The University of Texas at Arlington NURS 5461 Quiz 2 (pdf)
| 2026/2027 | Adult Gerontology Management Q&A |
Nursing
1. According to CMS guidelines, when should discharge planning for a hospitalized older adult
begin?
A) On the day of discharge
B) At the time of admission
C) 24 hours prior to discharge
D) When the patient requests it
Correct Answer: At the time of admission
Rationale: The CMS Discharge Planning Condition of Participation mandates that discharge planning
begin immediately upon admission to ensure a safe and timely transition. Waiting until discharge day
or when the patient requests it misses critical opportunities to arrange post-acute care and prevent
readmission. This requirement reflects the understanding that discharge planning is a process, not a
single event.
2. Which model of transitional care is led by advanced practice nurses and designed specifically
to improve outcomes for high-risk older adults through comprehensive in-hospital and home
follow-up?
A) Coleman's Care Transitions Intervention
B) Naylor's Transitional Care Model
C) The LACE Index
D) The SBAR Communication Tool
Correct Answer: Naylor's Transitional Care Model
Rationale: Naylor's Transitional Care Model utilizes APNs to provide comprehensive discharge
planning and home follow-up for high-risk older adults, focusing on preventing complications and
reducing readmissions. Coleman's CTI is a different model that emphasizes patient self-management
skills. The LACE Index is a readmission risk assessment tool, and SBAR is a communication framework.
3. A 78-year-old woman is admitted with community-acquired pneumonia. She appears frail,
has difficulty following multi-step instructions, and has had two falls in the past month.
Which assessment approach is most critical to prevent further functional decline during this
acute hospitalization?
A) A focused physical therapy assessment for safe mobility
B) A detailed medication review for drug interactions
C) A comprehensive geriatric assessment evaluating physical, cognitive, psychological, and
social domains
D) A thorough nutritional evaluation to identify caloric deficits
Correct Answer: A comprehensive geriatric assessment evaluating physical, cognitive,
psychological, and social domains
Rationale: A comprehensive geriatric assessment addresses multiple interrelated domains
simultaneously, which is essential during acute illness when older adults are most vulnerable to
functional decline and iatrogenic harm. A focused physical therapy assessment is too narrow to
,capture cognitive and psychosocial contributors to decline. Medication review and nutritional
evaluation are components of the broader assessment but insufficient alone.
4. An 82-year-old man is three weeks post right total hip arthroplasty. He now requires standby
assistance for toileting and showering and cannot cook or manage finances. How should the
nurse practitioner document his functional status?
A) Instrumental activities of daily living only
B) Basic activities of daily living only
C) Deficits in both basic and instrumental activities of daily living
D) Neither category, because standby assistance does not constitute a deficit
Correct Answer: Deficits in both basic and instrumental activities of daily living
Rationale: Needing standby assistance for toileting and showering indicates impairment in basic
ADLs, while inability to cook and manage finances reflects IADL deficits. Documenting only one
category understates the patient's functional limitations. Standby assistance does constitute a
functional deficit in the post-surgical period, reflecting the patient's need for support.
5. A 71-year-old woman has stopped tending her garden, stopped attending her weekly church
group, and says nothing matters anymore. She reports fatigue and poor sleep. Which
screening tool is most appropriate for this patient?
A) The Patient Health Questionnaire-9
B) The Cornell Scale for Depression in Dementia
C) The Geriatric Depression Scale-15
D) The Montgomery-Asberg Depression Rating Scale
Correct Answer: The Geriatric Depression Scale-15
Rationale: The GDS-15 is specifically validated for older adults, uses simple yes/no questions, and
avoids somatic items that overlap with normal aging. The PHQ-9 includes somatic items such as
fatigue and sleep disturbance that are common in older adults without depression, increasing false
positives. The Cornell Scale requires caregiver observation and is designed for dementia patients.
6. The nurse practitioner is calculating a patient's risk of readmission using the LACE index. The
patient has a length of stay of 5 days, acuity of admission via Emergency, 2 comorbidities,
and 2 ED visits in the last 6 months. What is the approximate LACE score?
A) 5
B) 8
C) 12
D) 15
Correct Answer: 12
Rationale: LACE scoring assigns Length (5 days = 4 points), Acuity (Emergency = 3 points),
Comorbidities (2 = 2 points), and ED visits (2 = 3 points). The total is 12, indicating high risk for
readmission since a score of 10 or greater is the threshold. This score guides the intensity of
transitional care interventions.
7. An 82-year-old female is being discharged after hospitalization for heart failure. She lives
alone and has difficulty managing her complex medication regimen. What is the next best
step to ensure a safe transition?
A) Provide a written medication list and discharge her home
, B) Arrange for home health nursing to evaluate safety and medication management within
24-48 hours
C) Admit her to a Long-Term Acute Care Hospital for medication observation
D) Instruct her to call the office if she feels confused
Correct Answer: Arrange for home health nursing to evaluate safety and medication management
within 24-48 hours
Rationale: This patient has functional deficits and social isolation, increasing her risk for adverse
events. Home health nursing provides immediate support for medication reconciliation and safety
assessment in the home environment. Discharging home alone is unsafe, LTACH is for acute medical
needs, and passive instruction is insufficient for a high-risk patient.
8. Which of the following is a core component of Coleman's Care Transitions Intervention?
A) 24-hour physician presence in the home
B) Patient self-management skill building regarding medication reconciliation
C) Mandatory enrollment in a clinical trial
D) Hospital observation for 48 hours post-discharge
Correct Answer: Patient self-management skill building regarding medication reconciliation
Rationale: Coleman's CTI focuses on four pillars: medication self-management, a patient-centered
record, follow-up with primary care, and knowledge of red flags. Empowering the patient with skills is
central to the model. Physician home presence and mandatory trial enrollment are not components,
and post-discharge observation does not reflect the model's self-management emphasis.
9. A caregiver of a patient with dementia reports feeling overwhelmed, sleeping poorly, and
having frequent arguments with the patient. Which tool should the nurse practitioner use to
assess this situation?
A) Mini-Mental State Exam
B) Geriatric Depression Scale
C) Zarit Burden Interview
D) Timed Up and Go test
Correct Answer: Zarit Burden Interview
Rationale: The Zarit Burden Interview is specifically designed to assess the level of burden
experienced by caregivers of individuals with dementia or chronic illness. The MMSE assesses the
patient's cognition, the GDS screens for depression in the patient, and the TUG evaluates mobility.
None of these directly measure caregiver burden.
10. During a handoff report, the receiving nurse states, "This patient has a history of falls and is
on anticoagulants." Which component of the SBAR tool does this represent?
A) Situation
B) Background
C) Assessment
D) Recommendation
Correct Answer: Background
Rationale: Background provides the context or medical history relevant to the patient's current status,
including fall history and anticoagulant use. Situation is what is happening now, Assessment is what
| 2026/2027 | Adult Gerontology Management Q&A |
Nursing
1. According to CMS guidelines, when should discharge planning for a hospitalized older adult
begin?
A) On the day of discharge
B) At the time of admission
C) 24 hours prior to discharge
D) When the patient requests it
Correct Answer: At the time of admission
Rationale: The CMS Discharge Planning Condition of Participation mandates that discharge planning
begin immediately upon admission to ensure a safe and timely transition. Waiting until discharge day
or when the patient requests it misses critical opportunities to arrange post-acute care and prevent
readmission. This requirement reflects the understanding that discharge planning is a process, not a
single event.
2. Which model of transitional care is led by advanced practice nurses and designed specifically
to improve outcomes for high-risk older adults through comprehensive in-hospital and home
follow-up?
A) Coleman's Care Transitions Intervention
B) Naylor's Transitional Care Model
C) The LACE Index
D) The SBAR Communication Tool
Correct Answer: Naylor's Transitional Care Model
Rationale: Naylor's Transitional Care Model utilizes APNs to provide comprehensive discharge
planning and home follow-up for high-risk older adults, focusing on preventing complications and
reducing readmissions. Coleman's CTI is a different model that emphasizes patient self-management
skills. The LACE Index is a readmission risk assessment tool, and SBAR is a communication framework.
3. A 78-year-old woman is admitted with community-acquired pneumonia. She appears frail,
has difficulty following multi-step instructions, and has had two falls in the past month.
Which assessment approach is most critical to prevent further functional decline during this
acute hospitalization?
A) A focused physical therapy assessment for safe mobility
B) A detailed medication review for drug interactions
C) A comprehensive geriatric assessment evaluating physical, cognitive, psychological, and
social domains
D) A thorough nutritional evaluation to identify caloric deficits
Correct Answer: A comprehensive geriatric assessment evaluating physical, cognitive,
psychological, and social domains
Rationale: A comprehensive geriatric assessment addresses multiple interrelated domains
simultaneously, which is essential during acute illness when older adults are most vulnerable to
functional decline and iatrogenic harm. A focused physical therapy assessment is too narrow to
,capture cognitive and psychosocial contributors to decline. Medication review and nutritional
evaluation are components of the broader assessment but insufficient alone.
4. An 82-year-old man is three weeks post right total hip arthroplasty. He now requires standby
assistance for toileting and showering and cannot cook or manage finances. How should the
nurse practitioner document his functional status?
A) Instrumental activities of daily living only
B) Basic activities of daily living only
C) Deficits in both basic and instrumental activities of daily living
D) Neither category, because standby assistance does not constitute a deficit
Correct Answer: Deficits in both basic and instrumental activities of daily living
Rationale: Needing standby assistance for toileting and showering indicates impairment in basic
ADLs, while inability to cook and manage finances reflects IADL deficits. Documenting only one
category understates the patient's functional limitations. Standby assistance does constitute a
functional deficit in the post-surgical period, reflecting the patient's need for support.
5. A 71-year-old woman has stopped tending her garden, stopped attending her weekly church
group, and says nothing matters anymore. She reports fatigue and poor sleep. Which
screening tool is most appropriate for this patient?
A) The Patient Health Questionnaire-9
B) The Cornell Scale for Depression in Dementia
C) The Geriatric Depression Scale-15
D) The Montgomery-Asberg Depression Rating Scale
Correct Answer: The Geriatric Depression Scale-15
Rationale: The GDS-15 is specifically validated for older adults, uses simple yes/no questions, and
avoids somatic items that overlap with normal aging. The PHQ-9 includes somatic items such as
fatigue and sleep disturbance that are common in older adults without depression, increasing false
positives. The Cornell Scale requires caregiver observation and is designed for dementia patients.
6. The nurse practitioner is calculating a patient's risk of readmission using the LACE index. The
patient has a length of stay of 5 days, acuity of admission via Emergency, 2 comorbidities,
and 2 ED visits in the last 6 months. What is the approximate LACE score?
A) 5
B) 8
C) 12
D) 15
Correct Answer: 12
Rationale: LACE scoring assigns Length (5 days = 4 points), Acuity (Emergency = 3 points),
Comorbidities (2 = 2 points), and ED visits (2 = 3 points). The total is 12, indicating high risk for
readmission since a score of 10 or greater is the threshold. This score guides the intensity of
transitional care interventions.
7. An 82-year-old female is being discharged after hospitalization for heart failure. She lives
alone and has difficulty managing her complex medication regimen. What is the next best
step to ensure a safe transition?
A) Provide a written medication list and discharge her home
, B) Arrange for home health nursing to evaluate safety and medication management within
24-48 hours
C) Admit her to a Long-Term Acute Care Hospital for medication observation
D) Instruct her to call the office if she feels confused
Correct Answer: Arrange for home health nursing to evaluate safety and medication management
within 24-48 hours
Rationale: This patient has functional deficits and social isolation, increasing her risk for adverse
events. Home health nursing provides immediate support for medication reconciliation and safety
assessment in the home environment. Discharging home alone is unsafe, LTACH is for acute medical
needs, and passive instruction is insufficient for a high-risk patient.
8. Which of the following is a core component of Coleman's Care Transitions Intervention?
A) 24-hour physician presence in the home
B) Patient self-management skill building regarding medication reconciliation
C) Mandatory enrollment in a clinical trial
D) Hospital observation for 48 hours post-discharge
Correct Answer: Patient self-management skill building regarding medication reconciliation
Rationale: Coleman's CTI focuses on four pillars: medication self-management, a patient-centered
record, follow-up with primary care, and knowledge of red flags. Empowering the patient with skills is
central to the model. Physician home presence and mandatory trial enrollment are not components,
and post-discharge observation does not reflect the model's self-management emphasis.
9. A caregiver of a patient with dementia reports feeling overwhelmed, sleeping poorly, and
having frequent arguments with the patient. Which tool should the nurse practitioner use to
assess this situation?
A) Mini-Mental State Exam
B) Geriatric Depression Scale
C) Zarit Burden Interview
D) Timed Up and Go test
Correct Answer: Zarit Burden Interview
Rationale: The Zarit Burden Interview is specifically designed to assess the level of burden
experienced by caregivers of individuals with dementia or chronic illness. The MMSE assesses the
patient's cognition, the GDS screens for depression in the patient, and the TUG evaluates mobility.
None of these directly measure caregiver burden.
10. During a handoff report, the receiving nurse states, "This patient has a history of falls and is
on anticoagulants." Which component of the SBAR tool does this represent?
A) Situation
B) Background
C) Assessment
D) Recommendation
Correct Answer: Background
Rationale: Background provides the context or medical history relevant to the patient's current status,
including fall history and anticoagulant use. Situation is what is happening now, Assessment is what
