(Midterm Exams) NR 601 Aging Chamberlain -
Complete Package Bundle
1. Which physiologic change in older adults most
significantly increases the risk of toxicity from digoxin?
a) Increased gastric motility
b) Decreased lean body mass
c) Reduced renal clearance
d) Increased hepatic blood flow
Answer: c
Rationale: Digoxin is renally excreted. Age-related
decline in GFR reduces clearance, prolonging half-life
and increasing toxicity risk.
2. A 79-year-old has a serum creatinine of 0.7 mg/dL.
Why is this misleading?
a) Creatinine overestimates GFR in older adults
b) Low muscle mass lowers creatinine production despite
poor kidney function
c) The lab error is common
1
,d) Dehydration artificially lowers creatinine
Answer: b
Rationale: Sarcopenia reduces creatinine generation;
normal or low creatinine can coexist with significantly
reduced GFR. Always calculate CrCl (Cockcroft-Gault).
3. Which statement about pharmacokinetics in aging is
correct?
a) Phase I metabolism (CYP450) is unchanged
b) Phase II metabolism is more affected than Phase I
c) Phase I metabolism often declines, prolonging drug
half-life
d) Absorption is markedly reduced for all drugs
Answer: c
Rationale: Hepatic Phase I (oxidation, reduction) declines
with age, slowing clearance of many drugs (e.g.,
diazepam, warfarin). Phase II is relatively preserved.
4. An 82-year-old develops new confusion after starting
amitriptyline for neuropathic pain. This is an example of:
2
,a) Therapeutic failure
b) Anticholinergic toxicity
c) Allergic reaction
d) Altered absorption
Answer: b
Rationale: Amitriptyline is a strong anticholinergic. Older
brains are sensitive, causing delirium, dry mouth,
constipation, and urinary retention.
5. According to the Beers Criteria, which medication
should be avoided in older adults with a history of falls or
fractures?
a) Acetaminophen
b) Atorvastatin
c) Benzodiazepines
d) Metformin
Answer: c
Rationale: Benzodiazepines impair balance, psychomotor
3
, function, and increase fall risk by ~50%. They are on the
Beers list as "avoid."
6. The leading cause of injury-related hospitalization in
adults >85 years is:
a) Motor vehicle accident
b) Falls
c) Burns
d) Medication overdose
Answer: b
Rationale: Falls are the most common cause of injury
hospitalization and death in the oldest old, often leading
to hip fracture and functional decline.
7. Sarcopenia contributes directly to:
a) Hypertension
b) Diabetes
c) Falls and frailty
d) Hearing loss
Answer: c
4
Complete Package Bundle
1. Which physiologic change in older adults most
significantly increases the risk of toxicity from digoxin?
a) Increased gastric motility
b) Decreased lean body mass
c) Reduced renal clearance
d) Increased hepatic blood flow
Answer: c
Rationale: Digoxin is renally excreted. Age-related
decline in GFR reduces clearance, prolonging half-life
and increasing toxicity risk.
2. A 79-year-old has a serum creatinine of 0.7 mg/dL.
Why is this misleading?
a) Creatinine overestimates GFR in older adults
b) Low muscle mass lowers creatinine production despite
poor kidney function
c) The lab error is common
1
,d) Dehydration artificially lowers creatinine
Answer: b
Rationale: Sarcopenia reduces creatinine generation;
normal or low creatinine can coexist with significantly
reduced GFR. Always calculate CrCl (Cockcroft-Gault).
3. Which statement about pharmacokinetics in aging is
correct?
a) Phase I metabolism (CYP450) is unchanged
b) Phase II metabolism is more affected than Phase I
c) Phase I metabolism often declines, prolonging drug
half-life
d) Absorption is markedly reduced for all drugs
Answer: c
Rationale: Hepatic Phase I (oxidation, reduction) declines
with age, slowing clearance of many drugs (e.g.,
diazepam, warfarin). Phase II is relatively preserved.
4. An 82-year-old develops new confusion after starting
amitriptyline for neuropathic pain. This is an example of:
2
,a) Therapeutic failure
b) Anticholinergic toxicity
c) Allergic reaction
d) Altered absorption
Answer: b
Rationale: Amitriptyline is a strong anticholinergic. Older
brains are sensitive, causing delirium, dry mouth,
constipation, and urinary retention.
5. According to the Beers Criteria, which medication
should be avoided in older adults with a history of falls or
fractures?
a) Acetaminophen
b) Atorvastatin
c) Benzodiazepines
d) Metformin
Answer: c
Rationale: Benzodiazepines impair balance, psychomotor
3
, function, and increase fall risk by ~50%. They are on the
Beers list as "avoid."
6. The leading cause of injury-related hospitalization in
adults >85 years is:
a) Motor vehicle accident
b) Falls
c) Burns
d) Medication overdose
Answer: b
Rationale: Falls are the most common cause of injury
hospitalization and death in the oldest old, often leading
to hip fracture and functional decline.
7. Sarcopenia contributes directly to:
a) Hypertension
b) Diabetes
c) Falls and frailty
d) Hearing loss
Answer: c
4
