CYP450)
,B) Phase II (conjugation)
C) Phase III (transport)
D) Absorption
Rationale: Phase I metabolism (oxidation and reduction via the cytochrome P450 system)
is most affected by aging, leading to prolonged drug half-lives and increased toxicity risk.
3. A 78-year-old client is prescribed a medication that is highly protein-bound.
Which age-related change increases the risk of toxicity?
A) Increased albumin levels
B) Decreased albumin levels
C) Increased body water
D) Increased lean body mass
Rationale: Albumin levels decrease with age, especially during illness. Less albumin
means more free (unbound) active drug, increasing the risk of toxicity for highly protein-
bound medications.
4. Which of the following drugs is most likely to accumulate and cause toxicity in
an older adult due to reduced renal clearance?
A) Amoxicillin
B) Digoxin
C) Acetaminophen
D) Atorvastatin
Rationale: Digoxin is primarily excreted unchanged by the kidneys. Age-related decline in
renal function leads to accumulation and increased risk of toxicity.
,5. What is the most appropriate initial approach when prescribing a new
medication for an 82-year-old client?
A) Start at the standard adult dose
B) Start at a lower dose and titrate slowly
C) Start at a higher dose and taper down
D) Avoid all medications
Rationale: The principle "start low, go slow" applies to geriatric prescribing. Age-related
pharmacokinetic changes require lower initial doses with gradual titration.
6. Which medication is on the Beers Criteria due to increased risk of falls and
fractures?
A) Lisinopril
B) Lorazepam
C) Metformin
D) Atorvastatin
Rationale: Benzodiazepines (e.g., lorazepam) are on the Beers Criteria due to increased
risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older
adults.
7. Which medication is on the Beers Criteria due to strong anticholinergic effects?
A) Sertraline
B) Diphenhydramine
, C) Metoprolol
D) Losartan
Rationale: First-generation antihistamines like diphenhydramine are on the Beers Criteria
due to strong anticholinergic effects, including confusion, dry mouth, urinary retention,
and constipation.
8. What is the "prescribing cascade"?
A) Prescribing multiple medications for one condition
B) Treating medication side effects with additional medications
C) Tapering medications gradually
D) Prescribing generic medications
Rationale: The prescribing cascade occurs when a new problem is not recognized as
medication-related and is treated with another medication, potentially leading to further
adverse effects.
9. Which class of medications is most likely to cause orthostatic hypotension in
older adults?
A) Alpha-blockers
B) Beta-blockers
C) Calcium channel blockers
D) Statins
Rationale: Alpha-blockers (e.g., doxazosin, terazosin) cause vasodilation and are
associated with orthostatic hypotension, increasing fall risk in older adults.
