, NURS 5461 FINAL EXAM
Adult Gerontology Management Across the Continuum of Care
University of Texas at Arlington (UTA)
100-Question Original Comprehensive Practice Examination
2026/2027 Edition
Original study assessment aligned to the verified NURS 5461 course and comprehensive-final topic pattern.
Aging, Geriatric Syndromes, and Medication Safety
1. An 82-year-old becomes dizzy immediately after standing. Which age-related change most increases this risk?
A) Reduced baroreceptor responsiveness
B) Increased plasma volume
C) Greater total body water
D) Increased beta-adrenergic sensitivity
Correct Answer: A) Reduced baroreceptor responsiveness
Rationale: Aging reduces baroreceptor sensitivity and autonomic responsiveness, so blood pressure may fall
more after position change. Older adults also have less physiologic reserve, making orthostatic symptoms more
clinically important.
2. An older adult has a serum albumin of 2.7 g/dL while taking a highly protein-bound medication. What is the
mainconcern?
A) Reduced drug effect because all drug remains bound
B) Complete prevention of drug interactions
C) A larger free drug fraction and greater toxicity risk
D) Faster renal elimination of every drug
Correct Answer: C) A larger free drug fraction and greater toxicity risk
Rationale: Low albumin leaves fewer binding sites, increasing the unbound fraction of highly protein-bound drugs.
Because unbound drug is pharmacologically active, adverse effects or toxicity can occur even when the total
measured concentration appears acceptable.
3. Why can a normal serum creatinine underestimate renal impairment in a frail older adult?
A) Older kidneys produce extra creatinine
B) Low muscle mass reduces creatinine production
C) Aging always increases GFR
D) Creatinine is unrelated to renal function
Correct Answer: B) Low muscle mass reduces creatinine production
Rationale: Serum creatinine reflects both production and excretion. Frail older adults may generate little
creatinine because of reduced muscle mass, so kidney function can be substantially impaired despite a seemingly
normal serum value.
4. Which medication is generally concerning for chronic use in an older adult because it can increase GI
bleeding,kidney injury, and blood pressure?
NURS 5461 Final Practice Examination | 2026/2027 Edition | Page 1
, A) Topical emollient
B) Saline nasal spray
C) Acetaminophen at appropriate doses
D) Naproxen
Correct Answer: D) Naproxen
Rationale: Chronic systemic NSAID use can cause gastrointestinal bleeding, kidney injury, fluid retention, and
hypertension, with risk increasing in older adults. Safer alternatives depend on the pain source and comorbidities.
5. An 80-year-old develops new confusion over several hours during a urinary infection. Which syndrome is
mostlikely?
A) Delirium
B) Major neurocognitive disorder from aging alone
C) Chronic depression
D) Dementia
Correct Answer: A) Delirium
Rationale: Delirium has an acute, fluctuating course with impaired attention and often a clear precipitating medical
problem. Dementia is typically chronic and progressive rather than abrupt.
6. Which feature best distinguishes delirium from dementia?
A) Older age
B) Fluctuating attention and acute onset
C) Memory loss only
D) Sleep disturbance
Correct Answer: B) Fluctuating attention and acute onset
Rationale: Attention fluctuates markedly in delirium, and onset is usually hours to days. Dementia more often
begins insidiously and progresses over months to years.
7. An older adult falls twice in one month. What is the best initial approach?
A) Stop all antihypertensives
B) Perform a multifactorial fall-risk assessment including medications, gait, vision, and orthostasis
C) Recommend a cane without assessment
D) Prescribe bed rest
Correct Answer: B) Perform a multifactorial fall-risk assessment including medications, gait, vision, and
orthostasis
Rationale: Falls are usually multifactorial. Assessment should include medications, mobility, balance, orthostatic
blood pressure, vision, home hazards, footwear, cognition, and neurologic or cardiovascular contributors.
8. Which medication class commonly increases fall risk through sedation and impaired balance?
A) Calcium supplements
B) Saline eye drops
C) Benzodiazepines
NURS 5461 Final Practice Examination | 2026/2027 Edition | Page 2
Adult Gerontology Management Across the Continuum of Care
University of Texas at Arlington (UTA)
100-Question Original Comprehensive Practice Examination
2026/2027 Edition
Original study assessment aligned to the verified NURS 5461 course and comprehensive-final topic pattern.
Aging, Geriatric Syndromes, and Medication Safety
1. An 82-year-old becomes dizzy immediately after standing. Which age-related change most increases this risk?
A) Reduced baroreceptor responsiveness
B) Increased plasma volume
C) Greater total body water
D) Increased beta-adrenergic sensitivity
Correct Answer: A) Reduced baroreceptor responsiveness
Rationale: Aging reduces baroreceptor sensitivity and autonomic responsiveness, so blood pressure may fall
more after position change. Older adults also have less physiologic reserve, making orthostatic symptoms more
clinically important.
2. An older adult has a serum albumin of 2.7 g/dL while taking a highly protein-bound medication. What is the
mainconcern?
A) Reduced drug effect because all drug remains bound
B) Complete prevention of drug interactions
C) A larger free drug fraction and greater toxicity risk
D) Faster renal elimination of every drug
Correct Answer: C) A larger free drug fraction and greater toxicity risk
Rationale: Low albumin leaves fewer binding sites, increasing the unbound fraction of highly protein-bound drugs.
Because unbound drug is pharmacologically active, adverse effects or toxicity can occur even when the total
measured concentration appears acceptable.
3. Why can a normal serum creatinine underestimate renal impairment in a frail older adult?
A) Older kidneys produce extra creatinine
B) Low muscle mass reduces creatinine production
C) Aging always increases GFR
D) Creatinine is unrelated to renal function
Correct Answer: B) Low muscle mass reduces creatinine production
Rationale: Serum creatinine reflects both production and excretion. Frail older adults may generate little
creatinine because of reduced muscle mass, so kidney function can be substantially impaired despite a seemingly
normal serum value.
4. Which medication is generally concerning for chronic use in an older adult because it can increase GI
bleeding,kidney injury, and blood pressure?
NURS 5461 Final Practice Examination | 2026/2027 Edition | Page 1
, A) Topical emollient
B) Saline nasal spray
C) Acetaminophen at appropriate doses
D) Naproxen
Correct Answer: D) Naproxen
Rationale: Chronic systemic NSAID use can cause gastrointestinal bleeding, kidney injury, fluid retention, and
hypertension, with risk increasing in older adults. Safer alternatives depend on the pain source and comorbidities.
5. An 80-year-old develops new confusion over several hours during a urinary infection. Which syndrome is
mostlikely?
A) Delirium
B) Major neurocognitive disorder from aging alone
C) Chronic depression
D) Dementia
Correct Answer: A) Delirium
Rationale: Delirium has an acute, fluctuating course with impaired attention and often a clear precipitating medical
problem. Dementia is typically chronic and progressive rather than abrupt.
6. Which feature best distinguishes delirium from dementia?
A) Older age
B) Fluctuating attention and acute onset
C) Memory loss only
D) Sleep disturbance
Correct Answer: B) Fluctuating attention and acute onset
Rationale: Attention fluctuates markedly in delirium, and onset is usually hours to days. Dementia more often
begins insidiously and progresses over months to years.
7. An older adult falls twice in one month. What is the best initial approach?
A) Stop all antihypertensives
B) Perform a multifactorial fall-risk assessment including medications, gait, vision, and orthostasis
C) Recommend a cane without assessment
D) Prescribe bed rest
Correct Answer: B) Perform a multifactorial fall-risk assessment including medications, gait, vision, and
orthostasis
Rationale: Falls are usually multifactorial. Assessment should include medications, mobility, balance, orthostatic
blood pressure, vision, home hazards, footwear, cognition, and neurologic or cardiovascular contributors.
8. Which medication class commonly increases fall risk through sedation and impaired balance?
A) Calcium supplements
B) Saline eye drops
C) Benzodiazepines
NURS 5461 Final Practice Examination | 2026/2027 Edition | Page 2
