HERZING UNIVERSITY
Course Code: NU 662
Instructor:
Date: 2026
FINAL EXAM – ADULT GERONTOLOGY PRIMARY CARE
NURSE PRACTITIONER II
An 80-year-old patient with multiple chronic conditions has suspected
polypharmacy. What is the primary concern when managing polypharmacy in
older adults?
a) Risk of underdosing medications
b) Increased risk of drug-drug interactions and adverse drug events
c) Lack of medication adherence due to cost
d) Overuse of herbal supplements
Answer: b) Increased risk of drug-drug interactions and adverse drug events
Rationale: Polypharmacy increases the chance of harmful interactions,
adverse effects, and medication non-adherence in older adults.
Which intervention has the strongest evidence to reduce the risk of delirium
in hospitalized older patients?
a) Routine use of antipsychotics for all elderly patients
b) Mobility enhancement and reorientation protocols
c) High-dose sedation
d) Restriction of all visitors
Answer: b) Mobility enhancement and reorientation protocols
Rationale: Evidence supports non-pharmacologic interventions such as early
mobilization and cognitive reorientation to prevent delirium.
For primary prevention of osteoporosis in older adults, the most appropriate
initial test is:
1
,a) Serum calcium levels
b) DEXA scan (Dual-energy X-ray absorptiometry)
c) MRI of the spine
d) Bone biopsy
Answer: b) DEXA scan
Rationale: DEXA scan is the gold standard for assessing bone mineral
density and fracture risk in older adults.
True/False
The presence of multiple co-morbidities in older adults always
contraindicates aggressive treatment of new acute illnesses.
Answer: False
Rationale: Treatment decisions should be individualized based on functional
status, goals of care, and patient preferences rather than solely on the
number of co-morbidities.
Cognitive impairment in older adults can be reversible if caused by certain
underlying conditions like vitamin B12 deficiency.
Answer: True
Rationale: Some causes of cognitive impairment such as nutritional
deficiencies or thyroid dysfunction are reversible with proper management.
Advanced age alone is a contraindication to immunization with the influenza
vaccine.
Answer: False
Rationale: Influenza vaccination is strongly recommended in older adults as
they are at higher risk of complications.
Urinary incontinence in older adults is considered a normal part of aging.
Answer: False
Rationale: Urinary incontinence is not a normal aging process and warrants
assessment and management.
Fill in the Blank
The ________________ is a screening tool commonly used to assess
depression in older adults in primary care.
Answer: Geriatric Depression Scale (GDS)
Rationale: The GDS is specifically designed and validated for depressive
symptom screening in older adults.
Sarcopenia is characterized by the loss of ________________ and physical
2
, function in the elderly.
Answer: muscle mass
Rationale: Sarcopenia involves the degenerative loss of skeletal muscle
mass and strength with aging.
The medication class _________________ should be used with caution in
older adults due to increased risk of falls and cognitive impairment.
Answer: benzodiazepines
Rationale: Benzodiazepines have sedative effects leading to fall risk and
delirium in elderly patients.
A common and underdiagnosed cardiovascular condition in older adults
presenting with fatigue and syncope is ________________.
Answer: aortic stenosis
Rationale: Aortic stenosis prevalence increases with age and can cause
exertional symptoms in the elderly.
Multiple Choice
Which of the following vaccines is specifically recommended as a one-time
dose for adults aged 65 and older to prevent pneumonia?
a) PPSV23 (Pneumococcal polysaccharide vaccine)
b) HPV vaccine
c) Varicella vaccine
d) Tdap vaccine
Answer: a) PPSV23
Rationale: PPSV23 protects against pneumococcal pneumonia and is
recommended for adults 65 and older.
The primary reason for evaluating gait speed during a geriatric assessment is
to:
a) Predict risk of stroke
b) Assess risk of future functional decline and mortality
c) Diagnose arthritis
d) Evaluate cognitive function
Answer: b) Assess risk of future functional decline and mortality
Rationale: Gait speed is a powerful predictor of disability, hospitalization, and
death in elderly patients.
Daily vitamin D supplementation in older adults primarily aims to:
a) Improve cognitive function
b) Prevent osteomalacia and reduce fracture risk
c) Lower blood pressure
3
Course Code: NU 662
Instructor:
Date: 2026
FINAL EXAM – ADULT GERONTOLOGY PRIMARY CARE
NURSE PRACTITIONER II
An 80-year-old patient with multiple chronic conditions has suspected
polypharmacy. What is the primary concern when managing polypharmacy in
older adults?
a) Risk of underdosing medications
b) Increased risk of drug-drug interactions and adverse drug events
c) Lack of medication adherence due to cost
d) Overuse of herbal supplements
Answer: b) Increased risk of drug-drug interactions and adverse drug events
Rationale: Polypharmacy increases the chance of harmful interactions,
adverse effects, and medication non-adherence in older adults.
Which intervention has the strongest evidence to reduce the risk of delirium
in hospitalized older patients?
a) Routine use of antipsychotics for all elderly patients
b) Mobility enhancement and reorientation protocols
c) High-dose sedation
d) Restriction of all visitors
Answer: b) Mobility enhancement and reorientation protocols
Rationale: Evidence supports non-pharmacologic interventions such as early
mobilization and cognitive reorientation to prevent delirium.
For primary prevention of osteoporosis in older adults, the most appropriate
initial test is:
1
,a) Serum calcium levels
b) DEXA scan (Dual-energy X-ray absorptiometry)
c) MRI of the spine
d) Bone biopsy
Answer: b) DEXA scan
Rationale: DEXA scan is the gold standard for assessing bone mineral
density and fracture risk in older adults.
True/False
The presence of multiple co-morbidities in older adults always
contraindicates aggressive treatment of new acute illnesses.
Answer: False
Rationale: Treatment decisions should be individualized based on functional
status, goals of care, and patient preferences rather than solely on the
number of co-morbidities.
Cognitive impairment in older adults can be reversible if caused by certain
underlying conditions like vitamin B12 deficiency.
Answer: True
Rationale: Some causes of cognitive impairment such as nutritional
deficiencies or thyroid dysfunction are reversible with proper management.
Advanced age alone is a contraindication to immunization with the influenza
vaccine.
Answer: False
Rationale: Influenza vaccination is strongly recommended in older adults as
they are at higher risk of complications.
Urinary incontinence in older adults is considered a normal part of aging.
Answer: False
Rationale: Urinary incontinence is not a normal aging process and warrants
assessment and management.
Fill in the Blank
The ________________ is a screening tool commonly used to assess
depression in older adults in primary care.
Answer: Geriatric Depression Scale (GDS)
Rationale: The GDS is specifically designed and validated for depressive
symptom screening in older adults.
Sarcopenia is characterized by the loss of ________________ and physical
2
, function in the elderly.
Answer: muscle mass
Rationale: Sarcopenia involves the degenerative loss of skeletal muscle
mass and strength with aging.
The medication class _________________ should be used with caution in
older adults due to increased risk of falls and cognitive impairment.
Answer: benzodiazepines
Rationale: Benzodiazepines have sedative effects leading to fall risk and
delirium in elderly patients.
A common and underdiagnosed cardiovascular condition in older adults
presenting with fatigue and syncope is ________________.
Answer: aortic stenosis
Rationale: Aortic stenosis prevalence increases with age and can cause
exertional symptoms in the elderly.
Multiple Choice
Which of the following vaccines is specifically recommended as a one-time
dose for adults aged 65 and older to prevent pneumonia?
a) PPSV23 (Pneumococcal polysaccharide vaccine)
b) HPV vaccine
c) Varicella vaccine
d) Tdap vaccine
Answer: a) PPSV23
Rationale: PPSV23 protects against pneumococcal pneumonia and is
recommended for adults 65 and older.
The primary reason for evaluating gait speed during a geriatric assessment is
to:
a) Predict risk of stroke
b) Assess risk of future functional decline and mortality
c) Diagnose arthritis
d) Evaluate cognitive function
Answer: b) Assess risk of future functional decline and mortality
Rationale: Gait speed is a powerful predictor of disability, hospitalization, and
death in elderly patients.
Daily vitamin D supplementation in older adults primarily aims to:
a) Improve cognitive function
b) Prevent osteomalacia and reduce fracture risk
c) Lower blood pressure
3
