, NURS 5461 MODULE 7 QUIZ
Adult Gerontology Primary Care
Mental Health & Psychiatric Disorders
University of Texas at Arlington (UTA)
100-Question Original Practice Examination
2026/2027 Edition
1. A 78-year-old reports persistent sadness, anhedonia, poor sleep, and low energy for 2 months. Which
diagnosis should be considered first?
A) Normal aging
B) Delirium
C) Adjustment disorder lasting only a few days
D) Major depressive disorder
Correct Answer: Major depressive disorder
Rationale: Persistent depressed mood or loss of interest with associated neurovegetative symptoms over weeks is
consistent with major depressive disorder. Depression is not a normal part of aging. Delirium is acute and
fluctuating, while adjustment disorder requires a clear stressor and generally does not meet full criteria for major
depression.
2. A PHQ-9 score of 18 in an older adult most strongly suggests:
A) No clinically important symptoms
B) Only mild transient sadness
C) Definite dementia
D) Moderately severe depression requiring clinical evaluation and treatment planning
Correct Answer: Moderately severe depression requiring clinical evaluation and treatment planning
Rationale: A PHQ-9 score in this range indicates substantial depressive symptom burden and warrants diagnostic
assessment, suicide-risk evaluation, and treatment planning. Screening tools do not by themselves diagnose
dementia. Depression in later life should be taken seriously because it affects function, adherence, and suicide risk.
3. Which symptom is most concerning when assessing suicide risk in an older adult with depression?
A) Occasional frustration
B) A specific plan with access to lethal means
C) Preference for solitude
D) Reduced appetite alone
Correct Answer: A specific plan with access to lethal means
Rationale: A specific suicide plan, intent, and access to lethal means indicate substantially higher acute risk than
nonspecific distress. Assessment should also explore prior attempts, substance use, hopelessness, recent losses,
and protective factors. Immediate safety planning or emergency intervention may be required depending on
severity.
4. An older adult says, 'My family would be better off without me.' What is the best next response?
A) Ask directly about suicidal thoughts, intent, plan, and access to means
B) Avoid mentioning suicide so the idea is not reinforced
C) Change the subject to sleep hygiene
D) Reassure the patient without further assessment
Correct Answer: Ask directly about suicidal thoughts, intent, plan, and access to means
NURS 5461 Module 7 Quiz | Practice Examination | 2026/2027 Edition Page 1
, Rationale: Direct questioning about suicide does not create suicidal intent and is necessary when warning
statements occur. The clinician should clarify ideation, intent, planning, means, and protective factors. Vague
reassurance or changing the subject risks missing an urgent safety problem.
5. Which antidepressant class is commonly considered first-line for late-life depression because of overall
tolerability?
A) Monoamine oxidase inhibitors
B) Selective serotonin reuptake inhibitors
C) Barbiturates
D) Typical antipsychotics
Correct Answer: Selective serotonin reuptake inhibitors
Rationale: SSRIs are commonly used first-line in older adults because they are effective and generally safer than
older antidepressant classes. Choice still depends on comorbidities, drug interactions, hyponatremia risk, bleeding
risk, and prior response. MAOIs and antipsychotics are not routine first-line choices.
6. When starting an SSRI in a frail older adult, the safest general approach is to:
A) Start at the maximum adult dose
B) Double the dose after one day
C) Start low, titrate gradually, and monitor adverse effects
D) Combine immediately with an MAOI
Correct Answer: Start low, titrate gradually, and monitor adverse effects
Rationale: Age-related pharmacokinetic changes and polypharmacy increase adverse-effect risk, so lower starting
doses and gradual titration are often prudent. Early monitoring should include falls, gastrointestinal effects, sodium,
bleeding risk, and clinical response. Combining an SSRI with an MAOI is dangerous.
7. Which electrolyte abnormality can occur after initiating an SSRI in an older adult?
A) Hypercalcemia
B) Hyperphosphatemia only
C) Severe hypernatremia in every case
D) Hyponatremia
Correct Answer: Hyponatremia
Rationale: SSRIs can contribute to syndrome of inappropriate antidiuretic hormone secretion and hyponatremia,
particularly in older adults and those using diuretics. New confusion, weakness, falls, or seizures after starting
therapy should prompt consideration of sodium abnormalities.
8. Which medication is generally avoided as a routine first-line antidepressant in older adults because of
anticholinergic and orthostatic effects?
A) Sertraline
B) Escitalopram
C) Mirtazapine
D) A tricyclic antidepressant such as amitriptyline
Correct Answer: A tricyclic antidepressant such as amitriptyline
Rationale: Tricyclic antidepressants can cause anticholinergic effects, orthostatic hypotension, conduction
abnormalities, sedation, and overdose toxicity. These risks are especially important in older adults. SSRIs or other
better-tolerated options are usually preferred when clinically appropriate.
9. An older adult with depression also has poor appetite and insomnia. Which antidepressant may be
useful because it can increase appetite and cause sedation?
A) Mirtazapine
B) Fluoxetine
NURS 5461 Module 7 Quiz | Practice Examination | 2026/2027 Edition Page 2
Adult Gerontology Primary Care
Mental Health & Psychiatric Disorders
University of Texas at Arlington (UTA)
100-Question Original Practice Examination
2026/2027 Edition
1. A 78-year-old reports persistent sadness, anhedonia, poor sleep, and low energy for 2 months. Which
diagnosis should be considered first?
A) Normal aging
B) Delirium
C) Adjustment disorder lasting only a few days
D) Major depressive disorder
Correct Answer: Major depressive disorder
Rationale: Persistent depressed mood or loss of interest with associated neurovegetative symptoms over weeks is
consistent with major depressive disorder. Depression is not a normal part of aging. Delirium is acute and
fluctuating, while adjustment disorder requires a clear stressor and generally does not meet full criteria for major
depression.
2. A PHQ-9 score of 18 in an older adult most strongly suggests:
A) No clinically important symptoms
B) Only mild transient sadness
C) Definite dementia
D) Moderately severe depression requiring clinical evaluation and treatment planning
Correct Answer: Moderately severe depression requiring clinical evaluation and treatment planning
Rationale: A PHQ-9 score in this range indicates substantial depressive symptom burden and warrants diagnostic
assessment, suicide-risk evaluation, and treatment planning. Screening tools do not by themselves diagnose
dementia. Depression in later life should be taken seriously because it affects function, adherence, and suicide risk.
3. Which symptom is most concerning when assessing suicide risk in an older adult with depression?
A) Occasional frustration
B) A specific plan with access to lethal means
C) Preference for solitude
D) Reduced appetite alone
Correct Answer: A specific plan with access to lethal means
Rationale: A specific suicide plan, intent, and access to lethal means indicate substantially higher acute risk than
nonspecific distress. Assessment should also explore prior attempts, substance use, hopelessness, recent losses,
and protective factors. Immediate safety planning or emergency intervention may be required depending on
severity.
4. An older adult says, 'My family would be better off without me.' What is the best next response?
A) Ask directly about suicidal thoughts, intent, plan, and access to means
B) Avoid mentioning suicide so the idea is not reinforced
C) Change the subject to sleep hygiene
D) Reassure the patient without further assessment
Correct Answer: Ask directly about suicidal thoughts, intent, plan, and access to means
NURS 5461 Module 7 Quiz | Practice Examination | 2026/2027 Edition Page 1
, Rationale: Direct questioning about suicide does not create suicidal intent and is necessary when warning
statements occur. The clinician should clarify ideation, intent, planning, means, and protective factors. Vague
reassurance or changing the subject risks missing an urgent safety problem.
5. Which antidepressant class is commonly considered first-line for late-life depression because of overall
tolerability?
A) Monoamine oxidase inhibitors
B) Selective serotonin reuptake inhibitors
C) Barbiturates
D) Typical antipsychotics
Correct Answer: Selective serotonin reuptake inhibitors
Rationale: SSRIs are commonly used first-line in older adults because they are effective and generally safer than
older antidepressant classes. Choice still depends on comorbidities, drug interactions, hyponatremia risk, bleeding
risk, and prior response. MAOIs and antipsychotics are not routine first-line choices.
6. When starting an SSRI in a frail older adult, the safest general approach is to:
A) Start at the maximum adult dose
B) Double the dose after one day
C) Start low, titrate gradually, and monitor adverse effects
D) Combine immediately with an MAOI
Correct Answer: Start low, titrate gradually, and monitor adverse effects
Rationale: Age-related pharmacokinetic changes and polypharmacy increase adverse-effect risk, so lower starting
doses and gradual titration are often prudent. Early monitoring should include falls, gastrointestinal effects, sodium,
bleeding risk, and clinical response. Combining an SSRI with an MAOI is dangerous.
7. Which electrolyte abnormality can occur after initiating an SSRI in an older adult?
A) Hypercalcemia
B) Hyperphosphatemia only
C) Severe hypernatremia in every case
D) Hyponatremia
Correct Answer: Hyponatremia
Rationale: SSRIs can contribute to syndrome of inappropriate antidiuretic hormone secretion and hyponatremia,
particularly in older adults and those using diuretics. New confusion, weakness, falls, or seizures after starting
therapy should prompt consideration of sodium abnormalities.
8. Which medication is generally avoided as a routine first-line antidepressant in older adults because of
anticholinergic and orthostatic effects?
A) Sertraline
B) Escitalopram
C) Mirtazapine
D) A tricyclic antidepressant such as amitriptyline
Correct Answer: A tricyclic antidepressant such as amitriptyline
Rationale: Tricyclic antidepressants can cause anticholinergic effects, orthostatic hypotension, conduction
abnormalities, sedation, and overdose toxicity. These risks are especially important in older adults. SSRIs or other
better-tolerated options are usually preferred when clinically appropriate.
9. An older adult with depression also has poor appetite and insomnia. Which antidepressant may be
useful because it can increase appetite and cause sedation?
A) Mirtazapine
B) Fluoxetine
NURS 5461 Module 7 Quiz | Practice Examination | 2026/2027 Edition Page 2
