, NURS 5461 EXAM 4
Adult Gerontology Management Across the Continuum of Care
University of Texas at Arlington (UTA) 100-
Question Practice Examination
2026/2027 Edition
1. An 82-year-old with Parkinson disease has increasing 'off' periods before the next carbidopa-
levodopadose. Which add-on strategy is most appropriate to prolong levodopa effect?
A) Stop levodopa abruptly
B) Use a benzodiazepine as primary motor therapy
C) Add a COMT inhibitor such as entacapone
D) Start a strong anticholinergic as first-line therapy in this older adult
Correct Answer: Add a COMT inhibitor such as entacapone
Rationale: COMT inhibition prolongs levodopa availability and can reduce wearing-off. Abrupt withdrawal can precipitate
severe rigidity and a malignant-like syndrome, while benzodiazepines and strong anticholinergics are poor choices for
routine motor fluctuation management in older adults.
2. A 78-year-old with Parkinson disease develops visual hallucinations after a medication increase.Which
medication class deserves particular suspicion?
A) Calcium supplements
B) Topical emollients
C) Bisphosphonates
D) Dopamine agonists
Correct Answer: Dopamine agonists
Rationale: Dopaminergic therapies, especially dopamine agonists, can worsen hallucinations, somnolence, and
orthostatic hypotension in older adults. Medication review is essential before labeling the change as primary psychosis.
3. A patient with Parkinson disease complains of dizziness when standing. Which
nonpharmacologicintervention is most appropriate?
A) Restrict all fluids
B) Rise slowly, maintain hydration, and use compression strategies when indicated
C) Increase prolonged bed rest
D) Take hot showers before standing
Correct Answer: Rise slowly, maintain hydration, and use compression strategies when indicated
Rationale: Autonomic dysfunction can cause orthostatic hypotension in Parkinson disease. Slow position changes,
adequate hydration, compression garments, and medication review reduce symptoms; dehydration and heat can worsen
hypotension.
NURS 5461 Exam 4 | Practice Examination | 2026/2027 Edition | Page 1
, 4. Which tremor pattern is most typical of Parkinson disease?
A) Pure intention tremor
B) Resting pill-rolling tremor
C) Only postural tremor relieved by motion
D) Isolated facial tic
Correct Answer: Resting pill-rolling tremor
Rationale: Parkinson disease classically produces a resting tremor that decreases with purposeful movement. Essential
tremor is more often action or postural, while cerebellar lesions can cause intention tremor.
5. A 74-year-old reports bilateral action tremor that improves after a small amount of alcohol.
Whichdisorder is most likely?
A) Essential tremor
B) Parkinson disease
C) Normal pressure hydrocephalus
D) Myasthenia gravis
Correct Answer: Essential tremor
Rationale: Essential tremor is usually an action/postural tremor and may improve transiently with alcohol. Parkinson
tremor is typically resting and accompanied by bradykinesia and rigidity.
6. First-line pharmacologic therapy for bothersome essential tremor often includes:
A) Propranolol or primidone
B) Carbidopa-levodopa only
C) Warfarin
D) Donepezil
Correct Answer: Propranolol or primidone
Rationale: Propranolol and primidone are established first-line options for essential tremor. Drug selection should
account for comorbid asthma, bradycardia, sedation risk, and fall risk.
7. A patient with Parkinson disease develops dyskinesias after years of levodopa use. This
complicationmost closely reflects:
A) Motor fluctuations associated with chronic dopaminergic therapy
B) New-onset peripheral neuropathy only
C) Irreversible cerebellar stroke by definition
D) A normal aging change
Correct Answer: Motor fluctuations associated with chronic dopaminergic therapy
Rationale: Long-term levodopa therapy can produce peak-dose dyskinesias and wearing-off as disease progression
and fluctuating dopamine availability alter motor response.
NURS 5461 Exam 4 | Practice Examination | 2026/2027 Edition | Page 2
Adult Gerontology Management Across the Continuum of Care
University of Texas at Arlington (UTA) 100-
Question Practice Examination
2026/2027 Edition
1. An 82-year-old with Parkinson disease has increasing 'off' periods before the next carbidopa-
levodopadose. Which add-on strategy is most appropriate to prolong levodopa effect?
A) Stop levodopa abruptly
B) Use a benzodiazepine as primary motor therapy
C) Add a COMT inhibitor such as entacapone
D) Start a strong anticholinergic as first-line therapy in this older adult
Correct Answer: Add a COMT inhibitor such as entacapone
Rationale: COMT inhibition prolongs levodopa availability and can reduce wearing-off. Abrupt withdrawal can precipitate
severe rigidity and a malignant-like syndrome, while benzodiazepines and strong anticholinergics are poor choices for
routine motor fluctuation management in older adults.
2. A 78-year-old with Parkinson disease develops visual hallucinations after a medication increase.Which
medication class deserves particular suspicion?
A) Calcium supplements
B) Topical emollients
C) Bisphosphonates
D) Dopamine agonists
Correct Answer: Dopamine agonists
Rationale: Dopaminergic therapies, especially dopamine agonists, can worsen hallucinations, somnolence, and
orthostatic hypotension in older adults. Medication review is essential before labeling the change as primary psychosis.
3. A patient with Parkinson disease complains of dizziness when standing. Which
nonpharmacologicintervention is most appropriate?
A) Restrict all fluids
B) Rise slowly, maintain hydration, and use compression strategies when indicated
C) Increase prolonged bed rest
D) Take hot showers before standing
Correct Answer: Rise slowly, maintain hydration, and use compression strategies when indicated
Rationale: Autonomic dysfunction can cause orthostatic hypotension in Parkinson disease. Slow position changes,
adequate hydration, compression garments, and medication review reduce symptoms; dehydration and heat can worsen
hypotension.
NURS 5461 Exam 4 | Practice Examination | 2026/2027 Edition | Page 1
, 4. Which tremor pattern is most typical of Parkinson disease?
A) Pure intention tremor
B) Resting pill-rolling tremor
C) Only postural tremor relieved by motion
D) Isolated facial tic
Correct Answer: Resting pill-rolling tremor
Rationale: Parkinson disease classically produces a resting tremor that decreases with purposeful movement. Essential
tremor is more often action or postural, while cerebellar lesions can cause intention tremor.
5. A 74-year-old reports bilateral action tremor that improves after a small amount of alcohol.
Whichdisorder is most likely?
A) Essential tremor
B) Parkinson disease
C) Normal pressure hydrocephalus
D) Myasthenia gravis
Correct Answer: Essential tremor
Rationale: Essential tremor is usually an action/postural tremor and may improve transiently with alcohol. Parkinson
tremor is typically resting and accompanied by bradykinesia and rigidity.
6. First-line pharmacologic therapy for bothersome essential tremor often includes:
A) Propranolol or primidone
B) Carbidopa-levodopa only
C) Warfarin
D) Donepezil
Correct Answer: Propranolol or primidone
Rationale: Propranolol and primidone are established first-line options for essential tremor. Drug selection should
account for comorbid asthma, bradycardia, sedation risk, and fall risk.
7. A patient with Parkinson disease develops dyskinesias after years of levodopa use. This
complicationmost closely reflects:
A) Motor fluctuations associated with chronic dopaminergic therapy
B) New-onset peripheral neuropathy only
C) Irreversible cerebellar stroke by definition
D) A normal aging change
Correct Answer: Motor fluctuations associated with chronic dopaminergic therapy
Rationale: Long-term levodopa therapy can produce peak-dose dyskinesias and wearing-off as disease progression
and fluctuating dopamine availability alter motor response.
NURS 5461 Exam 4 | Practice Examination | 2026/2027 Edition | Page 2
