Quiz 1: NURS 5461 / NURS5461 ACTUAL EXAM
2026/2027 | Adult Gerontology Management Across
the Continuum of Care | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Foundational Gerontological Principles (Q1–Q10)
Q1: An 80-year-old patient reports that they no longer enjoy eating steak because it "takes too much
effort to chew." Which age-related physiological change is MOST likely responsible?
A. Xerostomia from anticholinergic medications
B. Decreased muscle mass and strength of the masseter muscles, combined with potential periodontal
disease [CORRECT]
C. Early Parkinson's disease
D. Esophageal stricture
Correct Answer: B
Rationale: Age-related sarcopenia affects all skeletal muscles, including the masticatory muscles
(masseter, temporalis). Combined with periodontal disease (prevalence increases with age) and
potential tooth loss, chewing tough foods becomes difficult. This is a normal age-related change, not
pathology. Xerostomia (A) affects swallowing and taste but typically causes difficulty with dry foods, not
specifically chewing. Parkinson's (C) would present with tremor, rigidity, or dysphagia, not isolated
chewing fatigue. Esophageal stricture (D) causes dysphagia to solids but not specifically chewing
difficulty. The key distinction: masticatory effort = muscle weakness + dental changes, not esophageal
or neurologic pathology.
Q2: A 76-year-old patient has a resting heart rate of 58 bpm. They are asymptomatic, exercise regularly,
and have no history of cardiac disease. Which age-related cardiovascular change BEST explains this
finding?
A. Sick sinus syndrome requiring pacemaker evaluation
B. Decreased intrinsic heart rate due to sinoatrial node fibrosis and increased vagal tone [CORRECT]
C. Beta-blocker toxicity
D. Hypothyroidism
,Correct Answer: B
Rationale: Normal aging causes sinoatrial node fibrosis and loss of pacemaker cells (up to 75% by age
75), resulting in a decreased intrinsic heart rate (typically 60-100 in younger adults, may be 50-60 in
healthy older adults). Athletic older adults may have even lower resting rates due to increased vagal
tone. This is asymptomatic bradycardia — no intervention needed. Sick sinus syndrome (A) presents
with symptoms (dizziness, syncope, fatigue) and arrhythmias. Beta-blocker toxicity (C) is plausible only
if medicated. Hypothyroidism (D) would present with additional symptoms (cold intolerance, weight
gain, constipation). The clinical clue: asymptomatic + active lifestyle = normal age-related change.
Q3: Which of the following is a component of the Fried Frailty Phenotype?
A. Body mass index >30 kg/m²
B. Slow gait speed (<0.8 m/s over 4.6 meters) [CORRECT]
C. Polypharmacy (>5 medications)
D. Chronic kidney disease stage 3
Correct Answer: B
Rationale: The Fried Frailty Phenotype (2001) includes 5 criteria: (1) unintentional weight loss (>10 lbs
in past year); (2) exhaustion (self-reported); (3) weakness (decreased grip strength); (4) slow gait speed
(<0.8 m/s over 4.6m or 15 feet for women, adjusted for height/sex); and (5) low physical activity
(kcal/week below threshold). 3+ criteria = frail; 1-2 = pre-frail; 0 = robust. BMI >30 (A) is obesity, not
frailty. Polypharmacy (C) and CKD (D) are common in older adults but not Fried criteria. The FRAIL scale
(Fatigue, Resistance, Ambulation, Illness, Loss of weight) is a simpler alternative screening tool.
Q4: A 72-year-old patient has decreased vital capacity and increased residual volume on pulmonary
function testing. These changes are primarily due to:
A. Chronic obstructive pulmonary disease
B. Age-related chest wall stiffening, kyphosis, and decreased elastic recoil of the lungs [CORRECT]
C. Congestive heart failure
D. Pulmonary fibrosis
Correct Answer: B
Rationale: Normal aging causes: calcification of costal cartilage (stiff chest wall); kyphosis (reduced
thoracic expansion); decreased elastic recoil (increased compliance, reduced recoil pressure); and
weakened respiratory muscles. Result: decreased vital capacity (VC ↓ ~25-30 mL/year after age 30);
increased residual volume (RV ↑); and increased functional reserve capacity — but FEV₁/FVC ratio
remains normal (unlike COPD). COPD (A) shows decreased FEV₁/FVC (<0.70). CHF (C) causes restrictive
, pattern or effusions. Pulmonary fibrosis (D) causes severe restriction with decreased TLC and DLCO. The
key: normal ratio + age-appropriate changes = normal aging.
Q5: Which statement about sarcopenia is CORRECT?
A. Sarcopenia is inevitable and cannot be prevented
B. Sarcopenia is defined by low muscle mass, low muscle strength, and/or low physical performance
(EWGSOP2 criteria) [CORRECT]
C. Sarcopenia only affects bedbound older adults
D. Sarcopenia is primarily caused by excessive protein intake
Correct Answer: B
Rationale: Sarcopenia (EWGSOP2 2018 definition) requires: low muscle strength (primary parameter;
grip strength or chair stand test) AND low muscle quantity/quality (DXA, BIA, CT, MRI). Low physical
performance (gait speed, SPPB) confirms severity. It is NOT inevitable (A) — resistance training, protein
supplementation (1.0-1.2 g/kg/day), and vitamin D can prevent/treat. It affects all older adults, not
just bedbound (C). Excessive protein (D) does not cause sarcopenia; inadequate protein + inactivity +
inflammation are primary causes. The SARC-F questionnaire (Strength, Assistance walking, Rise from
chair, Climb stairs, Falls) is a screening tool.
Q6: A 78-year-old patient has a creatinine clearance of 45 mL/min. Their serum creatinine is 1.1 mg/dL.
Which age-related change BEST explains this finding?
A. Acute kidney injury
B. Decreased muscle mass producing less creatinine, masking true renal function decline [CORRECT]
C. Dehydration
D. Nephrotic syndrome
Correct Answer: B
Rationale: Serum creatinine is an imperfect marker of renal function in older adults because: muscle
mass decreases with age (less creatinine production); dietary protein intake may decrease; and tubular
secretion of creatinine increases. A "normal" creatinine (1.1 mg/dL) with low CrCl (45) indicates
significant renal impairment — the creatinine is falsely reassuring. Always use Cockcroft-Gault or CKD-
EPI equations (which account for age, sex, weight) rather than relying on creatinine alone. AKI (A) would
show rising creatinine. Dehydration (C) causes prerenal azotemia with elevated BUN:Cr ratio. Nephrotic
syndrome (D) presents with edema, proteinuria, and hyperlipidemia.
Q7: Which neurological change is considered normal aging rather than pathological?
2026/2027 | Adult Gerontology Management Across
the Continuum of Care | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Foundational Gerontological Principles (Q1–Q10)
Q1: An 80-year-old patient reports that they no longer enjoy eating steak because it "takes too much
effort to chew." Which age-related physiological change is MOST likely responsible?
A. Xerostomia from anticholinergic medications
B. Decreased muscle mass and strength of the masseter muscles, combined with potential periodontal
disease [CORRECT]
C. Early Parkinson's disease
D. Esophageal stricture
Correct Answer: B
Rationale: Age-related sarcopenia affects all skeletal muscles, including the masticatory muscles
(masseter, temporalis). Combined with periodontal disease (prevalence increases with age) and
potential tooth loss, chewing tough foods becomes difficult. This is a normal age-related change, not
pathology. Xerostomia (A) affects swallowing and taste but typically causes difficulty with dry foods, not
specifically chewing. Parkinson's (C) would present with tremor, rigidity, or dysphagia, not isolated
chewing fatigue. Esophageal stricture (D) causes dysphagia to solids but not specifically chewing
difficulty. The key distinction: masticatory effort = muscle weakness + dental changes, not esophageal
or neurologic pathology.
Q2: A 76-year-old patient has a resting heart rate of 58 bpm. They are asymptomatic, exercise regularly,
and have no history of cardiac disease. Which age-related cardiovascular change BEST explains this
finding?
A. Sick sinus syndrome requiring pacemaker evaluation
B. Decreased intrinsic heart rate due to sinoatrial node fibrosis and increased vagal tone [CORRECT]
C. Beta-blocker toxicity
D. Hypothyroidism
,Correct Answer: B
Rationale: Normal aging causes sinoatrial node fibrosis and loss of pacemaker cells (up to 75% by age
75), resulting in a decreased intrinsic heart rate (typically 60-100 in younger adults, may be 50-60 in
healthy older adults). Athletic older adults may have even lower resting rates due to increased vagal
tone. This is asymptomatic bradycardia — no intervention needed. Sick sinus syndrome (A) presents
with symptoms (dizziness, syncope, fatigue) and arrhythmias. Beta-blocker toxicity (C) is plausible only
if medicated. Hypothyroidism (D) would present with additional symptoms (cold intolerance, weight
gain, constipation). The clinical clue: asymptomatic + active lifestyle = normal age-related change.
Q3: Which of the following is a component of the Fried Frailty Phenotype?
A. Body mass index >30 kg/m²
B. Slow gait speed (<0.8 m/s over 4.6 meters) [CORRECT]
C. Polypharmacy (>5 medications)
D. Chronic kidney disease stage 3
Correct Answer: B
Rationale: The Fried Frailty Phenotype (2001) includes 5 criteria: (1) unintentional weight loss (>10 lbs
in past year); (2) exhaustion (self-reported); (3) weakness (decreased grip strength); (4) slow gait speed
(<0.8 m/s over 4.6m or 15 feet for women, adjusted for height/sex); and (5) low physical activity
(kcal/week below threshold). 3+ criteria = frail; 1-2 = pre-frail; 0 = robust. BMI >30 (A) is obesity, not
frailty. Polypharmacy (C) and CKD (D) are common in older adults but not Fried criteria. The FRAIL scale
(Fatigue, Resistance, Ambulation, Illness, Loss of weight) is a simpler alternative screening tool.
Q4: A 72-year-old patient has decreased vital capacity and increased residual volume on pulmonary
function testing. These changes are primarily due to:
A. Chronic obstructive pulmonary disease
B. Age-related chest wall stiffening, kyphosis, and decreased elastic recoil of the lungs [CORRECT]
C. Congestive heart failure
D. Pulmonary fibrosis
Correct Answer: B
Rationale: Normal aging causes: calcification of costal cartilage (stiff chest wall); kyphosis (reduced
thoracic expansion); decreased elastic recoil (increased compliance, reduced recoil pressure); and
weakened respiratory muscles. Result: decreased vital capacity (VC ↓ ~25-30 mL/year after age 30);
increased residual volume (RV ↑); and increased functional reserve capacity — but FEV₁/FVC ratio
remains normal (unlike COPD). COPD (A) shows decreased FEV₁/FVC (<0.70). CHF (C) causes restrictive
, pattern or effusions. Pulmonary fibrosis (D) causes severe restriction with decreased TLC and DLCO. The
key: normal ratio + age-appropriate changes = normal aging.
Q5: Which statement about sarcopenia is CORRECT?
A. Sarcopenia is inevitable and cannot be prevented
B. Sarcopenia is defined by low muscle mass, low muscle strength, and/or low physical performance
(EWGSOP2 criteria) [CORRECT]
C. Sarcopenia only affects bedbound older adults
D. Sarcopenia is primarily caused by excessive protein intake
Correct Answer: B
Rationale: Sarcopenia (EWGSOP2 2018 definition) requires: low muscle strength (primary parameter;
grip strength or chair stand test) AND low muscle quantity/quality (DXA, BIA, CT, MRI). Low physical
performance (gait speed, SPPB) confirms severity. It is NOT inevitable (A) — resistance training, protein
supplementation (1.0-1.2 g/kg/day), and vitamin D can prevent/treat. It affects all older adults, not
just bedbound (C). Excessive protein (D) does not cause sarcopenia; inadequate protein + inactivity +
inflammation are primary causes. The SARC-F questionnaire (Strength, Assistance walking, Rise from
chair, Climb stairs, Falls) is a screening tool.
Q6: A 78-year-old patient has a creatinine clearance of 45 mL/min. Their serum creatinine is 1.1 mg/dL.
Which age-related change BEST explains this finding?
A. Acute kidney injury
B. Decreased muscle mass producing less creatinine, masking true renal function decline [CORRECT]
C. Dehydration
D. Nephrotic syndrome
Correct Answer: B
Rationale: Serum creatinine is an imperfect marker of renal function in older adults because: muscle
mass decreases with age (less creatinine production); dietary protein intake may decrease; and tubular
secretion of creatinine increases. A "normal" creatinine (1.1 mg/dL) with low CrCl (45) indicates
significant renal impairment — the creatinine is falsely reassuring. Always use Cockcroft-Gault or CKD-
EPI equations (which account for age, sex, weight) rather than relying on creatinine alone. AKI (A) would
show rising creatinine. Dehydration (C) causes prerenal azotemia with elevated BUN:Cr ratio. Nephrotic
syndrome (D) presents with edema, proteinuria, and hyperlipidemia.
Q7: Which neurological change is considered normal aging rather than pathological?
