NURS 5461 ADULT GERONTOLOGY FINAL EXAM 2026/2027 &
STUDY GUIDE COMPLETE ACCURATE EXAM ACTUAL
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES (100% CORRECT VERIFIED SOLUTIONS)
CURRENTLY UPDATED VERSION 2026 EDITION
|GUARANTEED PASS A+ |APPROVED NURS 5461 FINAL |UT
ARLINGTON
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with a 3-day history of
progressive dyspnea on exertion and orthopnea. He denies chest pain. On exam, blood pressure is
148/92 mm Hg, heart rate 102 bpm, respiratory rate 24 breaths/min, and oxygen saturation 92% on
room air. Jugular venous pressure is elevated at 12 cm H₂O, and crackles are heard up to the mid-lung
fields bilaterally. A third heart sound (S3) is audible. What is the most appropriate initial pharmacologic
intervention?
A) Oral metoprolol succinate
B) Intravenous furosemide
C) Sublingual nitroglycerin
D) Oral Lisinopril
CORRECT ANSWER: B) Intravenous furosemide
*Rationale: This patient presents with acute decompensated heart failure with signs of volume overload
(elevated JVP, crackles, S3). IV loop diuretics such as furosemide are first-line to rapidly reduce preload
and relieve pulmonary congestion. Beta-blockers (A) are not initiated in acute decompensated failure.
Nitroglycerin (C) may be used but is not the initial priority without ischemia. ACE inhibitors (D) are
chronic therapy. *
2. A 68-year-old woman is brought to the clinic by her daughter for a 6-month history of progressive
memory loss, difficulty managing finances, and getting lost while driving in familiar areas. She scores
,22/30 on the Montreal Cognitive Assessment (Mocha). Which of the following is the most appropriate
next step?
A) Prescribe donepezil 5 mg daily
B) Order a non-contrast head CT
C) Refer for neuropsychological testing
D) Obtain thyroid function tests and vitamin B12 level
CORRECT ANSWER: D) Obtain thyroid function tests and vitamin B12 level
Rationale: Before diagnosing a primary neurodegenerative dementia, reversible causes must be
excluded. Hypothyroidism and B12 deficiency are common reversible causes of cognitive impairment in
older adults. Head CT (B) and neuropsychological testing (C) may be indicated later, but initial labs are
essential. Donepezil (A) should not be started without excluding reversible causes.
3. A 74-year-old male with a 50-pack-year smoking history presents with a 3-week history of progressive
back pain, worse at night, and unintentional 15-lb weight loss. He denies trauma. On exam, tenderness
to palpation over the thoracic spine. Plain radiographs of the spine show a lytic lesion in the T8 vertebral
body. What is the most appropriate next step?
A) Prescribe high-dose naproxen and muscle relaxants
B) Order a bone scan
C) Obtain serum protein electrophoresis (SPEP) and urine immunofixation
D) Refer for physical therapy for core strengthening
CORRECT ANSWER: C) Obtain serum protein electrophoresis (SPEP) and urine immunofixation
,*Rationale: The combination of lytic bone lesion, night pain, weight loss, and age >65 is highly suspicious
for multiple myeloma. SPEP and urine immunofixation are first-line screening tests. NSAIDs (A) may
mask symptoms. Bone scan (B) is less sensitive for lytic lesions. Physical therapy (D) could be harmful if a
pathologic fracture is imminent. *
4. An 80-year-old female with a history of atrial fibrillation on warfarin presents with sudden onset of
severe left lower quadrant abdominal pain, nausea, and bloody diarrhea. On exam, abdomen is tender
with guarding but no rebound. Labs show INR 3.2, WBC 14,000/all. What is the most likely diagnosis?
A) Diverticulitis
B) Ischemic colitis
C) Acute appendicitis
D) Gastric ulcer perforation
CORRECT ANSWER: B) Ischemic colitis
Rationale: Sudden onset of severe pain, bloody diarrhea, and history of atrial fibrillation (emboli risk)
points to acute mesenteric ischemia, often ischemic colitis. Diverticulitis (A) typically presents with fever
and left lower quadrant pain but less commonly with sudden bloody diarrhea. Appendicitis (C) usually
presents with periumbilical pain migrating to RLQ. Perforated ulcer (D) would present with sudden
epigastric pain and peritonitis.
5. A 71-year-old man with Parkinson’s disease for 8 years on carbidopa-levodopa presents with
worsening mobility, frequent falls, and new-onset orthostatic hypotension. He reports that his
medication “wears off” before the next dose. Which of the following is the most appropriate
pharmacologic adjustment?
A) Increase each dose of carbidopa-levodopa by 25%
B) Add entacapone
, C) Add pramipexole
D) Discontinue carbidopa-levodopa and switch to amantadine
CORRECT ANSWER: B) Add entacapone
Rationale: Wearing-off phenomenon in Parkinson’s is managed by adding a Catechol-O-methyl
transferase (COMT) inhibitor like entacapone to prolong the effect of levodopa. Increasing each dose (A)
may worsen dyskinesia’s. Pramipexole (C) could be added but is less effective for wearing-off.
Amantadine (D) is used for dyskinesia’s, not wearing-off.
6. A 66-year-old female with type 2 diabetes, hypertension, and stage 3b chronic kidney disease (eGFI 38
mL/min/1.73m²) is started on Lisinopril 10 mg daily. Two weeks later, she presents with fatigue, nausea,
and muscle cramps. Labs show potassium 6.7 me/L, BUN 48 mg/ld., creatinine 2.4 mg/ld. (baseline 1.3
mg/ld.), and eGFI 24 mL/min/1.73m². What is the most appropriate immediate action?
A) Stop Lisinopril and administer IV calcium gluconate
B) Continue Lisinopril and add furosemide
C) Increase Lisinopril to 20 mg daily
D) Add sodium polystyrene sulfonate orally
CORRECT ANSWER: A) Stop Lisinopril and administer IV calcium gluconate
*Rationale: Life-threatening hyperkalemia (K >6.5) with ECG changes (though not described, assume
risk) requires immediate IV calcium gluconate to stabilize cardiac membranes AND discontinuation of
ACE inhibitor. Lisinopril reduces aldosterone, worsening hyperkalemia in CKD. Furosemide (B) can help
but is not the immediate priority. Increasing dose (C) is dangerous. Sodium polystyrene (D) works slowly.
*
7. An 82-year-old male presents with a 1-day history of “not feeling right,” confusion, and ataxia. He
lives alone and was recently discharged from the hospital for pneumonia 1 week ago, for which he
STUDY GUIDE COMPLETE ACCURATE EXAM ACTUAL
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES (100% CORRECT VERIFIED SOLUTIONS)
CURRENTLY UPDATED VERSION 2026 EDITION
|GUARANTEED PASS A+ |APPROVED NURS 5461 FINAL |UT
ARLINGTON
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with a 3-day history of
progressive dyspnea on exertion and orthopnea. He denies chest pain. On exam, blood pressure is
148/92 mm Hg, heart rate 102 bpm, respiratory rate 24 breaths/min, and oxygen saturation 92% on
room air. Jugular venous pressure is elevated at 12 cm H₂O, and crackles are heard up to the mid-lung
fields bilaterally. A third heart sound (S3) is audible. What is the most appropriate initial pharmacologic
intervention?
A) Oral metoprolol succinate
B) Intravenous furosemide
C) Sublingual nitroglycerin
D) Oral Lisinopril
CORRECT ANSWER: B) Intravenous furosemide
*Rationale: This patient presents with acute decompensated heart failure with signs of volume overload
(elevated JVP, crackles, S3). IV loop diuretics such as furosemide are first-line to rapidly reduce preload
and relieve pulmonary congestion. Beta-blockers (A) are not initiated in acute decompensated failure.
Nitroglycerin (C) may be used but is not the initial priority without ischemia. ACE inhibitors (D) are
chronic therapy. *
2. A 68-year-old woman is brought to the clinic by her daughter for a 6-month history of progressive
memory loss, difficulty managing finances, and getting lost while driving in familiar areas. She scores
,22/30 on the Montreal Cognitive Assessment (Mocha). Which of the following is the most appropriate
next step?
A) Prescribe donepezil 5 mg daily
B) Order a non-contrast head CT
C) Refer for neuropsychological testing
D) Obtain thyroid function tests and vitamin B12 level
CORRECT ANSWER: D) Obtain thyroid function tests and vitamin B12 level
Rationale: Before diagnosing a primary neurodegenerative dementia, reversible causes must be
excluded. Hypothyroidism and B12 deficiency are common reversible causes of cognitive impairment in
older adults. Head CT (B) and neuropsychological testing (C) may be indicated later, but initial labs are
essential. Donepezil (A) should not be started without excluding reversible causes.
3. A 74-year-old male with a 50-pack-year smoking history presents with a 3-week history of progressive
back pain, worse at night, and unintentional 15-lb weight loss. He denies trauma. On exam, tenderness
to palpation over the thoracic spine. Plain radiographs of the spine show a lytic lesion in the T8 vertebral
body. What is the most appropriate next step?
A) Prescribe high-dose naproxen and muscle relaxants
B) Order a bone scan
C) Obtain serum protein electrophoresis (SPEP) and urine immunofixation
D) Refer for physical therapy for core strengthening
CORRECT ANSWER: C) Obtain serum protein electrophoresis (SPEP) and urine immunofixation
,*Rationale: The combination of lytic bone lesion, night pain, weight loss, and age >65 is highly suspicious
for multiple myeloma. SPEP and urine immunofixation are first-line screening tests. NSAIDs (A) may
mask symptoms. Bone scan (B) is less sensitive for lytic lesions. Physical therapy (D) could be harmful if a
pathologic fracture is imminent. *
4. An 80-year-old female with a history of atrial fibrillation on warfarin presents with sudden onset of
severe left lower quadrant abdominal pain, nausea, and bloody diarrhea. On exam, abdomen is tender
with guarding but no rebound. Labs show INR 3.2, WBC 14,000/all. What is the most likely diagnosis?
A) Diverticulitis
B) Ischemic colitis
C) Acute appendicitis
D) Gastric ulcer perforation
CORRECT ANSWER: B) Ischemic colitis
Rationale: Sudden onset of severe pain, bloody diarrhea, and history of atrial fibrillation (emboli risk)
points to acute mesenteric ischemia, often ischemic colitis. Diverticulitis (A) typically presents with fever
and left lower quadrant pain but less commonly with sudden bloody diarrhea. Appendicitis (C) usually
presents with periumbilical pain migrating to RLQ. Perforated ulcer (D) would present with sudden
epigastric pain and peritonitis.
5. A 71-year-old man with Parkinson’s disease for 8 years on carbidopa-levodopa presents with
worsening mobility, frequent falls, and new-onset orthostatic hypotension. He reports that his
medication “wears off” before the next dose. Which of the following is the most appropriate
pharmacologic adjustment?
A) Increase each dose of carbidopa-levodopa by 25%
B) Add entacapone
, C) Add pramipexole
D) Discontinue carbidopa-levodopa and switch to amantadine
CORRECT ANSWER: B) Add entacapone
Rationale: Wearing-off phenomenon in Parkinson’s is managed by adding a Catechol-O-methyl
transferase (COMT) inhibitor like entacapone to prolong the effect of levodopa. Increasing each dose (A)
may worsen dyskinesia’s. Pramipexole (C) could be added but is less effective for wearing-off.
Amantadine (D) is used for dyskinesia’s, not wearing-off.
6. A 66-year-old female with type 2 diabetes, hypertension, and stage 3b chronic kidney disease (eGFI 38
mL/min/1.73m²) is started on Lisinopril 10 mg daily. Two weeks later, she presents with fatigue, nausea,
and muscle cramps. Labs show potassium 6.7 me/L, BUN 48 mg/ld., creatinine 2.4 mg/ld. (baseline 1.3
mg/ld.), and eGFI 24 mL/min/1.73m². What is the most appropriate immediate action?
A) Stop Lisinopril and administer IV calcium gluconate
B) Continue Lisinopril and add furosemide
C) Increase Lisinopril to 20 mg daily
D) Add sodium polystyrene sulfonate orally
CORRECT ANSWER: A) Stop Lisinopril and administer IV calcium gluconate
*Rationale: Life-threatening hyperkalemia (K >6.5) with ECG changes (though not described, assume
risk) requires immediate IV calcium gluconate to stabilize cardiac membranes AND discontinuation of
ACE inhibitor. Lisinopril reduces aldosterone, worsening hyperkalemia in CKD. Furosemide (B) can help
but is not the immediate priority. Increasing dose (C) is dangerous. Sodium polystyrene (D) works slowly.
*
7. An 82-year-old male presents with a 1-day history of “not feeling right,” confusion, and ataxia. He
lives alone and was recently discharged from the hospital for pneumonia 1 week ago, for which he
