NURS 5461 EXAM 1 AND STUDY GUIDE (UTA) NEWEST 2026 TEST
BANK ADULT GERONTOLOGY MANAGEMENT EXAM 1 REVIEW
ALREADY GRADED A+ (MOST RECENT!!)
SECTION 1: PHARMACOKINETICS & PHYSIOLOGY OF AGING (Questions 1-30)
1. An 82-year-old female presents with insomnia. Her provider is considering a
low-dose hypnotic. Which age-related physiological change most significantly
increases her risk for prolonged sedation?
A) Decreased gastric motility
B) Increased total body water
C) Increased body fat composition
D) Decreased hepatic blood flow
Correct Answer: C
Rationale: Aging increases body fat and decreases lean mass. Lipophilic drugs
(like many hypnotics and benzodiazepines) have a larger volume of
distribution, leading to a longer half-life and prolonged duration of
action.
Why others are incorrect:
A) Decreased gastric motility affects absorption rate but not the
distribution or half-life of lipophilic drugs.
B) Total body water decreases with aging, not increases. This affects
water-soluble drugs, not lipophilic ones.
D) Decreased hepatic blood flow affects drug metabolism but is not the
primary factor for prolonged sedation with lipophilic drugs.
2. A provider calculates a reduced dose of a water-soluble medication (e.g.,
digoxin) for an 80-year-old male. Why is the volume of distribution (Vd)
for water-soluble drugs decreased in the elderly?
A) Increased serum albumin
B) Increased lean body mass
C) Decreased total body water
1
, D) Increased gastric pH
Correct Answer: C
Rationale: Total body water decreases by 10-15% with aging. This
concentrates water-soluble drugs in a smaller fluid volume, leading to
higher serum concentrations if standard doses are used.
Why others are incorrect:
A) Serum albumin may decrease with age, not increase, affecting protein
binding.
B) Lean body mass decreases with aging, not increases.
D) Gastric pH increases with age but does not directly affect volume of
distribution.
3. An 85-year-old patient is started on a statin. Besides dosage adjustment,
what physiological change makes this patient more susceptible to
statin-induced myopathy?
A) Increased glomerular filtration rate (GFR)
B) Sarcopenia (loss of muscle mass)
C) Increased protein binding
D) Faster hepatic metabolism
Correct Answer: B
Rationale: The loss of muscle mass (sarcopenia) reduces the buffering
capacity for drugs distributed in muscle, potentially leading to higher
plasma concentrations and increased toxicity risk.
Why others are incorrect:
A) GFR decreases with age, not increases, affecting renal clearance.
C) Protein binding generally decreases with age due to lower albumin.
D) Hepatic metabolism slows with age, not faster.
4. Which of the following is a Beers Criteria medication that should be
avoided in older adults due to increased risk of falls and cognitive
impairment?
2
, A) Acetaminophen
B) Metformin
C) Benzodiazepines
D) Lisinopril
Correct Answer: C
Rationale: Benzodiazepines are on the Beers Criteria list due to increased
risk of falls, cognitive impairment, and dependence. They should be avoided
in older adults whenever possible.
Why others are incorrect:
A) Acetaminophen is generally safe for older adults when used at
appropriate doses.
B) Metformin is safe in older adults with normal renal function.
D) Lisinopril is an ACE inhibitor commonly used in older adults for
hypertension and heart failure.
5. An older adult patient is prescribed a new medication. The nurse
practitioner uses the START criteria to:
A) Identify potentially inappropriate medications
B) Identify potentially beneficial omitted medications
C) Calculate renal dosing
D) Assess fall risk
Correct Answer: B
Rationale: The START criteria (Screening Tool to Alert to Right Treatment)
helps identify medications that should be started to manage specific
conditions in older adults (e.g., a statin after a myocardial
infarction).
Why others are incorrect:
A) The STOPP criteria (Screening Tool of Older Persons' Prescriptions)
identifies potentially inappropriate medications.
C) Renal dosing is based on GFR, not START criteria.
D) Fall risk assessment is a separate clinical tool.
3
, 6. A patient reports chronic NSAID use for knee pain. The NP is most
concerned about which two age-related vulnerabilities interacting with
this drug?
A) Reduced renal reserve and reduced GI mucosal protection
B) Increased hepatic function and increased cardiac output
C) Decreased body fat and increased bone density
D) Enhanced immune function and decreased clotting time
Correct Answer: A
Rationale: NSAIDs can cause acute kidney injury in patients with reduced
renal reserve and increase the risk of GI bleeding due to reduced GI
mucosal protection.
Why others are incorrect:
B) Hepatic function and cardiac output generally decrease with age.
C) Body fat increases and bone density decreases with age.
D) Immune function decreases and clotting factors may be altered with age.
7. An 80-year-old patient with heart failure is prescribed digoxin. The
nurse practitioner should be most concerned about which age-related
change affecting digoxin?
A) Decreased lean body mass
B) Decreased renal clearance
C) Increased gastric motility
D) Increased hepatic metabolism
Correct Answer: B
Rationale: Digoxin is primarily renally excreted. Decreased renal function
with aging leads to higher serum digoxin levels and increased risk of
toxicity.
Why others are incorrect:
A) Decreased lean body mass affects distribution but renal clearance is
the primary concern for digoxin toxicity.
4
BANK ADULT GERONTOLOGY MANAGEMENT EXAM 1 REVIEW
ALREADY GRADED A+ (MOST RECENT!!)
SECTION 1: PHARMACOKINETICS & PHYSIOLOGY OF AGING (Questions 1-30)
1. An 82-year-old female presents with insomnia. Her provider is considering a
low-dose hypnotic. Which age-related physiological change most significantly
increases her risk for prolonged sedation?
A) Decreased gastric motility
B) Increased total body water
C) Increased body fat composition
D) Decreased hepatic blood flow
Correct Answer: C
Rationale: Aging increases body fat and decreases lean mass. Lipophilic drugs
(like many hypnotics and benzodiazepines) have a larger volume of
distribution, leading to a longer half-life and prolonged duration of
action.
Why others are incorrect:
A) Decreased gastric motility affects absorption rate but not the
distribution or half-life of lipophilic drugs.
B) Total body water decreases with aging, not increases. This affects
water-soluble drugs, not lipophilic ones.
D) Decreased hepatic blood flow affects drug metabolism but is not the
primary factor for prolonged sedation with lipophilic drugs.
2. A provider calculates a reduced dose of a water-soluble medication (e.g.,
digoxin) for an 80-year-old male. Why is the volume of distribution (Vd)
for water-soluble drugs decreased in the elderly?
A) Increased serum albumin
B) Increased lean body mass
C) Decreased total body water
1
, D) Increased gastric pH
Correct Answer: C
Rationale: Total body water decreases by 10-15% with aging. This
concentrates water-soluble drugs in a smaller fluid volume, leading to
higher serum concentrations if standard doses are used.
Why others are incorrect:
A) Serum albumin may decrease with age, not increase, affecting protein
binding.
B) Lean body mass decreases with aging, not increases.
D) Gastric pH increases with age but does not directly affect volume of
distribution.
3. An 85-year-old patient is started on a statin. Besides dosage adjustment,
what physiological change makes this patient more susceptible to
statin-induced myopathy?
A) Increased glomerular filtration rate (GFR)
B) Sarcopenia (loss of muscle mass)
C) Increased protein binding
D) Faster hepatic metabolism
Correct Answer: B
Rationale: The loss of muscle mass (sarcopenia) reduces the buffering
capacity for drugs distributed in muscle, potentially leading to higher
plasma concentrations and increased toxicity risk.
Why others are incorrect:
A) GFR decreases with age, not increases, affecting renal clearance.
C) Protein binding generally decreases with age due to lower albumin.
D) Hepatic metabolism slows with age, not faster.
4. Which of the following is a Beers Criteria medication that should be
avoided in older adults due to increased risk of falls and cognitive
impairment?
2
, A) Acetaminophen
B) Metformin
C) Benzodiazepines
D) Lisinopril
Correct Answer: C
Rationale: Benzodiazepines are on the Beers Criteria list due to increased
risk of falls, cognitive impairment, and dependence. They should be avoided
in older adults whenever possible.
Why others are incorrect:
A) Acetaminophen is generally safe for older adults when used at
appropriate doses.
B) Metformin is safe in older adults with normal renal function.
D) Lisinopril is an ACE inhibitor commonly used in older adults for
hypertension and heart failure.
5. An older adult patient is prescribed a new medication. The nurse
practitioner uses the START criteria to:
A) Identify potentially inappropriate medications
B) Identify potentially beneficial omitted medications
C) Calculate renal dosing
D) Assess fall risk
Correct Answer: B
Rationale: The START criteria (Screening Tool to Alert to Right Treatment)
helps identify medications that should be started to manage specific
conditions in older adults (e.g., a statin after a myocardial
infarction).
Why others are incorrect:
A) The STOPP criteria (Screening Tool of Older Persons' Prescriptions)
identifies potentially inappropriate medications.
C) Renal dosing is based on GFR, not START criteria.
D) Fall risk assessment is a separate clinical tool.
3
, 6. A patient reports chronic NSAID use for knee pain. The NP is most
concerned about which two age-related vulnerabilities interacting with
this drug?
A) Reduced renal reserve and reduced GI mucosal protection
B) Increased hepatic function and increased cardiac output
C) Decreased body fat and increased bone density
D) Enhanced immune function and decreased clotting time
Correct Answer: A
Rationale: NSAIDs can cause acute kidney injury in patients with reduced
renal reserve and increase the risk of GI bleeding due to reduced GI
mucosal protection.
Why others are incorrect:
B) Hepatic function and cardiac output generally decrease with age.
C) Body fat increases and bone density decreases with age.
D) Immune function decreases and clotting factors may be altered with age.
7. An 80-year-old patient with heart failure is prescribed digoxin. The
nurse practitioner should be most concerned about which age-related
change affecting digoxin?
A) Decreased lean body mass
B) Decreased renal clearance
C) Increased gastric motility
D) Increased hepatic metabolism
Correct Answer: B
Rationale: Digoxin is primarily renally excreted. Decreased renal function
with aging leads to higher serum digoxin levels and increased risk of
toxicity.
Why others are incorrect:
A) Decreased lean body mass affects distribution but renal clearance is
the primary concern for digoxin toxicity.
4
