NURS 5461 Adult-Gerontology
Management Across the Continuum of
Care
Midterm Exam latest 190 Questions, Answers & Rationales
1. A nurse practitioner is reviewing age-related changes in renal function. Which change most
directly affects drug dosing in older adults?
Correct Answer: Decreased glomerular filtration rate (GFR)
Rationale: Renal mass, blood flow, and GFR decline with age (roughly 1%/year after age 40)
even with normal serum creatinine, because reduced muscle mass lowers creatinine production.
This necessitates use of creatinine clearance (e.g., Cockcroft-Gault) rather than serum creatinine
alone when dosing renally cleared drugs.
2. Why is serum creatinine an unreliable marker of renal function in frail older adults?
Correct Answer: Reduced muscle mass lowers creatinine production, masking true GFR
decline
Rationale: Because creatinine is produced by muscle, sarcopenic older adults can have a 'normal'
serum creatinine despite significantly reduced GFR, leading to overestimation of renal function
and risk of drug toxicity.
3. Which body composition change in aging increases the volume of distribution for lipophilic drugs
(e.g., diazepam)?
Correct Answer: Increased total body fat relative to lean mass
Rationale: Aging shifts body composition toward relatively more fat and less water/muscle,
increasing distribution and prolonging the half-life of lipophilic drugs while decreasing the
volume of distribution (and raising plasma concentration) of hydrophilic drugs.
4. An 82-year-old is prescribed a hydrophilic medication (e.g., digoxin, aminoglycoside). What age-
related change requires dose adjustment?
Correct Answer: Decreased total body water, raising drug concentration
1
, Rationale: Total body water declines with age, so hydrophilic drugs have a smaller volume of
distribution, resulting in higher plasma concentrations at standard doses and greater risk of
toxicity.
5. Which hepatic change with aging most affects phase I drug metabolism?
Correct Answer: Decreased hepatic blood flow and liver mass reducing oxidative
(CYP450) metabolism
Rationale: Aging reduces liver mass and hepatic blood flow, slowing phase I oxidative
metabolism (CYP450 pathways) more than phase II conjugation, prolonging half-life of drugs like
diazepam that rely on oxidation.
6. A geriatric patient has decreased serum albumin. What is the clinical significance for a highly
protein-bound drug like warfarin or phenytoin?
Correct Answer: More free (unbound) active drug is available, increasing risk of toxicity
Rationale: Hypoalbuminemia reduces protein binding sites, increasing the free fraction of highly
protein-bound drugs, which raises pharmacologic effect and toxicity risk at standard doses.
7. Which homeostatic mechanism blunted in aging increases the risk of orthostatic hypotension?
Correct Answer: Decreased baroreceptor sensitivity
Rationale: Reduced baroreceptor reflex responsiveness impairs the compensatory heart
rate/vasoconstriction response to positional change, increasing fall risk from orthostatic
hypotension, especially with antihypertensives.
8. An older adult has a blunted febrile response to infection. What is the physiologic reason?
Correct Answer: Age-related decline in thermoregulatory response and hypothalamic
set-point resetting
Rationale: Impaired thermoregulation and a reduced pyrogenic response mean older adults may
present with sepsis without a significant fever, requiring vigilance for atypical presentation (e.g.,
delirium, tachypnea).
9. Presbycusis is best described as which of the following?
Correct Answer: Age-related, bilateral, progressive sensorineural hearing loss,
especially for high frequencies
2
, Rationale: Presbycusis results from cochlear hair cell degeneration and affects high-frequency
consonant sounds first, making speech (especially in noisy environments) difficult to understand
even when volume is adequate.
10. Which change in the aging cardiovascular system contributes to isolated systolic hypertension?
Correct Answer: Decreased arterial compliance (arterial stiffening)
Rationale: Loss of elastin and increased collagen in arterial walls reduce vessel compliance,
raising systolic pressure while diastolic pressure may fall, widening pulse pressure — a marker of
vascular stiffness and cardiovascular risk.
11. An older adult takes longer to fall asleep, has more nighttime awakenings, and less slow-wave
sleep. This reflects which change?
Correct Answer: Age-related alteration in sleep architecture
Rationale: Normal aging reduces slow-wave (deep) and REM sleep and increases sleep
fragmentation; this is a normal change but is often compounded by comorbid illness, pain,
nocturia, and medications.
12. Which statement about theories of aging is most accurate?
Correct Answer: Aging is multifactorial, involving both programmed (genetic) and
stochastic (damage-accumulation) processes
Rationale: No single theory fully explains aging; current understanding integrates programmed
theories (e.g., telomere shortening, genetic programming) with error/damage theories (e.g.,
oxidative stress, cross-linking) acting together.
13. A patient is prescribed a new medication metabolized primarily by first-pass hepatic
metabolism. Why might oral bioavailability increase in an older adult?
Correct Answer: Reduced first-pass hepatic metabolism from decreased liver mass and
blood flow
Rationale: Reduced first-pass effect allows more active drug to reach systemic circulation,
increasing bioavailability and effect at a given oral dose — relevant for drugs like propranolol or
morphine.
14. Which age-related GI change most affects drug absorption timing rather than extent?
Correct Answer: Delayed gastric emptying
3
, Rationale: While most drugs are still absorbed to a similar extent, delayed gastric emptying can
slow the onset of action; achlorhydria may also affect absorption of drugs requiring an acidic
environment (e.g., calcium carbonate, some iron).
15. What best defines 'homeostenosis' in the context of geriatric physiology?
Correct Answer: A progressive narrowing of the body's reserve capacity to respond to
physiologic stress
Rationale: Homeostenosis describes reduced organ reserve across multiple systems with aging,
so a stressor (illness, surgery, dehydration) that a younger adult tolerates easily can precipitate
decompensation (e.g., delirium, falls) in an older adult.
16. What is the primary purpose of a Comprehensive Geriatric Assessment (CGA)?
Correct Answer: To systematically evaluate an older adult's medical, functional,
cognitive, and psychosocial status to guide an individualized care plan
Rationale: CGA is a multidimensional, interdisciplinary process designed to identify medical,
functional, and psychosocial problems to optimize treatment, improve outcomes, and coordinate
care across settings.
17. Which tool assesses basic self-care abilities such as bathing, dressing, toileting, transferring,
continence, and feeding?
Correct Answer: Katz Index of Independence in Activities of Daily Living (ADLs)
Rationale: The Katz ADL index measures basic self-care function; loss of these abilities signals a
higher level of care need than loss of instrumental activities alone.
18. The Lawton Instrumental Activities of Daily Living (IADL) scale assesses which type of
function?
Correct Answer: Higher-level skills needed for independent community living (e.g.,
managing finances, medications, transportation, shopping)
Rationale: IADLs are typically lost before basic ADLs and reflect the capacity to live
independently in the community; decline here often signals need for additional support services.
19. A nurse practitioner administers the Mini-Cog to screen for cognitive impairment. What does
this tool combine?
Correct Answer: A three-item recall test and a clock-drawing test
4
Management Across the Continuum of
Care
Midterm Exam latest 190 Questions, Answers & Rationales
1. A nurse practitioner is reviewing age-related changes in renal function. Which change most
directly affects drug dosing in older adults?
Correct Answer: Decreased glomerular filtration rate (GFR)
Rationale: Renal mass, blood flow, and GFR decline with age (roughly 1%/year after age 40)
even with normal serum creatinine, because reduced muscle mass lowers creatinine production.
This necessitates use of creatinine clearance (e.g., Cockcroft-Gault) rather than serum creatinine
alone when dosing renally cleared drugs.
2. Why is serum creatinine an unreliable marker of renal function in frail older adults?
Correct Answer: Reduced muscle mass lowers creatinine production, masking true GFR
decline
Rationale: Because creatinine is produced by muscle, sarcopenic older adults can have a 'normal'
serum creatinine despite significantly reduced GFR, leading to overestimation of renal function
and risk of drug toxicity.
3. Which body composition change in aging increases the volume of distribution for lipophilic drugs
(e.g., diazepam)?
Correct Answer: Increased total body fat relative to lean mass
Rationale: Aging shifts body composition toward relatively more fat and less water/muscle,
increasing distribution and prolonging the half-life of lipophilic drugs while decreasing the
volume of distribution (and raising plasma concentration) of hydrophilic drugs.
4. An 82-year-old is prescribed a hydrophilic medication (e.g., digoxin, aminoglycoside). What age-
related change requires dose adjustment?
Correct Answer: Decreased total body water, raising drug concentration
1
, Rationale: Total body water declines with age, so hydrophilic drugs have a smaller volume of
distribution, resulting in higher plasma concentrations at standard doses and greater risk of
toxicity.
5. Which hepatic change with aging most affects phase I drug metabolism?
Correct Answer: Decreased hepatic blood flow and liver mass reducing oxidative
(CYP450) metabolism
Rationale: Aging reduces liver mass and hepatic blood flow, slowing phase I oxidative
metabolism (CYP450 pathways) more than phase II conjugation, prolonging half-life of drugs like
diazepam that rely on oxidation.
6. A geriatric patient has decreased serum albumin. What is the clinical significance for a highly
protein-bound drug like warfarin or phenytoin?
Correct Answer: More free (unbound) active drug is available, increasing risk of toxicity
Rationale: Hypoalbuminemia reduces protein binding sites, increasing the free fraction of highly
protein-bound drugs, which raises pharmacologic effect and toxicity risk at standard doses.
7. Which homeostatic mechanism blunted in aging increases the risk of orthostatic hypotension?
Correct Answer: Decreased baroreceptor sensitivity
Rationale: Reduced baroreceptor reflex responsiveness impairs the compensatory heart
rate/vasoconstriction response to positional change, increasing fall risk from orthostatic
hypotension, especially with antihypertensives.
8. An older adult has a blunted febrile response to infection. What is the physiologic reason?
Correct Answer: Age-related decline in thermoregulatory response and hypothalamic
set-point resetting
Rationale: Impaired thermoregulation and a reduced pyrogenic response mean older adults may
present with sepsis without a significant fever, requiring vigilance for atypical presentation (e.g.,
delirium, tachypnea).
9. Presbycusis is best described as which of the following?
Correct Answer: Age-related, bilateral, progressive sensorineural hearing loss,
especially for high frequencies
2
, Rationale: Presbycusis results from cochlear hair cell degeneration and affects high-frequency
consonant sounds first, making speech (especially in noisy environments) difficult to understand
even when volume is adequate.
10. Which change in the aging cardiovascular system contributes to isolated systolic hypertension?
Correct Answer: Decreased arterial compliance (arterial stiffening)
Rationale: Loss of elastin and increased collagen in arterial walls reduce vessel compliance,
raising systolic pressure while diastolic pressure may fall, widening pulse pressure — a marker of
vascular stiffness and cardiovascular risk.
11. An older adult takes longer to fall asleep, has more nighttime awakenings, and less slow-wave
sleep. This reflects which change?
Correct Answer: Age-related alteration in sleep architecture
Rationale: Normal aging reduces slow-wave (deep) and REM sleep and increases sleep
fragmentation; this is a normal change but is often compounded by comorbid illness, pain,
nocturia, and medications.
12. Which statement about theories of aging is most accurate?
Correct Answer: Aging is multifactorial, involving both programmed (genetic) and
stochastic (damage-accumulation) processes
Rationale: No single theory fully explains aging; current understanding integrates programmed
theories (e.g., telomere shortening, genetic programming) with error/damage theories (e.g.,
oxidative stress, cross-linking) acting together.
13. A patient is prescribed a new medication metabolized primarily by first-pass hepatic
metabolism. Why might oral bioavailability increase in an older adult?
Correct Answer: Reduced first-pass hepatic metabolism from decreased liver mass and
blood flow
Rationale: Reduced first-pass effect allows more active drug to reach systemic circulation,
increasing bioavailability and effect at a given oral dose — relevant for drugs like propranolol or
morphine.
14. Which age-related GI change most affects drug absorption timing rather than extent?
Correct Answer: Delayed gastric emptying
3
, Rationale: While most drugs are still absorbed to a similar extent, delayed gastric emptying can
slow the onset of action; achlorhydria may also affect absorption of drugs requiring an acidic
environment (e.g., calcium carbonate, some iron).
15. What best defines 'homeostenosis' in the context of geriatric physiology?
Correct Answer: A progressive narrowing of the body's reserve capacity to respond to
physiologic stress
Rationale: Homeostenosis describes reduced organ reserve across multiple systems with aging,
so a stressor (illness, surgery, dehydration) that a younger adult tolerates easily can precipitate
decompensation (e.g., delirium, falls) in an older adult.
16. What is the primary purpose of a Comprehensive Geriatric Assessment (CGA)?
Correct Answer: To systematically evaluate an older adult's medical, functional,
cognitive, and psychosocial status to guide an individualized care plan
Rationale: CGA is a multidimensional, interdisciplinary process designed to identify medical,
functional, and psychosocial problems to optimize treatment, improve outcomes, and coordinate
care across settings.
17. Which tool assesses basic self-care abilities such as bathing, dressing, toileting, transferring,
continence, and feeding?
Correct Answer: Katz Index of Independence in Activities of Daily Living (ADLs)
Rationale: The Katz ADL index measures basic self-care function; loss of these abilities signals a
higher level of care need than loss of instrumental activities alone.
18. The Lawton Instrumental Activities of Daily Living (IADL) scale assesses which type of
function?
Correct Answer: Higher-level skills needed for independent community living (e.g.,
managing finances, medications, transportation, shopping)
Rationale: IADLs are typically lost before basic ADLs and reflect the capacity to live
independently in the community; decline here often signals need for additional support services.
19. A nurse practitioner administers the Mini-Cog to screen for cognitive impairment. What does
this tool combine?
Correct Answer: A three-item recall test and a clock-drawing test
4
